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Preparing for Crisis X — Not If but When

COVID-19 has highlighted the urgency for ASEAN leaders to collaborate and strategise viable and sustainable solutions for more resilient healthcare systems to withstand future challenges. It’s not a matter of if the next pandemic will happen, but when.

by Benedict Cheong

This was one of the many topics discussed at the Special Ministerial Conference for ASEAN Digital Public Health (SMCADPH) held in October 2021. The conference was led and hosted by Brunei Darussalam, the 2021 Chair of ASEAN. Temasek Foundation was a co-organiser of the event, together with EVYD Knowledge Hub, and in collaboration with the Ministry of Finance and Economy, and the Ministry of Health in Brunei Darussalam.

Temasek Foundation’s work in Asia has always been centred on promoting dialogue and exchange, and leading projects that help build mutual or collective capability and capacity. So, our involvement in the conference was a natural extension of our international and regional programmes.


A Steep Learning Curve

The learning curve with COVID-19 turned out to be very steep. The pandemic has disrupted every aspect of our lives – the way we work, play, and live. Beyond the personal level, business, particularly our supply chains have been disrupted, and our healthcare systems have been subjected to tremendous stress.

We have learnt many lessons from the current pandemic, but the question is whether these lessons will be sufficient for us to prepare for future crises.

The biggest lesson we learnt from COVID-19 is that the world was not prepared for a pandemic, despite doctors and scientists warning us for years that it was a question of when, and not if, it would happen.

As we were not adequately prepared, we had to learn how to deal with it on the fly – how to slow the spread and minimise infection rates with social distancing and mask-wearing, treating COVID-19 patients, and eventually getting vaccines into communities to protect people. And now it seems we may have to learn to manage and live with COVID-19 for the foreseeable future.

But as we contemplate the next unknown crisis — what the scientists and policymakers call Crisis X or if it is a pandemic, then Disease X — the important question is, will all the lessons we have learnt during this crisis help us to be better prepared for the next?

Or do we need to extrapolate and perhaps even imagine beyond what we have learnt, to look for what we might not be prepared for? Must we anticipate other “what ifs” to ensure we cover a wider range of possible scenarios for Crisis X, to greatly improve our preparedness for whatever it might throw at us?

That is why a key focus of the SMCADPH was on Crisis X preparedness and the importance of regional collaboration and data sharing.

One big takeaway from the conference was that in a pandemic or when faced with an unknown Disease X, we need to move away from an acute healthcare model traditionally provided by public sector institutions, to a wider public health response by the community as a whole.

When we have a health issue, an injury, or an illness, we see a doctor or nurse at a clinic, or we are treated in a hospital. Otherwise, we rarely interact with our healthcare services. Our healthcare institutions were designed and developed as emergency resources for the treatment of individuals.

But public health is different – it is not just about distinct institutions providing acute treatment. Rather, it means a collective response to the crisis at hand. And for that, we need every sector of the community to be involved – all stakeholders, from government industry, and non-government organisations (NGOs) right down to families and individuals. All stakeholders must play their part, because otherwise there will be too much strain on the healthcare system and the whole system will crumble.


Private-Public Sector Collaboration

Most private companies have supply chains and supply chain partners such as logistics companies who move things from one point to another. So, we can look at that existing infrastructure and see how it could play a role in an emergency, like the current pandemic, by using their expertise and facilities to ensure essential provisions and supplies move and reach the people that need them most, whether it is food or medical supplies such as, personal protective equipment (PPE).

There are also numerous private health companies with different areas of expertise, such as diagnostics, pharmaceuticals, therapeutics, and vaccines, each with different capabilities in research and development (R&D), testing, manufacturing, distribution, and so on. These are expertise and capabilities that are beyond that of the public healthcare system, but which take place in tandem and complement what the public sector healthcare system is doing.

The public health approach is to mobilise private sector companies to collaborate with other sectors and stakeholders and assume roles in which they are strongest, for example, in R&D. The astonishingly rapid development of vaccines around the world is a clear example of this at work.

The COVID-19 virus genome was sequenced by academics and researchers in the public sector in China, and made available to academics, doctors, and importantly, private sector pharmaceutical companies around the world. Governments then stepped in to offer funding and guarantee orders, which allowed the private sector companies to devote their huge resources to developing vaccines in record time.

Once the vaccines were developed, governments and NGOs could work together to distribute vaccines to all countries and territories, including countries that could not afford to make or buy them. That’s how different stakeholders (government, academia, private sector, and NGOs) can collaborate in public health.


Understanding Vaccine Efficacy

In our continuing work to study the virus, Temasek Foundation has partnered with the Brunei Ministry of Health on a field research project designed to compare the long-term immune response and efficacy of COVID-19 vaccines by measuring the neutralising antibodies (nAbs) in 3,000 fully vaccinated individuals based in Bandar Seri Begawan, Brunei Darussalam.

Supported by Temasek Foundation, the research will be co-led by Brunei’s Ministry of Health, Universitas Brunei Darussalam, and Duke-NUS Medical School in Singapore. The research data from the project can be used to infer the level of herd immunity to COVID-19 based on the level of neutralising antibodies in the vaccinated individuals. If vaccine breakthrough occurs in the vaccinated individuals, it will also provide data on the correlation of protection against infection.

Results of the study could be used to inform the decisions of public health policymakers regarding COVID-19 control strategies, such as travel policies, vaccinated-travel lane arrangements, the optimum length of quarantine periods for travellers, and whether to mandate booster vaccines for individuals with low levels of nAbs.

Aside from this research study, Temasek Foundation is also collaborating with other ASEAN countries on various initiatives to enhance the wider learning towards crisis preparedness and response. These include research and sero-surveillance programmes, where the outcomes will be shared with public health policymakers from these ASEAN countries.


COVID-19 and Lessons for Preparing for the Next Crisis X

What we have learnt from coping with COVID-19 is the importance of communicating, cooperating, and collaborating within individual communities and among or across them.

One way to do that on the international level is by building the networks of exchange today. Getting people and institutions comfortable with each other, and enabling them to talk to each other and exchange information, data, samples, and ideas. We hope this will eventually lead to the exchange of solutions.

We need to build those habits and protocols together so when that next crisis comes, the level of trust has been established and it will be easy for people and institutions to transition from everyday pre-crisis mode to a crisis mode.

One significant way of building trust is to bring people together to work on projects. When you work on things together with common and aligned objectives, your barriers will come down and you gradually build trust and understanding. That is really what we want to achieve by collaborating across ASEAN communities and beyond.

The other important driving force towards greater dialogue and collaboration is practicality. We all rely on high levels of inter-ASEAN travel and inter-ASEAN trade. As that starts to pick up again, we expose ourselves and the region to the risk of another crisis, whether this is in health or environment or some other dimension. So, no country can really stand or do it alone.

It is often said of the pandemic that “no one is safe until everyone is safe.” This resonates with our core principle – “If we want to succeed as individual communities, we must succeed together, and we must help others succeed, and others must help us succeed.” And that success must be founded on mutual trust, sharing, and collaboration.

ASEAN was founded on a spirit of cooperation and collaboration, but the pandemic has now made it imperative to get together and look at all the possible dimensions of risk. The nature of Crisis X is that there are many unknown unknowns. To be prepared, we need to look beyond just the lessons learnt from this pandemic. We need to think through what are the other kinds of crises that could happen and try to create pathways to learn and develop protocols. so that we can prepare to manage them better when they do happen.

Of course, we all hope for the best, but as the saying goes – by all means, hope for the best, but we must prepare and plan for the worst. We owe it to our communities to start acting now. [APBN]

About the Author

Mr Benedict Cheong is the Chief Executive of Temasek Foundation International. Prior to this, he was the Chief Executive Officer of the National Council of Social Service. He serves on a few public sector and non-profit sector organisation committees. He also served in the Singapore Police Force for 15 years in various appointments at headquarters and in the operational units.