The secret to Singapore's effective management of the COVID-19 crisis has been its handling of three crucial trade-offs, Gwendolyn Thong, Steven PL Ooi, Eduardo Araral, and Alfred Muluan Wu write.
Singapore has been lauded as highly effective in its management of COVID-19, with a very low number of deaths from the virus. For long periods of the pandemic, Singapore was ranked first in Bloomberg's COVID-19 resilience ranking, with New Zealand coming in at second position, though they have now swapped places. With the Delta variant spreading, Singapore has heightened the alert level recently.
Underlining the public health response to COVID-19 in every country was a crucial question: how should scarce resources be allocated? We note that the principles behind Singapore's management of COVID-19 have revealed three key trade-offs at play in its crisis management process.
These are lives versus livelihoods, immediacy versus incrementalism, and finally, communicating plainly versus being diplomatic.
Consider these one by one. First is the lives versus livelihoods argument – there is no real trade-off here. From the start, the implementation of a national lockdown following a major outbreak was not considered a real solution but a stop gap measure for protecting the healthcare system, as such a policy would cripple the economy and affect livelihoods. Instead, cautious reopening with phased periods of heightened alert has proven to be a viable solution. Case fatality remains extremely low, with Singapore's coronavirus death toll at just 35 as of 23 June.
Of course, public wellbeing must account for livelihoods and economic sustainability for families, as well as physical health.
Keeping families locked up in their homes for an extended period may also exacerbate pre-existing socio-economic divisions, as low-income families are more likely to suffer economically from the crisis.
But the impact of lockdowns doesn't stop there. The number of domestic violence cases in Singapore has been on the rise in 2020 and 2021, and extended lockdowns seem to worsen this.
Governments should attempt to reopen their economies and put an end to the lockdowns as soon as possible, and Singapore understood this from the start. The key to achieving this would be to step up on community hygiene measures and safe distancing, and to develop an effective contact tracing system that works in their country.
As such, the success of its contact tracing app, TraceTogether, has made it possible for the nation-state to restart its economy without the fear of the pandemic spreading out of control.
Contact tracing needs to achieve a high level of efficacy to work, but Singapore's contact tracing has been able to isolate over 90 per cent of all who have come into close contact with individuals confirmed to have contracted the virus. In this way, it avoided long lockdowns and managed this first trade-off well.
When the COVID-19 pandemic first hit Singapore in the earlier half of 2020, the government insisted on prioritising the testing of patients with flu-like symptoms. The worried but well had to be turned away because of the limited number of test kits available.
This is an example of how Singapore handled the second key trade-off, in which the government prioritised incrementalism over immediacy due to its lack of available resources. This pragmatic approach was also taken with the use of surgical masks, which were initially reserved for healthcare settings as indiscriminate public consumption would have led to too much stress on supplies.
In addition, Singapore did not have enough isolation facilities at the outbreak of the pandemic and large-scale management of asymptomatic cases was only feasible after containment facilities were prepared with the help of the Ministry of National Development, which refitted large buildings and other venues to act as community isolation centres.
Prioritising incrementalism did not mean that no effort was made to expand resources rapidly, but even when mobilising the whole government there is always a delay between policy implementation and results. Thus, at the start of any crisis, those who need the resources the most must be able to access them first, and the decisive and incremental deployment of Singapore's resources has been critical in managing the COVID-19 situation.
Finally, Singapore's government communicated with its people effectively. Sometimes, being plain-speaking can run counter to being effective – local governments and regional organisations can rightly be accused of being incompetent when they choose their words too carefully – and evidence shows citizens prefer governments to be upfront about a crisis.
Still, information needs to be handled prudently, and governments need to make a trade-off between trying to prevent panic while also being open with the public about the seriousness of a situation.
When this balance is found it generates great trust and cooperation, something Singapore achieved well in its own management of COVID-19.
An example of this was when public debate emerged in Singapore over whether or not the Chinese Sinovac COVID-19 vaccine should be included in its national vaccine program.
Some citizens, particularly originating from mainland China, placed a lot of pressure on the government to introduce Sinovac since it arrived in Singapore in February 2021. Nevertheless, the government's message to the public was firm: Sinovac had not provided sufficient data for the Health Sciences Authority in Singapore to evaluate the quality, safety, and efficacy of the vaccine.
Eventually, the Singapore Government invited private healthcare institutions to provide Sinovac to those who are eager to have it on a voluntary basis. Still, until it is cleared by the Health Sciences Authority, Sinovac is not covered by the country's Vaccine Injury Financial Assistance Program.
It is tricky to strike a good balance, but Singapore's strategy on communicating these choices has been to have a firm and clear position, but not to ignore important voices, and a sound compromise was reached in this case. This is especially important given the crucial role trust plays in the management of COVID-19.
Ultimately, what made Singapore so effective at managing the crisis has been its handling of these three key trade-offs. It's short and sharp lockdown kept the healthcare system working and the economy moving, it effectively prioritised its resources and was urgent without rushing its decisions, and it managed its communication well, building a high level of trust between citizens and the government.
These trade-offs were the key factors in managing the crisis, and in countries where vaccines are thin on the ground, Singapore's effective management can provide a roadmap for managing COVID-19 and its spread into the future.
This article was first published in Policy Forum on 23 June 2021.
(Photo: Victor He)