In response to the extreme uncertainty brought about by a global health crisis, as mentioned above, governments initially tend to behave reactively to meet the immediate demands not only of the healthcare system, but also of the community. In practice, as seen in Tables 2 and 3, collaborative partnerships among public agencies and/or between the public and private sectors can meet pressing needs of a community in a state of agitation (e.g., by ensuring the resilience of the food and essential medical equipment/devices supply chains) [12].

In the early stages of the SARS outbreak, the Singapore government was not adequately prepared to deal with the infectious disease that was fluid and unprecedented [39]. Due to the initial lack of dedicated testing and isolation facilities and on-going contact-tracing effort, the first patient who had contracted SARS was only hospitalized and isolated after five days upon her return from Hong Kong, during which she had spread the virus to 22 other individuals [24]. Given this, the MOH initiated a SARS taskforce to study and manage the unexpected spread of the virus throughout the community, focusing on collaboration within the public sector that could better serve the public [35]. However, in practice, the presence of the first confirmed SARS cases within one public hospital––Tan Tock Seng Hospital (TTSH)––highly influenced the condition of other patients in the same hospital and caused the further spread of SARS to other healthcare institutions such as Singapore General Hospital and National University Hospital [24]. In response, to effectively contain the spread among various healthcare workers, institutions, and patients, the government tapped into the so-called “all-in-one” approach which has been considered as a unique Singapore term. In turn, at first, TTSH was designated as a SARS hospital by the MOH on March 22, 2003 [35, 39]. That is, the “all-in-one” approach required all suspected and confirmed cases of SARS were sent only to TTSH. Restrictions were also imposed on the movement of healthcare workers and patients among hospitals [35]. Meanwhile, all elective procedures in other public hospitals were placed on hold as the MOH redirected non-flu illness cases (that is, non-SARS related emergency patients) to other public hospitals and local general practitioners (GPs) [39]. The Singapore Armed Forces (SAF) were also activated to provide manpower support to public hospitals [54]. All these efforts were intended to prevent the overstraining of hospitals and to prevent cross-contamination.

In addition, during the SARS outbreak, to curb trans-border spread of the disease, a mandatory health declaration was imposed on travelers to Singapore. The Defence Science and Technology Agency (DSTA) under the Ministry of Defence collaborated with Singapore Technology (ST) Electronics to develop a temperature scanner, the Infrared Thermal Fever Scanner (Defence Science & Technology Agency, 2003) [21]. This cross-sectoral collaboration, which capitalized on the thermal imagers commonly used in the military, led to the rapid deployment of the scanner within one week at immigration checkpoints at Changi Airport to prevent the entry of suspected SARS patients [44].

During the COVID-19 pandemic, the Singapore government has moved in a timely way to roll out preventive strategies intended to control the spread of the disease in the community, across borders, and in hospitals. Notably, there has been an increase in collaborative partnerships to meet the needs of the healthcare industry as well as society—the general populace, healthcare workers and foreign workers—and such partnerships have been found not only in the healthcare arena but also in non-healthcare fields (e.g., IT, R&D, and the economic sector). As indicated in Table 3, for example, as the first line of defense, Public Health Preparedness Clinics (PHPCs) were activated in February 2020, within a few weeks of the first COVID-19 case in Singapore. GPs enrolled in the PHPC scheme underwent courses on the importance of infection control and were trained on the use of personal protective equipment (PPE) [15]. Because patients with respiratory illnesses were offered subsidized treatment at PHPCs, these patients were diverted away from hospitals to clinics, and only suspected positive cases of COVID-19 were referred to hospitals for further diagnostics [29]. Additionally, in contrast to Singapore’s SARs response, in March 2020, private hospitals in the city-state were allowed to collaborate with public ones to better accommodate stable patients, preventing a hospital bed crunch and ensuring that public hospitals had enough capacity to deal with more severe cases of COVID-19 [19].

Despite these timely response efforts, within a few months, confirmed positive cases of COVID-19 in local communities had increased substantially, and Singapore’s government faced the simultaneous challenge of a massive outbreak of new cases in the foreign workers’ dormitories where daily cases reached the thousands [1, 89]. This was largely attributable to the cramped living arrangements therein and residents’ lack of access to protective supplies such as masks and hand sanitizers [89]. In response, the Singapore government required foreign workers’ dormitories to be isolated and to undergo mass testing. What is more, to ensure that patients including foreign workers in critical condition received immediate attention and treatment with enough medical manpower, the government engaged Surbana Jurong, a private consultancy firm, to convert exhibition centers into Community Care Facilities (CCFs). The CCFs were used to accommodate individuals with mild symptoms that it is not required to have extensive medical treatment [51]. These were similar to the temporary hospitals, such as Huoshenshan Hospital, that were constructed in a matter of days in China. Given Surbana Jurong’s expertise and networks in the construction industry, they were well equipped to overcome the logistical issues posed by disruptions to the supply chain [51]. Meanwhile, the medical care in CCFs was provided by personnel deployed from private hospitals [51].

The imposition of mandatory wearing of face masks in Singapore coincided with a massive supply chain shortage as countries that were major producers of such masks were in lockdown and people worldwide were scrambling for masks. The Ministry of Trade and Industry (MTI) initially distributed masks from their stockpiles, but this was unsustainable. The Temasek Foundation, a subsidiary of Temasek Holdings, later became the main distributor of masks and other precautionary items such as hand sanitizers in Singapore [78]. Given Temasek Holdings’ broad networks due to its diverse investment portfolio on every continent, it was able to procure reusable masks that were new innovations and of better quality [79]. Some of the masks distributed utilized technology by Swiss-based Livinguard and UK-based DET30. Temasek Holdings’ distribution of essential items ensured that the MTI could divert their resources to the procurement of other items such as food while ensuring that the populace received better quality masks [50].

Apart from the Temasek Foundation’s procurement of masks from overseas suppliers, there have also been local efforts to restart the domestic production of masks amid worries of future supply chain shortages as the demand for masks increases globally. The domestic production of surgical masks, overseen by the MTI, was aided by Innosparks at ST Engineering, which had experience producing N95 masks [4]. These masks were meant to be distributed to healthcare workers amidst a market shortage of medical-grade masks. Meanwhile, the shortage of masks meant for the general public was also addressed by private firms such as Razer, which set up an automated manufacturing line that has been able to produce up to 5 million masks per month (CNA, 2020b) [20].

Furthermore, the government noted the importance of securing vaccines early on to reduce the death toll and curb the spread of COVID-19. This led to the formation of a Therapeutics and Vaccines expert panel (TxVax) that included 18 scientists and clinicians across hospitals, research groups, and the private sector in April 2020 [30, 83]. While the approval of vaccines was eventually done by the Health Sciences Authority (HSA) like a normal medication approval process, the panel played an additional yet a critical role in recommending the more promising vaccines directly and swiftly to government planners and the MOH for early procurement logistics after examining and discussing the results of the clinical trials of prospective vaccines [83]. In addition to increasing the healthcare sector’s capacity and procuring vaccines, there were also efforts to improve contact-tracing, which was the bedrock of containment of the disease in its initial phases. The MOH engaged a research team from Duke-NUS Medical School to conduct serological tests during the early phases of COVID-19, in which serological tests were limited [20]. Serological testing allowed for the detection of past infections even after an individual had recovered, allowing for more precise contact-tracing [65]. In practice, the development of the test helped contact-tracers detect the source of a cluster of 23 COVID-19 cases in the initial phase of the epidemic in Singapore and stemmed further outbreaks in the community [65]. The incident was the world’s first successful use of the serological test kit [65].

Aside from healthcare policies, multi-sector collaboration on non-healthcare policies was intended to meet other needs of society. During the outbreak in the foreign workers’ dormitories which led to the isolation or hospitalization of many foreign workers in CCFs, NGOs such as Healthserve, Transient Workers Count Too (TWC2), Singapore Migrant Friends, and the Alliance of Guest Workers Outreach worked with the inter-agency task force to cater meals suited to the tastes of foreign workers and provided psychological support to those in isolation [13, 67, 81]. Additionally, given the language barrier between local healthcare workers and foreign workers, a volunteer project, VisualAid, was also rolled out to provide informational cards containing terms translated into six different languages to help healthcare workers communicate more effectively with foreign workers [43].

Healthcare workers meanwhile faced discrimination from the general public while using public transport due to the public’s fear of contracting the mysterious new virus [74]. Such discrimination resulted in difficulties for healthcare workers looking for a ride home from hospitals after their shifts. Grab, one of the top-ranked mobile app–based private transport service companies in Southeast Asia, stepped in to resolve the challenge by launching GrabCare. GrabCare is similar to the company’s ride-hailing services, but caters specifically to healthcare workers traveling to and from their workplaces with the fixed fare for all 24 h, and employs only those drivers who voluntarily sign up for the service.

Aside from domestic multisector collaboration, the Singapore government has also signaled its commitment to transnational collaboration at the Association of Southeast Asian Nations’ (ASEAN’s) Defence Ministers’ meeting (ADMM) on February 19, 2020 where the management of COVID-19 was discussed. The joint statement issued on Defence Cooperation against Disease Outbreak emphasized the importance of information sharing to facilitate domestic contact-tracing and quarantine efforts [6].

In line with Baxter and Casady’s [12] typology of short-term, medium-term, and long-term governmental responses, we note that medium-term partnerships between the public and private sectors represent a shift away from reactive responses to proactive responses and anticipation of potential challenges in a pandemic. Multisectoral collaborative partnerships may, for example, facilitate product development, strengthen existing healthcare services, or repurpose existing facilities to improve society’s resilience to potential outbreaks. But notably, during the COVID-19 pandemic, such partnerships have progressively expanded into non-healthcare arenas, given the economic repercussions a prolonged pandemic can have on society. In short, governments can use this strategy to work toward an economic recovery, thereby further stabilizing and strengthening the economy against the backdrop of an ongoing pandemic.

Because the SARS outbreak was over in 3 months, it resulted in minimal healthcare partnerships. Nevertheless, the outbreak had longer-term economic repercussions in Singapore, particularly for the tourism industry. The Ministry of Trade and Industry (MTI) reduced its GDP growth forecast from 3% to 0.5% after the initial outbreak of SARS [40, 55]. In addition, the unemployment rate reached a peak of 4.8% (higher than during the 2007–2009 Global Financial Crisis) for a few months after the end of the SARS outbreak in September 2003 [68]. These signals of an economic downturn prompted the government to work with the private sector to revitalize the economy and reduce retrenchment. For instance, as seen in Table 2, one notable initiative was the collaboration between the public sector Singapore Tourism Board (STB) and major private sector hoteliers. While Singapore’s borders remained partially open to travelers, foreigners were wary of visiting Singapore due to the rapid spread of the virus and the country’s strict quarantine orders. Singaporeans were also reluctant to staycation at hotels and instead chose to stay home to avoid contracting the disease during that period. This situation led to the collaborative partnership between the STB and hoteliers to provide travelers and Singaporeans assurance that hotels were safe environments by monitoring the temperatures of hotel employees [31]. The initiative later expanded into a full-fledged certification system known as the ‘Cool Singapore Awards,’ which were awarded to hotels and other tourist attractions. The certification worked as a motivator to participants to ensure their complete adherence to government health advisories and the disinfection of their facilities during the SARS outbreak [31].

Aside from its efforts to prop up the local economy, the Singapore government also engaged in transnational cooperation to mitigate the cross-border spread of SARS. For instance, beginning with bilateral arrangements with neighboring countries such as Malaysia and Indonesia, Singapore has sought to exchange the information required for contact-tracing and quarantine to ensure that visitors are safe [35]. Later, through the Joint Declaration of the Special Meeting by ASEAN Leaders on SARS 2003 and an ASEAN + 3 summit involving ASEAN leaders, China, Japan and South Korea, Singapore further collaborated with other countries to facilitate information-sharing and pre-departure screenings to reduce the cross-border transmission of SARS [31].

The longer duration of the COVID-19 pandemic has illustrated the need to increase the resilience of the healthcare system to battle the next outbreak while also ensuring that the economy recovers. The summer of 2020 saw massive outbreaks on every continent while Singapore was barely able to control the spread in foreign workers’ dormitories [90]. The need for stronger measures to mitigate community outbreaks that could bog down the healthcare infrastructure and to reduce mortality rates led to closer partnerships between the government and hotels. One of the control measures was an issuance of stay-home notice (SHN),Footnote 4 a form of individual quarantine orders for all travelers. The government prevented travelers and returning Singaporeans from completing SHN at their place of residence in order to prevent household spread, but for the measure to be effective, more dedicated SHN facilities were needed. More than half of the hotel rooms in Singapore were put to this use through July 2020 [77]. While some hotels have reopened to accommodate staycationing Singaporeans, these hotels remain ready to be converted back to quarantine facilities if required [88].

In addition to expanding Singapore’s healthcare facilities, the private sector has also made significant contributions to Singapore’s vaccine roll out. In a bid to achieve herd immunity by vaccinating the population as quickly as possible, the Singapore government started its national vaccination drive in January 2021, accompanied by rigorous public outreach and media coverage (e.g., TV and radio spots, personal SMS from the MOH, social media campaigns, and printed brochures). In addition, the government prepared financial assistance and insurance packages (e.g., on-time pay-out) for cases with serious side effects. Given the temperature-sensitive nature of the vaccines, air transportation business partners including Singapore Airlines (SIA) and DHL Global Forwarding played a critical role in delivering the vaccines from overseas [91].Footnote 5 As a result, Singapore became the first Asian country to receive the Pfizer-BioNTech shots from Brussels, Belgium in December 2020, and Moderna’s COVID-19 vaccines arrived in Singapore in February 2021 once they were approved by the government.

Even after the delivery of the vaccines, the vaccination programs were conducted jointly by the two sectors—the MOH and private medical providers. Community roll-out of the first doses of the vaccines started on February 22, 2021 [59]. The government aimed to complete COVID-19 vaccinations by the third quarter of 2021 to keep the virus under control.Footnote 6 It strongly encouraged residents to get the jab and first made vaccines available to Singapore Armed Forces personnel, then workers in the land transport sector, seniors aged 70 and above, seniors aged 60 to 69, and each progressively younger age group in a timely sequence. In order to ensure the seamless and efficient roll-out of vaccines as planned, the MOH set up 36 vaccination centers including public general hospitals (e.g., for frontline healthcare workers), community centers, and 10 mobile vaccination teams island-wide. The tender to run these vaccination centers, worth a total of $38 million, was awarded to 17 healthcare providers in February 2021 [92]. The main service providers from the private sector have been Raffles Medical and Fullerton Health. Although the vaccination dosage interval was initially increased from 6 to 8 weeks due to a supply crunch, it was later shortened to 4 weeks to ensure that the population could be vaccinated quickly [60].

The local production of masks in the short-term was accompanied by ongoing innovations to increase the efficiency of production lines. In particular, the Agency for Science, Technology and Research (A*STAR) collaborated with Ramatex to design more effective masks [4]. Through the combination of A*STAR’s scientific knowledge and Ramatex’s expertise in textiles, the collaboration was able to produce a reusable mask that was as effective as medical masks, as shown in Fig. 4.

Details of mask produced by Ramatex and A*STAR. Source: A*STAR [3]

Aside from increasing the resilience of the healthcare sector, the government also sought to reduce youth unemployment brought about by the pandemic through the SG United Traineeship program, which works with private organizations to provide traineeships to recent graduates. Participating companies ranged from financial institutions such as DBS Bank, to telecommunications and event management firms such as Singtel and Kingsmen, respectively. As part of the program, Workforce Singapore (WSG), a government agency (a statutory board) under the Ministry of Manpower, has funded about 80% of the training fees while the participating private companies have agreed to pay the remaining costs.

Another major impact of COVID-19 was the closure of borders, which was extremely detrimental to Singapore’s small and open economy. Singapore’s government has continued to strive to open its borders safely once pandemic situations in its key partners stabilize. One key pillar in this initiative is to ensure that travelers are vaccinated or test negative for COVID-19 pre-departure. To facilitate information sharing about vaccination status, technologies such as Israel’s Green Pass and the European Covid Digital Certificate have been used. Building on the Open Attestation Framework developed by the Government Technology Agency (GovTech), private companies such as Accredify and Trybe.ID helped to amplify the reach of HealthCerts in other countries through their international networks [28]. The private companies have therefore enabled HealthCerts to be used in 9 countries and 420 medical facilities [28]. Foreign buy-in to HealthCerts for the storage of digital records of COVID-19 tests has been critical to the reopening of borders in Singapore and elsewhere.

Another instance of Singapore’s government capitalizing on digitalization is the collaboration between the MOH, SG United, GovTech Singapore and Nanyang Polytechnic to develop and further enhance the effectiveness of an app called TraceTogether across different models of phones [72]. The collaboration capitalized on the latter two’s existing facilities to accurately measure the signal strength between two phones [42].

According to Baxter and Casady [12], in the long-term, governments may continue their multisectoral partnerships and/or trans-national partnerships to ensure sufficient service delivery to the people. Yet it should be noted that relative to COVID-19, the short timeframe of SARS reduced the possibilities for long-term cross-sector collaboration. In contrast, in its response to COVID-19, Singapore’s government has shifted from a pandemic response to an endemic one, suggesting that it intends to maintain and expand such collaborative partnerships. Domestic policies that emphasize living with the virus, as we do with influenza, and eventually easing control measures, can be considered a long-term, strategic response to COVID-19.

Singapore’s population is highly vaccinated, with 90% having received the full regimen as of March 2022. Thus the government has increasingly strived to transition toward treating COVID-19 as endemic [70]. As with influenza or dengue, when COVID-19 is considered endemic, occasional outbreaks will be expected, but a shift will be seen to home recovery over hospitalization [37]. Given that the virus is still prevalent in many other countries and that there are wide disparities in vaccination rates internationally, the Singapore government has needed to ensure that healthcare policies and related infrastructure are in place for home-based treatment and focused care. For example, private telemedicine enterprises such as CommCare, Doctor Anywhere, Fullerton Health, and HiDoc were brought in to reinforce the MOH’s home recovery program by providing virtual consultation to COVID-19 patients including children. Their services have also included delivery of medications and in-person swabbing that can accommodate home recovery. Later, general practitioners (GPs and dentists in a voluntary manner have stepped into this telemedicine care for their own patients [62, 75].

In addition, looking to the future, Singapore has actively sought to prevent or at least mitigate the impacts of a future global pandemic by building up its international cooperation and collaboration chains. One notable effort by the government has taken place through the ASEAN member states. The ASEAN Strategic Framework for Public Health Emergencies was finalized in late 2020. It provides for a multilateral approach to public health emergencies and increases the capacity of ASEAN’s public health networks [56]. In particular, an ASEAN Regional Reserve of Medical Supplies was created to enhance the region’s ability to stockpile essential medical items such as PPE to protect healthcare workers and prevent a shortage as seen during the initial phase of the COVID-19 outbreak, when countries had to scramble to obtain PPE and oxygen ventilators [7].