Historian LOH KAH SENG and physician HSU LI YANG, authors of a new book, Pandemics in Singapore, 1819–2022, argue that history, governance and science should work better with one another in the next pandemic.
How can a historical lens inform our understanding of the COVID-19 pandemic in Singapore? The Singapore government has long prided itself on good governance and scientific expertise. While it drew upon those strengths in managing COVID-19, the past was deemed to be of little use.[1] Yet, we argue, we have much to learn from Singapore’s encounters with infectious diseases in the 19th and 20th centuries, and a failure to do so affected Singapore’s responses to COVID-19.
This article draws on analysis from our new book, Pandemics in Singapore, 1819-2022: Lessons for the Age of COVID-19 (Routledge, 2023). In particular, we consider the pandemic as a historical event with a past, against which it can be compared and measured. At the same time, Singapore’s experience with COVID-19 challenges us to rethink our understanding of previous and future pandemics.
Applying a historical method
Historians are often wary about lessons because it is possible to draw opposing ones from the same event. We must study the past before turning to the present, rather than look to history to justify preconceived ideas derived from contemporary events.
This requires attention to three principles of historicism, the concept at the heart of the historical discipline.[2] One is Difference: the past and the present are not the same, so a straight line should not be drawn between two events. This prevents a precedent, say the 1918 influenza pandemic, from being selectively chosen and its learning points passed off as historical lessons.
The second principle is Context. No two events are the same, because their contexts are different. The 1918 pandemic was an event of its times, just as COVID-19 is an event of our times.
The third is Process. Contexts are different, because changes have occurred in between two events. If there is continuity, it is because the process has favoured it over change. Usually, there is a combination of change and continuity. Contrary to common belief, historicism means that history does not really repeat itself.
Historicism also means that any ‘lessons’ from a historical examination of the COVID-19 pandemic are modest questions rather than big answers. The study of history pushes us to question what we have been doing. One of its strengths is for us to rethink assumptions and values we may hold dear, by confronting us with the assumptions and values of previous eras.
Lessons from history
A clear lesson from Singapore history was the error of taking the biggest or most obvious precedent as the point of reference. When COVID-19 began to spread, it seemed that the Singapore government and scientists were fighting the last major epidemic — SARS in 2003. The early months of 2020 were spent applying what were believed to be the lessons of that outbreak. Some were helpful, such as the clear communication from the authorities and the use of PPE.
But while SARS is part of the country’s pandemic history, it is only one event. Singapore leaned too heavily on the memory of SARS, and the experience misled in significant ways. Masks were initially discouraged and the aim was to eliminate COVID-19, as it was with SARS. Only a year later, in mid-2021, with a good rate of mass vaccination, did Singapore accept the idea of ‘Living with COVID-19’ as an endemic disease.[3]
Perhaps hindsight is 20-20. But the principles of historicism would have sounded a note of caution. The SARS virus, while also a human coronavirus, is different from the COVID-19 pathogen. While it took time for scientists to establish this, Singapore was not self-aware enough to avoid using the SARS lessons as a package. COVID-19 should have been treated as a different disease from the start.
In fact, the government and the scientists had reason to know this. A pandemic plan had been drawn up after SARS, stressing that Singapore should be flexible when implementing the plan in the next outbreak.[4] This is difficult to do, especially when data is incomplete. But history is our aid because it makes us study a large number of pandemics, so that we do not mistakenly dwell on the seemingly obvious precedent.
Another lesson is that human behaviour matters as much as policy and drugs in controlling a pandemic. Singapore overemphasised governance and science, neglecting the humanities and social sciences. But it was not really the vaccines in isolation that tamed COVID-19, but the fact that most people accepted them.
The importance of this element is manifest from a study of history. Most Asians in colonial Singapore did not report cases of infectious disease to the authorities as required by the law. They were deterred by how the British handled cases – the person and their neighbours would be treated like criminals, their belongings burned, before they were marched off to the quarantine station on St. John’s Island. This was a beautiful island, but a commission of inquiry in 1912 found that the conditions of quarantine there were horrific. Some quarantine cases were beaten by the attendants, who were less interested in their well-being than in rearing poultry to sell. Women in particular had no privacy and their spouses often joined them in quarantine to care for them. The quarantine station earned the nickname ‘the slaughterhouse’, as people could see the bodies in the morgue in plain sight, thinking that was where they would end up.[5]
Thus Chinese, Indian and Malay residents of Singapore alike did not notify the colonial government of an outbreak. When someone in a shophouse died from an infectious disease, the neighbours would leave the body alone inside a cubicle. They called the authorities and waited for the body to be removed, and the cubicle disinfected, before reoccupying the space. They did not act like this when the disease was non-infectious. They cooperated on their own terms, but even then refused to give details of the dead.
It was not only the illiterate coolie who did not cooperate, but also the educated and wealthy, such as merchants and the Straits Chinese. The latter pushed the government to build, in 1913, a new infectious diseases hospital at Moulmein Road, where they would be properly treated.
But history also tells us that people’s psychology and behaviour can change. After the Second World War, Singapore’s population was more receptive to new antibiotics, vaccines and public health campaigns, because these were demonstrably more effective. Social cooperation is not a given, but determined by historical circumstances.
Looking to the future
The humanities and the social sciences are of vital importance to fighting the next pandemic. They provide insights into people’s worldviews and socio-economic concerns — something that should not be taken for granted.
When Singapore transitioned to living with COVID-19, it was difficult for some groups of people, such as business owners and older people, to adapt. Yet historically, living with an endemic disease is not new; it has been Singapore’s default experience. The denizens of the colonial city lived constantly with the continuing threat of endemic diseases such as plague, cholera, smallpox, and flu, after the initially explosive outbreaks of each passed. Knowing this history might have helped ease the transition to living with COVID-19 for many.
This is a salient point for Singapore’s migrant workers, who endured mental and financial distress in a prolonged period of lockdown. Ambassador Tommy Koh, in the foreword of Pandemics in Singapore, questioned if the massive outbreak of COVID-19 in the worker dormitories could have been prevented. The plight of migrant workers is deeply-rooted in Singapore history, where people’s perspectives and interests have been secondary to the demands for outbreak management.
Generally, Singapore did well against COVID-19, but also made mistakes that could have been mitigated with knowledge of our medical history. Conversely, recent experience can help us rethink our historical narratives. Before SARS and COVID-19, quarantine had been dismissed as an archaic measure, while historically, influenza was accepted as a slippery disease that could not be controlled by quarantine or vaccination. Both viewpoints may no longer be tenable.
This analysis offers the hope that history, governance and science can work better with one another in the next pandemic. As John Tosh put it, a historian is not only an academic scholar, but also a guardian of society’s cultural heritage.[6] The history of pandemics is part of that heritage. We need not wait till the next crisis to study the past.
Loh Kah Seng is a historian of Singapore and Director of Chronicles Research and Education, a research consultancy. His books include Squatters into Citizens: The 1961 Bukit Ho Swee Fire and the Making of Modern Singapore (NUS Press 2013); Tuberculosis – The Singapore Experience, 1867-2018: Disease, Society and the State (Routledge 2020); and Theatres of Memory: Industrial Heritage of 20th Century Singapore (Pagesetters 2021).
Hsu Li Yang is an infectious diseases physician who currently serves as the Vice Dean of Global Health at the Saw Swee Hock School of Public Health. He has been on the frontlines of various major epidemics and outbreaks in Singapore, starting from SARS in 2003. He is co-author of Tuberculosis – The Singapore Experience, 1867-2018: Disease, Society and the State (Routledge 2020).
[1] Sumiko Tan (ed.), In This Together: Singapore’s COVID-19 Story (Singapore: Straits Times Press, 2022), p. 56.
[2] John Tosh, The Pursuit of History: Aims, Methods and New Directions in the Study of History (London and New York: Routledge, 2015), 6th edition.
[3] Straits Times, 24 June 2021.
[4] Tan Chorh-Chuan, ‘Public Health Response: A View from Singapore’, in Malik Peiris at al. (ed.), Severe Acute Respiratory Syndrome (Malden, Massachusetts: Blackwell Publishing, 2005).
[5] Straits Settlements Quarantine Inquiry Commission, Proceedings of the Commission Appointed to Inquire into the Working of the Quarantine and Prevention of Diseases Ordinance in the Settlement of Singapore, in the Colony of the Straits Settlements (Singapore: Government Printing Office, 1912), 2 volumes.
[6] Tosh, The Pursuit of History.