Singapore less ready than Malaysia, Thailand to tackle an infectious disease outbreak, says global study

SINGAPORE — Singapore is not fully prepared for a major infectious disease outbreak and is, in fact, less ready than Malaysia and Thailand, the Economist Intelligence Unit (EIU) said in its Global Health Security (GHS) Index on Friday (Oct 25).

The extensive 324-page report by the EIU also found that no country is fully prepared for such a pandemic or epidemic. It said that only 13 out of the 195 countries studied, including Thailand and South Korea, scored in the top tier — suggesting that most of the world would struggle to deal with the outbreak of a major deadly disease such as Ebola.

Singapore was ranked 24th out of the 195 countries, after it received an index score of 58.7 out of a possible 100. The higher the index score, the better prepared the EIU study considers the country to be.

Malaysia was ranked 18th, with a score of 62.2, while Thailand ranked 6th (73.2) and South Korea was 9th (70.2). The top tier of 13 countries scored 67 or higher on the index.

The average overall GHS Index score among the 195 countries was 40.2.

The top ranked country was the United States, with a score of 83.5, followed by Britain (77.9) and the Netherlands (75.6).

The EIU said that while high-income countries achieved an average score of 51.9, the index shows that collectively, international preparedness for epidemics and pandemics remains very weak.

HOW DID SINGAPORE FARE?

The study evaluated the national health security capacities and capabilities for 195 countries by assessing their level of preparedness through their answers to 140 detailed questions.

They were then scored across six categories: Prevention, detection, response, health system, commitment to improve, and vulnerability to biological threats.

1. Prevention. This category refers to the prevention of the emergence or release of pathogens.

Singapore’s ranking: 23. Score: 56.2

2. Early detection and reporting. This category refers to the detection and reporting for epidemics of potential international concern, which can spread beyond national or regional borders.

Singapore’s ranking: 40. Score: 64.5

3. Rapid response. This category refers to the rapid response to, and the mitigation of, the spread of an epidemic.

Singapore’s ranking: 11. Score: 64.6

4. Health system. This category refers to a country having a sufficient and robust health system to treat the sick in the event of an outbreak and protect health workers.

Singapore’s ranking: 38. Score: 41.4

5. Compliance with international norms. This refers to a country’s commitments to improving national capacity, financing plans to address gaps, and adhering to global norms.

Singapore’s ranking: 101. Score: 47.3

6. Risk environment. This refers to a country’s overall risk environment and country vulnerability to biological threats.

Singapore’s ranking: 15. Score: 80.9

FIGURES FROM THE SIX CATEGORIES THAT STOOD OUT:

• Singapore scored full marks for biosafety with an index reading of 100. The global average was 22.8. For biosecurity, Singapore scored 28 which, while seemingly low, was still higher than the average of 16. Biosafety addresses possible biological accidents while biosecurity is directed at possible deliberate acts involving biological agents.

• Singapore scored zero in an area where most countries did very poorly too, with an average global score of just 1.7. This relates to the oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, along with other dual-use research.

• Singapore scored well for its laboratory systems (83.3 compared to the global average of 54.4) and data integration between the human, animal and environmental health sectors (100 compared to 29.7).

• The score of 25 for Singapore's epidemiology workforce was markedly lower than the global average of 42.3. This field of medicine deals with the incidence, distribution and possible control of diseases and other factors relating to health.

• Singapore received zero marks for its cross-border agreements on public and animal health emergency response. In comparison, the global average was 54.4.

OTHER FINDINGS

• Stronger health security conditions are not dependent on a country’s wealth. Instead, the study found that these are driven by a multitude of factors, including effective governance and a strong disease surveillance system.

• For example, the EIU found that more than 100 high- and middle-income countries scored below 50 in the index.

• Having an emergency plan in place does not necessarily mean it will work in a crisis. The EIU said that 85 per cent of countries showed no evidence of having completed a biological threat-focused simulation exercise with the World Health Organization in the past year.

• It also found that fewer than 5 per cent of countries surveyed have a national requirement to test their emergency operations centres to respond to a health emergency on an annual basis.

• More than half of countries face major political and security risks that could undermine national capability to counter biological threats. According to the study, political and security risks are “clear barriers to effective response”.

• Only 23 per cent of countries scored in the top tier for indicators related to their political system and government effectiveness, covering only about 14 per cent of the world’s global population.

‘A THREAT ANYWHERE IS A THREAT EVERYWHERE’

The EIU said that epidemics have been occurring with increasing frequency.

For instance, figures from the World Health Organization showed that the 2014 to 2016 Western Africa Ebola epidemic claimed more than 11,000 lives, while the latest outbreak of the disease, in the Democratic Republic of the Congo, killed another 2,100 in 2018 and 2019.

“These emergencies and others, including the Zika epidemic in 2015-16, highlight the need to understand how countries can better prepare to face these threats,” said report.

It added that the Index serves as a barometer for global preparedness, and is based on a central tenet: “A threat anywhere is a threat everywhere”.

The report warned that deadly infectious diseases can travel quickly as increased global mobility through air travel means that a disease outbreak in one country “can spread across the world in a matter of hours”.

Mr Leo Abruzzese, the EIU’s senior global adviser for public policy, said that without a way of identifying gaps in the system, “we’re much more vulnerable” than we need to be.

“The index is specific enough to provide a roadmap for how countries can respond, and gives donors and funders a tool for directing their resources,” he said.

MOH RESPONSE

In a statement on Friday, a Ministry of Health spokesperson said the ministry is reviewing the report.

"An independent assessment by the World Health Organization and other international experts under the Joint External Evaluation that Singapore underwent in April 2018 had unanimously agreed that Singapore has demonstrated strong leadership and a highly developed capacity to detect and respond to potential public health emergencies," the spokesperson added.

"Nevertheless, we will continue to strengthen our capabilities to prevent, detect and respond promptly and effectively to public health threats, and address any gaps that may exist."