We were preparing for a pandemic since 2003: Singapore health ministry official

“Probably the most critical factor in our pandemic response is trust,” Singapore Prime Minister Lee Hsien Loong said earlier this year. The country, which already had a mature health care system, was widely seen as having responded well to the pandemic. Lee credited this to three factors―a resilient healthcare system, an effective public health response and public trust. “When there were errors in execution... we explained to the public what had happened,” he said. This transparency helped a lot.

In an interview, Dinesh Vasu Dash, who is part of Singapore’s health ministry, explains how his country’s medicare system got even better. Excerpts:

Q Public trust in the health care system is critical to any government’s success in handling a crisis. How did Singapore tide over Covid-19?

A Singapore’s policy responses were coordinated through a multi-ministry task force, chaired by two and subsequently three cabinet ministers, and supported by multiple agencies and ministries. Hence, we were able to coordinate across sectors and implement measures that had the confidence of the population. The task force communicated frequently with the public, explaining the situation, their thinking about how to respond, and their rationale for taking certain actions. This assured the public and prevented panic.

Q How did hospitals and clinics re-strategise as the threat evolved?

A Since the SARS outbreak in 2003, we have been preparing to deal with a large-scale pandemic. A case in point was the inauguration of the National Centre for Infectious Diseases in 2019, which played a pivotal role in managing Covid-19. We have also been building resilience in our medical logistics chains, including for the provision of oxygen and other critical medical supplies. Despite these efforts, and given the infectiousness of Covid-19, we still had to do some rapid procurement of some equipment, like testing kits. We also had to institute a nationwide “circuit breaker” (period of restrictions) on April 7, 2020 for almost two months.

Q How would you rate the public health expertise in Singapore? What are the challenges?

A Singapore has a world-class health care sector, with high commitment level and professional standards among our health care professionals, which are complemented by robust logistics. This was a significant strength during the pandemic, [and allowed us to keep] death rates among the lowest in the world. However, the pandemic had placed our public health care institutions under strain because of the multiple waves, resulting in staff fatigue and attrition.

Q Has the focus shifted from a hospital-centric to a more patient-centric approach?

A As the pandemic progressed, Singapore quickly pivoted from a hospital-centric approach to primary care to address the needs of our patients. At the height of the pandemic, patients were taken care of in Covid care facilities and hospitals. However, with more transmissible but less severe waves, coupled with our high vaccination rates, we were comfortable [letting] our patients be cared for by general practitioners and recover at home.

Q How successful is the vaccination programme? There have been concerns around youngsters being administered the vaccine.

A Over 93 per cent of our population is fully vaccinated. We have since pushed out boosters, and many among our vulnerable seniors have already taken at least two boosters. Most recently, we have launched the vaccination of our infants and toddlers, between the ages of six months to four. Our vaccination programme was highly successful because of our detailed operations and logistics plans, coupled with mobile applications for appointment bookings and an effective mass media campaign. While there was an understandable hesitancy at first, this was quickly overcome thanks to the significant trust and support from the public. We have also been transparent to the public on potential serious adverse event rates and vaccination errors, which had added to the public’s confidence, resulting in our high vaccination rates, even for our youngsters. There has been a whole lot of government effort to support our vaccination efforts. Grassroots organisations and volunteers continue to reach out to seniors, while mobile and home vaccination programmes [help those] who are unable to make the trip to a vaccination centre.

Q How are you ramping up hospitals and clinics along with essential medical supplies?

A There are several public and private hospitals and over 1,000 private clinics in Singapore. The health care landscape in Singapore will pivot more strongly to primary care in future. This will allow every Singaporean to have a family GP of choice to allow for the provision of high-quality care that is accessible, particularly for our growing catchment of elderly Singaporeans. For pandemic preparedness in future, public-private partnerships are especially important to ensure sufficient capacity.

Q The world is likely to experience more pandemics. What are Singapore’s long- and short-term goals?

A We wish to further build our pandemic preparedness in areas of better global and local surveillance, and establish a deeper capacity that could be repurposed from peace-time use to contingent pandemic use.

We are also working towards establishing national protocols and processes for greater alignment among health care institutions in managing communicable diseases. Lastly, we are strengthening our supply chain and stockpile resilience in various areas including personal protective equipment, and developing capabilities to research and develop diagnostics, vaccines and therapeutics.

Learning to live with the virus is only possible with a high vaccination coverage. It involves an ability to see through waves of infection without the need to resort to extraordinary community-based measures to restrict transmission. Sufficient health care capacity is also necessary to manage both ongoing health needs and increased needs from the outbreak.