Singapore tops ranking of world's best places to be amid Covid-19 pandemic

Singapore topped Bloomberg's Covid Resilience Ranking this month.PHOTO: ST FILE

APR 27, 2021


HONG KONG (BLOOMBERG) - A combination of nailing the virus and rolling out vaccines at one of the fastest rates in Asia saw Singapore top Bloomberg's Covid Resilience Ranking this month, dethroning New Zealand for the first time in the measure of the best and worst places to be in the pandemic era.

The tiny city state had got locally transmitted cases down to near zero thanks to border curbs and a strict quarantine programme, allowing citizens to largely go about their everyday lives, even attending concerts and going on cruises.

At the same time, Singapore had already administered vaccines that cover the equivalent of a fifth of its population, an aspect of pandemic control that other virus eliminators like New Zealand, Australia and Taiwan are lagging on.

But if there's one lesson from April, it's that vaccination alone isn't ending the pandemic.

Places like France and Chile, where people have good access to shots, fell in the Ranking as outbreaks swelled - fuelled by mutations of the virus that increasingly have their source in the developing world, where vaccines are in short supply and mitigation efforts are failing. While more than one billion doses have now been administered globally, not enough are going to poorer nations like India, which are driving global infection levels to new records.

Nowhere has this played out more worryingly than in Poland and Brazil, which dropped to the bottom two spots among the 53 economies ranked. Mexico, which has been last since the Ranking debuted in November, inched up in April for the first time, to 48th, as its virus testing improved.

The United States climbed four rungs this month to 17th, as its fast vaccination programme saw a reduction in deaths, though cases ticked up amid a loosening of precautions.

Britain - up seven places to No. 18 as its lockdown lifts - was pairing rapid inoculation with tighter border controls to keep out new variants, the most recent barring travellers from India, where a new "double mutation" strain has emerged. The Asian giant, which is now seeing more than 300,000 infections every day in a resurgent outbreak, sank 10 places to 30th in April.

The Covid Resilience Ranking uses a wide range of data to capture where the pandemic is being handled most effectively, with the least social and economic disruption - from mortality and testing rates to vaccine access and freedom of movement. It scores economies of more than US$200 billion (S$265 billion) each month on 10 core metrics.

The start of vaccinations in a number of places a few months ago meant some governments loosened restrictions too early, presenting an opening for variants to seed widely before high enough levels of immunity had been established.

Poland has administered vaccinations enough for 13 per cent of its population, greater penetration than two-thirds of the world. Yet the variant first identified in Britain took over, accounting for 90 per cent of new infections and causing a record spike in cases and fatalities. Meanwhile, the virulent strain first identified in Brazil is ravaging Latin America, even in places like Chile where nearly a third of the population has been fully vaccinated.

Though some places like Israel have seen marked reductions in their outbreaks thanks to early and widespread vaccination, experts caution against complacency that could still undo their progress. With over 55 per cent of its population fully vaccinated, Israel rose to 4th in April's Ranking.

"This is not over by any means," said Dr Ali Mokdad, chief strategy officer for population health at the University of Washington. "The longer this drags on, the more likely it is that we will see new variants. Then there is a need for a new vaccine or a booster vaccine, and we start all over again."

With the variants' spread outpacing vaccination in many places, the Asia-Pacific region's success at eliminating and keeping out Covid-19 means its economies continue to dominate the Ranking. The top three - Singapore, New Zealand and Australia - are able to provide a pre-pandemic quality of life for their populations, with the exception of international travel, which is basically shut down to prevent the virus from slipping back in.

Vaccine supply in most places around the world is grossly inadequate, with richer nations like the US and Japan snapping up stock of the highly sought-after and effective mRNA shots. Even among the biggest vaccine manufacturers in the world, supplies are tight, with India and China having difficulty producing enough doses for their vast populations. Side effects associated with shots from AstraZeneca and Johnson & Johnson are adding to hesitation among people in some places to get inoculated.

The fate of tenuous steps towards reopening by some countries, and the race between vaccination and virus variants, will be the key focus for the Covid Resilience Ranking into May.


The poverty trap

While the failure of powerful, developed economies to curb the spread of the coronavirus has been a stunning development of the pandemic, major Western nations like the US and Britain have since gained back ground in sewing up vaccine supply and rolling out shots.

Meanwhile, most developing nations have yet to start inoculations in a significant way, lacking the purchasing power to sign supply deals. Countries with the highest average incomes are getting vaccinated about 25 times faster than those with the lowest.

Covax, the World Health Organisation-backed effort to help poorer countries procure doses, started distributing shots only at the end of February.

Disparities in immunity pose a threat to the world: The more the coronavirus spreads unchecked, the more opportunity there is for dangerous new mutations to develop. Some existing vaccines have already been shown to be less effective against new variants like the one from South Africa, and the chance of a mutation entering a vaccinated country and igniting a new wave cannot be discounted.

"We need countries and companies that control the tools that could save lives to share financial resources, vaccine doses and know-how and to be transparent about their bilateral donations," WHO director-general Tedros Adhanom Ghebreyesus tweeted in April.

The growing crisis in the developing world is putting pressure on advanced economies to do more to help. In India, where devastating scenes of oxygen shortages and overwhelmed crematoriums are unfolding, vaccine makers say that production capacity is limited by the US prioritising raw materials for its own use. Meanwhile, US President Joe Biden's government is also sitting on a stockpile of tens of millions of extra doses after securing enough for the American adult population.

The pandemic's hit to emerging economies is likely to be longer and more sustained.

Most countries in Latin America won't be able to return to pre-pandemic growth levels until 2023 and per capita income won't recover until 2025, later than anywhere else, according to the International Monetary Fund.

The World Bank says the pandemic will push as many as 150 million people into extreme poverty by the end of 2021.

Vaccine advantage

It's in vaccination where former laggards like the US and Britain have made up for lost ground, with investment in science and research proving pivotal to their leads when it comes to shots. Operation Warp Speed saw some US$18 billion ploughed into developing the first Covid vaccines that have now been administered to cover the equivalent of 35 per cent of the American population.

In Israel, where more than half of the country's nine million people have been fully vaccinated, life is normalising fast. Live theatre and sporting events are back on, mask wearing is no longer required outdoors, restaurants and bars are packed, and students are attending classes in person. In Britain, some pubs are allowed to open while in the US, domestic travel bookings are surging.

Still, in an acknowledgement that these gains are fragile, officials are trying to reopen only cautiously. Israel will allow international tourists starting from May 23, but only in stages, starting with groups for easier monitoring. Britain will allow non-essential travel to a list of "greenlit" countries next month, but the government is asking citizens to lower their expectations for summer vacations.

Even in the US, which has largely refrained from imposing travel curbs throughout the pandemic, the State Department issued guidance in April advising travellers not to go to over a hundred countries due to the Covid-19 risk.

The worldwide vaccination effort has seen some major setbacks, with reports of blood clotting after inoculation associated with the AstraZeneca and Johnson & Johnson vaccines. Although roll-outs have resumed after regulators said the vaccines' benefits outweigh the risks, the controversy has discouraged some people from coming forward.

In the Asia-Pacific region, a delay in starting inoculation is being compounded by widespread hesitation. After early success containing the virus, people in places like China and Japan appear less enthusiastic about taking shots compared with Western nations, with some not seeing an urgent need.

With smaller outbreaks and few fatalities, these economies still have an edge in the Resilience Ranking, but for how long?


Magic formula?

The underperformance of some of the world's most prominent democracies in containing the coronavirus, contrasted with the success of authoritarian countries like China and Vietnam, has raised questions over whether democratic societies are cut out for tackling pandemics.

Bloomberg's Covid Resilience Ranking tells a different story: Democracies have made up the majority of our top 10 since the measure's debut in November. Success in containing Covid-19 with the least disruption appears to rely less on being able to order people into submission and more on governments fostering a high degree of trust and societal compliance.

When citizens have faith in the authorities and their guidance, lockdowns may not be needed at all, as Japan and South Korea showed through most of 2020, though fierce winter waves definitely challenged those more open approaches.

Now No. 2 after a five-month run at the top, New Zealand emphasised communication from the start, with a four-level alert system that gives people a clear picture of how and why the government acts as the outbreak evolves. Like China, Singapore and Australia, it also shut its borders, which has proven a key metric for containment success.

Investment in public health infrastructure also matters. Undervalued in many places before 2020, systems for contact tracing, effective testing and health education bolstered the top performers, helping socialise hand-washing and the wearing of face masks. This has been key to avoiding economically crippling lockdowns, according to Dr Anthony Fauci, the US' top infectious diseases official. Singapore - the new No. 1 - mandates masks in public and uses apps to make contact tracing easier.

What next?

Bloomberg's Covid Resilience Ranking is a snapshot of how the pandemic is playing out in 53 major economies. By zeroing in on the progress of vaccine distribution, it also provides a window into how these economies' fortunes may shift in the future.

It's not a final verdict - it never could be, given the imperfections in virus and vaccine data and the fast pace of this crisis, which has seen subsequent waves confound places that handled outbreaks well initially. Circumstance and pure luck also play a role, but are hard to quantify.

Vaccine roll-out is a decisive factor in 2021, with challenges from logistics and storage to hesitancy about getting inoculated. Still, having endured over a year of fighting Covid-19, governments and populations now have a better understanding of the pathogen and how best to curb its spread and mitigate the damage it inflicts.

As the data shift, the Ranking will change too.