Public Health Legacies: Tuberculosis, HIV/AIDS, and SARS in Singapore

Abstract

Tuberculosis, HIV/AIDS, and Severe Acute Respiratory Syndrome (SARS) are historically significant cases of infectious disease outbreaks that have posed economic, social, reputational, and moral challenges to Singapore and its much-vaunted model. Until only in recent years, Singapore’s neoliberal public health system—focused on efficiency and optimal allocation—had neglected HIV/AIDS and thus the segments of society often associated with it. This neglect had been heightened by prevailing social stigmas and stereotypes. This may shed some light on the COVID-19 pandemic, which elicited rapid, responsive, robust, and inclusive government action where mainstream Singaporean community was concerned, but at the same time failed to recognize and deal with the marginalized and possibly stigmatized segments of society, such as migrant workers, whose badly infected dormitories became an international spectacle of crisis and social injustice. COVID-19 resembled tuberculosis and HIV/AIDS in terms of social stigmatization and even moral panic over the unhealthy elements in society. This resulted in the othering of—and disproportionate concern and hostility towards—teenage “spitters” who threatened to spread tuberculosis through their “defiant” behaviour, homosexuals who threatened to spread HIV/AIDS through their “immoral” behaviour and migrant workers in dormitories who were the foreign bringers of disease. The SARS crisis in 2003 was a “wake-up call” for a less-than-prepared Singapore. A subsequently more proactive government learnt key lessons from the crisis, which were systematically institutionalized in readiness for the next infectious disease outbreak.