Speech by Dr Janil Puthucheary, Senior Minister of State, Ministry of Health, At the Precise-ihcc Conference, On Wednesday, 21 August 2024, 9:00am, At One Farrer Hotel

Good morning. I would like to congratulate both the Precision Health Research, Singapore (PRECISE) and the International Health Cohorts Consortium for your collaboration and your vision. This Conference is the culmination of a lot of hard work. I am honoured to have the opportunity to be able to speak in front of many Professors and Chairmen.

2. Among us, we also have leaders from prominent population cohort study programmes worldwide, creating an intellectual nexus in Asia that spans the Americas and European regions.

The Promise of Precision Medicine

3. I am also heartened to know and to see that you have been able to have a number of trainees, students, people beginning their journey in academia and clinical medicine, come and join you here today. It is always a good sign when a Conference is able to attract trainees and students. They know that this is the cutting edge of the future and this is where their opportunity lies.

4. Precision medicine marks a shift away from the traditional approach to diagnosis and treatment. It integrates genetics, lifestyle and environmental factors to provide targeted treatment for patients. If done well, it has the potential to improve the overall health of the population through disease prevention and early intervention.

Establishing Singapore's Capabilities in Precision Medicine

5. Singapore has an ageing population, an increasing burden of chronic disease and rising healthcare expenditure. We recognise that fundamental changes are needed in our healthcare system to improve our population health in an affordable and sustainable manner.

6. To deal with these challenges, we have prioritised research in areas such as precision and preventive medicine, population health, and the outcomes of healthy and meaningful longevity.

7. To this end, PRECISE was set up with MOH's support to drive the National Precision Medicine programme to realise the potential of precision medicine and at the same time minimise the downsides of such an approach.

8. Phase I of the programme began in 2017. It set out to create a reference database of 10,000 Singaporean genomes, a unique resource contributing to global genomic research, in which Asians were historically under-represented. The cohort study was completed in three years and created a database with the most detailed genomic information in Southeast Asia to date.

9. The National Precision Medicine programme, which is currently in its second phase, is enrolling 100,000 healthy Singaporeans to understand their health outcomes over time. Participants of the study will undergo a clinical assessment, contribute their genomes and over 2,000 data points and parameters. When completed, this would put us in a strong position to address key questions about health and disease with precision.

10. Participant recruitment is progressing very well, with close to 90,000 registered participants thus far.

Milestones of the National Precision Medicine Programme

11. The National Precision Medicine Programme has had an impact already. Clinicians can now reference genomic data from an Asian population and so make more meaningful comparisons, interpret genetic variants of concern more confidently and share significant insights into genetic conditions prevalent in our population.

Pre-emptive Pharmacogenomics

12. Take pre-emptive pharmacogenomics testing as an example. Phase I has revealed that about one in four Singaporeans carries a genetic variant that raises the risk of side effects to at least one medication. A local study concluded that approximately 30% of adverse drug reactions requiring admission to the Singapore General Hospital could have been pre-empted and potentially prevented.

13. The current process of evaluating drug reactions is still largely reactive, due to the lead time required for the pharmacogenomics results. In the meantime, clinicians continue to order medication and do not have the benefit of the advanced sight of potential side effects due to patient specific genomic risks.

14. Seeing this gap, the National Precision Medicine programme funded a clinical implementation pilot for Associate Professor Wee Hwee Lin, Professor Goh Boon Cher and Dr Elaine Lo from the National University Hospital and a local start-up, Nalagenetics, to pilot the implementation of pre-emptive pharmacogenomics testing into clinical practice to optimise drug therapy outcomes for patients.

15. To date, close to 400 best practice advisories have been triggered by this, directly influencing doctors' prescribing decisions, and ensuring that right medications are prescribed to patients most likely to benefit, while preventing adverse drug reactions in others. So it is already having a real-world impact of clinical outcomes, operations and practise.

Utilising NPM datasets to catalyse translational research efforts

16. The Phase I datasets have also resulted in customised genetic test kits to screen for common severe recessive conditions among Singaporeans. These will be more accurate for the local population compared to the standard commercial kits produced elsewhere.

17. By providing the dataset, the National Precision Medicine programme aims to enable collaboration among academia, industry, and healthcare providers for biomedical innovation. The dataset will create opportunities for developing diagnostics, therapeutics and other products that could be potentially globally marketable.

Laying the Foundation towards a Future-Ready Healthcare System

18. In November 2023, the programme released the first batch of anonymised clinical, phenotypic and genomic data of 50,000 participants from the PRECISE-SG100K study, for our scientists to explore the relationships in Singaporeans' health and disease conditions and there were invitations to submit the proposals to utilise the data results.

19. In July this year, 36 projects were selected to work closely with the PRECISE Scientific Committee and Data Science Team to tap on the dataset to translate research findings into precision health care capabilities and approaches.

20. I would like to express our collective appreciation to all the participants who have donated their samples and provided a wealth of genetic, environmental, as well as lifestyle data. They have enabled us to uncover patterns and correlations to identify disease risk factors, understand genetic variations, and enable more accurate diagnoses and targeted therapies. The second round of thanks to the team that is represented here - the professors, the chairman, the leadership of the various institutions and organisations. Thank you for your collaborative efforts across borders, institutions, organisations, pursuing a common interest in driving population health and the future health of all of us. Also, to the trainees and students that I mentioned at the beginning of my speech, thank you very much for going down this path. I look forward to being the recipient and beneficiary of excellent care under your hands as I age together with the rest of Singapore's population.

Closing

21. My congratulations to Patrick and the team at PRECISE for their remarkable success to date. Best wishes for a great conference ahead.

22. Thank you very much.