Minister for Foreign Affairs Dr Vivian Balakrishnan’s Skype Interview with The Hill’s Editor-At-Large Steve Clemons, 9 June 2020

Presenter (Steve Clemons): Welcome to The Hill’s Coronavirus Report. I am Steve Clemons, Editor-at-Large at The Hill. Each day, we are interviewing consequential leaders and innovators in the fight against the coronavirus. COVID-19 continues to cause wreckage around the world, but nowhere so intensely as here in the United States, where the numbers of infected are clearly on the rise again.

But this virus knows no boundaries as it quickly spread from Wuhan, China, to nearly every corner of the globe. One of the nations earliest hit was one of the world’s leading trading states – a powerhouse node in finance, in investment, trade, and a vital hub in the world’s global supply chain networks. An incredible amount of the world’s global output has a foot in Singapore. But Singapore put in place stay-at-home orders, event cancellations, and a commitment to quality contact tracing, to help identify those exposed to the virus and infected with it, so that they could be held in quarantine, and others protected. Singapore has had a bit of a teeter-totter relationship with the virus, having done an obvious job early- on squelching it, but having to repeat when the virus re-emerged. Singapore is now re-opening but with health guardrails, and is working to manage ongoing coronavirus cases, particularly in its poorer migrant communities which have seen second waves of the virus.

To talk with us today about the view of COVID-19 from another global perch, is the Foreign Minister of Singapore, Vivian Balakrishnan. The Foreign Minister has held a wide number of portfolios in previous governments there, and has been one of the architects of Singapore’s rise. And he’s also the Minister of something I’m very interested in, Singapore’s Smart Nation initiative. Minister Balakrishnan, thank you so much for joining me. I just wanted to get a snapshot real quickly in our conversation about where do things stand with regards to the coronavirus today in Singapore?

Minister: Well, we are on the careful road to recovery – you just pointed that out. The way to understand Singapore is to imagine Manhattan ejected by upstate New York and having to be independent. We have 5.5 million people on a tiny island, but we have 17 million tourists in a usual year. So it’s no surprise, it should be no surprise to you, that in fact we were one of the early destinations for the virus when it got out of China; so that was the first wave in late January and February. Well, as you mentioned, with good contact tracing, with good care and isolation, we were able to deal with that first wave. The second wave began in February and March, and that’s basically because we had lots of Singaporeans who were seeking safe refuge at a time when the virus was spreading across the globe. And citizenship has its privileges, and of course, they had a right to come home. We ended up with about 580 imported cases by middle to late of March. That again, in turn, was controlled – and then what happened at the end of March and across April, really was a surge of cases in our migrant worker dormitories. And – this is one key differentiator from SARS that we experienced 17 years ago – and that is that this virus is far more infective than SARS. Whenever you have living in close quarters – whether you’re on an aircraft carrier, or a 6-star luxury liner, or in our case, foreign workers living in a dormitory – interacting, socalising intensively, sharing their cooking, sharing meals, having picnics, shopping together. Whenever you get that kind of situation with this particular virus, it will spread exponentially. So that’s what happened.

Right now, as I said, we are on the careful road to recovery. If you look at the total number of cases that we’ve had, it’s about 38,000 – 94% of that is really from the migrant worker dormitories; 1.5% imported; 4.5% are cases in the community. If you look at the mortality rates, our figures are less than 0.1%. In fact, if you want to go to the second decimal point, it is 0.07%. Now, the point is this – of course, the very low mortality rate can be ascribed to the excellent healthcare facilities and in particular, the wonderful staff that we have. But it can’t be that Singapore’s healthcare facilities are ten times better than those everywhere else in the world. So basically what you are seeing here is the fact that we are testing so extensively. In fact, most of the patients who turned out positive now are asymptomatic, and in fact probably past their infective prime. So that’s why we get apparently large numbers but such good outcomes. And the other way to look at it is that if you look at mortality rates, and you realise – well, in the case of Singapore it is also low because the vast majority of the 94% of migrant workers are young, fit, healthy men. Clearly, in that demographic, the mortality rate is going to be very low. But even in the older age groups where you do get a higher mortality rate, in Singapore, we are still running well below 1%.  

Steve Clemons: Why do you think that is?  

Minister: It’s a combination of factors. I wanted to say, number one, from the medical point of view, we know that age makes a difference. Pre-existing diseases – diabetes, hypertension, cardiovascular problems, stroke, obesity – also contributes to mortality rate. But basically if you have a young and fit population, and – a very important point – your healthcare facilities are not overwhelmed, you can get mortality rates round about 1% overall. But the point is, you’ve got to make sure you’re not overwhelmed, and that means making sure your healthcare capacity [is sufficient], which cannot be increased overnight. But in our case, because we went through SARS 17 years ago, we invested heavily in healthcare facilities, testing facilities, and in having a system with sufficient buffers and sufficient resilience to deal with it – so that made a critical difference. But the other way to look at it is that, in fact, for many countries, especially for less developed countries with young populations, if you told them, “well, the mortality rate is less than 1% or sometimes even down to 0.1% or less”, many people would be tempted to say, “well, then perhaps this isn’t such a significant condition”.

But here, the point is that because we know that it is an asymmetrically heavier burden on the older population. In fact, what we have done is to make a choice. That this is a values decision, and that if you want to protect your old and vulnerable, you need to take this disease seriously. And, in terms of impact, without a vaccine and without proven anti-virals, you are left with what we call “non-pharmaceutical interventions” of which, there are only three: social distancing, hand hygiene, and masking – in that order. And what we have shown in the last eight weeks when we went through what we call a “circuit breaker”, is that social distancing is very, very effective. It really takes the edge off the pandemic rise, but it is also very, very, costly. It has a huge impact on the economy, on society, and after a while, people get restless. They get a form of cabin fever. But the point I’m making here is this – the reason why we are prepared to pay this price is because we want to protect the most vulnerable people in our society. So, it’s a values judgement; it’s a choice that we make.

But having said that, there is a corollary to that, which is that if you have effective social distancing and the vast majority of your population in fact remains immunologically naïve – which means that we don’t have immunity to it – it means that we remain vulnerable to secondary rises in the pandemic. And, what that means then, is that in this phase when we are opening up, we’ve done three things in particular: number one, ramp up medical capacity for any future increases; number two, increase testing capacity considerably by several orders of magnitude; number three, you need the ability to contact trace, and contact trace very, very, quickly and at scale. Because this is the only way you can re-open your economy in the presence of the vast majority of your population not having immunity, and yet do it safely. So that’s where we’re at.

Steve Clemons: Minister, let me just jump in here and ask you because you’ve been a big advocate of expanding contact tracing and doing something that hasn’t really happened in the United States yet. There’s been discussion – I talked to the Head of the Centers for Disease Control and Prevention in the United States, Dr Robert Redfield, the other day, who wants to hire anywhere between 30,000 and 100,000 contact tracers in the United States. Your answer has been electronic – to find wearables, to use Bluetooth, to find mechanisms that would do this, as I understand it. Can you tell us your strategy on contact tracing because I think it’s important that we hear that, because it sounds very different than the contact tracing strategies we’re hearing in this country.

Minister: No, actually, I agree with your contact tracing. I need to admit this point and to emphasise this point – contact tracing is a professional art. It remains a human endeavour; it requires human judgement, and no technology is going to replace the human in the loop. So you do need to hire and train lots more contact tracing people if you’re going to get a grip on this. So that’s the first point. Now, having said that, you can facilitate, you can accelerate their work, and you can reduce the whole difficulty in doing what they need to do. Let me give you an example – a key ingredient of contact tracing is to jog people’s memory and say “where were you over the last 14 days?” And the truth is, for all of us, if I asked you that, you would have great difficulty reconstructing your movements, your calendar, and even the people that you met. And that’s even people that you know. What about the people whom you don’t know, whom you happened to have spent significant amount of time with? So that’s where technology comes in – it enables the human being making those decisions to quickly fill up that schedule of activities, identify risk events, identify potential contacts, and then the key point is to be able to issue quarantine or isolation orders and to institute treatment quickly.

It makes a difference on two counts. One, is we know that instituting early access to care makes a difference to outcomes, so that’s clearly a benefit for the patient himself. Second, it prevents secondary or tertiary spread of the disease, so it’s worth doing that. And the other point is this, which is worth emphasising in the case of COVID-19 – which is that unlike SARS and maybe even unlike MERS, in this particular disease, a significant number of people do not show symptoms or have very mild symptoms. Now, if you think about it, if there is a significant proportion of your population with no symptoms but yet having the ability to transmit the disease, the only way you’re going to identify them and the only way you’re going to stop that from continuing to spread, is contact tracing.

So again, it comes back to the importance of contact tracing and to be able to trace at scale, and to trace quickly, but to leave the final judgement to human beings in the loop, so you do need a lot more.

Steve Clemons: Thank you for that. I find it fascinating –  your comments on the technology, and in your Smart Cities world, it all sort of makes sense that we should be able to have more data, more reminders as you said, but let me get into your foreign policy hat for a minute. I’m interested in how diplomacy has shifted or changed, if at all for you, and then, secondly, something that seems to be happening from the Washington anchor, is more and more distancing from China. More and more division in the world where you’re looking at technology and 5G and Huawei, whether you’re looking at whether the World Health Organization was deployed there. Are you worried, as someone who watches this relationship so closely and really is between them that the world is in danger of becoming around two hubs – the US hub and the China hub? And when it comes to health, when it comes to transnational challenges, isn’t that a problem?

Minister: How long do we have?

Steve Clemons: That’s up to you.

Minister: Well, let’s deal with the easy one first – diplomacy. I think for anyone who has been a Foreign Minister for several years, the fact is we’ve all been used to getting on a plane, we’ve met so many people over the years. In effect, we’ve all learned to use Skype, to Zoom, to make videoconference calls; we’re able to transact, we’re able to negotiate, we’re able to connect and communicate. But I will say this – I think we are all living off accumulated diplomatic capital. Diplomatic capital because we have met each other, we know each other, we have shaken hands, we’ve looked into each other’s eyes, and it’s so much easier. But if we had never met before, we never had the measure of the man or the woman, I think all these electronic means of communication would be far less effective. So, in the short-term, not a lot has changed except for the fact that we are all not jumping onto a plane, but the level of interaction and communication in fact, has been increased, not decreased at all. So that’s just at a technical level, where diplomacy is concerned.

Your latter part of your question is far more difficult. The way I look at it is that I agree completely with Richard Haass – that this epidemic has not changed history, but it has accelerated the shifts and the trends which were already evident before that. So let’s take a step back and say, well, what was happening before COVID-19 arose?

First question – was the relationship between the United States and China fraught with difficulty as evidenced by sanctions, trade wars, tariffs, apparent reconciliation, a ‘Phase One’ deal? I think the point is that there were already difficulties in that relationship. That’s the first point.

Second point – was there already a domestic political pushback against globalisation and free trade, and in particular, its impact on jobs and inequality? And the answer is, that was already on the political agenda.

Third point – if we look at global supply chains, for a long time, supply chains became more and more complex, more and more spread out in a network formed across the entire globe, because people were in search of efficiency. The optimal way was to be just-in-time and have low inventories, and suddenly we’re now confronted in a world where just-in-time needs to be supplemented with just-in-case. And you suddenly realise: hey, wait a minute, critical supplies – chemicals, drugs, ventilators, even what should be simple, routine stuff – personal protective equipment, suddenly became in short supply because no one had stockpiled enough, diversified their sources enough, and suddenly there became a premium on reliable partners in your supply chain. So again, what I’m saying is this focus was enhanced by this crisis. But it’s not really new.

The next question then is what are the implications of all this? Of a difficult and perhaps turbulent relationship between the two superpowers of the world, of a pushback against globalisation and free trade, and of the disruption and what you have indicated – possible bifurcation of supply chains. If you look at just these three trends – and we’ll get to technology in a little bit – if you look at these three trends, it means we are probably headed for a world that is going to be far more difficult, far more disrupted. The easy, low-hanging fruit of economic growth that came from globalisation and free trade are not going to be there anymore. You will see a less prosperous world, you will see a less interdependent world. We have to appreciate that, in fact, globalisation, free trade, and interdependence was the formula for peace and prosperity since the end of the Second World War. So, we are leaving that phase and we’re headed into an unknown where many things can go wrong. For all of us, and especially for us in Singapore – and you need to appreciate our unique position – we are a city-state, trade is 3.5 times our GDP. China is our largest trading partner, in fact, we are the largest foreign investor in China. The United States is the biggest foreign investor in Singapore by a long way; the United States is the biggest trading partner of Singapore where services are concerned, and I think – third, where goods are concerned. Of course, I always remind President Trump that you’ve got a healthy surplus against us – that’s just to keep us off the radar screen.

Steve Clemons: Well that’s good, that’s good you remind him. Minister Balakrishnan, I want to say thank you so much. We’re going to have to end it there, but I feel like we’ve had a masterclass talking not only about how to handle coronavirus’ various waves, but also Singapore’s very unique role in the world. You know – looking at two superpowers and how this may all go in the future. So thank you so much for joining us today.

Minister: Well, we hope they get along, we hope they get along, that would be best for a place like Singapore.

Steve Clemons: Well, thank you. Mr Minister, thank you for joining us. Thank all of you for joining me today. I’m Steve Clemons, we’ll see you tomorrow. Be well.

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