Singapore flags errors, good calls and lessons from the ‘complex and wicked’ COVID-19 pandemic
By Salma Khalik, Senior Health Correspondent, The Straits Times, 8 Mar 2023
Singapore has looked at how it performed in its fight against Covid-19 and concluded that while it got several big calls right, it slipped up on a few aspects.
The White Paper on the nation’s performance, released on March 8, was not a self-congratulatory exercise but an effort to understand how it can build on its successes and avoid the errors committed in the fog of war, when the next big pandemic knocks on its doors.
The 92-page document listed eight things that Singapore did well, such as not letting the healthcare system get overwhelmed and saving lives and livelihoods, six where there was scope for improvement, including over-calibrating safe management measures which were not always consistent, and near disastrous stumbles in handling outbreaks in migrant workers’ dormitories.
There were also seven lessons listed in preparing for the next crisis.
An important lesson which was weaved in throughout the paper was to not rely on past pandemics to provide the road map for dealing with the next one, but instead, to be flexible enough to cope with nasty surprises.
Some of the problems that dogged Singapore’s response stemmed partly from the Government basing most of its actions on the previous major outbreak, the Severe Acute Respiratory Syndrome or Sars – which was caused by a virus in the same family as the one responsible for Covid-19.
The paper stated: “It was soon clear that in building pandemic preparedness on a Sars model, we had not adequately challenged certain assumptions.”
When the first cases appeared in the migrant workers’ dorms, “the prevailing view was that asymptomatic transmission was not possible” – since that was the case with Sars – resulting in insufficient precautions. As a result of that misjudgment, “the dormitory outbreak had every possibility of becoming a major disaster”.
Because Sars did not spread easily, the Government initially said masks were not required unless the person was feeling unwell. This advice was also spurred by the shortage of masks which the Government wanted to keep for healthcare workers.
The White Paper said we could have been less definitive in our position on mask-wearing. Instead, when masks became mandatory in April 2020, the public viewed the policy as a U-turn, contradicting the Government’s earlier position – which “undoubtedly affected public trust and confidence in our handling of the crisis”.
Deputy Prime Minister Lawrence Wong, who co-chaired the multi-ministry task force on Covid-19, said at the release of the White Paper: “So while the lessons will help give us a better sense of preparedness, we must never fight the last war.
“We must not allow the lessons to become hard coded into a certain doctrine that might lead us down the wrong path, especially if the next virus turns out to be very different in character and nature from what we have experienced so far.”
Mr Wong noted that while Singapore is now better prepared, it can never be complacent.
But there are things Singapore can and will do to prepare for the next pandemic, no matter how different it might be. These include building strong public health expertise, institutionalising the use of science and technology, strengthening forward planning, and reviewing stockpiling strategies and further diversifying critical supplies.
When the next pandemic hits – and it will, said Mr Wong – the Government needs to decide on what to prioritise and adapt quickly to changing situations. The focus should be “broader brush but more implementable measures, and to guard against the instinct to aim for unrealistic standards of perfection”.
In a complex and fast-moving crisis, the normal government machinery does not have the bandwidth to plan future operations. So a dedicated forward planning team will be set up to ask the “what if” questions, and prepare ahead for situations which have not yet arisen and perhaps may not arise at all.
Covid-19, said Mr Wong, “has been a very complex and wicked problem on a grand scale, with many twists and turns and disruptions and surprises along the way. We had to operate in a fog of war. We had to make decisions amid conditions of incomplete information.”
With the benefit of hindsight, “we probably could have handled certain situations differently”, he added, pointing to the foreign worker’s dormitory outbreaks as one of the most challenging difficulties faced during the pandemic.
This was also highlighted in the White Paper, which draws on an internal review led by former head of civil service Peter Ho. It said: “There were a few close calls, the most dangerous being the outbreak in the migrant worker dormitories that put more than half a million migrant workers at risk with the threat of the infection spilling over into the wider local community.
“Had that happened, Singapore could have experienced a devastating surge of infections that would have overwhelmed its healthcare system. Mortality rates would have been catastrophic. The economy would have suffered even more with a significant proportion of the workforce out of action.”
Although several things could have been done better, the paper concluded: “The quality of governance throughout the crisis has been generally high. Through a strong Whole-of-Nation response to the pandemic, we have effectively preserved lives and livelihoods.”
Singapore’s procurement and roll-out of vaccines for the entire population was a high point of its response, said Mr Wong. It was among the first countries in the world to get the mRNA vaccines, with the first batch arriving in December 2020.
“Vaccination was clearly such an important way out of this pandemic for the world and for Singapore,” he added. “Overall, our whole vaccine strategy from procurement, to the rolling out of the vaccines, to the communication to actually delivering jabs to people, I think we have generally done well, and that has enabled us to get through this pandemic.”
With $72.3 billion spent on fighting the pandemic over three years, the resident unemployment rate was kept below 5 per cent, students could continue their education at home with 35,000 computing devices loaned out to them in 2020 and 2021, while the case fatality rate was kept to less than 0.1 per cent. This is among the lowest globally, with the average of about 1 per cent worldwide.
Mr Wong said this spending is being reviewed by the Auditor-General’s Office as he, too, as Finance Minister, wants every dollar accounted for.
So how would he grade Singapore’s fight against the pandemic? His reply: “I can’t possibly give a grade because I was being examined. So it’s for people to examine me and give me a grade.”
The White Paper, on the other hand, concluded: “This crisis of a generation showed us, and the world, what Singaporeans are capable of when faced with a severe existential test.
“It marks a certain maturity of Singapore as an economy, as a people, and as a nation. We can be proud of how far we have come. And we will learn from the experiences of the last three years to be better prepared for the next pandemic.”
The White Paper is available at go.gov.sg/covid-19-white-paper. It will be debated in Parliament later this month.