SINGAPORE - Many things about the coronavirus were still unknown in the first half of the year, but Singapore knew it had to act fast to secure Covid-19 vaccine doses for its people.
This was even though some solutions were as novel as the pathogen itself - some vaccine candidates were being developed with new technologies that have not been used in any other vaccines on the market.
The data was limited, so risks had to be taken and bets made after careful analysis of available information. They all paid off on Monday night (Dec 21), when Singapore became the first nation in Asia to receive doses of the Pfizer-BioNTech Covid-19 vaccine. This, just weeks after Britain and the United States received theirs.
Professor Benjamin Seet, who oversees the expert panel that provides the Singapore Government with advice on Covid-19 therapeutics and vaccines, said during a press conference on Monday that advance purchase agreements hinged upon many factors, including safety and availability.
"If we want to buy it, will it be available? Because the doses could actually be bought up by bigger jurisdictions - for example, we have seen from the global media, the United States, European Union, many of the larger economies have bought huge chunks," said Prof Seet, who is deputy group chief executive for education and research at the National Healthcare Group.
"So essentially, to even put ourselves in the early order book, we need to make decisions as early as possible. And that's why we have advance purchase agreements," he explained.
Singapore signed its first advanced purchase agreement in June with Moderna - the American biotechnology firm behind one of the early Covid-19 vaccine front runners - to buy its vaccine. A down payment was made to secure the agreement.
At least two other agreements with vaccine developers Pfizer-BioNTech and Sinovac have been inked since then, and efforts are ongoing to shortlist and procure other vaccine candidates as part of Singapore's plan to ensure a diverse portfolio of Covid-19 vaccines.
Earlier this month, Prime Minister Lee Hsien Loong had said that if all goes according to plan, Singapore will have enough vaccines for everyone here by the third quarter of 2021.
Mr Leo Yip, head of civil service and chair of the planning group on vaccines and therapeutics, said the 11 months it took from Covid-19 arriving on Singapore's shores to when the Republic received its first shipment of vaccines was no fluke.
He said: "This was due to the significant advances in vaccine technology. But it was also due to the dozens of public officers who worked tirelessly and quietly behind the scenes over this period, to ensure that Singapore had early access to vaccines."
Step 1: Identify
Knowledge is power, or so the saying goes. But this is limited when it comes to a novel pathogen never before seen by the world.
So in April, Singapore took steps to ensure that it had access to all available information. The nation's first move was to form the therapeutics and vaccines expert panel, which is led by Prof Seet.
The panel comprised 18 scientists and clinicians from the public and private sector, who went through data on potential drugs to treat the disease, as well as more than 35 vaccine candidates. Their aim was to identify the most promising ones and assess which were safe and efficacious for Singapore to procure.
There are currently 56 Covid-19 vaccine candidates in clinical trials, and many of them leverage different technologies, such as inactivated virus vaccines, viral vector vaccines, or even DNA/RNA vaccines. All of them work in different ways, and Prof Seet said the panel considered all of them.
Traditional vaccines, such as inactivated virus vaccines and live attenuated vaccines, work by injecting whole but inactive viruses into patients to stimulate an immune reaction.
"But we eventually looked at RNA vaccines with a lot more interest, particularly because they were easier to manufacture. And therefore, they could go into clinical trials earlier, and be made available globally in the large quantities needed," Prof Seet said.
"So it was interesting from the point that you can get it fast. And you could get it in a timely manner. And you could get more data about it very early," he added.
The Pfizer-BioNTech vaccine approved for use in Singapore, for instance, is an RNA vaccine. So is the Moderna shot, which was recently approved for use in the United States.
RNA vaccines work by injecting snippets of the viral genetic code so a patient's body mounts a protective response without being actually exposed to the whole virus.
Data from late-stage clinical trials released last month by Pfizer-BioNTech and Moderna showed high success rates - both were shown to be more than 90 per cent effective at preventing Covid-19.
But hindsight is always 20/20. In the earlier months, Singapore had to find other ways of getting the information it needed to make a decision on which vaccines to buy.
Step 2: Investigate
Singapore's next step in late April was to form another group to make "strategic bets" on some of the vaccine candidates recommended by the expert panel, said Mr Yip.
This planning group was chaired by Mr Yip, and its mission was to procure and support the development of promising therapeutics as well as to secure early access to vaccines for Singapore. This group relied on the science-based assessments made by the scientific panel.
"We relied on EDB officers to establish contact with a wide range of vaccine makers," said Mr Yip, referring to the Economic Development Board. "We leveraged the strong relationships built up between EDB Singapore and pharmaceutical companies like Pfizer, as well as biotech companies like Moderna and BioNTech."
Non-disclosure agreements were also signed with a number of the companies, he added, which gave Singapore access to confidential data on the progress of the vaccines.
Typically, data from clinical studies are made public when they are published in scientific journals. But the process of peer review may take some time.
Prof Seet said Singapore signed about 40 non-disclosure agreements. "This allows us to get access to data that is not available in the published literature - to get it early and to be able to find out more from the teams that actually developed the drugs," he said.
None of these agreements were contractual, he clarified. This means that Singapore was not obliged to purchase any vaccines from the firm whom it signed the non-disclosure agreements with.
Broadly speaking, Singapore's approach to securing vaccines mirrored how the country secured access to other vital resources like food and energy: diversification.
Mr Yip said it was important for Singapore to select a portfolio of vaccine candidates as there was no certainty that even the more promising ones would eventually succeed.
The first vaccines may have arrived in Singapore, but this strategy is still one that the nation is holding fast to.
Step 3: Negotiate
More than $1 billion has been set aside to support Singapore's search for vaccines.
Dr Lisa Ooi, vice-president for healthcare and wellness at EDB, said that other than the procurement of the vaccine doses, this budget also includes funds for other, related purposes.
This includes Singapore's participation in the multilateral Covax facility initiative meant to ensure equitable vaccine access worldwide, as well as support for local development efforts in terms of therapeutics and vaccines, and support for companies that would manufacture vaccines here in the longer term.
EDB would not be drawn on the cost for each dose of the vaccine, citing confidentiality reasons.
Asked if Singapore's relatively small order affected its bargaining power with pharmaceutical companies, EDB senior vice-president and head for healthcare and wellness Goh Wan Yee said many pharmaceutical firms recognise Singapore's status as a leading biomedical hub in Asia.
"So I think that position, plus the fact that many companies actually have a base in Singapore, put us on good footing to negotiate and work with them on vaccine access," said Ms Goh. "So despite our small market size, I think companies are still keen to have their products launched and used in Singapore."