All around the world, the structure and security measures for biodefense preparedness vary. Countries have very distinct strategies based on their location, size, and type of government. I was particularly interested in Singapore, a very small country of only 5.8 million residents and 278 square miles, because of its reputation for efficiency and high standards. Therefore, I asked the Singaporean Government if they could share information on their approach to protecting their country from biological threats.
The Ministry of Health kindly answered my questions by email. I will share with you Singapore’s approach by, first, describing the national security measures in place, as well as the personnel and departments responsible for planning, surveillance, and response, and the roles of each department. Then I will turn to describing how Singapore’s authorities coordinate internationally.
At a national level, biosecurity measures in Singapore involve a “whole of government” approach, in which several governmental departments, including the national government, the health system, law enforcement, and the military, play roles. Among the most important are the following:
- The Public Health Group, which is located within the Ministry of Health (MOH), has an Operations Group which is responsible for public health planning. The MOH also has a Communicable Diseases Division which is responsible for both public health surveillance and response, as well as groups that focus on biosafety (Biosafety Branch), and epidemiology and disease control (Epidemiology and Disease Control Division).
- Within the field of infectious disease, the Centre for Infectious Disease, Epidemiology, and Research (CIDER) at the National University of Singapore integrates multiple functions, including public health surveillance, clinical disease management, national research, and the training of healthcare professionals. Additionally, CIDER is critically involved in the prevention and management of potential infectious disease outbreaks in Singapore.
Together, the National Government, the health system, law enforcement, and the military have three main roles:
- Promoting good health and reducing illness;
- Ensuring access to good and affordable healthcare; and
- Pursuing medical excellence.
The Government of Singapore has developed a strategy for each of these three roles:
Promoting good health and reducing illness
One key strategy for promoting good health and reducing illness involves public awareness and education. The MOH plays a major role in this area by educating and providing information to the public on ways in which individuals can maintain a healthy lifestyle. The MOH also achieves its goal of reducing illness by allocating resources appropriately and controlling and preventing diseases.
Ensuring access to good and affordable healthcare
A second major strategy is ensuring that the population of Singapore has access to high quality healthcare at affordable prices. Again, the MOH plays a major role in this area by working towards good clinical outcomes, professional standards, and the delivery of services based on each patient’s needs. To make excellent healthcare affordable to individuals, the Singaporean Government significantly subsidizes costs and is involved in risk pooling via insurance. While the Government does emphasize co-payment principles, it also ensures the balance between individual and collective responsibilities.
Pursuing medical excellence
The Government has also identified medical excellence as key to success. In order to pursue medical excellence, the Government of Singapore seeks to “promote a culture of medical excellence in the public healthcare institutions for the greater benefit of Singaporeans, while ensuring affordable, cost-effective and appropriate care”. It seems to have achieved this objective: in 2014, Bloomberg found that Singapore had the best health care system in the world in terms of health care costs relative to life expectancy.This has been achieved through a unique system that mixes public and private health care organizations, health savings accounts and cost sharing, and government regulation.
Singapore is very well prepared for any biological threats to the public, due to its “whole of government” approach. This means that the country has an “integrated national response framework in place whereby public agencies, private organizations and the community work in a coordinated way to deal with both health and non-health issues”. During disease outbreaks, all national resources are able to be deployed quickly to ensure timely intervention.
To prepare for outbreaks and any biological acts of terrorism, the Ministry of Health has developed plans and procedures to treat and contain pathogens and diseases, and maintain essential governmental functions during these times. These plans are ready to be implemented as soon as the Government is made aware of an outbreak and are regularly tested and revised to ensure that they are up to date and remain relevant. In addition to all of the aforementioned safety measures, the Government also has robust surveillance and response measures to protect medical personnel and citizens from a biological threat.
To effectively safeguard against biological threats and any disease outbreaks, countries need not only to have in place effective national security measures; they also need to collaborate with the global system and neighboring countries. Singapore collaborates with the global system by participating in the Global Outbreak Alert and Response Network (GOARN). This network is a combination of numerous existing institutions which are required to be constantly alert and are able to respond at any time. Regionally, Singapore and neighboring countries work together to “develop mutually beneficial mechanisms for coping with a pandemic”. These mutual connections include improving medical surveillance and sharing timely reports with each other of possible pandemic or public health threats, based on early warning signs.
Overall, Singapore does a great job of planning for, preparing for, and monitoring any potential public health threats. The Government is also connected to and coordinates with global partners and other countries to ensure the safety of its citizens. However, as with any country’s approach to preparing for pandemics and emergencies, improvements can be made.
One suggestion that the Singaporean Government shared with me, which could lead to a more coordinated and planned out system, was to have “regular reporting/meeting platforms … to facilitate information exchange and the sharing of countries’ plans”. This is a great idea, and not just for Singapore. Biosecurity is a space that requires effective coordination across countries in real time, which can sometimes be hard to do because of concerns about secrecy and national security.
Singapore’s health care system is well-designed and responsive to its citizens’ needs and desires. The system and the suggestions they shared could also be used as a model for other countries to follow. While not every country can copy exactly what a small and wealthy country like Singapore has done, they can study it and borrow elements that would work for them. This could help to modernize public health systems everywhere, ensuring they are better able to cope domestically and cooperate with each other internationally in order to improve overall biosecurity in an increasingly complex and interconnected world.
“Where Do You Get The Most for Your Health Care Dollar?”, Bloomberg Visual Data, September 18, 2014 (at: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html).
See“What Makes Singapore’s Health So Cheap?”, by Aaron E. Carroll and Austin Frakt, The New York Times, October 2, 2017 (at: https://www.nytimes.com/2017/10/02/upshot/what-makes-singapores-health-care-so-cheap.html).