Hey guys, Dr. Eeks here.

I wanted to take a few minutes and write about Singapore and the COVID-19 pandemic. Some of you might remember that back in 2020, Singapore was THE model country when it came to the COVID-19 response. They had the lowest mortality rate in the world. People in the US, a country hit hard with both cases and deaths, would ask, “Why couldn’t we do it like Singapore did?”

To answer this question, I asked Singapore’s Dr. Abdullah to come on my Causes or Cures podcast and discuss Singapore’s response. He talked about the strict public health restrictions they implemented, economic interventions for folks who had to stay at home and couldn’t work, the relationship between Singapore’s government and its population, which is very different than the US, and also discussed the underlying conditions in Singapore versus underlying conditions in the US. For example, obesity makes COVID significantly worse and increases risk of death. Singapore’s obesity rate, while rising, is less than 10%, whereas in the US, it’s greater than 40%.

Public health interventions happen at the population-level, which makes them very different than a medical intervention, which happens at the individual level. That also makes it a lot more difficult to please everyone, while maintaining efficiency. Country-wide public health interventions involve federal public health and health policy experts, data gurus, health communication experts, epidemiologists, politicians and community leaders, and every response to a public health emergency depends on the relationship between a government and its population. How well a country does also depends on its wealth and the underlying health and age of its population. There is always a tradeoff between individual freedom and sacrifices for the “greater good,” and the balance people are willing to maintain depends on philosophy and politics. It’s important to keep that in mind when you compare COVID-19 responses between countries, because a policy that worked swimmingly in one country not work in another, simply because the population says, “Hell no, we aren’t doing that!”  Anyhow, you can listen to my conversation with Dr. Abdullah  here. 

I recorded that podcast in December of 2020, right when Singapore started their COVID-19 vaccination campaign. Continuing its streak as the model country, Singapore was the first Asian country to approve both mRNA vaccines and the first Asian country to start a vaccine campaign. Unlike the US, they used all vaccines approved for use by the World Health Organization, which includes Pfizer-BioNtech Comirnaty, Covishield and AstraZeneca, Johnson & Johnson’s Janssen, Moderna, and China’s Sinopharm and Sonvac-Coronavac. They quickly vaccinated more than 80% of their population, though I’m uncertain about the percentage of each vaccine uesd. Either way, people were confident that life would get back to normal.

But life didn’t get back to normal. In fact, things got a lot worse for Singapore. Fast forward to today and cases are surging in Singapore. Their death rate is increasing. They’ve started booster shots, much like another highly vaccinated nation, Israel, and they are increasing restrictions again.

No one knows for sure. It could just be that the vaccines were less effective against Delta, a much more infectious variant. We see that in the US, of course, as the original vaccines were designed to target the spike protein on the original COVID strain. Perhaps there was too little naturally-acquired immunity in their population, due to lack of exposure from strict social-distancing and lockdowns earlier in in 2020. Perhaps some of the vaccines they used were not effective. Either way, it’s a mystery, but one worth exploring. Singapore was the Straight-A student that went astray.  They are highly vaccinated but cases are surging. Why?