Lessons from Covid: Pandemic-proofing our cities

By Woo Hoi Yuet

Interagency collaboration, data-sharing and community healthcare can increase cities’ resilience to disease outbreaks. That’s the consensus view of healthcare and public sector experts who spoke at the latest edition of GovInsider’s Festival of Innovation.

Covid-19 may have dominated global headlines for more than two years, but it’s only one episode in the world’s long history of deadly disease outbreaks. The SARS crisis in 2003, for instance, was the last pre-Covid outbreak to highlight the importance of pandemic preparedness, mobilising a system that facilitated the global sharing of healthcare information.

Even as the Covid-19 pandemic rages on, other significant threats to public health have arisen. Monkeypox has spread around the world and recently arrived in Singapore. And earlier in the Covid crisis, in 2020, Singapore experienced its worst-ever outbreak of dengue fever. The looming threat of new Covid variants and other diseases means that governments must always be well-prepared to handle future health crises.

So, how can cities work towards a pandemic-proof future? At GovInsider’s Festival of Innovation 2022, healthcare experts gathered to look at how promoting environmental health, sharing data, and providing robust community healthcare can improve cities’ readiness for future global health crises.

Environmental essentials

Diseases are not simply about human health, but also animal and environmental health, according to Ng Lee Ching, Group Director of the Environmental Health Institute at Singapore’s National Environment Agency (NEA). Ng said that was especially true for cities in tropical regions, whose warm environments are conducive to insect-borne diseases such as dengue and malaria.

Holistic approaches to pandemic management should take into account every aspect of outbreaks and measures to counter them – from how diseases are transmitted in the environment to how healthcare systems manage infected patients. As a result, Ng said,  managing public health risks like Covid-19 required a “One Health” approach – a collaborative, multisectoral and transdisciplinary strategy in which government agencies with responsibilities for diverse fields tackle diseases together.

Such an approach to disease management is already in place in Singapore’s Zika control programme, which involves close cooperation between the NEA and the health ministry, Ng said. The NEA helps to eliminate mosquito breeding grounds in the community, while the ministry is responsible for managing patients and raising awareness about the Zika virus among members of the medical community.

According to the United Nations Environment Programme, 75 per cent of emerging infectious diseases in the past few decades have been zoonotic, meaning that they have been transmitted to humans by animals. Facilitating greater collaboration between environmental and healthcare agencies will allow governments to better handle new diseases, addressing root causes while simultaneously bolstering mitigation efforts.

Tackling outbreaks with tech

The World Health Organization warned of a potential “disease X” – a hypothetical pathogen that can cause a future pandemic – four years ago, somewhat eerily presaging the Covid pandemic. When fighting an unfamiliar enemy that can appear at any time, countries need to be ready with solid plans to fight back. This means fortifying the healthcare system’s ability to tackle future pandemics, including by preparing for the development of diagnostic kits and vaccines on an accelerated timeline.

Lisa Ng, Executive Director at Infectious Diseases Labs (ID Labs) in A*STAR, said Singapore had been proactive in learning from past disease outbreaks to create sizable research capacity at universities and other health institutions. Its rich knowledge of technologies such as genome sequencing and artificial intelligence allows authorities to repurpose these technologies quickly to deal with future incidences of disease.

For example, even though mRNA vaccines were developed as an anti-cancer therapy, they were first used against a virus that could cause a pandemic, said Hsu Li Yang, an Associate Professor and Vice Dean of Global Health at the National University of Singapore’s Saw Swee Hock School of Public Health, referring to the Ebola virus.

Similarly, new technologies developed during the Covid-19 pandemic can also allow governments to respond more flexibly to future diseases. Researchers at the National University of Singapore are using AI platform IDentif.AI to calculate the most effective drug combination and dosage against the Omicron variant of Covid. Going forward, the technology can be harnessed to develop effective treatments for future outbreaks.

Sharing is caring

Leo Yee Sin, Executive Director at Singapore’s National Centre for Infectious Diseases, said that beyond technology, data sharing was also critical to managing a global health crisis. No one knows what the next pandemic will look like, but faced with the unknown, the most critical asset the healthcare sector has is data.

Fortunately, the world is connected by data, with international organisations such as the WHO acting as central coordinators, consolidating and sharing clinical information from various countries. The International Health Regulations, put in place in 2005, also legally oblige countries to report public health events so others can take precautions and make preparations.

Leo added that Singapore must remain engaged in global networks and invested in global health. She said it was thanks to such connections that Singapore had been able to respond to Covid-19 quickly – before the first case reached the country’s shores – with the government already developing diagnostic tools for the virus.

Within cities, data sharing is also important to coordinate a whole-of-government approach toward pandemic management. Despite this, public sector experts who attended a roundtable discussion at the Festival of Innovation said that many data-driven initiatives remained confined to particular organisations.

To harness the power of data, authorities should move from simply capturing data to sharing it across agencies. The public sector experts highlighted some possible solutions that could facilitate such a shift. One possibility would be to establish a national “data lake” to host raw data that can be used by various agencies. The government could also introduce public sector governance legislation to standardise public healthcare data sharing among agencies.
“The best time to prepare for pandemics is
between pandemics”

- 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 needed to ensure that policies were in place to strengthen linkages between countries and establish whole-of-government data-sharing initiatives. This would avoid scrambles for resources and solutions when future outbreaks occurred.

Community healthcare

Hsu highlighted the problem of sustaining a government focus on pandemic preparedness in the future as society settles back into more comfortable norms and amid “Covid-fatigue”. Although continuing to invest in research and healthcare is important, it’s clear that the community must also remain sufficiently resilient to face the next pandemic, as it is in the front line as much as hospitals and healthcare personnel.

During the roundtable discussion, the public sector experts emphasised the importance of increasing community “ownership” of healthcare. Community healthcare plays a key role in pandemic management because it uses existing relationships between primary healthcare providers, neighbours, friends and family members who can help to identify at-risk individuals  such as homebound seniors and provide basic care for those suffering from mild symptoms.

One such community initiative in Singapore, named “Let’s Get Our Seniors Vaccinated”, offered vouchers for each individual referring and accompanying a senior citizen to get vaccinated. Taking advantage of strong community networks, it encouraged people to look out for others to boost vaccination rates among vulnerable communities.

In addition, although policy responses to pandemics aim mainly to curb the spread of viruses and ensure that hospitals can continue treating patients, they may fall short of addressing the full spectrum of psychological, social and economic impacts that pandemics have on people.  Building strong community networks fills these gaps, a phenomenon attested to by the many grassroots initiatives that have emerged to help vulnerable communities during the Covid crisis. For example, volunteers at local NGO The Food Bank distributed food packages to the elderly and households that faced income reductions during lockdown. Social service agencies in neighbourhoods can also distribute relief vouchers to residents in need who might be unaware of the availability of such measures to help them.

As much as Covid-19 caused huge disruption to people’s lifestyles, it presented a valuable opportunity for governments to rethink healthcare frameworks and policies. Now, the great recovery that everyone is anticipating entails not only a shift back to some of the reassuring norms of a pre-pandemic world, but also evolution of the healthcare system to make cities more pandemic-resilient.

To watch these panels or other panels at the Festival of Innovation, register here.