Introduction
Mr Speaker sir, the Covid pandemic put our society to the test in every way. It tested our healthcare workers, our companies and small businesses, our workers, our government and politics, our NGOs and indeed every citizen.
The costs and sacrifices were borne unequally, as is the case everywhere in the world that this pandemic touched. For example, in the business sector, some companies prospered exceptionally while many SMEs struggled or closed.
But what we can say today is that all the key stakeholders in our system, on the whole, pulled together and acted in the best interest of all. This is what history will remember. When we were tested, we rose to that call. If we had not, the losses, the scars would be far worse today.
On that note, I would like to register, alongside all members of this House, a profound debt of gratitude that we all owe to the front-line workers who toiled at the coal face of this crisis – healthcare workers and many other front-line staff, without whose sacrifice we would have collectively paid a much higher price.
Mr Speaker sir, my speech will touch on four aspects of the post-Covid review, namely the role of GPs in pandemic response, the approach we take to migrant workers, the role of NGOs and some observations on the Covid white paper itself.
Role of GPs
Firstly, on the role of GPs. There are about 1,800 GP clinics in Singapore, providing around 80% of primary healthcare services to our citizens. Under the newly launched Healthier SG, the role of GPs will be enhanced to become more proactive on the preventive healthcare front.
In the early stages of the Covid pandemic, a great deal of public funding was deployed to engage private healthcare companies to administer vaccinations and to conduct telehealth check-ins and surveillance of quarantine orders.
No doubt at the time, it may have been problematic for GPs to have played more of a role in this effort at least at the initial stage, due to the very slender staffing and administrative resources that most GPs have.
But given the enhancements to the role of GPs that will come about due to Healthier SG, which should see GPs enhance their access to IT and data for example, I wonder if, in case there is a future pandemic, could GPs play more of a role in the initial response in terms of vaccination and surveillance?
Why do I ask this? For a few reasons.
Firstly, GPs are locally based across the island. Citizens would have to travel less, be inconvenienced less and interact less with large crowds of people at collective vaccination centres if they obtain vaccinations at GP clinics.
Secondly, GPs may be familiar with patients personally and that familiarity may facilitate better communication and a better and less anxious patient experience.
Thirdly, anecdotally it would seem that many GPs are not fully utilised throughout the day in terms of doctor consultation time, though of course this is uneven. But I suspect many would have the capacity to take on more of this sort of a role at certain times of day.
It could be argued that GP clinics lack the manpower and equipment to play such a role. However, manpower and equipment could be deployed to these clinics from a central pool, as needed.
It could also be argued that GP clinics lack the physical space to handle large crowds. However, could this not be addressed through scheduling systems that could be run off a centralised IT backbone?
Of course, during the Covid pandemic we did not have the time to put in place all of the systems and processes to enable GPs to play more of a role in the initial phase. But for future pandemics, and given the changes we will make for Healthier SG, could we give some thought to how our GP clinics could play more of a role vis-à-vis private healthcare companies?
Migrant workers
Next, let me move to the subject of our migrant workers. All Singaporeans ought to recognise the vital role migrant workers play in our society and all of us should be in favour of treating them with the respect and dignity that should be owed to all workers. In fact, I believe many if not most Singaporeans these days strongly favour such principles.
The Covid outbreak in the migrant workers’ dormitories in Singapore will remain a blight on the report card of the way Singapore managed the pandemic. Our health protocols for the next pandemic must include protecting the most vulnerable communities among us. They must not be an afterthought in the next health crises.
On this note, I am glad that the Covid white paper does recognise these deficiencies.
“In retrospect, the early precautions we took in the dormitories were insufficient. Given
the communal living environment, the dormitory outbreak had every possibility of
becoming a major disaster. We should have probed deeper and conducted better and earlier
ground surveillance, such as by doing dipstick testing on sample populations to make
the most of limited testing resources. We also had to make a difficult judgement call on when
and how to relax movement restrictions on migrant workers living in dormitories. We
could have eased some of the restrictions earlier, especially after most of the workers
had been vaccinated and boosted….In the end, we decided to act with an abundance of caution to keep the workers and the broader community safe. But the extended restrictions did take a toll on their mental well-being.”
Before I go on, I should acknowledge that it was good that the white paper recognised the room for improvement on the migrant worker front. I also acknowledge PM Lee’s video message to migrant workers during the pandemic, which was helpful.
Widespread infection of the workers could have been mitigated if the government had taken more decisive action earlier. The light of the oncoming train was flagged out by the NGO TWC2 as early as 23 March 2020. In its letter to the ST Forum, TWC2 said, “We call on the Government to announce in advance what plans they have to rehouse workers should clusters break out in dorms. This would give reassurance to the resident and non-resident community.”
The outbreaks at the migrant worker dormitories exposed the cramped conditions that they lived in to many members of the general public for the first time and many Singaporeans were shocked. Despite MOM announcing improved standards for dormitories, anecdotes from migrant workers on the ground show that there is uneven enforcement for the smaller dormitories, and there is no timeline yet for the Purpose-Built Dormitories which meet these standards.
As an example of the cost to migrant workers of these measures, here is an excerpt from The Guardian newspaper from 17 Apr 2020 relating to migrant workers in Singapore: “The restrictions, an attempt to reduce further transmission, have left the dormitories even more crowded than usual as only essential workers are permitted to leave. One construction worker, from Bangladesh, told the Guardian there were long queues to use shared bathrooms….”
Also, migrant workers lived under prolonged lockdowns when others in the wider Singaporean community could already move freely, despite their vaccination rate already being higher than the average for Singaporeans, affecting their mental health. All movement restrictions were only wound down for migrant workers on 1 Mar 2023. It is good that the white paper acknowledges that this could perhaps have been done sooner.
A study conducted by Yale-NUS in 2020 concluded that migrant workers under lock-down conditions in dorms suffered from higher levels of stress and anxiety. A report in the media outlet Today in Aug 2021 read: “The large number of mental health symptoms reported among workers under complete restrictions suggests that while isolation of whole facilities may be expedient for limiting Covid-19 transmission, this comes at the cost of an increased mental health burden, researchers said.”
Hence I would like to ask what is the timeline for the improved standards in migrant worker dorms to be rolled out nationally including the role of NEST? And will the government build on this unfortunate experience to develop a clear plan to manage an infectious disease outbreak in migrant worker dorms, with all of the massive logistical challenges that will entail?
I also hope that the Covid episode with migrant workers serves as a powerful reminder to all of us to take the well-being and dignity of migrant workers seriously. In particular enforcement of rules and norms over all kinds of matters like food quality and access to bank accounts and payslips for example, and hotlines to aid in enforcement, should be in place and be seen to be working properly by the migrant workers themselves. In this House, I recently called for rewards for migrant worker whistle-blowers who expose genuine safety lapses. There are potentially many such ideas through which we can improve the system.
And the best generators of ideas are those NGOs who have been working tirelessly and fruitfully to bring migrant worker issues to the forefront of public debate – groups like HOME, TWC2, Healthserve and many others. I hope the government will lend an active listening ear to such groups so that in future they will not again become like the mythic Greek princess Cassandra who was fated to utter true prophecies which no one believed and who had to see her prophecies realised.
For at the end of the day, taking care of migrant workers is an urgent question of social justice and fairness. As Mahatma Gandhi once said “The true measure of any society can be found in how it treats its most vulnerable members.”
But there is more to it than that. By taking care of our migrant workers, we may be able to attract the more effective workers to come and work in Singapore, those who have more experience and a track record and who are capable of becoming more productive and perhaps innovative workers and supervisors. After all, there is competition for migrant workers from other countries, like the Gulf states for example. A robust migrant workers’ rights regime will help us attract workers who can become more skilled and productive and thus help us to reduce the size of the migrant worker workforce in Singapore, thereby lessening population pressures.
And, as I have argued a few times in this House, very skilled tradesmen and technicians from among this migrant worker population should be given an accelerated pathway to PR status and eventually citizenship, so as to strengthen the Singapore core in such fields.
Role of NGOs
Next, I would like to touch on the role of NGOs. I spoke of the migrant worker NGOs who played such a valuable role in the Covid crisis.
A more general point I would like to make here is that in future pandemics, there can be a stronger role for NGOs as partners, working with the government to execute initiatives, but also to inform and critique policies and to disseminate accurate information to their constituencies.
The Covid white paper refers to the role played by some food aid charities, migrant worker charities, PEERS as well as organizations under the People’s Association umbrella. However, these organizations were for the most part referred to as partners in the execution of projects and workstreams.
If a future pandemic or other national crisis happens, I hope the government can assign more institutional capacity to involving NGOs who are close to their various constituencies on the ground, not only in executing projects but also in formulating and refining policy approaches and making decisions. I had earlier referred to the pertinent advice that TWC2 had publicly aired back in March 2020 which we would have done well to heed at that point.
One area where NGOs could play an important role is mental health. The Covid pandemic took a heavy toll on the mental health of many Singaporeans, due to the general fear and anxiety level, the economic devastation felt by some groups of people even as others prospered, and having to work from home and learn from home for prolonged periods.
I am aware that the Health Promotion Board (HPB) is developing a national portal for mental health resources to be curated by experts and hosted on HealthHub
In future pandemics and crises, mental health-related NGOs should be empowered, resourced and given information to reach out and persuade those at risk to use the helping resources available – which is not always an easy task and may best be handled by non-state agencies.
One area where we can boost our mental health care capacity for future crises is in terms of our population of psychologists. In reply to a Parliamentary Question from Sengkang MP Ms He Ting Ru, the government revealed that our ratio of psychologists per 100,000 population is 9.7. This compares to around 30 in the US and 49 for Canada and France. The same ratio for psychiatrists places Singapore under 5 versus for example 15 for Canada and 24 for Finland.
Government scholarships are one tool to increase the number of trained psychologists in the public sector. Training to be a clinical psychologist takes as long as that for medical doctors. Currently, the Healthcare Graduate Studies Award is open to post-graduate courses for Clinical Psychology as one of 10 other courses of study, such as Audiology, Health Economics and Epidemology. . By contrast, the PSC Scholarship for Medicine and Dentistry targets applications for study only in Medicine and Dentistry. So the number of post-grad scholarships dedicated to clinical psychology is probably not as high as for medicine and dentistry and there is no clearly targeted number for clinical psychology alone, for the reasons I explained. This should be addressed.
Paper itself
And lastly Mr Speaker sir, let me conclude with some observations about the Covid response white paper itself.
The white paper appears to be a public communication document. In terms of format, evidence of academic and analytic rigour as well as granularity of detail, it stands in stark contrast to a different paper that was published in 2010 by academics on Singapore’s H191 pandemic response. That paper was entitled “Influenza A (H1N1-2009) Pandemic in Singapore – Public Health Control Measures Implemented and Lessons Learnt.” The authors were academics Joanne Tay, Ng Yuek Fan, Jeffrey Cutter and Lyn James. No doubt that was an academic paper rather than a government white paper, but that paper seems at the very least more detailed and, if I may, more clinical in how it marshals facts and uses them to build conclusions. That paper was also authored by independent academics who drew on interviews with MOH and other officials but did not represent the views of MOH. And it has a fuller methodological note.
In the spirit of these observations and to reiterate the arguments put forth by the Leader of the Opposition on this very same point, I hope the government would consider making public the original internal AAR report developed by Mr Peter Ho and his team, with redactions as regards any matters pertaining to national security or which have commercial sensitivities. This would serve the purpose of greater transparency and a fuller and better-informed public debate on what should be the lessons we learn.
Conclusion
In conclusion Mr Speaker sir, the pandemic was a terrible crisis that exacted an awful price in lives, livelihoods and peace of mind. But Singapore did not fail the test when called upon to exert ourselves and come together for the greater good. That should inspire the current and future generations with a true story of what we can do if we put our minds and hearts to it.