What Singapore could teach the world about disease control

Aerial view of Singapore business district and city at twilight in Singapore, Asia
The city state known for its no nonsense approach to public health - Shutterstock

Dressed in hazmat suits, public health officials stalk Singapore’s streets. They have just one job – to stamp out dengue before it spreads.

Hundreds of officials move house to house, seeking out sanctuaries for the disease carrying mosquitoes and issuing fines as they go.

Leaving old car tyres in a garden to gather water, for instance, will attract a fine of up to £5,000.

The initiative is part of what has been described by the epidemiologist Professor Neil Ferguson as the world’s “gold standard” in Dengue control and prevention.

Dengue has wreaked havoc across south-east Asia in the last few years. Between 2015 and 2019, cases in the region soared by 46 per cent.

Singapore has also been hit – there were 5,000 cases in the first quarter of this year, double the same period in 2023 – but the city state known for its no nonsense approach to public health is not taking the threat lying down.

An aedes aegypti mosquito is displayed under a microscope at the National Environmental Agency's mosquito production facility in Singapore
Traps capture mosquitoes so scientists can study them - EDGAR SU/REUTERS

“When you do get a sudden increase in the number of cases, it has to be taken seriously,” said, Professor Neelika Malavige, head of the Dengue Global Programme at DNDi.

“The control programs in Singapore are unmatchable to anywhere else on Earth”.

Dengue is a viral infection more common in tropical and subtropical climates. The most common symptoms are high fever, headache, body aches, nausea and rash. In rare cases it can be fatal.

Singapore has a two pronged approach to the disease, focusing on vector control and surveillance, which is ongoing even when the virus is at low ebb.

Vector control refers to any method to limit or eradicate mosquitoes, and it is where Singapore’s fight begins.

All year round public health officers inspect homes and businesses, checking for receptacles that could collect stagnant water, but their efforts step up during peak dengue season between May and October.

Any person found guilty of neglecting to keep their property clear of potential breeding grounds is issued with a hefty fine.

Hundreds of officials are ready and waiting to be called upon to up the programme if cases or mosquito populations increase.

A sanitation inspector uses a fogging machine during a fumigation operation against the spread of Dengue in a community of Marikina City, east of Manila, Philippines
The programme focuses on surveillance and vector control, which includes fumigation - ROLEX DELA PENA/EPA-EFE/REX

“It can happen literally overnight,” Professor Eng Eong Ooi, Duke-NUS Medical School’s Emerging Infectious Diseases programme, told The Telegraph.

He explained that the campaign is the “foundation” of Singapore’s approach and that as soon as mosquito habitats are reduced, populations crash.

“The foundation is that both the mosquito control officials and public health officials will be visible, going from house to house or apartment to apartment, to make sure that there are no receptacles that will collect water and then form breeding sites,” Professor Eng Eong Ooi said.

“The public is always educated to keep premises clean of places where mosquitoes can breed, and that’s backed up by law enforcement, so there are legal penalties if you get caught.”

Singapore uses this system as the basis for a far more high-tech approach. Since 2016, it has released five million mosquitoes infected with wolbachia bacteria every week.

This bacteria prevents the mosquitoes or their offspring from transmitting the virus that causes dengue at a cost of $35 million per year, or around $6 per resident.

“The programs are very costly,” said Professor Eng Eong Ooi. “But studies suggest that the very high expenditure of attempts to control have an overall benefit, because the cost of the burden of disease is actually much higher than what we’re spending.”

An enclosure filled with female and male Wolbachia-carrying mosquitoes mating at the newly opened National Environmental Agency (NEA) mosquitoes production facility is seen in Singapore
An enclosure filled with Wolbachia-carrying mosquitoes at Singapore's National Environmental Agency - ROSLAN RAHMAN/AFP via Getty Images

Across Singapore, mosquito-collection devices known as Gravitraps are in action.

The traps gather data on the distribution of mosquitoes and their density, which is then feeded into forecasting models that can provide early warnings of outbreaks and where resources need to be deployed.

“You use deadly traps to capture mosquitoes so you can study them,” explained Professor Malavige.

“To understand, okay, is their competence of transmitting dengue getting better? Do you see certain adaptations within the mosquito itself that makes it better in transmitting? Is it adapting better to climate change?”

Data collection is often a big challenge for countries facing dengue outbreaks, because cases often aren’t recorded, but Singapore is working on a solution for this too.

At different times different clinics are funded by the government to test all patients for dengue.

Each time a doctor diagnoses a case, they must immediately inform the Ministry of Health.

“Singapore is definitely getting better data than many other countries, if not all the other countries in the region,” said Professor Eng Eong Ooi.

“In terms of the control programme, it is arguably the best in the world.”

Protect yourself and your family by learning more about Global Health Security