“I endangered my own life for one of my colleagues,” recounts Lai Kim Fatt, the former CIO of Singapore’s Defence Science and Technology Agency (DSTA).

Lai was in charge of building the technology that would coordinate the government’s response to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, which claimed 33 lives in Singapore and 774 worldwide. 15 years on, it remains a vivid reminder of fear for yourself and your loved ones as you lined up for temperature scanning every morning.

While Singapore has not been hit by an epidemic of such a deadly scale since, the threat of infectious diseases still remains high. The spread of the Ebola and Zika viruses across international borders over the last few years are a grave reminder that infectious diseases still pose a grave threat to global security.

How Singapore responded

In 2003, the government did not possess advanced technology and social media did not exist, says Lai, who is now Regional Senior Advisor for the Defence & Public Sector at DXC Technology. The government had to leverage their existing network and combine their knowledge with the private sector to stop the spread of the disease. “We wanted to make sure that we put in all the preventive measures”, he adds.

This involved breaking down silos and connecting the staff of the Ministry of Defense (MINDEF), Ministry of Health (MOH), Ministry of Education (MOE), the Immigration Checkpoints Authority (ICA) and the private sector.

The government began working with airlines to gather data on incoming passengers. Lai also put in place protocols for childcare centres and primary schools to accurately log details of parents and children.

Over 60 officials were mobilised to get information from hospitals and train staff, contract IT companies to leverage their technology, and to even deliver food and set up camera monitors for the quarantined.

Tracing patients

As the number of cases doubled by the hour, there was no time to build an operations centre from scratch. Instead, existing systems were adapted and iterated to fit the needs. MINDEF combined a casualty management system used by the Singapore Armed Forces and an existing contact tracing system to build an operations centre. “I basically had the entire Singapore population database created in order to trace citizens effectively,” Lai says.

The database identified potential patients and monitored their status for the health ministry, provided exit control for the immigration authority, and held details of potentially infected students attending classes for the education ministry. This data was visually analysed so that Lai and his team could identify cases quicker.

This system helped cut the time taken to trace an infected person down to a few hours. Within a month of the system’s deployment, Singapore was declared SARS free by the World Health Organisation (WHO).

Building up global defences

International collaboration is key to containing epidemic outbreaks, says Professor David Heymann, who headed WHO’s global response to SARS as Executive Director of its Communicable Diseases Cluster. It took China, where the virus originated, three months to notify the WHO about SARS. By then, the virus had already spread to Hong Kong and subsequently other Asian countries.

In particular, he believes Singapore can be a regional leader in developing the infrastructure of neighbouring countries, especially with its chairmanship of ASEAN this year. “Japan has done that for years. That’s their development policy – to strengthen the healthcare infrastructure in countries around them as a means to protecting Japan. That way, you can keep diseases out of your borders,” says Heymann.

This is not limited to simply building health facilities, but also making sure such facilities and laboratories continue to function properly, and ensuring that health workers are well-trained. “The best thing is prevention, and that comes from working with countries in the region to make sure there aren’t any major risk factors for the emergence of infectious diseases,” says Heymann.

The Saw Swee Hock School of Public Health at the National University of Singapore is currently looking into setting up regional platforms in neighbouring ASEAN countries for the exchange of research and ideas.

Meanwhile, Australia will invest AU$300 million (US$ 221 million) over five years to support efforts to prevent and contain disease outbreaks that have the potential to cause large-scale economic impacts on the national, regional and global scale.

Ground-up protection against epidemics

The viral nature of the disease also prompted a revision of international laws to foster cooperation in public health and prevent the spread of diseases across borders.

Today, the International Health Regulations (IHR) recommends the strengthening of public health infrastructure as the first and most important part of the treaty. This includes establishing good disease detection and response systems, hospitals that do not collapse from stress and are capable of taking care of infected patients, and reliable communication to citizens and neighbouring countries during an outbreak.

Unfortunately, while the IHR is binding on all 194 countries, not all countries have abided by this treaty and many countries are still underdeveloped in these public health capacities.

Preventing the spread of infectious diseases internationally is not only the burden of governments to bear. It is also imperative that people take charge of their own health to minimise the spread of infectious diseases. And the best way to do that is through education.

Since outbreaks occur periodically, once every couple of years, there is a waxing and waning of interest in public health awareness among politicians and the public. Continuous public education thus becomes even more important during times of perceived low threat of infectious diseases.

Heymann says that this shouldn’t be seen as a risk of desensitising the public. Rather, continually pushing out educational messages ensures that people are equipped with the knowledge to deal with an epidemic when it actually happens.

Singapore’s experience with the SARS epidemic helped it build up the right systems and structures to respond to the next outbreak. But the risk of deadly diseases grows as communities get connected, and governments must continue preparing the ground to stop their spread.

Image from South China Morning Post, labelled for reuse.