S’pore adopts a ‘just in case’ approach to strategic vulnerabilities: Chan Chun Sing

SINGAPORE – Adopting a “just in case” instead of “just in time” approach to deal with potential crises is what Singapore requires, Defence Minister Chan Chun Sing said.

The essence of the “just in case” approach is investing ahead of time in capabilities that are not fully appreciated until the moment they are needed, Chan said, when he opened the 20th Public Health and Occupational Medicine Conference at Temasek Club on Aug 13.

Taking a leaf from what late former US defence secretary Donald Rumsfeld said about “known knowns”, “known unknowns” and “unknown unknowns”, Chan said the conference theme, “From Prevention to Preparedness: Safeguarding Health Across Systems”, was apt.

“We all know that preventing something from happening, dealing with the ‘known knowns’, is necessary but not sufficient... It is much more challenging to deal with the ‘known unknowns’ and the ‘unknown unknowns’,” he added.

An example of a “known unknown” is disease outbreaks, which are bound to happen at some point.

But something on the scale of the Covid-19 pandemic is considered an “unknown unknown”, as the world did not know the nature of the public health crisis, the timing of the outbreak or the preparations needed.

Touching on “unknown unknowns”, the minister said these could be in the realm of geopolitics, medicine and public health, for instance, and that this “should set us thinking about how we should prepare ourselves, our teams and our systems”.

Systems that are built “just in time” are lean and efficient and deploy resources only when the need arises.

But drawing parallels between public health and defence, Chan highlighted that there are vulnerabilities where the “just-in-time” approach is simply not good enough, as there will be no time to build capability from scratch when a crisis hits.

Hence, there is a need to go upstream with the “just in case” philosophy, which is also what the Singapore Armed Forces (SAF) medical system is built on, said Chan, who is also the Coordinating Minister for Public Services.

Through processes, including pre-enlistment medical examination and medical classification, SAF identifies risks and places national servicemen in roles suited to their health profiles, protects them from avoidable harm, and preserves operational readiness, he said.

In addition, the upstream approach continues throughout their service, including through vaccination, heat injury prevention and follow-up of medical issues that could affect their training and deployment.

“The objective is simply this – to keep our servicemen healthy, safe, deployable and able to contribute to Singapore’s defence,” Chan said.

Through lessons learnt from dealing with the 2003 severe acute respiratory syndrome, or SARS, crisis, Singapore made strategic investments in national stockpiles of masks and antivirals and SAF’s operational medical stockpiles, he pointed out.

The National Centre for Infectious Diseases was also opened in 2019 with dedicated isolation capacity and outbreak response capabilities.

Chan said the prior investments gave Singapore a stronger footing when faced with the Covid-19 pandemic.

“That is the essence of ‘just in case’ – investing ahead of time in capabilities that are not fully appreciated until the moment they are needed,” he said.

Beyond these upstream efforts, there is also a need to ensure that the entire system, not just individual sectors, is prepared to deal with future challenges.

As servicemen receive care from the national healthcare system before, during and after national service, the SAF medical services work closely with public healthcare institutions on specialist care, vaccinations, infectious disease management and continuity of care.

There are also efforts to deepen integration, such as the SAF adopting the Health Ministry’s Next Generation Electronic Medical Record for the next iteration of its own electronic medical record system.

The moves not only support better continuity of care between the SAF and the national healthcare system but also ensure healthcare resilience, which today extends beyond capacity and manpower to data integrity, system uptime, cybersecurity and continuity of operations.

“Preparedness must include secure data systems, interoperable systems and platforms, stronger cyber hygiene, regular stress-testing, and trusted coordination across services and sectors. If we neglect this, we are building resilience with a gap in our foundation,” Chan said.

Beyond systems and infrastructure, the minister stressed that people will always remain Singapore’s decisive advantage.

Most important investment is in the people

Investing in people is the most important “just in case” investment, “because it is the ingenuity and determination of our people that will make or break us in any crisis”.

Chan said training needs to be across disciplines, rather than within professional silos, and that doctors, nurses, public health practitioners, psychologists, exercise scientists, commanders and data specialists, who each bring their own expertise to the table, must learn to operate as one team before the next crisis emerges.

“To be able to deal with the ‘known knowns’ is level 101 basic competency,” he said.

“But for Singapore to continue to survive, to thrive and defy the odds of history, we will have to go beyond level 101, to seriously consider how we build our systems, how we build our teams, in order to deal with the many more ‘unknown unknowns’ in this tumultuous world.”

The two-day conference is jointly organised by the Academy of Medicine, Singapore (AMS) and its College of Public Health and Occupational Physicians (CPHOP).

The SAF Medical Corps has partnered with AMS and its college for the first time to organise the conference – a move that CPHOP president Brian See described as “especially fitting”.

See, who is also the chief air force medical officer, said military medicine, public health and occupational medicine all share a common purpose “to anticipate risks, protect people and build resilience before crises occur”.