TR EMERITUS

Salma Khalik This time, a clumsy attempt by the Senior Health Correspondent, Salma Khalik, to convince Singaporeans that the state purchases drugs from pharmaceutical giants from a “position of strength”. The gist of the article is that in the past, Singapore was a “dream market” for pharmaceutical giants, that we were “passive price takers, paying whatever price” they charged. But after the Agency for Care Effectiveness (ACE) was set up in 2015, which headhunted Mr Ng Kwong Hoe to head its health technology assessment department and built up expertise in assessing the “relative value of new drugs”, we could “bargain from a position of strength”, thus saving the country $400m. Instead of feeling grateful, readers should be concerned that pharmaceutical companies had complete bargaining power over us and that prior to 2015, we were buying drugs without knowing the “relative value of the drug”. I get the impression that people in the department responsible for purchasing drugs regarded money as just digits on their computer screen to be debited, so long as the drugs were purchased and within a budget, which is not insubstantial. In the article, Salma claims that $400m has been saved since 2015, but given that the annual healthcare budget is in the tens of billions of dollars in the last few years, $400m is actually a drop in the ocean. Is ACE really able to “bargain from a position of strength”? Or is it just a vain attempt at token resistance at best, or a charade to fool unsuspecting folks at worst? A Straits Times forum writer, Alban Kang, perhaps being in the pharmaceutical trade and thus is familiar with the technicalities of the business, urge the authorities to revamp the “patent linkage system” because it protects patent holders by preventing generic drugs from being marketed here. He also notes that process patents (I would qualify some process patents), such as methods of producing chemical ingredients for a medicine, are enforced here but not in other countries, thus creating more patents and therefore price protection for more drugs. The net effect in both instances is that Singaporeans are forced to pay more for drugs. Unlike ACE, Mr Kang is truly attacking the root cause of high prices of drugs here - rules stipulated in the numerous Free Trade Agreements (FTAs) signed with other countries, especially the United States, that enhances the monopolistic powers of foreign pharmaceutical companies here. As a member of the World Trade Organization (WTO), we are obligated to follow a minimum set of rules to protect Intellectual Property Rights (IPR), so that innovation will be encouraged. However our government, in striving to make Singapore an intellectual property hub and a bio-technology cum pharmaceutical hub, has compelled Singaporeans to not only adhere strictly to the IPR rules of the WTO, but also the numerous rules beyond the requirements of the WTO which it has agreed to in the FTAs, especially the US-Singapore FTA, that while enhances the monopolistic powers of pharmaceutical companies thus incentivizing them to invest here, has severely penalized Singaporeans as they have to pay much higher prices for drugs than consumers in many other countries. The “patent linkage system” that Mr Kang asks to be revamped is not required by WTO, but is stipulated in the US-Singapore FTA. In the same year that the FTA came into force (2004), the Singapore Medicines Act was amended to fulfill our obligation under the FTA. There are numerous other rules* our government has committed with other countries via the FTAs it has signed and imposed on us. These rules confer monopolistic powers on foreign pharmaceutical giants. We thus have to pay “whatever price” they charge and there is nothing that ACE can do, except go through the charade that we can “negotiate from a position of strength with pharmaceutical giants”.   Fong Swee Foong   *See, for example, Regulatory Flexibilities and Tensions in Public Health and Trade: An Asian Perspective, Locknie Hsu, Singapore Management University.      Read More →

As an UnVaxed (UnV), I should be happy when MOH announced all VDS are removed, but I am more surprised than happy. Just a few days ago, OYK had just spoken in parliament about an important announcement to be made about V (mandate?) protocol and such but he didn't mention anything about removing VDS at all. In fact, he was blabbering away how UnV percentage is small but non fully Vaccinated (V) death from Covid infec was higher.... (Well, that's actually not a good argument because non fully V percentage is actually around 20% to 25% during earlier this year.) After F 1, infec numbers incressed as expected and I was expecting a tightening of measures, imposing Vaccine mandate and enhancing VDS rather than removing it totally. The announcement of removing VDS totally came as a total surprise although I feel that's the only logical and scientific thing to do. However, if we look at the MOH press release, the title was about change in how fully V status should be defined BUT there isn't any Vaccine mandate imposed. The strangest part is that since VDS is totally removed, how many people would be bothered about how Fully V status is determined? The whole Press Release doesn't seem to be coherent nor making any sense at all. Even the MSM knew the main Big News is about the removal of VDS totally and nobody was interested to follow MOH headline! The most intriguing part is that now they allowed the supposedly ineffective Sin Vaccine to be used as booster instead of insisting people should only take the Pfizer or Mordena! This Press Release seems to be puzzling apart from the VDS surprise. It looks as if it was put up hastily or last minute changes were made so much so that it doesn't make much logical sense with such incoherence! It also seems that MOH was very reluctant in withdrawing all VDS measures by giving that "sulking threat" or reimposing all these measures again if situation gets worse.... But that doesn't even make any sense at all! UnV numbers are so small in SG and we need no protection from VDS. UnV plus Uninfec number is even smaller! (Yeah... Look at me!). There is absolutely no logical basis to keep the VDS at all. Most interesting thing is that OYK chose to post on his FB about the change in fully V status and the new Vaccines, etc etc instead of focusing on the Big News of removing VDS! It seems that he isn't really the advocate for the removal of VDS! Did someone force him to do that? Most interesting observation is, for such "big major announcement", the Committee in charge of this Covid-19 (CV) didn't convene a proper press conference. The CHAIRMAN of the Committe abd PM-IN-WAITING Lawrence Wong has not uttered a single word about it. What's going on here? Nobody wants to bear the responsibility of asking people and young toddlers from 6 month old to take the Vaccine except OYK? It can't be the case that nobody wants to take credit of removing VDS and declare they have led the country back to normalcy by living with CV! Seriously, I don't know what OYK is thinking by pushing for young kids to take the Vaccine when many countries have either quietly stop the Vaccine for kids and teenagers or straight away announce a total reversal on Vaccination for them! It is very silly for OYK to take such great risks for nothing... Especially when others are subtlely distancing themselves from this decision. OYK will be made a scapegoat and thrown under the bus if anything goes wrong with such program.   Goh Meng Seng      Read More →

DPM Wong Singapore will refresh its measures to support lower-income groups, seniors and young families, said DPM Lawrence Wong, reported the ST on 10 October. DPM Wong said the most important and hardest gap to narrow is not defined in terms of income or wealth, but in respect and status. "How do we shift attitudes and mindsets, so that the contributions of every individual and every worker across all professions are valued and appreciated," he said, adding that he would speak more on this topic at another time. I have no doubt that DPM Wong sincerely intends to help the poor and really hope his new measures will actually significantly do so. However with all due respect to DPM Wong, I completely disagree that the most important gap to narrow in this regard is that of respect or status. To put it bluntly, the most important gap the government needs to fill in helping the poor is the money to meet basic needs. First the Workfare Income Supplement ( WIS ) needs to minimally give out an additional $600 a month in addition to the current paltry $300 a month to help the working poor make ends meet. Second the Silver Support Scheme ( SSS ) similarly needs to give another $600 a month in addition to the current miserly $200-300 given to our elderly poor to enable them to keep body and soul together given recent sharp rise in food and energy prices. Finally a basic unemployment insurance support for the poor is also badly needed. The total cost of these three measures is around $5bn a year or 1% of GDP but it would permanently and systemically lift some 250, 000 citizens out of absolute poverty in an automatic dignified manner which current schemes only partially do. This is eminently affordable and should have been done long, long ago. In terms of the need for respect, the biggest need of the poor is rather for dignity in receiving assistance. In this regards WIS and SSS are automatic payouts once means tested, rather than the indignity of having to constantly re-apply and justify eligibility for many of the other support schemes. Perhaps then, the biggest gap in attitudes and mindsets needed to help the poor that DPM Wong referred to is that of our policy makers themselves.   Yeoh Lam Keong      Read More →