Back in 1959, publicity trucks roamed the streets of Singapore to encourage citizens to get vaccinated against smallpox. The nation has taken a page from history – it’s rolling out mobile vaccination drives and catchy jingles to persuade citizens to get their Covid-19 shots.

Singapore has fully vaccinated 81 per cent of its population from the virus, making it one of the most vaccinated countries in the world. “I don’t think there are many countries that have achieved such a high rate of vaccination,” says Ong Ye Kung, Singapore’s Minister for Health.

How did Singapore do it, and what’s next in the country’s reopening as infections rise? In an exclusive interview with GovInsider, Ong discusses lessons from the pandemic, the need for public trust in government, and mental health.

Don’t waste the crisis

In a push to get seniors jabbed, the Ministry of Health (MOH) has rolled out mobile vaccination teams and allowed walk-ins at any vaccination centre.

Singapore has vaccinated 87 per cent of its seniors above 70, according to Ong. This is “not low”, but places like the American state of Vermont have seen almost 100 per cent of those over 65 receive at least one dose, he says.

It’s not about whether the government’s “explanation and persuasion is not good enough, but a much deeper explanation needs to be done.” He shares three possible reasons for the relatively lower rate of vaccinations amongst the elderly.

First, the elderly in Singapore are taken care of by their family members, Ong says. The island has much fewer nursing homes, and although there is an ongoing family nuclearisation process, “that sense of filial piety and responsibilities is still there.”

“When it comes to vaccination, it’s quite different when the [nursing] home decides to vaccinate all their patients and their residents, versus children trying to persuade their parents.”

Second, Singapore’s primary care system is not as strong as those in the US or UK, he says. There, family doctors are the “first port of call”. In Singapore, when citizens have a serious medical issue, they “tend to go straight to specialists” in the hospital.

“But it also means it’s a lot more impersonal, whereas a family doctor is a friend whom you grow up with. And when he says ‘take the vaccine’, chances are you’ll take it.”

Healthcare has to “devolve downwards”, Ong says. Covid-19 has shown that community centres can be a place that provides vaccinations, for instance. “Medical help is available in the community, it’s not in the hospital bed.”

Lastly, the flu virus thrives year-round in Singapore, whereas it’s seasonal in other countries. The latter creates a habit of “annual vaccination” – “come winter, you take your vaccination for flu.”

But Singapore “has not been pushing flu vaccination in a big way”, Ong says. “Actually we should, because the number of deaths per year caused by flu is not smaller than Covid-19.”

“These are some lessons that we should reflect on, as to how we can be better. And we make use of Covid-19, to try to build it up. We don’t waste the crisis.”

Trust in public institutions

Image from the Ministry of Health’s Facebook

In the pandemic, there are two kinds of countries, says Ong. The first suffered many deaths and “had such widespread transmission that when there’s a chance to be vaccinated, people do come forward”. The US, UK, and Europe are some examples, he says.

“The second did not suffer many infections or deaths – but citizens also do not have a strong incentive to be vaccinated, although I believe in time, they too will have a high vaccination coverage,” he shares.

Hong Kong, for instance, has carried out vaccine lotteries with prizes including a US$1.4 million apartment or a Tesla car to encourage citizens to be vaccinated, Bloomberg reported.

Singapore “didn’t suffer a very high death toll, and when we called out to people to get vaccinated, people still came forward in record numbers”.

“I think the reason is trust amongst people and very importantly, trust in institutions,” he adds. Polls conducted by advisory firm Gallup found that many countries that handled Covid-19 well, such as New Zealand, had trust in institutions and strangers.

What will reopening look like?

As Singapore reopens, “it also means the virus starts to have legs, and it starts to run around.” Infections have been on the rise – the number of new community cases nearly doubled to more than 1,200 in the past week from about 600 in the week before, according to a MOH press release.

Ong hopes the city can still keep the number of ICU patients, severe illnesses, and deaths under control. MOH is looking to care for more patients in community care facilities and at home, as “over 98 per cent of vaccinated people have no symptoms or very mild symptoms”, he says.

Singapore currently has the capacity to accommodate more than 5,500 individuals in such facilities, with Connect@Changi being the latest addition as a community care facility, Ong says.

Even then, the city needs to solve the next possible constraint: the lack of community care facilities, he says. MOH started piloting home recovery for 50 to 60 patients with mild or no symptoms from last Monday.

Singapore will also need differentiated measures for the unvaccinated – they are currently unable to dine out in restaurants or use the gym, for instance. But Ong recognises that this group “needs an outlet” – so if they test negative, they can attend high-risk events for 24 hours.

“But it doesn’t protect you, it just says you’re not infected.”

In the meantime, MOH is working on vaccinating this group. “Those who refuse, persuade them,” Ong says.

For those who are unable to take the mRNA vaccines, Singapore has started to offer Sinovac vaccines. About two to 3000 people have taken the Sinovac shot, he adds.

For those who “absolutely can’t take the vaccine, we will wait for the day we can reach 95 per cent vaccinated,” Ong says. “Maybe there is some form of herd protection, and maybe we can then lift off restrictions and differentiation.”

Antidotes for mental health

Singapore cannot underplay the importance of mental health, Ong emphasises. In a poll conducted by mental health advocacy group SG Mental Health Matters, 51.2 per cent said social restrictions have negatively affected their mental health.

Mental health is another reason why Singapore must reach a Covid-resilient state, so we can “live normally again”, he says.

Today’s youth face more mental health issues than previous generations, not just in Singapore, but across the world, Ong says. “We’ve got to ask ourselves what is it in this generation that is so different … that is global in nature.”

The many distractions from technology and social media have a “certain impact”, and Singapore needs to tackle this. “Like all chronic illnesses, by the time you treat it as a medical problem, it is too late.”

Ong believes the intervention has to come earlier in education: teaching people cyber awareness and hygiene, how to socialise more, and lead a healthy lifestyle. These are all “antidotes that you take in small doses in order to stave off mental illnesses”, he adds.

‘The saga continues’

How would Ong sum up his past few months in MOH? “It’s too short la,” he chuckles. “Just say the saga continues.”

Singapore is “constantly engaged in the fog of war”, with so many “twists and turns”, he adds.

“Whatever we do now, may prove to be right … [or] wrong. So, never despair when things don’t go well, never celebrate too early when things go well. The saga continues.”

Lead photo taken by Joy Lim