Jul 27, 2019
Doc behind S'pore's effort to tackle liver disease and cancer
In 1983, 20 vials of the hepatitis B vaccine
arrived in Singapore and were sent to Singapore General Hospital
(SGH), which housed the hepatitis B and liver cancer research team
led by oncologist Gabriel Oon Chong Jin. Dr Oon and his team members administered
the largely unknown vaccination on themselves. When more vials
arrived, medical and nursing staff who dealt with hepatitis B
patients received shots as well. The virus was known to cause primary liver cancer.
Since the vaccines were made from the blood plasma of infected carriers,
those who were vaccinated were afraid they might get cancer. Unidentified contaminants in the vaccine
such as the HIV virus and severe side effects were also big
fears. When the individuals showed no signs
of ill health, the team vaccinated children and newborns
because babies born of heavily infected mothers were over
200 times more at risk of developing liver cancer. "Founding Prime Minister Lee Kuan Yew
said he wanted the vaccine to be 300 per cent safe, not just
100 per cent safe. I decided that if I had to vaccinate babies,
I must vaccinate my children first," said Dr Oon, who was
speaking at his final academic lecture at Duke-NUS Medical School
on July 4 when he recounted the research team's journey to end
the hepatitis B epidemic here. "I said to my wife: 'We must vaccinate
our children.' And she said to me: 'You have to vaccinate me
first. Because if they die, we will perish together'." His sons were six and eight years old
in 1983, the first children to receive the vaccine. After Dr Oon's family was immunised,
clinical trials on newborns in Kandang Kerbau Hospital
(now KK Women's and Children's Hospital) started, paving
the way for the National Hepatitis B Vaccination Programme
in 1985 and Singapore's foray into the biotech sector. The ancient virus is spread by
contact with infected blood and bodily fluids through
needles, and is transmitted from an infected mother
to her newborn at birth. Every year between 1972 and 1976,
government hospitals saw about 650 patients with acute
viral hepatitis, and two-thirds of them were infected
with hepatitis B. Liver cancer was also the third
most common cancer afflicting Singapore. Dr Oon said surgeons had to conduct
liver resections - the surgical removal of diseased portions
of the liver - twice a week. "(The hospital was) handling all
these infectious materials and, sadly, we lost some
medical students and nurses who got infected. It was a
situation of desperation. We needed vaccine on a very
large scale," he added. In 1973, when the then 34-year old
oncologist was conducting research in cancer immunology
in England, he was invited by Singapore physician Seah
Cheng Siang to "return to the East to help (his) people". In the 1970s, cancer research was
in its infancy but, seeing its importance, three top
professors from SGH and the Singapore Cancer Registry
asked Dr Oon in 1975 to conduct research on primary liver
cancer. He obtained seed funding with the
help of his aunt - Dr Oon Chiew Seng, the country's first
obstetrician and gynaecologist - who also set up the first
home for dementia patients. She is now 104 years old. With $10,000 from the Lee Foundation,
he recruited clinicians and researchers to conduct liver
cancer studies and, over the next few years, they found
that hepatitis B must be curbed to prevent liver
cancer. The mission to bring in a vaccine began. In 1981, the Ministry of Trade and
Industry gave the research team a $1.3 million grant. The World Health Organisation was
also excited about the project as it was the first time
that a vaccine was going to be used to reduce or prevent
a major cancer, said Dr Oon. The International Agency for Research
on Cancer awarded Singapore a US$22,550 grant to study
the vaccine's outcome on liver cancer trends. Singapore Biotech, a subsidiary of
Temasek Holdings, worked with American multinational
pharmaceutical company Merck Sharp & Dohme (MSD) to build
a vaccine manufacturing plant in Jurong. In 1985, MSD did away with plasma-derived
vaccines - which were inefficient to manufacture and may have
contained viruses - and made the vaccines from yeast instead,
Dr Oon noted. The new-generation vaccine was created
by implanting the hepatitis B surface antigen gene into
ordinary baker's yeast. Since 1987, the yeast-based vaccine
has been used for the vaccination programme. On Oct 1, 1985, the programme was launched
with the aim of vaccinating children born to carrier mothers,
and hospital staff and military recruits who were non-immune,
free of charge. Two years later, all newborns received the
vaccination, with the costs covered by Medisave.
The programme was a success. Dr Oon turned 80 two weeks ago, and he
is still involved in cancer treatment as a consultant physician
and oncologist at Mount Elizabeth Medical Centre. It has been 34 years since the voluntary
hepatitis B immunisation programme was launched. Dr Oon mused: "My work is completed.
The job I was asked to do... is done. The joy really is to
see healthy children." Our Badminton Greats - Gabriel Oon Chong Jin |