IN THE wake of Covid-19, Singapore will strengthen hospital capacity with transitional facilities; improve public health research capabilities; and set up a Communicable Diseases Agency, as part of broader Health Ministry (MOH) restructuring.

Laws will be amended for a wider range of public health scenarios, with four tiers to replace the existing Disease Outbreak Response System Condition (Dorscon) colour-coding.

Health Minister Ong Ye Kung made these announcements on the second day of debate on a White Paper reviewing the handling of Covid-19, in a speech where he also set out Singapore’s vaccine strategy.

How countries fared in the pandemic came down to three key judgment calls, where Singapore made the right decisions, said Ong: not making hospitals the only defence, achieving high vaccination coverage, and opening up at the right time.

Yet Covid-19 has been “a humbling experience”, with Singapore learning from it to make improvements for the next pandemic, said the minister, who co-chaired the Covid-19 taskforce.

One lesson is to strengthen hospital capacity. While it is unrealistic to have too much spare capacity, Wong noted that public hospital bed occupancy has risen to 93.1 per cent in 2022, from 87.6 per cent in pre-Covid 2019, driven by longer stays.

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Transitional care facilities (TCFs) run by private operators helped to meet pandemic demand, with 500 beds at five sites. These will be retained and “become a medium or even long-term feature of our healthcare system”, said Ong.

A new TCF will be set up near Ng Teng Fong General Hospital.

Second, Singapore will improve its pandemic preparedness and response. It launched the national Programme for Research in Epidemic Preparedness and Response last November and will strengthen international partnerships.

Such capabilities will help Singapore quickly ascertain key characteristics of any new pathogen and determine the right response, said Ong.

Third, MOH will restructure to be better prepared for the next crisis. A Communicable Diseases Agency will consolidate functions from various agencies.

MOH will retain a scaled-down but permanent Crisis Strategy and Operations Group. Set up during Covid-19, this facilitates operations such as contact tracing, home quarantine, testing, vaccinations, and home recovery. A Healthcare Reserve Force of former healthcare workers and volunteers will be established.

Meanwhile, the Infectious Diseases Act (IDA) will be amended to deal with a wider range of scenarios. Currently, the law allows the declaration of a public health emergency – which was not done during Covid-19.

Emergency powers such as curfews “were too blunt and heavy compared to the public health measures and SMMs (safe management measures) that were needed at that time”, said Ong. The current IDA “envisages only two worlds of public health – peacetime or public health emergency, with no gradations in between”.

The law will thus be amended with four tiers: baseline, a peacetime state; outbreak management; public health threat; and public health emergency.

On vaccines, the health minister noted that Singapore’s caution came with a price: about 15 per cent of vaccine doses ordered, worth S$140 million, have expired. This is expected to approach 25 per cent as more vaccines expire in the coming months, before stabilising.

Attempts to donate spare vaccines were unsuccessful due to global oversupply, with potentially up to 500 million expired doses worldwide, he said.

But he added: “The expiry of unused vaccines was an insurance premium – the price we were prepared to pay to stave off the risk of catastrophic consequences.”

Singapore must continue to prepare for a future dangerous variant, said Ong, as he set out the country’s vaccine strategy.

The MOH will maintain and periodically refresh an adequate stock of Covid-19 vaccines, to allow protection of the elderly and vulnerable and enable a rapid response if there is another wave. A network of vaccination centres will be maintained, to administer booster shots as needed.

Singapore is “negotiating agreements to secure early access to vaccines against other pathogens with pandemic potential”, which might include new influenza and other respiratory viruses.

It is also investing in vaccine research and development, and has anchored six vaccine manufacturing plants here, with the Economic Development Board continuing to engage vaccine manufacturers.

“A crisis forces us to do or try new things” – allowing Singapore to accomplish, within months, what previously seemed impossible or would have taken years.

Said Ong: “We were stretched and will not rebound to our previous equilibrium.”