Covid-19 has dominated global headlines for more than two years, but it is just one episode in the long history of deadly disease outbreaks around the world. For example, the SARS crisis of 2003 was the last pre-Covid outbreak, which highlighted the importance of pandemic preparedness and mobilized a system that facilitated the sharing of health information around the world.
Also, as the Covid-19 pandemic rages on, other significant public health threats have emerged. Monkeypox has spread all over the world and recently arrived in Singapore. And at the start of the Covid crisis, in 2020, Singapore experienced its worst dengue outbreak yet. The looming threat of new variants of Covid and other diseases means governments must always be well prepared for future health crises.
So how can cities work towards a pandemic-proof future? At GovInsider’s 2022 Festival of Innovation, health professionals gathered to explore how promoting environmental health, sharing data and providing resilient community health services can improve cities’ preparedness for future global health crises.
According to Ng Lee Ching, group leader of the Environmental Health Institute at Singapore’s National Environment Agency (NEA), diseases are not only about human health, but also animal and environmental health. Ng said this is especially true for cities in tropical regions, whose warm environments are conducive to insect-borne diseases like dengue and malaria.
Holistic approaches to pandemic management should consider all aspects of outbreaks and responses to them, from how diseases are transmitted in the environment to how healthcare systems deal with infected patients. As a result, Ng said, tackling public health risks like Covid-19 requires a “One Health” approach – a collaborative, multisectoral and transdisciplinary strategy in which government agencies with responsibilities for different areas tackle diseases together.
Such an approach to disease management already exists in Singapore’s Zika Control Program, which involves close collaboration between the NEA and the Ministry of Health, Ng said. The NEA helps eliminate mosquito breeding grounds in the community, while the ministry is responsible for managing patients and raising awareness of the Zika virus among members of the medical community.
According to the United Nations Environment Program, 75 percent of emerging infectious diseases in recent decades have been zoonotic, meaning they have been transmitted from animals to humans. Facilitating greater collaboration between environmental and public health agencies will allow governments to better manage emerging diseases, addressing root causes while strengthening containment efforts.
Fight outbreaks with technology
Four years ago, the World Health Organization warned of a potential “Disease X” – a hypothetical pathogen that can cause a future pandemic – and announced, in a somewhat eerie way, the Covid pandemic. When fighting an unknown enemy that could appear at any time, countries with solid plans must be ready to fight back. This means strengthening the health system’s ability to deal with future pandemics, including by preparing for the development of diagnostic kits and vaccines in an accelerated timeframe.
Lisa Ng, executive director at Infectious Diseases Labs (ID Labs) at A*STAR, said Singapore has been proactive in learning from past disease outbreaks to create significant research capacity at universities and other healthcare institutions. His extensive knowledge of technologies such as genome sequencing and artificial intelligence enables authorities to quickly reuse these technologies to deal with future cases of disease.
For example, although mRNA vaccines were developed as a cancer therapy, they were first used against a virus that could cause a pandemic, said Hsu Li Yang, associate professor and vice dean of global health at National University of Singapore’s Saw Swee Hock School of Public Health. related to the Ebola virus.
Likewise, new technologies developed during the Covid-19 pandemic may allow governments to be more flexible in their response to future illnesses. Researchers at the National University of Singapore are using the IDentif.AI AI platform to calculate the most effective drug combination and dosage against the Omicron variant of Covid. In the future, the technology can be used to develop effective treatments for future outbreaks.
Sharing is caring
Leo Yee Sin, executive director of Singapore’s National Center for Infectious Diseases, said that data sharing beyond technology is also critical to addressing a global health crisis. No one knows what the next pandemic will be like, but in the face of the unknown, data is the healthcare sector’s most important asset.
Fortunately, the world is connected by data, with international organizations such as WHO acting as central coordinators, bringing together and sharing clinical information from different countries. The International Health Regulations, introduced in 2005, also legally require countries to report public health events so that others can take precautionary measures and prepare.
Leo added that Singapore must continue to engage in global networks and invest in global health. She said it was thanks to these connections that Singapore was able to respond quickly to Covid-19 – before the first case reached the country’s shores – and the government was already developing diagnostic tools for the virus.
Within cities, data sharing is also important to coordinate a whole-of-government approach to pandemic management. Despite this, public sector experts who participated in a panel discussion at the Festival of Innovation said many data-driven initiatives have remained limited to specific organizations.
To harness the power of data, agencies should move from simply collecting data to sharing it across agencies. The public sector experts outlined some possible solutions that could facilitate such a transition. One option would be to set up a national “data lake” to host raw data that can be used by different agencies. The government could also introduce public sector management legislation to standardize public health data sharing between agencies.
“The best time to prepare for pandemics is
Hsu Li Yang, Associate Professor, Saw Swee Hock School of Public Health,
National University of Singapore
“The best time to prepare for pandemics is between pandemics,” Hsu said, adding that governments need to ensure policies are in place to strengthen ties between countries and establish state-of-government data-sharing initiatives. This would avoid searching for resources and solutions in future outbreaks.
Community Health Care
Hsu highlighted the problem of maintaining the government’s focus on pandemic preparedness going forward as society settles back into more comfortable norms and finds itself amid “Covid fatigue.” Of course, while it is important to continue investing in research and healthcare, the community must also remain sufficiently resilient to face the next pandemic, as they are on the front lines, as are hospitals and medical workers.
During the panel, public sector experts stressed the importance of increasing community ‘ownership’ of healthcare. Community health care plays a key role in pandemic management as it leverages existing relationships between primary health care providers, neighbors, friends and family members who can help identify vulnerable individuals such as homebound seniors and provide primary care to those with mild symptoms.
One such community initiative in Singapore, called Let’s Get Our Seniors Vaccinated, offered vouchers for anyone who referred and accompanied a senior for vaccination. It leveraged strong community networks and encouraged people to look to others to increase immunization rates in vulnerable communities.
While policy responses to pandemics are primarily aimed at containing the spread of viruses and ensuring hospitals can continue to treat patients, they may not address the full spectrum of psychological, social, and economic impacts that pandemics have on people. Building strong community networks is filling these gaps, a phenomenon attested to by the many grassroots initiatives that have sprung up to help vulnerable communities during the Covid crisis. For example, volunteers from local NGO The Food Bank distributed food parcels to elderly people and households facing lost income during lockdown. Neighborhood social services can also distribute relief vouchers to residents in need who may not be aware of such relief efforts.
As much as Covid-19 has severely impacted people’s lifestyles, it has presented governments with a valuable opportunity to rethink healthcare frameworks and policies. Now, the great recovery everyone awaits means not only a return to some of the reassuring norms of a pre-pandemic world, but also the evolution of healthcare systems to make cities more pandemic-resilient.
To view these panels or other panels at the Festival of Innovation, register here.