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World of Genomics: Singapore

World of Genomics: Singapore originally written by Skel Yeung, September 2022. Updated by Aleisha Collins, 2024.

In this week’s world of genomics, we explore Asia’s “Garden City,” Singapore is a small island known for its diverse population and global contributions to finance, technology, genetics, and genomics. Its notable achievements include the creation of the world’s most extensive Asian genetic databank, with whole genome sequences of over 5,000 Singaporeans, a population that had not been comprehensively studied previously.

The Population of Singapore

Singapore, a sovereign island country in Southeast Asia, is situated at the tip of the Malay peninsula, with maritime borders shared with Malaysia and Indonesia.

According to Malay tradition, the island was visited by a prince from the Sumatran empire of Śrivijaya, who founded and named the city of Singapura. Although the city was devastated by the Javanese in the 14th century, it was later founded by Stamford Raffles of the British East India Company in 1819.  During World War II, Singapore was occupied by Japan in 1942 before returning to British control in 1945. In the following decade, Singapore achieved independence and became a self-governing city-state under the leadership of the People’s Action Party.

Geographically, Singapore encompasses the main island and sixty-four smaller offshore islands. Often referred to as the “Lion City” or “Garden City” for its abundance of parks and tree-lined streets, Singapore is renowned for its cultural diversity. The country officially recognizes four languages: English, Malay, Mandarin and Tamil, reflecting its multicultural identity. In fact, a 2014 survey by the Pew Research Centre recognized Singapore as the “most religiously diverse nation in the world.”

Geographic and demographic information

Summary statistics

Land area: 718 km²

Gross domestic product (GDP):

  • Total: USD 466.79 billion (2022)
  • Per capita: $82,807.6 USD (2022)

Population statistics

Population size:  5,637,022 people (2022 est.)

Birth rate: In 2020, the crude birth rate was 9 births per 1000 people.

Death rate: In 2021, the crude death rate was 6 per 1,000 people

Infant mortality rate: In 2021, it was 2 deaths per 1,000 live births

Life expectancy: 

  • Males: 81
  • Females: 86
  • Total: 83 (2021)

Ethnicities: Singapore is a multicultural and multiethnic country. 75.9% of the citizens and permanent resident visa holders are ethnic Chinese, with ethnic Malays and Indians comprising 15.0% and 7.5% respectively. When combined, the three largest ethnic groups comprise 98.4% of the population.

Healthcare system

Singapore stands tall as the healthcare and medical hub of the region, boasting Asia’s finest healthcare system and offering its citizens universal coverage with multiple layers of care.

The foundation of Singapore’s current healthcare system was laid in 1983 with the introduction of the National Health Plan. A multi-payer financing framework forms the basis, wherein citizens share the responsibility through funding via taxes and insurance schemes. The system features a single-payer program, Medishield, providing catastrophic insurance, alongside universal Health Savings Accounts, known as Medisave. Singaporeans contribute a portion of their income to Medisave accounts, securing funds for future medical expenses. Medishield, an affordable medical insurance scheme, aids Medisave account holders in meeting the costs of serious or chronic illnesses. In addition, the government has set up Medifund, a safety net to support individuals who cannot afford medical care, ensuring access for all without reliance on third-party payers.

Government hospitals make up 80% of all hospital beds, while the private sector accounts for the remaining 20%. Over the years, the density of physicians has significantly improved, rising from 13 per 10,000 population in 1999 to 24 in 2019, surpassing other ASEAN countries like Indonesia, the Philippines and Myanmar. The density of nursing and midwifery personnel has also grown, increasing from 40.2 per 10,000 people in 1999 to 61.8 in 2017.

Despite spending the most annually on healthcare among its ASEAN peers, Singapore’s healthcare spending, comprising both public and private healthcare expenditure, remains relatively low at 6.05% of its GDP. However, this seemingly modest figure does not diminish the country’s achievements in healthcare. Singapore has attained world-class standards and ranks 10th in the 2022 World Index of Healthcare Innovation. The Bloomberg Health-Efficiency Index of 2020 also crowned Singapore as the world’s most efficient healthcare system, thanks to its top-notch digital healthcare and research universities.

As of July 2023, Singapore’s healthcare system is undergoing significant changes with the phased implementation of the Healthcare Services Act (HCSA). This transformative act replaces the outdated Private Hospitals and Medical Clinics Act (PHMCA), shifting from premises-based to services-based regulation. The move aims to adapt to evolving care models and promote a more flexible approach to delivering healthcare services. The phased implementation is set to conclude by the end of 2023 when the PHMCA is slated for repeal.

Singapore’s unwavering commitment to quality healthcare and innovative advancements solidifies its position as a beacon of excellence in the healthcare world, setting an example for the entire region.

Health Priorities

Singapore faces several healthcare priorities to ensure the well-being of its population.

Among the primary causes of death in the country, cancer leads, accounting for 26.4% of 2021 deaths. Ischaemic heart diseases and pneumonia follow closely, making up almost 40% of overall deaths. Despite Singapore’s excellent healthcare system, there are challenges to address, including a shortage of doctors and nurses, compounded by an ageing population that strains resources like hospital beds. By 2030, over a quarter of the population will be 65 years and older, necessitating the development of more facilities for the elderly, such as nursing homes and rehabilitation centres. Singapore’s ageing strategy focuses on value-based payment, community-based services, caregiver support and empowering personal and family responsibility for social connection, prevention and health-promoting behaviours.

Mental health remains stigmatised in Singapore, with suicide only decriminalised in 2020. Disturbingly, Singapore had the highest suicide mortality rate among all ASEAN member states between 2000 and 2019. Approximately 13.9% of the adult population experiences at least one mood, anxiety or alcohol use disorder during their lifetime and reports indicate that around 1 in 7 Singaporeans have experienced a mood or anxiety disorder at some point in their lives. To address the rising prevalence of mental health issues, Singapore has been working to increase awareness, enhance mental health services and reduce the stigma associated with seeking help. There are plans to improve access to mental health services and provide subsidies to lower-income Singaporeans and citizens with chronic conditions.

Singapore’s effective response to the COVID-19 pandemic was primarily focused on mitigation, drawing from its experience in adopting preventative measures during the SARS epidemic in 2003. Mitigation efforts aimed to limit population movement and encourage social distancing, while containment strategies focused on contact tracing and quarantine measures. Singapore has had 2,519,716 confirmed cases of COVID-19 since January 2020 and 1,841 deaths, which is notably better than the similarly sized Denmark, which has reported 3,414,510 cases and 8,764 deaths over the same period.

Addressing these healthcare priorities remains crucial for Singapore as it strives to maintain the well-being and health of its citizens, adapt to an ageing population and continue its effective response to public health challenges.

Genomic medicine capabilities

Singapore is a leading hub for genomics and biodata research, housing world-class institutions like the Genome Institute of Singapore (GIS) and the Singapore-MIT Alliance for Research and Technology (SMART) Center. These institutions are at the forefront of genomics research, focusing on areas such as cancer genomics, infectious diseases, population genomics and precision medicine. The Singaporean Ministry of Health has identified precision medicine as a transformative approach to address healthcare challenges, with the National Research Foundation, Singapore (NRF), making it a strategic goal in the Research, Innovation and Enterprise (RIE) 2025 plan. The integration of research with government efforts to establish national precision medicine as a strategy is targeted for completion by 2027.

Singapore has significantly expanded its engagement in genetics and genomics research over the past decade, marking a notable achievement in 2019 with the completion of the world’s largest multi-ethnic Asian genetic databank. Collaborative efforts from institutions like A*STAR’s Genome Institute of Singapore, NUHS, PRISM, NUS and others culminated in the whole genome sequencing of around 5,000 Singaporeans. This landmark project aimed to provide valuable insights into the unique genetic diversity of Asian populations. The study unveiled 98.3 million genetic variants, with a majority previously unreported in databases primarily focused on Western populations. Professor Yong Loo Yin highlighted the study’s potential in understanding the genetic basis of diseases in Asian populations, which would enable accurate diagnosis of inherited diseases, support chronic disease research and facilitate preventive medicine approaches and targeted therapies. Building on this progress, in 2022, PRECISE announced a strategic partnership to sequence and analyse 100,000 Singaporean whole genomes, establishing Southeast Asia’s most comprehensive consented population study.

Genetic counselling and testing are becoming increasingly accessible in Singapore. The launch of the SingHealth Duke-NUS Genomic Medicine Centre (SDGMC) in 2019 has accelerated genomics research and provided specialised genetics care to improve treatment for patients and families with genetic diseases in the country. This centre has seamlessly integrated genomics care into Singaporean healthcare clinics, offering crucial genomics perspectives, personalised treatment for patients with genetic conditions and better risk assessments and interventions for at-risk family members.

Singapore’s commitment to genomics research and its efforts to advance precision medicine demonstrate the country’s dedication to leveraging genomic insights for improved healthcare outcomes and transformative medical interventions.

Notable projects

  • National Precision Medicine (NPM) strategy: Singapore’s NPM strategy is a 10-year research roadmap to accelerate biomedical research and improve health outcomes. This strategy is sectioned into 3 phases. Phase I established a Singaporean reference database containing 10,000 genomes. Phase II involves the SG100k project and will embed genetics into clinics and capture economic value. Phase III will establish population-scale genomics and implement precision medicine by 2027.
  • SG100k: Part of the NPM strategy, Precision Health Research is partnering up with genomics firm Illumina to sequence and analyse the genomes of about 100,000 participants in Singapore. This will benefit local sequencing companies in Singapore and general healthcare in Singapore.
  • WGS of 5000 Singaporeans: Collaborative efforts from A*STAR’s Genome Institute of Singapore, NUHS, PRISM, NUS, etc. gathered the whole genome sequencing of around 5,000 Singaporeans.
  • Singapore Genome Variation ProjectConducted by the NUS, this project characterised the extent of common variation in the human genome across at least 1 million single nucleotide polymorphisms (SNPs) in DNA samples from Chinese, Malays and Indians in Singapore. The data generated has been uploaded to the public database of genetic variation.

Notable organisations and institutions

  • Genomics Institute of Singapore: Created in 2000, the GIS is a national initiative with a vision that seeks to use genomic sciences to achieve improvements in human health. They have been involved in research on disease gene discovery, population, evolutionary genomics and statistical genetics.
  • Precision Health Research, Singapore (PRECISE): This SME is involved in coordinating the government’s effort to implement Phase II of Singapore’s 10-year NPM strategy.
  • Single Cell Omics Centre (SCOC): A collaboration between GIS and A*STAR, SCOC is the first research centre in Asia exclusively dedicated to single-cell genomic applications.
  • Centre of Genome Diagnostics: This organisation was established to co-develop genomic technologies for nucleic acid-based therapeutics and diagnostics markets.

Notable individuals

  • Assistant Professor Xue ShifengWith her team, she discovered a new way to decipher unsolved Mendelian diseases by studying the inheritance of a protein known as SMCHD1, which is coded by the SMCHD1 gene.
  • Chan Lai FungChairman of the Agency for Science, Technology and Research. Responsible for GIS, Centre of Genome Diagnostics and more.
  • Professor Ivy Ng: Group CEO of SingHealth since January 2012, Professor Ng helped to launch the SingHealth Duke-NUS Genomic Medicine Centre, which helps provide citizens with genomic care and personalised treatments.

The future genomics landscape

Whilst Singapore may not yet match the genomic medicine advancements of countries such as the USA and the UK, it is steadily working towards making genomic medicine more accessible to the public. The rise of various initiatives focused on genetics and genomics, including the SingHealth Duke-NUS Genomic Medicine Centre (SDGMC) and the National Precision Medicine (NPM) strategy, demonstrates the country’s commitment. Phase III of the NPM strategy planned for 2024 to 2027, aims to implement precision medicine on a large scale by linking the genomic sequencing data of up to 1 million people with clinical and lifestyle information.

Singapore’s dedication to precision medicine and genomics research also extends to shaping public health policies and strategies. As the country continues to accumulate genomic data and deepen its understanding of genetic variations within its diverse population, precision medicine will become increasingly personalised and effective. The integration of genomics data into healthcare initiatives will expand access to targeted preventive measures, improve disease management and enhance health outcomes for the population.

Last year, collaborative efforts were initiated to digitise genomic data of cancer patients, with the goal of better matching them with ongoing clinical trials. Such partnerships and collaborations further support Singapore’s commitment to large-scale genomics initiatives and resolving health challenges.

As research and progress in genomics continue to grow, Singapore’s contributions will gain recognition, propelling the nation to become a leading provider of accessible genomic medicine for its citizens.

References

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