SINGAPORE: In the seven months since the pandemic was declared, there has been a seismic shifting of the goalposts to getting it under control.
Initial optimism that COVID-19 would be neutralised by summer temperatures turned into global lockdowns and, now, a new normal of mask wearing, social distancing, and telecommuting for the foreseeable future.
With its warm climate, breakneck urbanisation, and lush biodiversity, Southeast Asia is particularly susceptible to future infectious disease outbreaks.
The US Centres for Disease Control and Prevention (CDC) estimated that approximately 75 per cent of emerging infectious diseases (EID) found in humans are zoonoses, having originated in animals.
According to the UN Food and Agriculture Organization (FAO), 60 per cent of the world’s pigs and 43 per cent of its poultry were produced and farmed in East and Southeast Asia in 2012.
These numbers would have grown exponentially since, causing rapid deforestation, and a boom in unregulated wet markets, wildlife trafficking, as well as factory farms all of which have increased the number of human-animal interactions that lead to interspecies disease transfer and mutations.
Despite these risks, the borders of trade-reliant nations in this region cannot remain closed for long as the global recession deepens.
As a key regional business, aviation, and shipping hub – home to Asia’s top foreign exchange centre and the world’s second largest container port – Singapore is strategically positioned to lead the charge in demonstrating how to prevent a second wave as well as setting a global benchmark of how to build a sustainable pandemic preparedness programme.
This is especially so since Singapore is easing up on some of its travel restrictions. On Monday (Oct 26), Singapore and Indonesia opened a reciprocal green lane for essential business and official travel between the two countries.
Singapore is also exploring similar arrangements with other countries such as Australia and Germany while it is establishing a travel bubble with Hong Kong.
PREVENTING A SECOND WAVE
In the early days of the outbreak, European governments, in particular, cautioned about an eventual desensitisation to containment measures should they be implemented too soon.
There are concerns that “pandemic fatigue”, as it was dubbed by some psychologists, also crept into Singapore as people start to become less cautious about social distancing.
When Phase 2 started in mid-June, then Environment and Water Resources Minister Masagos Zulkifli warned about large crowds and inter-group mingling spotted on beaches. More recently, Sentosa implemented pre-booking and capacity limits for its beaches to control crowds.
We still see the occasional reports of people being fined or charged for flouting restrictions though it must be said that these involve a small segment of the population.
Nevertheless, pandemic fatigue can be a real issue so to continue to manage epidemics effectively in the future, more behavioural studies need to be conducted to examine what will motivate people to change their everyday actions on short notice and sustain them for the long-term.
When it comes to mask-wearing, research from the US National Academy of Sciences (NAS) shows that individual mask-wearing is often driven by a desire to be perceived as socially-responsible by other mask-wearers.
In short, every citizen needs to understand that their individual adherence to health guidelines is crucial to maintaining the majority required to turn an action – such as consistently using contact-tracing apps – into a norm.
One advantage the government has is that COVID-19 has given it the opportunity to further its strategic pivot towards self-reliance on technology, tools, and services related to infectious disease protection, detection, and decontamination in line with its broader vision of Singapore as a Smart Nation.
A nation of digital natives is also more equipped to understand these measures, hence allowing for their speedy implementation - the widespread adoption of the TraceTogether app is just one example of how Singapore is setting a global standard in contact tracing.
REDEFINING PANDEMIC PREPAREDNESS
Hopefully, every virus outbreak in the future will not turn into a pandemic. Nevertheless, the government must pre-empt this by fortifying Singapore’s pandemic preparedness efforts, especially since the threat of COVID-19 is far from over.
Like emergency-response trainings, public education is essential to epidemic preparedness.
Only when every citizen understands the next steps to a crisis can they play a part in its solution. One way is through fostering a better understanding of viral outbreaks via school curriculums.
While the evolving nature of infectious diseases means that it’s difficult to predict the next outbreak or the nature of it, schools should still delve into the important role national healthcare systems play in society, as well as inculcate in young minds the importance of personal hygiene, build psychological resilience, and hammer home the responsibility individuals have in battling a pandemic.
These are useful tools to help the nation be ready for the next outbreak – COVID-19 or otherwise.
Singapore’s early success in getting COVID-19 under control can be attributed to its rigour in early detection.
The outbreaks detected in foreign-worker dormitories were tempered through mass testing and the authorities should look to ramp up our biosurveillance capacity in Phase Three so Singapore can lead the way in charting immunity build-up.
Pooled testing has been trialled to address the paucity of testing kits when the outbreak in migrant-worker dormitories was first detected. Moving forward, this could be a viable solution to delineate infected clusters across the island.
Monitoring should also be extended to recovered patients with recent data around the durability of antibodies varying significantly from initial results.
While earlier studies indicated a sharp drop in antibodies a few months after infection, in September, deCode Genetics found that antibody levels rose and then held steady for up to four months in more than 90 per cent of recovered patients in Iceland.
The lack of clarity, coupled by evidence of reinfections caused by slightly different strains of the virus, raise concerns around the duration of immunity and risk of reinfection.
A COORDINATED REGIONAL RESPONSE
The complexity of viruses and the need to maintain open borders in the long-term means that Singapore needs to be mindful of the risks of outbreaks in the region too.
Asia as a region, lacks a harmonised regulatory approach to medical development and testing, hindering scientific collaboration, pandemic responsiveness and the accessibility of innovative treatments.
As the biomedical and R&D hub, Singapore can lead the way in establishing a robust and sensible framework that accelerates the development and commercialisation of therapeutics, diagnostics and vaccines developed in-country.
While most nations have indicated a willingness to do so, the main challenge is sustaining the motivation once the pandemic recedes.
For starters, the government can look to the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) for guidance on how to build a coordinated regulatory framework for Asia.
Across the world, governments are vying to secure their nation’s vaccine supply even as candidates are under development. Stockpiling – without hoarding - will bolster Singapore’s defences against the possibilities of a future outbreak.
A more pre-emptive approach can also be taken by ensuring a steady supply of personal protective equipment such as face masks and medical equipment like ventilators prior to a disease outbreak so frontline medical workers will have the supplies they need to save lives.
PRACTICAL AND PSYCHOLOGICAL PANDEMIC PREPAREDNESS
The final takeaway is that pandemic preparedness has two components – the practical and then the psychological. The latter refers to the importance of building psychological resilience in the face of a calamity – maintaining it even as no discernible end is in sight.
COVID-19 has brought to the forefront our need for a more long-term unified approach to not just pandemic responsiveness but preparedness.
Therein lies Singapore’s opportunity to lead by example in not just flattening the curve but preparing to ride out the next wave in a better shape.
Dr Priyabrata Pattnaik is currently a Director for Asia Pacific at the Life Science business of Merck, a Board Member at the Parenteral Drug Association (Singapore Chapter), specialising in infectious diseases and vaccine development. He was formerly a research scientist at the UN International Centre for Genetic Engineering and Biotechnology (ICGEB).