Singapore - Prostate cancer screening better with new thinking

Although prostate cancer is one of the less lethal cancers, a wide range of treatments is available, and one patient's fight has strengthened his belief in a healthy lifestyle.

Screening for prostate cancer, the third most common cancer here among males, has undergone a change in thinking. Doctors are likely to recommend it mainly for those who are at higher risk instead of every male of a certain age, as used to be the case.

This is because the prostate specific antigen (PSA) test is prone to false positives, so about two-thirds of men who have raised levels of the protein in their blood actually do not have cancer, said Dr Ravindran Kanesvaran of the National Cancer Centre Singapore.

They end up undergoing unnecessary biopsies, which have their own risk, just to rule out cancer.

What is more, most men with prostate cancer will not die of it, as it tends to be slow-growing in many cases, said Dr Kanesvaran.

But once diagnosed, men might end up having unnecessary treatments such as surgery or radiation therapy, he said. Screening is best done on men who meet certain criteria, such as those between 50 and 75 years old, with a life expectancy of more than 10 years, and a strong family history of prostate cancer - first-degree relatives who were diagnosed before they turned 65.

The prostate gland, about the shape and size of a walnut, secretes fluids that help in reproduction.

Prostate cancer was the third most common cancer diagnosed in men between 2010 and 2014, with 3,694 new cases found in that time period. During that period, 739 men died of prostate cancer, making it the sixth most common cause of cancer death among men.

In the 1980s, the rate of metatstatic prostate cancer was 72.4 per cent, said Dr Sim Hong Gee, who is a senior consultant urologist of the Ravenna Urology Clinic at Gleneagles Medical Centre. Because of screening, most patients are now diagnosed at Stage 1 or 2, he said.

According to the National Registry of Diseases Office, only three in 10 prostate cancer patients were diagnosed at Stage 4. At the National University Health System, one- quarter are diagnosed at Stage 4.

In comparison, about 5 per cent of men in the United States are diagnosed at Stage 4, simply because they screen more, said Dr Lincoln Tan, consultant at the division of surgical oncology (urology), National University Cancer Institute, Singapore (NCIS). But, he added: "In the US, there is a lot of unnecessary treatment going on, it is just overdone."

A test with better accuracy may put the screening dilemma to rest. The NCIS is working on a new blood test for screening called the Prostate Health Index. From a study of 150 men, its accuracy appears to be three times higher than that of the PSA test, said Dr Tan. But it is more expensive - about $120 out of pocket, compared to $30 for the PSA test.

On the treatment front, with prostate cancer being so slow-growing, the NCIS has embarked on an active surveillance programme, in which prostate cancer patients are observed instead of treated right away. They have a PSA test every six months, and a biopsy every one to three years."The key benefit of being on this programme is that patients avoid the toxicity of treatments," said Dr Tan.

Nevertheless, some patients request immediate treatment rather than monitoring. The latest treatments include using radiation seeds implanted directly onto the prostate gland to target cancer cells more directly, and robotic surgery, which is highly precise, to remove the tumour. There is also hormonal therapy to reduce testosterone levels.

As for prevention, a diet rich in certain nutrients is advised."Males may want to include more lycopene in their diet, which is present in tomatoes. Also, cruciferous vegetables and green tea may help. But how far it prevents the cancer, we aren't really sure," said Dr Sim.

DR SIM HONG GEE, senior consultant urologist of the Ravenna Urology Clinic at Gleneagles Medical Centre, on preventing prostate cancer through diet.

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Singapore - Local health sciences university will benefit S’pore

I applaud Professor Soo Khee Chee’s “grand vision” of expanding the role of Duke-NUS Medical School to a biomedical or health sciences university (“S’pore needs a health sciences university to fill current void: Professor”; Sept 24).

The proposal is timely, as Singapore has three medical schools that provide postgraduate training, but only one local university for nurses to pursue postgraduate studies, and none for physiotherapists, occupational therapists and radiographers.

Malaysia, with a population 5.7 times that of Singapore, provides as many as 45 institutions offering postgraduate health and medicine courses locally. As Prof Soo asked: “Can we really entrust the future of our healthcare training to other countries?”

The demand for health sciences professionals is rising. By 2020, Singapore needs 20,000 more healthcare professionals in the long-term-care sector. By 2035, the global health workforce will be short of 12.9 million workers.

Our future demand for health sciences professionals will require more than an expanded role for the Duke-NUS SingHealth partnership.

If the school is to consider converting into a health sciences university, it should expand its partnership to all six public health-care clusters, the private sector and service providers in the long-term-care sector, including the Agency for Integrated Care, to better meet our national initiatives for better health, better care and a better life.

As about half of Singapore’s 2,500 allied health professionals are between the ages of 20 and 29, access to more local postgraduate opportunities may keep them here.

With Singapore’s infrastructure and emphasis on innovation, we are well-positioned to research how embracing technology can provide better outcomes by disrupting traditional healthcare approaches, and how novel health promotion strategies can shift the mindset of individuals into taking responsibility for their physical and mental well-being, and prevent or delay the onset of non-communicable diseases.

Bala S. Rajaratnam

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Singapore - HSA approves world's first dengue vaccine for use in Singapore

A box of Dengvaxia being shown to AFP reporters at a hotel in Mexico City.PHOTO: AFP

The Health Sciences Authority (HSA) has approved the world's first dengue vaccine Dengvaxia for use in Singapore following a seven-month expedited review of the potential benefits and risks.

It will be made commercially available in several months' time. Sanofi has not yet said how much it will cost, although its its head of Global Medical Affairs, Dr Ng Su-Peing, has said that the company’s goal is to make the vaccine “as commercially accessible as possible”.

Studies have shown that overall, the vaccine is effective at reducing dengue by 60 per cent, and reducing severe dengue by 84 per cent.

Against the Den-1 and Den-2 strains – which account for three-quarters of the dengue cases in Singapore – the vaccine’s efficacy is 50 per cent and 40 per cent respectively, compared with 75 and 77 per cent for the other two strains.

The HSA's decision to approve the vaccine was based on 24 clinical studies carried out by Sanofi Pasteur - the company manufacturing the vaccine - which involved 41,000 people.

The vaccine is approved for use in anyone aged 12 to 45 years, as studies showed that the risk of hospitalisation from dengue was reduced in those above 12 years old but also showed that the vaccine was not very effective in those aged above 45.

The HSA said it is prepared to revise its age guidelines when more data is available.

Importantly, the vaccine was also 81 per cent effective in people who had already had a dengue infection previously, compared to 38 per cent in those who had never had the virus.

Younger children who had never had dengue also ran a higher risk of hospitalisation if they contracted the virus after being vaccinated, although this was not seen in older children.

The HSA therefore advises those who have not had dengue to speak with their doctors on whether or not they should get the vaccine.

The Health Ministry does not recommend rolling out this dengue vacine as a national programme as it "would not be a clinically and cost-effective means to tackling dengue infection in Singapore". This means that subsidises and Medisave cannot be used to pay for vaccination.

Professor Ooi Eng Eong, who is deputy director of the emerging infectious diseases programme at Duke-NUS Medical School, said: “The impact vaccination would have on the overall incidence of dengue in Singapore will depend tremendously on the number of people who become vaccinated.

“The larger this number, the greater impact vaccination would have on reducing the number of dengue cases in Singapore,” said Prof Ooi, who is also a scientific advisory board member on dengue for Sanofi.

The vaccine was launched late in 2015 and is currently approved for use in nine other countries, including Indonesia and the Philippines.

Linette Lai

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Singapore - Local unis in step with teaching in changing times

The National University of Singapore campus.PHOTO: ST FILE

They are providing new degree options, making more use of technology in classrooms

Universities that offer established degree courses - such as law, medicine and engineering - review them constantly to keep them relevant and attractive.

In Singapore's changing higher education landscape, a greater variety of degree options has been offered in the past few years. This is to cater to a wider range of interests among students looking to further their education.

Universities contacted said adjustments made to their established degree offerings include strengthening alumni networks, boosting opportunities for global exposure, attracting professors from top institutions and tapping on technology and progressive teaching methods.

The two existing law schools - at the National University of Singapore (NUS) and the Singapore Management University (SMU) - for instance, already offer sought-after law degrees. Law courses typically take in top A-level students, or polytechnic graduates with perfect or near-perfect grade point averages. But next year, another tertiary institution, SIM University (UniSIM), will start a law school here.

The NUS law faculty, widely regarded as Asia's leader, has close to 60 years of history.

Its dean, Professor Simon Chesterman, said the network students build at his school will hold them in good stead throughout their legal careers. "For them, the friends and mentors they work with at law school will go on to be their colleagues," he said.

The SMU School of Law, which took in its first batch of students in 2007, may not have as much history as NUS. To attract students and adapt to their learning styles today, it uses creative tools, such as animation and games, in the classrooms.

For a course on criminal law, for instance, an animation tool was developed to re-enact a real murder case in Singapore. At certain points during the animation, questions pertaining to the case are displayed and students are prompted to visit a forum to discuss relevant concepts.

The animation, which tracks students' learning progress via the completed scenes, requires them to review their course materials during and outside class.

Associate Professor Tan Swee Liang, director at SMU's Centre for Teaching Excellence, said: "In an age dominated by technology and social media, we have to think beyond the traditional instructional methods to cater to the new generation of learners.

"For the law discipline, these tools can help to demystify complex contexts and make it easy for students to comprehend them, and make learning engaging and interactive."

UniSIM said its School of Law will also tap on technology, by using a blended learning approach, which includes e-learning as well as classes conducted in the evenings and weekends.

In medicine, another field of study leading to a degree, students can now turn to Singapore's latest medical institution, the Lee Kong Chian School of Medicine.

This school, which opened its doors in 2013, was set up by the Nanyang Technological University (NTU) and Imperial College London, which is ranked highly for its medical degree.

Professor Kam Chan Hin, deputy provost for education at NTU, said students are getting a "rigorous curriculum".

"The learning pedagogy is innovative, with no lectures, and team- based learning," he said.

"Online learning materials, early exposure to patients from year one, and simulation training using actors are all part of the learning."

For decades, the NUS Yong Loo Lin School of Medicine, started in 1905, was the only medical school for undergraduates here.

Another medical school here, the Duke-NUS Medical School, was established by Duke University in the United States and NUS about 10 years ago to train graduate students.

The Yong Loo Lin school's dean, Associate Professor Yeoh Khay Guan, said it refines the curriculum to keep pace with new healthcare challenges, such as meeting the needs of an ageing population.

The school recently expanded its geriatric medicine module to prepare students to better care for the rising number of older people here.

It has also introduced simulation training that tests and trains medical students to work on realistic clinical situations as a team.

NUS is also revamping its engineering curriculum to get undergraduates excited about the profession and the diverse career paths they can pursue - from research and development to entrepreneurship.

For instance, students will get to take new hands-on modules early in their studies.

Besides training students for chosen fields in engineering, from mechanical to environmental, NUS will open up specialisation tracks for students in research and development, and in the design and innovation aspects of engineering.

At NTU, which counts engineering among its strengths, programmes are also updated to meet the future needs of the workforce.

Increasingly, its courses allow students to pursue areas beyond their core discipline of study. For instance, a popular programme is renaissance engineering, where students study disciplines such as engineering, business and liberal arts.

Prof Kam said: "In the new global workplace, many problems require interdisciplinary solutions. Today's work challenges go beyond any single field."

Calvin Yang

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Singapore - Singapore Confirms 41 Cases of Locally-Transmitted Zika Virus

Most of those tested for Zika were contract laborers from elsewhere in Southeast Asia.

Singapore authorities have confirmed 41 cases of locally-transmitted Zika virus, which in Brazil has been linked to a rare birth defect, and said more cases were expected to be identified.

Those infected include 36 foreign construction workers employed at a site near Aljunied in the southeast of the island, the health ministry and the National Environment Agency (NEA) said in a joint statement on Sunday.

On Saturday, authorities had confirmed Singapore’s first case of a local transmission of the virus, to a 47-year-old Malaysian woman, also from the Aljunied area.

“MOH (the ministry of health) cannot rule out further community transmission in Singapore since some of those tested positive also live or work in other parts of Singapore,” the statement said. “We expect to identify more positive cases.”

The authorities said they have tested 124 people, primarily construction workers. Seventy-eight tested negative and five cases were pending. Thirty-four patients have fully recovered. It was not immediately clear where the foreign workers were from, but Singapore hosts a large contingent of workers from the Asian sub-continent.

“All the cases are residents or workers in the Aljunied Crescent/Sims Drive area. They are not known to have traveled to Zika-affected areas recently, and are thus likely to have been infected in Singapore. This confirms that local transmission of Zika virus infection has taken place,” the statement said.

Dozens of NEA staff cleaned drains and sprayed insecticide in the mainly residential area early on Sunday, and volunteers and contractors handed out leaflets and insect repellent. The NEA workers had accessed more than 1,800 premises of a total of 6,000 in the area to check for mosquito breeding.

Local residents welcomed the clean-up.

“I’m very scared of mosquitoes because they always seem to bite me, they never bite my husband,” Janice, 31, who gave only her first name, told Reuters. “This concerns me because maybe in a couple of years I want to have another (child).”

Zika was detected in Brazil last year and has since spread across the Americas. The virus poses a risk to pregnant women because it can cause severe birth defects. It has been linked to more than 1,600 cases of microcephaly in Brazil.

The Singapore government said there were “ongoing local transmission” cases in Indonesia, Thailand and Vietnam. Other countries in the region to have detected the Zika virus since 2013 include Bangladesh, Cambodia, Laos, Malaysia, Maldives and the Philippines, according to the World Health Organization (WHO).

Malaysia said on Sunday it stepped up surveillance at main transit points with Singapore.

Health director-general Noor Hisham Abdullah said leaflets on Zika prevention were being handed out and paramedics were at entry points to handle visitors with potential symptoms.

As of this month, Malaysia said it has screened more than 2 million visitors at air, sea and land entrances, and found no Zika infections.

In Thailand, where close to 100 cases of Zika have been recorded across 10 provinces this year, the Department of Disease Control (DDC) was screening all athletes returning from the Olympic Games in Brazil, but was not otherwise changing its prevention measures.

“Every country in this region has Zika transmission cases,” said Prasert Thongcharoen, an adviser to the DDC. “Thailand has, however, managed to contain the problem through early detection.”

Indonesian foreign ministry spokesman Armanatha Nasir said the country was “following developments”. Oskar Pribadi, a health ministry official, said there have been no recent Zika cases.

Vietnam has to date reported three cases of locally-transmitted Zika infection.

The current strain of Zika that is sweeping through Latin America and the Caribbean originated in Asia, where people could have built up greater immunity.

U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems.

The WHO has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

Reuters

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Singapore - Joint Statement by the United States of America and the Republic of Singapore

1.      At the invitation of the President of the United States of America Barack Obama, Prime Minister of the Republic of Singapore Lee Hsien Loong made an official visit to the United States to celebrate 50 years of diplomatic relations and to enhance the bilateral strategic partnership.  For half a century, the two countries have built a strong relationship anchored by robust economic cooperation, security and defense cooperation, and enduring people-to-people ties.  Beyond bilateral cooperation, the two countries have worked as close partners to build a rules-based economic and security order for the Asia-Pacific and to address challenges on the global stage, including economic prosperity, climate change, terrorism, transnational crime, and the proliferation of weapons of mass destruction.   On the occasion of the visit and the August 2, 2016 meeting between the two leaders, the United States and Singapore adopted this Joint Statement, affirming a continued commitment to advancing their strategic partnership in the areas below.

Supporting Robust Economic Cooperation and Commercial Connectivity and Driving Innovation

2.      The U.S.-Singapore economic and commercial relationship provides a model to the world for how open markets and fair trade practices increase prosperity and drive innovation.  Our shared economic priorities embrace trade liberalization, market reform, trade security, capacity building, innovation, entrepreneurship, climate change mitigation, clean energy, intellectual property protection, fair labor practices, and cyber security.  Today, over 3,700 U.S. companies are located in Singapore, making Singapore a premier destination for U.S. businesses. A growing number of Singapore companies have also established a presence in the United States.

3.      The two sides noted that the U.S.-Singapore Free Trade Agreement, the first such U.S. agreement in Asia and now in its 12th year, is a gold-standard agreement that has shaped other bilateral and multilateral FTAs in the region.  The largest of these, the Trans-Pacific Partnership (TPP), reflects the commercial dimension of the U.S. rebalance to Asia and Singapore’s commitment to high trade standards.  Both countries emphasized the strategic and economic importance of all participating countries to ratify the TPP agreement expeditiously, and both committed to strengthen trade capacity building among TPP members.

4.      The two leaders affirmed efforts to support expanding economic ties through closer cooperation on bilateral tax issues, and noted ongoing discussions between the two sides on  a tax information exchange agreement (TIEA), which will permit our two countries to exchange relevant tax information to enforce our respective tax laws, and an intergovernmental agreement (IGA) that provides for reciprocal automatic exchange of information with respect to certain financial accounts under the Foreign Account Tax Compliance Act (FATCA).  Both sides are committed to complete negotiations and sign the TIEA and the reciprocal FATCA IGA as soon as possible with the aim of doing so by the end of 2017. The leaders noted the two countries would ‎maintain discussions on whether to negotiate an Avoidance of Double Taxation Agreement in the future, taking into account double taxation with respect to both U.S. investments in Singapore and Singaporean investments in the United States and our mutual interest in avoiding base erosion and profit shifting by multinationals.

5.      The two leaders forged new cooperation on Smart City development and digital innovation.  This includes (a) identifying opportunities for research collaboration between the National Science Foundation and the Singaporean National Research Foundation, (b) sharing of best practices and information exchange between both Governments on topics such as smart city policies, digital government, urban innovation and digital citizen engagement, through, among other things, the Digital Government Exchange forum to be held in Singapore and the Discover Global Markets: Building Smart Cities forum to be held in Chicago, and exchanges between the White House Office of Science and Technology Policy and the Smart Nation Program Office in the Prime Minister’s Office; and (c) facilitating exchanges for start-ups, as reflected in the MoU between the city of Austin and Singapore.

6.      The two nations look forward to deepening their economic cooperation including under the U.S.-ASEAN Connect (“Connect”) initiative, announced in February 2016 by President Obama during the U.S.-ASEAN Leaders Summit at Sunnylands.  As the strategic framework for U.S. economic engagement with ASEAN, Connect will build upon U.S. government economic initiatives within ASEAN to support regional integration efforts and cooperation with the private sector. Singapore offered support for a new Connect program focused on the digital economy, which could include innovation policy workshops under the Third Country Training Program.  The two leaders confirmed collaboration on the third US-ASEAN Connect event to be held in Singapore in 2016, which will focus on themes such as digital economy and financial technology (FinTech). The inaugural Singapore FinTech Festival will be supported by the Connect Center in Singapore and the United States Department of Commerce.  The two leaders welcomed the signing of an MOU between the US Department of Commerce and Singapore's Ministry of Trade and Industry to promote collaboration in the infrastructure sector between US and Singapore companies in Southeast Asia and third-party markets.

Enhancing Security and Defense Cooperation

7.      The two leaders reaffirmed the strong bilateral defense partnership, underpinned by the 1990 Memorandum of Understanding and 2005 Strategic Framework Agreement, and most recently elevated by the 2015 Enhanced Defense Cooperation Agreement.  Singapore trains or stations approximately 1000 personnel each year in the United States.  The United States deploys aircraft and ships to Singapore on a rotational basis to conduct a variety of regional maritime patrol activities covering counterpiracy, counterterrorism, humanitarian assistance, and disaster response. President Obama welcomed Singapore’s continued interest in the F-35 aircraft.  The two leaders expressed support to explore new training opportunities for the Singapore Armed Forces in Guam, with an eye toward a potential long-term training detachment for the Republic of Singapore Air Force. 

8.      The United States and Singapore are committed to broadening and deepening our cooperation to promote an open, interoperable, reliable, and secure global Internet that supports innovation, economic growth and social development.  We are committed to ensuring that the digital economy remains a force for robust economic growth and prosperity.  Both sides expressed strong support for the new U.S.-Singapore MOU on Cooperation in the Area of Cybersecurity, which lays a foundation for expanding our cooperation on cyber issues.  The United States and Singapore affirmed their support for the multi-stakeholder approach to Internet governance.  We reaffirm, moreover, that the same rights that people have offline must also be protected online. Both sides pledged to deepen their information exchange and sharing, to conduct new bilateral initiatives on critical infrastructure cybersecurity, and to continue to cooperate on cybercrime, cyber defense, and on regional capacity building activities, including through joint exercises, regular exchanges and visits, joint R&D and capability development, regional cyber capacity building programs or initiatives.

9.      The two leaders endorsed a common approach to international cyber stability, affirming that international law applies to State conduct in cyberspace, and committing to promote voluntary norms of responsible state behavior in cyberspace.  The United States and Singapore affirm that no country should conduct or knowingly support online activity that intentionally damages critical infrastructure or otherwise impairs the use of critical infrastructure to provide services to the public; that no country should conduct or knowingly support activity intended to prevent national computer security incident response teams (CSIRTs) from responding to cyber incidents, or use CSIRTs to enable online activity that is intended to do harm; that every country should cooperate, consistent with its domestic law and international obligations, with requests for assistance from other states in mitigating malicious cyber activity emanating from its territory; and that no country should conduct or knowingly support cyber-enabled theft of intellectual property, including trade secrets or other confidential business information, with the intent of providing competitive advantages to its companies or commercial sectors.

10.  First discussed by both Leaders when they met in 2013, both leaders welcomed a new joint statement to extend the Law Enforcement and Homeland Security, and Safety Cooperation Dialogue for another 3 years, which reinforces the strong cooperation in law enforcement matters, including counter-terrorism and anti-corruption, between the two countries.  The two leaders also welcomed the MOU, which will be signed in September, between Singapore’s Home Team Academy (HTA) and the U.S. Federal Law Enforcement Training Centers (FLETC) to collaborate and share expertise and best practices in law enforcement training, leadership development, and capacity building.  Both countries sought to increase bilateral and regional cooperation to combat internet and computer crime.

11.  The United States has partnered with Singapore on a number of issues related to transportation security. Both sides welcomed the 2016 signing of a Memorandum of Understanding between the Transportation Security Administration and Ministry of Transport on capability development in the Asia-Pacific Region through joint training and capacity building to enhance the level of aviation security standards. The first joint training outreach event will take place in Singapore in 2017 where Asia-Pacific States will be invited to participate.

Addressing Regional and Global Challenges

12.  Both countries reaffirmed their commitment to ASEAN Centrality and to strengthening the regional architecture in the Asia-Pacific, including existing ASEAN-led mechanisms such as the East Asia Summit (EAS) and the ASEAN Regional Forum (ARF) to better address common transnational challenges such as maritime security, climate change and trafficking-in-persons.  The two leaders highlighted the importance of the U.S.-ASEAN strategic partnership, and the principles underpinning this relationship as outlined in the Sunnylands Declaration, for the peace, prosperity, and security of the Asia-Pacific.

13.  The two leaders highlighted the success of the U.S.-Singapore Third Country Training Program (TCTP), which has received more than 700 officials from across ASEAN since its establishment in 2012. They expressed support for its continued growth, including in the areas of trade policy, environment protection, and addressing   non-traditional security threats.

14.  The two leaders resolved to enforce UN Security Council Resolution (UNSCR) 2270, adopted in response to the DPRK’s January nuclear test, which imposes unprecedented sanctions on the DPRK.  The United States welcomed and offered full support for Singapore’s commitment to prevent the proliferation of weapons of mass destruction, including the full and effective implementation of UNSCR 2270.  Both leaders welcomed the commitment to expand bilateral cooperation to ensure the enforcement of this resolution, including on cargo inspections, shipping, and finance. The United States welcomed and offered full support of Singapore's commitment to strengthen advanced cargo screening procedures, which is essential to securing the global supply chain, including through Singapore’s decision to conduct a three-year trial of the World Customs Organization’s Cargo Targeting System. Such measures play an essential role in securing global commerce, not only against proliferation from all sources, but against terrorism and other criminal activity.

15.  The two leaders acknowledged the continued global threat posed by terrorism and the need to enhance information sharing on counterterrorism related issues. The two countries have also co-invested $30 million to date under the 2006 Combating Terrorism Research and Development agreement to improve capabilities to combat terrorism.  Both leaders welcomed the extension of the agreement for another 10 years for investments up to $100 million.  The two leaders reaffirmed their commitment as Counter-ISIL coalition members to degrade and defeat ISIL.  President Obama welcomed Singapore’s commitment to continue existing contributions to coalition efforts, including the deployment of refueling tanker aircraft and an Imagery Analysis Team, as well as Singapore’s new commitment to deploy medical support to Iraq.

16.  The leaders reaffirmed the importance of maintaining regional peace and stability and upholding freedom of navigation in and overflight above the South China Sea.  They emphasized the importance of resolving disputes peacefully, including full respect for legal and diplomatic processes, without resorting to the threat or use of force, in accordance with international law, including as reflected in the 1982 United Nations Convention on the Law of the Sea.  They urged all parties to avoid actions that would escalate tensions, including the further militarization of outposts in the South China Sea.  They reaffirmed their support for the full and effective implementation of the Declaration on the Conduct of Parties in the South China Sea and the expeditious conclusion of a Code of Conduct in the South China Sea. 

17.  Both countries affirmed the importance of addressing climate change and transitioning towards a low greenhouse gas emissions and climate-resilient development pathway, and committed to pursue a range of initiatives to advance these goals. They resolved to work together to implement the historic Paris Agreement.  The United States reaffirms its commitment to join the Agreement this year, and Singapore commits to taking the domestic steps necessary to join as soon as possible, with a view to joining in 2016.  They also called on all nations to support the Agreement’s early entry into force in 2016.  Both nations affirmed the importance of supporting the development and implementation of the transparency framework established under the Paris Agreement, with common modalities, procedures and guidelines. Both nations look forward to the early operationalization of the Capacity-building Initiative for Transparency.  They resolve to explore opportunities to collaborate on institutional and technical capacity-building activities to help other Parties meet the requirements of the transparency framework.  Both countries affirmed their commitment to work to adopt an ambitious and comprehensive hydrofluorocarbons (HFCs) phase-down amendment in 2016 within the Montreal Protocol pursuant to the Dubai Pathway. They supported the adoption of a global market-based measure (MBM) at the upcoming Assembly of the International Civil Aviation Organization for implementation from 2020, as part of a collective effort to address climate change through a comprehensive basket of measures. The leaders emphasized the importance of a global MBM in supporting the aviation industry's desire to grow sustainably and prevent a patchwork of national or regional MBM schemes given the cross-border nature of international flights.

18.  The two leaders commended the adoption of the fifth Plan of Action in August 2015 under the U.S.-Singapore Free Trade Agreement’s environmental cooperation Memorandum of Intent (MOI).  To protect our shared environment, the United States and Singapore commit to strengthen cooperation to conserve biodiversity and ecosystems by combating the illegal trade in CITES species, improving the capacity of institutions, and strengthening policies to ensure effective implementation and enforcement of environmental laws.  Singapore also stated its intention to positively consider implementing a ban on the domestic trade in ivory.  Both countries also look forward to deepening the exchange of information on environmental policies, best practices and the use of innovative environmental technology and pollution management techniques, and to work closely together and with other WTO Members to conclude an ambitious Environmental Goods Agreement (EGA) that eliminates tariffs on a wide range of environmental goods by the end of the year.  We also resolve to cooperate to conserve our oceans and to combat illegal, unreported, and unregulated (IUU) fishing, including by implementing port State measures in recognition of the importance of concerted international action to address IUU fishing as reflected in regional and international instruments, including the Port State Measures Agreement.

19.  The United States and Singapore affirmed their commitment to advance the Global Health Security Agenda (GHSA) to assist other countries to implement the International Health Regulations (IHR) and prevent, detect, and respond to biological threats, whether naturally occurring, deliberate or accidental.  In 2016, the United States underwent a Joint External Evaluation (JEE) of its national capabilities to achieve the GHSA and other IHR-related targets and will publish the results.  In 2017, Singapore will initiate a JEE.  The United States has made a commitment to assist at least 31 countries to achieve the GHSA targets, and Singapore will join two GHSA Action Packages to share best practices to assist others.  Singapore will also provide experts, where available, to support the assessments of other countries, including within ASEAN.

Strengthening People-to-People Ties

20.  Both the United States and Singapore affirmed their commitment to further strengthen the already deep bonds of friendship, cooperation, and mutual understanding between the peoples of the two countries.  The United States welcomed the launch of an exchange scholarship program to mark 50 years of diplomatic relations and deepen people-to-people ties.  The scholarship will fund summer exchange programs for 50 Singaporean and 50 U.S. students over the course of the next 5 years.  In support of the U.S. Young Southeast Asian Leaders Initiative (YSEALI), which has grown into a network of more than 80,000 youth across the region, the U.S. will convene an Urban Planning Workshop in 2017 in Singapore.  Both sides recognized the success of the YSEALI program and the contributions made by its Singaporean participants in promoting innovation, inspiring cross-ASEAN connectivity, and advancing bilateral ties.

21.  The United States was pleased to open Global Entry eligibility to include citizens of Singapore from June 2016.  Singapore in turn allowed Americans to apply for its enhanced-Immigration Automated Clearance System (eIACS) under the Trusted Traveller Program (TTP).  Following the Joint Statement issued by the United States and Singapore on Dec. 1 2014, both countries had worked together to officially launch the TTP on June 27, 2016. The TTP reaffirmed the strong trust and ties that the United States and Singapore enjoy given that Singapore is the 1st ASEAN country to be in the program. These trusted traveler programs will make travel between our two nations more convenient and secure for travelers.

Enhancing our Enduring Partnership

22.  Through a half-century of diplomatic relations, the United States and Singapore have forged an expansive and enduring relationship by cooperating on issues of mutual interest and shared principles.  Both leaders committed to further enhance the U.S.-Singapore strategic partnership, making it deeper, more substantive, and more effective to better support peace, stability, and cooperation across the region and around the world.

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Singapore - The Straits Times' interview with US President Barack Obama

WASHINGTON - In an e-mail interview with The Straits Times ahead of an official visit by Prime Minister Lee Hsien Loong - the first by a Singapore prime minister since 1985 - US President Barack Obama stressed the importance of the US-Singapore relationship in his administration’s rebalance to Asia.

Mr Obama, who will step down in January 2017 after eight years at the helm, also expressed confidence that Washington's emphasis on the region will outlive his presidency.

Here is the full interview:

Q:  You've had a relatively small number of state dinners during your presidency and none for any country in South-east Asia. Can you elaborate on your approach to state dinners and your decision to hold one in honour of PM Lee and Singapore?

A:  State visits are often an opportunity for the United States to reaffirm our ties and friendship with our closest partners around the world. This visit is an occasion to mark the 50th anniversary our bilateral relationship with Singapore, which is one of our strongest and most reliable partners in South-east Asia. 

I look forward to hosting Prime Minister Lee, whose friendship and partnership I appreciate very much and with whom I’ve worked throughout my administration. This will also be an opportunity for me to reciprocate the hospitality that the Prime Minister and the people of Singapore showed to me during my visit to Singapore for the APEC summit in 2009.

This visit also reflects the important role that Singapore plays in the rebalance of American foreign policy to the Asia Pacific. With Singapore’s partnership, the United States in engaging more deeply across South-east Asia and Asean, which is central to the region’s peace and prosperity. Singapore is an anchor for the US presence in the region, which is a foundation of stability and peace. Both our nations are committed to building a regional order where all nations play by the same rules and disputes are resolved peacefully and this visit will be an opportunity to continue deepening our cooperation on behalf of regional stability and prosperity.

More broadly, Prime Minister Lee and I will work to advance the US-Singapore partnership across the board. We’re committed to sustaining the dynamism of our economies with the Trans-Pacific Partnership—the highest-standard trade agreement ever—which will support trade and innovation in both our countries. 

Singapore was the very first South-east Asian nation to join the global coalition against ISIL (ISIS) coalition, and we’ll work to sustain our momentum in destroying that terrorist organisation.

We’ll discuss how we can implement the Paris climate change agreement in order to protect coastal cities like Singapore.

And building on our Young South-east Asian Leaders Initiative, I’m hopeful that we can continue expand the ties and cooperation between our young people and students.

US' REBALANCE TO ASIA TO ENDURE

Q:  You've expressed some confidence that the US commitment to Asia will not fade away after your presidency, primarily because a majority of Americans understand the importance of the region. However, the election campaign thus far seems to show that Americans are not convinced about globalisation, even Donald Trump notwithstanding, Americans of all political stripes seem to be turning inwards. Are you still as confident that the Asia rebalance will persist? What will happen if your successor doesn't attend the annual Asian summits and never hosts another Asean meeting like the one in Sunnylands?

A:  There’s no question that a lot of Americans on both the right and the left are expressing some fears and frustrations about the dislocations brought on by globalisation. Many of those frustrations are legitimate and they need to be addressed. 

But in an interconnected world, I remain convinced that the best way to manage these dislocations and to ensure our security and prosperity is to engage more deeply with countries around the world, not less—especially in the Asia Pacific.

That’s why, over the past eight years, the United States has worked hard to deepen partnerships across the region and across South-east Asia in particular.  We’re now a part of the East Asia Summit and we have a strategic partnership with Asean.  At the US-Asean Leaders Summit I hosted earlier this year in Sunnylands, California, we agreed to a set of principles that will shape the future peace and prosperity of the region, from promoting innovation and furthering economic integration to addressing transnational challenges like global health security and climate change.

I’m confident that America’s foreign policy rebalance to the region will endure beyond my presidency because it’s in the national interest of the United States. The United States has been a Pacific nation for over two centuries. That’s not going to change. That reality transcends election cycles. And just as our past has been integrally linked to the region, so, too, is our future. The Asia Pacific is home to nearly half the world’s population, a growing middle class and holds so much opportunity for us all. It’s no wonder that America’s engagement in the region has strong, sustained, bipartisan support. So I’ll be handing my successor a strong foundation—including closer ties with Singapore—on which to continue building, and I’m optimistic that will happen.

TPP 'WILL GET CONGRESS SUPPORT'

Q:  On the TPP, many observers, including Singapore's PM Lee, have said that if it doesn't happen this year, the chances of it happening at all drop significantly. And that would be a big hit to US credibility in the region.  Do you agree with that assessment and how optimistic are you that it will pass Congress this year?

A:  I remain committed to TPP because it’s a good deal—for America, for the region and for the world. TPP advances America’s economic and our strategic interests.  It would eliminate 18,000 tariffs – basically taxes -- on American products and help us sell more American exports to the Asia Pacific. It levels the playing field for our workers and helps to ensure countries abide by strong labour and environmental rules. It will help strengthen our relationships with partners like Singapore and lay the foundation for even greater cooperation in other areas. It will make sure that we’re writing the rules for trade in the 21st century.

That said, I know that the politics around trade can be very difficult—especially in an election year. There are legitimate concerns and anxieties that the forces of globalisation are leaving too many people behind—and we have to take those concerns seriously and address them. But the answer isn’t to turn inward and embrace protectionism. We can’t just walk away from trade. In a global economy where our economies and supply chains are deeply integrated, it’s not even possible.

The answer is to make sure that trade is working for our people by supporting good jobs, reducing inequality and creating more opportunity. That’s what TPP does. I’ll continue making the case for TPP, and I’m optimistic that the United States Congress will ultimately support this landmark agreement.

SOUTH CHINA SEA RULING 'LEGALLY BINDING'

Q:  The permanent court of arbitration issued its ruling on the Philippines South China Sea case on July 12. What is your administration's approach to the ruling and how will it engage on it with a Chinese government that has already indicated it does not recognise the ruling?

A:  The United States is committed to a regional order rooted in international rules and norms, including freedom of navigation, and the peaceful resolution of disputes. That’s the only way to ensure our common security. We believe that big nations should not bully smaller nations, and that the sovereignty of nations must be respected. And we have long urged that disputes be resolved peacefully, including through mechanisms like international arbitration.

The Philippines made a lawful and peaceful effort to resolve their maritime claims with China using the tribunal established under the Law of the Sea Convention (Unclos). The tribunal’s ruling delivered a clear and legally binding decision on maritime claims in the South China Sea as they relate to China and the Philippines—and that ruling should be respected. We believe this decision can and should serve as an opportunity to renew efforts to address maritime claims peacefully. And we continue to urge China and other claimants to work constructively to resolve these disagreements, so that the South China Sea – which is so vital to the global economy -- can be defined by commerce and cooperation.

RULES-BASED ORDER

Q:  There is a belief in China that the US is practising double standards and double talk and that this belief is impending deeper progress in Sino-US ties. It is not a signatory to Unclos but is pushing China to respect the international law. It is beefing up military alliances with China's neighbours and conducting military operations in China's backyard but issuing alerts over Beijing's military activities or modernisation. What is your response to such views and what can future US governments in response?

A:  The United States believes that every nation should respect international law, including in the South China Sea. This is not an area where we can pick and choose. It is in the interests of all of us—the United States, China and the rest of the world—to make sure that the rules of the road are upheld. These rules and norms are part of the foundation of regional stability, and they have allowed nations across the region, including China, to grow and prosper.

The United States, therefore, works to ensure that any actions we take are consistent with international laws and norms—including those reflected in the Law of the Sea Convention. It’s worth remembering that our presence in the region is nothing new. For more than 60 years, the United States has stood by our allies and partners in the Asia Pacific. That includes our defence partnership with Singapore, which stretches back more than two decades.

Moreover, our alliances and partnerships are not directed against any nation. Rather, they are focused on protecting and defending our common security and upholding a rules-based order that undergirds the peace and prosperity of the region and the world.  In this work, we are grateful for our continued partnership with Singapore.

Jeremy Au Yong

straitstimes

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