WHEN CRISIS MEETS PREPARATION AND DISCIPLINE: SINGAPORE'S SUCCESSFUL RESPONSE TO COVID-19.

• Author: Berman, Ayelet

1. INTRODUCTION

   The results speak for themselves: nine months after the World Health Organization ("WHO") announced that COVID-19 was a Public Health Emergency of International Concern, Singapore successfully contained the spread of COVID-19 within its borders. As of June 2021, Singapore has had approximately sixty-two thousand cases, of which there have been thirty three fatalities. Since at least October 2020, there have been zero- or single digit daily cases. Schools reopened in July 2020, and social and economic activity - although subject to social distancing and contract tracing rules - resumed operating under the "new normal" state.

   What explains Singapore's unbelievably successful response to this pandemic? In this paper, we identify and describe the following three main factors that have played key roles: pandemic preparedness, an assertive, public-health guided response to COVID-19, and Singapore's unique political and social system.

   As we shall layout below, pandemic preparedness has been key. Following the severe acute respiratory syndrome ("SARS") pandemic in 2003, Singapore made significant investments in pandemic preparedness and committed to complying with the WHO International Health Regulations (IHR). Thus, when COVID-19 broke out, Singapore already had in place a developed public health and policy system to detect and respond to disease outbreaks.

   Further, Singapore's government, guided by science and public health, has taken an assertive and firm approach, applying the rules of the pandemic playbook. Among other measures, the government has undertaken tight border and incoming travelers' controls to prevent the infiltration of infected people. It has also carried out large-scale testing, rapidly identified and isolated infected cases and their contacts, and has mandated mask wearing and social distancing. These measures have been strictly enforced and have been coupled with a transparent public communication model that has garnered broad public support. That being said, Singapore's use of surveillance technology and its management of migrant dormitories have given rise to concerns over privacy and the rights of vulnerable populations, respectively.

   Singapore's effective implementation of these measures has been made possible by the country's unique sociopolitical system, which is characterized by high levels of unity, coordination, pragmatism, and compliance.

   The purpose of this Essay is to describe and better understand Singapore's public health response to COVID-19. We first describe the political and social context (Section 2), and we then describe the state of Singapore's pandemic preparedness before COVID-19 (Section 3). Thereafter (Section 4), we describe Singapore's policy response to COVID-19. Section 5 concludes.

2. THE POLITICAL AND SOCIAL CONTEXT

   Before delving into the specific public health measures applied in Singapore, it is important to understand that Singapore's coordinated and effective response has been made possible by the country's unique sociopolitical system. This system has played a key and decisive role in the effective implementation of and compliance with public health measures. Indeed, the WHO Director-General has lauded Singapore for its 'all-ofsociety, all-of-governmcnt approach. (1)

   Since Singapore's independence in 1965, the People's Action Party ("PAP") has continuously held a supermajority or in Parliament. An emphasis on meritocracy and pragmatism ingrained in the culture of the political party and of the civil service has allowed for real-time technocratic decision-making, expedient implementation, and strict enforcement of government health policies. There are also considerably fewer contradictory views or misinformation circulating on the status of the pandemic owing to

   Singapore's regulations on freedom of speech and fake news, which - although criticized in other instances (a matter which is beyond the scope of this paper) (2) - has resulted in restrained behavior from the traditional media and social media outlets. As we describe below, this enabled the government to swiftly communicate accurate information, policies, and guidance to the public.

   Furthermore, as a matter of social culture, Singaporeans tend to trust the authority of the government and arc generally receptive to the government's policies and measures. Thus, during COVID-19, there was no significant outcry or pushback to the government's top-down approach. Most Singaporeans have complied with the restrictions imposed (which we address below).

   While this paper focuses on the government's response, community support from individuals and businesses has also been critical, whether by reassigning staff to the healthcare industry, (3) or producing face masks and other essentials. (4) These factors have contributed to plugging the supply gaps in the system, improving compliance with safety measures, and ultimately spreading social consciousness within Singapore society.

3. SINGAPORE'S PANDEMIC PREPAREDNESS

   While COVID-19 exposed certain gaps in Singapore's pandemic preparedness (which wc address below), overall, Singapore was relatively well prepared for the COVID-19 pandemic.

   One of the main reasons for Singapore's preparedness was its harrowing experience in 2003 with the SARS pandemic, resulting in 238 cases and 33 deaths within Singapore. (5) The SARS crisis caused Singapore to invest significantly in pandemic preparedness. It also drove Singapore's political commitment to comply with its IHR core capacity obligations.

   Thus, when COVID-19 broke out, Singapore already had a developed public health and policy system to detect and respond to disease outbreaks. The level of Singapore's preparedness was examined in two recently published external evaluations: the 2018 WHO Joint External Evaluation and the 2019 Global Health Security Index. The 2018 WHO Joint External Evaluation Report found Singapore to have a high level of preparedness and to be in good compliance with its IHR obligations. Singapore's achievement on the 2019 Global Health Security Index, which assesses the global health security capacities in 195 countries, has been lower, yet still relatively good at 24th place.

   Below, we briefly layout the main findings of these reports regarding Singapore's pandemic preparedness. We then provide some examples of the pandemic capacities that Singapore has developed and established in recent years.

   1. External Evaluations i . 2018 Joint External Evaluation ("JEE")

      Under IHR 2005, all States Parties are required to develop minimum core public health capacities to "detect, assess, notify and report events,'" (6) and to respond "promptly and effectively" (7) to public health emergencies. Under the WHO's IHR Monitoring and Evaluation Framework, Member States may voluntarily request an external investigation - through the joint external evaluation ("JEE") scheme - of their compliance with IHR core capacity requirements. (8) Based on the information provided by the Member States, the JEE mission, which is composed of external experts, reviews national capacities in the following four fields: preventing, detecting, and responding to an outbreak and other IHR-related hazards and points of entry. Under the JEE, these four topics are divided into seventeen technical areas (which are divided into forty-eight indicators) that cover matters such as national legislation, policy, and financing, IHR coordination and communication, national laboratory systems, surveillance, and more. (9) The JEE scores each of the indicators and technical areas.

      Singapore opted to undergo such an evaluation, and in 2018, the JEE issued its report. (10) It found, on the basis of the information that Singapore had compiled, that Singapore had successfully passed the evaluation. The JEE team found that "Singapore had demonstrated strong leadership and a highly developed capacity to detect and respond to potential public health emergencies." (11) It concluded that across the different technical fields, "Singapore has shown a high level of achievement in fulfilling IHR obligations." Singapore received the highest or second highest score (5 = sustainable capacity and 4 = demonstrated capacity out of a scale of 0 through 5) in 96% of the indicators (65% of the indicators received the highest score, while 31% received the second highest score). This included high rankings in areas such as national legislation, policy, and financing, IHR coordination and communication, zoonotic diseases, the national laboratory system, food safety, and many more. The report highlighted the state-of-the-art facilities and the coordinated whole-of-government approach to pandemic response, allowing for comprehensive risk communication and multisectoral implementation of a pandemic response. (12) ii . The Global Health Security Index ("GHSI")

      The Global Health Security Index ("GHSI") is a nongovernmental initiative that was developed by the Nuclear Threat Initiative, the Johns Hopkins Center for Health and Security, and the Economist Intelligence Unit, in conjunction with an international advisory panel of twenty-one experts from thirteen countries. The GHSI assesses the global health security preparedness of all 195 countries that are party to the IHR 2005. The GHSI is based on 140 questions that are organized across the six categories of prevention; detection and reporting; rapid response; health system; compliance with international norms; and risk environment. In contrast to the JEE, which relics on information provided by Member States, the GHSI aims to be more independent, as it scores each country by relying entirely on open-sourced information on the country's policies and practices.

      The 2019 Report ranked Singapore 24 (th) in the world, scoring 58.7 out of 100, behind the top-ranked United States of America, United Kingdom, and other Southeast Asian countries, such as Thailand and Malaysia. (13)

      Singapore ranked very high on a few...