COVID-19 White Paper: What lessons did Singapore learn?

The White Paper, prepared by the Prime Minister’s Office, summarises findings and reviews on the successes and shortcomings of the COVID-19 pandemic. It now serves as a point of reference to better prepare the nation in the effect of a future crisis.

Globally, the pandemic claimed approximately 6.6 million lives as of March 7, 2023. Singapore’s fatality rate was at less than 0.1%, or 1,722 deaths, compared with the average of about 1% worldwide. This is attributed to some of the successful actions taken by the government whilst working toward a new normal.

Protecting the public through a nationwide vaccination campaign

Currently, more than 90% of Singapore’s population have taken at least one dosage of either Moderna, Pfizer-BioNTech, or Sinovac.

Credit: New York Times, Our World in Data

The government knew that vaccination would be the best exit strategy from the pandemic.

Working closely with the relevant industry partners, they secured early access to COVID-19 vaccines and authorised the first vaccine rollout in December 2020. Subsequently, to ensure that all Singaporeans were vaccinated at least once, doses were scheduled in a timely manner.

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In order to supplement the vaccination campaign’s success, an SMS-based appointment booking system was set up to increase efficiency of vaccinations. It allowed the public to book their vaccine slots, and was key in supporting the administering of over 10-million vaccine doses nationwide.

By August 2021, 80% of Singaporeans had completed the full vaccine regime.

Enforcing public trust was key in Singapore's vaccination success

Globally, the U.K was the first country in the world to approve a COVID-19 vaccination for emergency use in early December, signing a contract for vaccine approval in June 2020.

The U.K were ahead of Singapore - having been able to plan and successfully secure vaccines prior to the peak of the pandemic. However, to date, only 75.7% of the U.K population is fully vaccinated.

Mass vaccinations became a point of contention for the U.K population. Thousands of protestors from across the U.K gathered in London’s Trafalgar Square in Aug 2020. Many demonstrators described the pandemic as a scam, and called for an end to movement restrictions and mandatory masks.

Credit: CTV News UK

Some schools in the U.K were also harassed by anti-vaccination campaigners. In east London, police had to prevent anti-vaccine protestors from barging into the headquarters of Britain’s medical regulator ‘Medicines and Healthcare products Regulatory Agency (MHRA)’. Prominent anti-vaxxers hosted their protests on social media platforms, garnering a reach of over 1.5 million people. David Icke, a high-profile British conspiracy theorist, promoted the false belief that COVID-19 spread by 5G.

A more severe end of the spectrum, some anti-vaxxers such as the Alpha Men Assemble (AMA) group even became militant to resist vaccinations. People were even buying fake vaccine certificates.

Credit: Mirror.co U.K

Mass immunisation campaigns across the globe caused many countries to become politicised and divisive. The situation in the U.K heavily juxtaposes the mild cases of protest in Singapore. Although Singaporeans were hesitant, only a minority protested the measures”. A website called Truth Warriors promoted false information about Invermectin - an anti-parasitic drug - as an alternative. Anti-vaxxer, Iris Koh, founded a vaccination activism group ‘Healing the Divide’ that consisted of over 2,000 members.

In Oct 2021, both Koh and her husband Raymond Ng, encouraged their members to flood several public hotlines such as the MOH Quality Service and Feedback hotline, the National Care hotline, and the Ministry of Social and Family Development hotline.

Credit: The New Paper

The following month, she uploaded various videos surrounding the pandemic and the vaccine, which was eventually taken down for violating community guidelines. In Jan 2022, MOH filed a report against Koh for encouraging members to overwhelm on-site medical staff with questions at vaccination centres.

She also collaborated with Dr.Jipson Quah of Wan Medical Clinic in Bedok to falsify COVID-19 vaccination records and upload it to the MOH database. Dr Quah also injected patients with saline instead of a vaccine.

Finally, amongst the anti-vaxxers is Phoon Chiu Yoke. Familiarly known as “The Badge Lady”, Phoon refused to wear a mask at Marina Bay Sands despite the regulations, and kicked up a fuss as Safe Distancing Ambassadors repeatedly tried to advise her.

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To encourage an endemic society, agencies persuaded the public of the importance of vaccination, and reassured everyone that the vaccine was safe. The various measures put in place - fully vaccinated individuals allowed to dine-in at hawker centres and coffee shops - among others, also contributed to Singaporeans being more willing to get vaccinated.

Outbreak in migrant worker dormitories

The success of Singapore’s nationwide vaccination campaign allowed the government to progressively relax the COVID-19 measures put in place due to an increase in locally transmitted infections.

However, the same could not be done for migrant workers residing in dormitories. Limited testing capabilities due to the lack of integrated access to migrant workers’ health records contributed to inefficient tracking of the dormitory outbreaks. Coupled with the living conditions close proximity, it escalated the speed and scale of the outbreaks causing a surge in the community cases.

When the pandemic hit in the first year, migrant workers accounted for approximately 90% of the confirmed cases; from 31 in April 2020 to over 15,000 in May, and doubling to 33,000 in June.

Mr Alex Au, the vice-president of migrant workers’ rights group Transient Workers Count Too (TWC2), had also raised the concern of a possible outbreak in workers’ dormitories in early 2020.

“I think it was symptomatic of the way of life in Singapore, that we seldom have migrant workers at the forefront of our thoughts, that the spread of the virus in the dorms came as an unexpected surprise,”

Migrant workers in dormitories affected by the pandemic were quarantined and practised safe-distancing within a dormitory room that housed 12 to 20 men in double-decker beds.

Credit: Open Global Rights

There was also a limited number of PCR machines and healthcare workers to conduct the testing at a large scale. Hence, the government could not track the outbreak in a timely manner, thus hampering their ability to identify and isolate infected individuals.

Although the Ministry of Manpower (MOM) worked with other agencies to reallocate the workers, it was insufficient. The only effective way was to identify infected individuals quickly and move them to isolated recovery facilities.

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Only at the end of April was medical support set up at the dormitories to care for those who were unwell and monitor the health of others.

By the end of 2020, nearly half of the 300,000 workers residing in dormitories had caught COVID-19, with many not showing any symptoms.

Despite 98-percent of workers being fully vaccinated against COVID-19, the government continued to defend the extended restrictions placed on migrant workers, citing that it would protect them.

Credit: The Statesman

“They are eating out, going shopping, meeting their friends. And I think, ‘why is that not me?’ Did I make this coronavirus?” said a foreign worker in an interview with the BBC.

TraceTogether, and social distancing

When news of COVID-19 hit our borders, Singaporeans went into a state of panic. The government developed contact tracing through the TraceTogether app and token, as well as SafeEntry. This allowed them to determine how the virus would spread, and track the contacts who were at highest risk.

These helped reduce the time needed to identify and quarantine close contacts from four days to less than a day and a half.

Although the app reached a million downloads within the span of a month, it did not cover the digitally-excluded population - seniors, and young children with no smartphones. There was also a shortage in tokens, as residents beyond the target groups of seniors and children collected them instead.

In June 2020, it was also revealed in parliament that police sought and obtained access to TraceTogether data during a murder investigation.

This sparked an online petition opposing the implementations with the public commenting it was a “blatant infringement upon (the) rights to privacy, personal space, and freedom of movement”.

Credit: Ministry of Foreign Affairs

Following the chaos of the TraceTogether saga within Parliament, the COVID-19 (Temporary Measures) Amendment Bill was passed. The bill summarises that personal contact tracing data obtained can only be used in the investigation of serious offences. Despite the bill, approximately 350 people wrote in to the authorities to request that their data be deleted.

A different degree of social distancing

In April 2020, to mitigate the rising community cases, the government announced a Circuit Breaker. They also deployed approximately 3,000 Safe Distancing Ambassadors (SDAs) and Safe Distancing Enforcement Officers (EOs) to remind the public of the prevailing restrictions.

SDAs and EOs patrolled shopping malls, parks, and weaved between the cordoned-off tables and chairs in hawker centres. Despite being enlisted to help the public navigate the confusion of the restrictions, within the first eight months of 2021, authorities received 75 reports related to the conduct of SDAs and 17 related to EOs. 22 were mostly for rude or unprofessional behaviours.

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Some were sentenced to jail or fined, others were involved in theft, and a few SDAs were seen using measuring tapes to ensure diners were spaced out enough in eateries and in outdoor public settings.

Credit: Collage by The Independent SG

The confusion escalates

The SDAs and EOs became an icon on the ground. For most Singaporeans, they had someone to refer to or provide them with up-to-date advice on the frequently changing restrictions.

However, before the public had time to adapt to the first set of measures that were announced, a new set would precede.

Following the unexpected announcement of the Circuit Breaker, schools and businesses had to pivot to digital learning and deliveries respectively. Companies had to arrange for non-essential workers to work-from-home. Just as Singaporeans were settling into the new norm, Phase One marked the gradual reopening.

The reopening provided the public with hope that the pandemic would soon stabilise. People were allowed to visit their parents or grandparents if they were from the same household. The number of visitors soon expanded to five, and subsequently, eight in Phase Three. This was short lived as restrictions were again shifted when the government announced Phase Three (Heightened Alert) in May 2021.

The cumulation of the frequently changing COVID-19 measures set by the government not only left the public confused, it severely impacted businesses who wanted to remain open during the reopening phases.

Credit: Singapore First Aid Training

Impact of differentiated measures on businesses

Hawker and coffee shop owners were also confused by the “on-again-off-again” measures implemented by the government. Post-Circuit Breaker, COVID-19 restrictions were relaxed and dine-in was allowed for fully vaccinated groups up to five people. Groups of two were allowed to dine-in at hawker centres and coffee shops regardless of vaccination status.

The government soon changed the restriction and disallowed unvaccinated individuals to eat at hawker centres.

To make it harder, hawker owners were tasked with making sure customers showed them their vaccination status via the TraceTogether app prior to purchasing their food.

Credit: Ong Wee Jin, The Straits Times

“This morning there was a customer who got angry with us for asking to see his vaccination status, but we are just following the government’s rules. Why make our jobs difficult? It’s extra work for us,” said a hawker from a Hougang coffee shop.

On the other hand, stallholders at the Kovan food centre had not been informed about the need to verify patrons’ vaccination status. Owners were growing increasingly frustrated by the constantly changing rules, stating that they were already working hard to keep their businesses running.

In March 2022, situations became more complicated for hawkers as the government announced that coffee shops and canteens would have three options to implement vaccination-differentiated safe management measures (VDS) to accommodate groups of up to five fully vaccinated individuals for dine-in, without compromising the safety of diners.

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Barely a month later, the Ministry of Health (MOH) lifted the VDS measures for most social settings, and food-and-beverage outlets no longer needed to conduct vaccination checks on their customers.

Overall, how well did we do?

COVID-19 brought uncertainty to our shores. Singaporeans experienced a rollercoaster of emotions: from initial panic, to confusion, and even frustration due to the frequent restriction changes.

Measures such as the nationwide vaccination campaign have helped successfully transition Singapore safely into an endemic society. However, the frustration felt by the public due to an unsuccessful dissemination of information still has to be rectified by prioritising what is important and adapting to the unpredictability of future pandemics.