The executive director of Singapore’s National Centre for Infectious Diseases espouses global citizenship in the face of international healthcare crises.

BY CARA YAP

PHOTO THE STRAITS TIMES/SPH

“At the end of the day, we hope that Covid-19 will bring the world closer in terms of information sharing, with the common aim of improving clinical care to reduce mortality. I don’t think any clinician would deviate from this primary objective.”

Professor Leo Yee Sin, executive director of Singapore’s National Centre for Infectious Diseases, has been at the forefront of several healthcare crises such as SARS, Zika and, now, Covid-19.

While the island state’s swift national response to the ongoing pandemic has elicited praise from international public health experts, Prof Leo further placed Singapore on the map through multilateral efforts to bolster crucial information sharing related to the coronavirus. For instance, she is a member of the World Health Organization’s (WHO) guideline development group on the use of steroids to treat Covid-19.

The recipient of the Public Administration Medal (Silver) at the 2020 National Day Awards is regarded as part of Singapore’s vanguard in infectious disease control, having dealt with previous outbreaks such as SARS (2003), Zika (2016) and Nipah (1999). As an accomplished researcher published in more than 200 scientific papers, she is highly sought after in international forums covering everything from disease management strategies to vaccine communication.

1. Singapore has made significant progress in its fight against Covid-19, from research breakthroughs to infection control. How has its strong ethos of global cooperation contributed to this?

Singapore is not alone in its fight against Covid-19. The more connected we are in gathering and exchanging information, the more clarity we have on the entire situation. This helps us to calibrate our risk assessment as well as prevention measures.

For instance, Singapore is committed to the WHO’s International Health Regulations (IHR), an international risk assessment platform set up in 2005 in response to the SARS outbreak. By facilitating the early sharing of information between regions and countries, the IHR has greatly helped in Singapore’s fight against Covid-19.

Locally, we also have a team that scans the region and beyond to gather information. This is crucial in helping us form our own strategy in terms of disease prevention.

On the research front, our multi-centre research set-up has been useful. Singapore is involved in several international Covid-19 therapeutic studies, with partners including the National Institutes of Health in the US. We are, through clinical trials, exploring the efficacy of medications such as Remdesivir to treat Covid-19. We have tested or are testing other promising treatments, including interferon beta, which is the natural defence of our body against viruses that is suppressed by Covid-19. These multilateral trial collaborations have allowed us to gain early access to the aforementioned medications.

2. Singapore, as an early supporter of the global Covid-19 vaccine facility COVAX, is co-chairing the Friends of the Covax Facility initiative to promote vaccine multilateralism. Why is it important for us to assume such a leadership role?

The best strategy to effectively protect our small but wellconnected population is to participate in the global initiative with an aim to protect others so as to protect ourselves, given the borderless nature of infection.

SARS-CoV-2 has successfully used humans as a silent transmitter of the disease to all corners of the world. Humans can carry the virus without symptoms or before they are aware of them. In the scientific arena, Singapore is actively participating as a global citizen, exchanging our experiences, sharing research development and materials, and participating in therapeutic trials.

3. Why is cross-border collaboration so important in combating infectious diseases?

t is common knowledge that infectious diseases respect no borders. We, therefore, have to engage our neighbouring countries and stay connected with the world. Countries within Asia and Southeast Asia have varying levels of technological capabilities. These include diagnostic capabilities that are key to detecting the presence of a pathogen or whether an individual is infected with it. Hence, a key strategy is to increase our shared ability to detect the presence, quantity and impact of viruses.

4. What kind of expertise can Singapore offer to other countries when it comes to pandemic response, while learning from its experiences and that of other countries?

Singapore can help build capacity in technologies and human capital. For instance, NCID – in collaboration with the Saw Swee Hock School of Public Health – has embarked on field epidemiology training courses to beef up human capital networks with participants locally and in the region. NCID also recently launched an inaugural Asia regional discussion platform to share experiences in managing Covid-19 and updating treatment approaches. Overall, Singapore can serve as a central node in organising conferences and training courses mutually beneficial to itself and the region. In return, building up trust and a network for timely information sharing aids pre-emptive readiness in outbreak response.

5. How did the lessons learnt from the 2003 SARS outbreak prepare Singapore to handle the Covid-19 pandemic in a better way?

The SARS outbreak left a deep impression on Singapore, which has since been preparing for a similar outbreak through preparedness drills, expanded laboratory capacity, more isolation rooms, and added emphasis on infection control. We were fortunate that NCID was ready just in time for Covid-19. The new infrastructure, in terms of both the building and the organisation, has strengthened our ability to isolate, treat and research the disease – earning Singapore international recognition.

Through SARS we learnt the importance of a decisive and calibrated whole-of-government approach to fighting disease outbreaks, with a flexible and scalable system – including the construction of community care facilities within a short period of time – and strong community support. The healthcare industry has also been spurred to formulate preventative measures such as enhanced surveillance for active case finding; contact tracing and quarantine measures; an emphasis on personal hygiene and social responsibility; as well as safe distancing and management measures. On top of that, the healthcare system has been ramped up with safety protocols and personal protective equipment for healthcare workers.

6. What insights, both cultural and professional, have you gained from interactions with your international counterparts?

Fundamentally, it is about mutual respect. We have different systems and cultures, and there is no one size fits all. It is important to exchange information and then allow one another to utilise it to support their systems. Though my personal interactions with global counterparts amid Covid-19 have been limited, I’ve noticed that Singapore’s success in curbing the spread of the coronavirus can be attributed to our proficiency in risk communication, our high level of trust in the government, and community compliance due to Singaporeans’ innate belief in social responsibility that allowed for the successful implementation of safe distancing measures.

In contrast, my international colleagues have shared that certain regions – without singling them out – that are still witnessing a surge in cases may experience a dissonance between their cultural beliefs and restrictive measures that are counterintuitive to social behaviour.

“We hope we can play a significant role in the region. Though patient treatment is mostly localised, we are happy to share clinical information, and our research has been extensively published.”

7. What exciting developments in the field of infectious diseases emerging from Singapore have made a global impact?

Dengue research was boosted by a flagship grant in 2008. We are international frontrunners in researching dengue in adults. Our work reduced hospital admission rates from dengue cases without compromising mortality. We also guided clinical management by developing a standard care path, providing evidence on appropriate platelet use, cutting unnecessary platelet transfusion, and making active contributions to dengue vaccine trials. In terms of Covid-19 research, Singapore was the third country outside of China to isolate the virus, thus leading to the development of a serology diagnostic kit that has since been commercialised.

8. Covid-19 has emphasised the importance of a concerted effort to fight diseases. How will this shape the global healthcare industry in years to come?

At the end of the day, we hope that Covid-19 will bring the world closer in terms of information sharing, with the common aim of improving clinical care to reduce mortality. I don’t think any clinician would deviate from this primary objective. With the recognition of Covid-19’s fast spread, however, we are seeing a rapid response in terms of technological and vaccine development. For example, the public and private healthcare sectors have come together to make vaccines available to the entire population with unprecedented speed. With that being said, I think Singapore can take on a more prominent role in the global healthcare arena in the future. We already have an edge in information technology, artificial intelligence and diagnostic capabilities, along with a strong presence in biomedical science and a reputable regulatory framework.

9. The NCID came into operation before the start of the Covid-19 pandemic. What significance does the organisation hold for the region?

We moved into NCID in December 2018, which gave us time to put together key essential elements, and test our infrastructure and work flows. We have a strong team from the Communicable Diseases Centre [old facility] that has handled outbreaks, so how patients are managed remains unchanged. NCID is a purpose-built facility that is continuously progressive and has competent infrastructure, technology, and a strong organisation of people that enabled us to effectively tackle the Covid-19 outbreak.

We hope we can play a significant role in the region, but I would say that it’s still too early. Though patient treatment is mostly localised, we are happy to share clinical information and our research has been extensively published. This provides good scientific evidence that can help in disease understanding. In terms of disease prevention, the Covid-19 serological test kit co-developed by my colleagues has been used regionally, thus helping in capacity building.

10. How can Singapore leverage its strengths in the biomedical sciences to develop effective mitigation strategies in infectious disease management?

We can do so by building diagnostic capabilities and conducting studies on how a virus can cause damage and disease; how the human immune system responds and sometimes overreacts to infection; and how available therapeutics can serve to interrupt disease progression or re-purpose therapy.

The discovery of new therapeutic agents and vaccines will also help. These are all fundamental elements of biomedical sciences that have demonstrated their value during Covid-19.