Transcript of Minister for Foreign Affairs Dr Vivian Balakrishnan's Keynote Address at the 2nd APIC-ADVA Asia Pacific Summit on Infectious Diseases & Immunisation, 11 February 2025

Professor Heidi Larson,

Professor Tikki Pangestu,

Professor Zulkifli Ismail,

Professor Chong Yap Seng,

Distinguished guests,

Ladies and gentlemen,

Introduction

1        It is a pleasure to be here this morning. Let me first congratulate all of you for getting this group together, hosting this event, and for the launch of the Centre for Infectious Disease Emergency Response (CIDER) yesterday. This is a significant development that will make a difference to Singapore, to our region, and, indeed, to the world.

2        It is also fitting that you launch this in the Year of the Snake. Depending on culture, the snake may convey danger. In the Chinese Zodiac, it also symbolises wisdom, transformation and adaptability.  It is no accident that the medical community, for millennia, has also embraced the snake as a symbol of healing and medicine. In mythology, it appears as a test of veracity and truth, and a reminder of the significant adverse consequences when you lose that adherence to truth. The attribute of the snake which is relevant here is when it sheds its skin- it is a reminder of the need for renewal, resilience and transformation. All these reflect the state of global health and medicine today.

3        It has been five years since COVID-19 was declared a pandemic, and it is painful that the world remains mired in polycrisis – the theme of your conference.

4        Conflicts in the Middle East, Ukraine and Africa continue unabated and there is still too much unnecessary and painful loss of lives. It is not just the immediate conflict, but also the consequential collapse of medical supply chains, damaged infrastructure and the displacement, injuries and deaths to healthcare workers in these conflict zones, which complicate the situation even further.

5        Climate change is also going to exacerbate the existing health crisis and indeed, create new ones. 2024 was supposed to be the warmest year on record. You do not need to be a doctor or scientist to know that that will also mean speeding up the evolution of antimicrobial resistance. It will expand the zones of the threat posed by emerging disease vectors. Dengue fever is no longer just a tropical disease. It is expanding into temperate regions and countries such as Brazil and Colombia, as the Aedes mosquito expands its geographical range.  Loss of habitat,  closer and more intensive interaction between humans and animals will act as another accelerator for the development of new and zoonotic diseases. 

6        In addition to the danger posed by infections and vectors, we also live in an age of misinformation, which is another pandemic in its own right. We witness the proliferation of medical quackery and the rise of anti-vaxxers. Since the Age of Enlightenment, the age of science and reason, healthy scepticism based on data and evidence has been an integral part of medical and scientific progress. But the cynical, almost superstitious approach that some anti-vaxxers take, preying on the fears of people who know less than them, is downright dangerous and immoral. We have all seen the impact of that, even during COVID-19.

7        At a time like this, it becomes even more important that we coordinate our efforts, not just in clinical science, not just in immunisation, but also in the way we approach science, the delivery of healthcare and the sharing of data. But, especially in the last few weeks and months, we have additional challenges.

8        Funding  for global health security is now more unpredictable and will have to depend on discretionary and national approaches, even as we potentially hobble global ability to respond, especially given the recent pull-out from the WHO of at least two countries.

9        Negotiations on the Pandemic Treaty remain deadlocked, and there is clearly a lack of trust and political will. I do not think any breakthrough is imminent.

10      All these should be a cause of concern for all of us.  Without strong and effective multilateralism in healthcare, we are going to have a world that is vulnerable and ill-equipped to tackle the next global health crisis. And the next healthcare crisis is inevitable. What is most painful is not just an emerging pandemic, but the unnecessary loss of lives because we did not do what needed to be done both in terms prevention and action when the crisis actually emerges.

11      The question that confronts all of us in this room is, what are we going to do about it, from the point of view of Singapore, Southeast Asia, and, indeed, the world?  

12      I have three points to make.

Multilateralism and vaccine equity

13      First, we still need to reaffirm the need for a functioning multilateral global health system.

14      As a small State, all vectors will eventually transit through Singapore, and quite rapidly, as we have seen during SARS and COVID-19.

15      Perhaps because of our own vulnerability, Singapore clearly understands the importance of multilateral cooperation. These are not just a form of words for us, but blindingly obvious.

16      That is why Singapore always extends our staunch support for the WHO. Singapore was one of the first countries globally and the first in Asia to contribute to the WHO’s inaugural investment round for 2025 to 2028. We contributed S$24 million in the first instance. This will go towards building domestic capacities to prepare for, prevent and respond to health crisis and emergencies, especially in developing countries.

17      Singapore is not alone in making these contributions.  The UK, Germany, Japan, Australia, and others have made significant contributions to the WHO, Gavi, and to the Global Fund to Fight AIDS, amongst other key global health organisations.

18      Vaccine equity must be a key priority for all of us.

19      If you were to take an unvarnished assessment of the last five years, the truth is that we have fallen short.

20      Going back earlier, to the 2009 H1N1 pandemic, low- and middle-income economies struggled to access vaccine doses. It often only became available after the crisis had largely subsided, even though these same vulnerable countries were often the first in readily sharing their data and pathogen samples.

21      I am also reminded of the Ebola vaccine. I was just informed that Heidi is married to Peter Piot, who played a key role in helping to discover the Ebola virus. He made that discovery in 1976 – that is 49 years ago. And yet there was no breakthrough in the development for the Ebola vaccine until the devastating 2014–2016 epidemic in West Africa, which then led to a scramble for investment and development. Even after its approval in 2019, vaccine distribution for Ebola still remains limited for a variety of reasons.

21      Clearly, even in this day and age, this paradigm does not work. The irony is viruses are not bound by ideology, political borders or attitudes.

22      Hence, when the COVID-19 pandemic hit us, because of our technocratic and scientific Cabinet consisting of engineers, doctors and people who understand evidence and data, and also informed by our experience during SARS in 2003, we were an early champion for vaccine equity. Then-PM Lee Hsien Loong coined the term “vaccine multilateralism” when he spoke in June 2020 at the Global Vaccine Summit.

23      I am very glad that Switzerland and Singapore worked together to found and co-chair the Friends of the COVAX Facility (FOF) Group. This was a positive global initiative co-led by Gavi, WHO and others to promote equitable access to COVID-19 vaccines. This is not a political posture; this is simply responding to the brutal reality that a threat anywhere to a human being, anywhere on this globe, is a threat to all of us. Those of us who can do more, should do more.

24      The Gavi COVAX Advance Market Commitment (AMC) also received over US$12 billion in donor funding, mostly from middle- and high-income countries and, fortunately, philanthropic organisations throughout the world.  Thanks to these donors, 92 low-income countries were eligible to receive over a billion free doses of COVID-19 vaccines. A good achievement.

25      COVID-19 was not the worst pandemic which has befallen the world, and there may be far worse waiting. Even this level of performance would be inadequate. So that is the first point, the need for multilateralism.

Data Sharing

26      My second point is the need for all of us, and especially those in this room, to restore trust in science and evidence-based collaboration to optimise health outcomes. It is not about convincing the people in this room, but those outside this room.

27      During the COVID-19 pandemic, we had the Global Initiative on Sharing All Influenza Data (GISAID). This was a platform to accelerate global understanding of the virus as it spread and mutated. Researchers in over 170 countries worked together to make GISAID the world’s largest database of COVID-19 sequences.

28      Thanks to the hard work and the academic generosity of these researchers, the genetic sequence of the Omicron variant of COVID-19 was quickly uploaded when it was detected in South Africa, allowing it to be identified in other regions, including Botswana and Hong Kong, in the very early phase of its emergence.  At a time of confusion and panic, GISAID allowed for greater clarity and coordination.

29      That is why Singapore’s Agency for Science, Technology and Research (A*Star) played a major role in setting up and maintaining GISAID, by performing high quality checks on genome sequences submitted and classifying them. As a science and technology hub, I can give you the assurance Singapore will continue to support GISAID and efforts like this.

Domestic Resilience

30      My third point is that our domestic healthcare systems and infrastructure form the bedrock of our response to health crises.

31      In Singapore, we have always emphasised the need for training and retaining healthcare professionals in our national systems.  Intakes to our local medical schools have increased by about 30% in the past ten years. We offer awards and grants to attract Singaporeans who graduated from overseas medical schools to come back home and contribute to our local public healthcare system.

32      We also launched the Award for Nurses’ Grace, Excellence and Loyalty – we call this the Angel scheme – in September last year.  Under this scheme, about 29,000 nurses will receive up to S$100,000 each in payouts over a 20-year period.  Just two weeks ago, Minister for Health Ong Ye Kung also announced that another 37,000 public healthcare workers can expect salary increases this year.

33      At the same time, we have also strengthened our disease surveillance systems and established the Communicable Diseases Agency (CDA) this year to consolidate public health functions such as genomic and waste-water testing, as well as the emerging use of predictive AI, to ensure that any emerging waves of infections are detected early. 

34      Our robust surveillance systems can and must act as an early warning system of new outbreaks and, if we can do so, must be replicated in our region and beyond it. These systems strengthen the preparedness and ability to respond of our region and for the world.

Conclusion

35      Let me conclude by reminding all of us, again, that the next global health crisis is not a matter of if, but when. We must be prepared to respond swiftly and effectively, in a collaborative and scientific way, based on data and science, at a global level.  For that to happen, we need conferences like this, we need the spirit encapsulated by this room, and we need this to be disseminated outside. We need our own “pandemic” of science and cooperation.

36      Let me thank all of you for coming together, for establishing this, and for those of you who have travelled a long way to come here, a warm welcome to Singapore. Thank you all very much.

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