Singapore prides itself as one of the busiest air hubs in the world, having served 69.98 million passengers and processed 2.08 million tonnes of air cargo in 2025 1. Carbon dioxide (CO2) emissions are significant at 18 million tonnes from domestic airport operations and Singapore-based international airlines 1. To address the environmental impact of our air-hub, the Civil Aviation Authority of Singapore launched the Sustainable Air Hub Blueprint in 2024 with aspirations to reduce domestic aviation emissions from air operations by 20% over the next 10 years and to achieve net zero carbon emissions from both domestic and international aviation by 2050 1. Domestic emissions will be addressed by increasing the use of photovoltaic systems for electricity at its airport, tapping on predictive tools to improve the efficiency of air traffic control, introducing electric vehicles within its air-side premises, and harnessing the use of heat-reflective materials to reduce the need for air-conditioning 1. Plans to lower international CO2 emissions include increasing the use of renewable or organic waste-derived Sustainable Aviation Fuels (SAF) from 1% currently to 3%–5% in 2030 with reduced reliance on conventional aviation fuel thereby decreasing total greenhouse gases production 1. Swiss aviation authorities have reported that SAF produces less particulate matter, soot, and sulphur content, with consequent potential benefits on air quality 2. However, as SAFs use does not eliminate emissions completely, pollutants such as nitrous oxides and hydrocarbons are still released; hence, its impact on air quality requires continued attention and vigilance 2. Poor air quality is a risk factor for the development of chronic lung diseases such as the ‘Big 5’ (asthma, chronic obstructive lung disease, lung cancer, lower respiratory tract infections, and tuberculosis) and in exacerbating lung diseases. We regard with optimism the lung health benefits the Sustainable Air Hub Blueprint will bring. Tight tobacco control has long been a principal feature of Singapore's public health landscape: the early 1970s saw the implementation of measures limiting smoking in public spaces; Singapore was one of the first in the world to ban tobacco advertisements. In response to the rising popularity of electronic cigarette (e-cigarette, otherwise known as vapes), Singapore has banned the purchase, use and possession of e-cigarettes since 2017. Despite our reputation as a ‘relentlessly hostile environment for tobacco companies’, ‘K-pods’ (anaesthetic drug-laced e-cigarettes) have arisen as a significant issue in Singapore, such that experts have now coined the term ‘K-podemic’, clearly demonstrating the gravity of the problem 3. Although the true prevalence of K-pod use in Singapore is unknown, it is reported that 1 in 3 of e-cigarettes seized by authorities were found to be laced with etomidate, an anaesthetic drug causing ‘zombie-like’ effects 3. Vapes are also known to contain drugs such as synthetic cannabinoids, methamphetamines, and other psychoactive substances which can cause e-cigarette or vaping product related lung injury (EVALI), respiratory depression and altered mental status. Strong measures implemented in 2025 legislated vaping as an illegal drug offence, with etomidate reclassified as a controlled drug under the Misuse of Drugs Act, ultimately sending the unambiguous message that vaping is not tolerated in Singapore. However, anti-vaping laws alone will not resolve the problem: much effort has also been dedicated to providing medical and psychosocial support to vapers and their families to help them in vaping cessation (Figure 1). Healthcare professionals have been made aware of their legal responsibilities in reporting vape-related offences and have been educated on avenues available to support vaping cessation. We are aware that a draconian approach to vaping may backfire, as illegal markets may emerge, ultimately exposing youth to unregulated vaping products 4. Nevertheless, from Singapore's perspective, such an approach has certain long-term benefits while providing an opportunity for others to observe for potential trade-offs from a strict prohibitive policy stance 4. Vaccinations and immunisations have long been an essential component of Singapore's preventive health measures. Following enhancements in 2020, children between 2 and 12 months of age routinely receive the Haemophilus influenzae type b and Pneumococcal Conjugate Vaccine (PCV) alongside other vaccines as part of the National Childhood Immunisation Programme (NCIP). The Pneumococcal Polysaccharide Vaccine (PPSV23) recommended for children between 2 to 17 years old with specific medical conditions was also incorporated with NCIP 2020 enhancements. The NCIP also recommends that all children between 6 months and 5 years old receive influenza vaccination annually, while those > 5 years old only need to be vaccinated if they have specific medical conditions. All NCIP vaccines can be obtained free of charge from public outpatient clinics. In 2017, the Ministry of Health established the National Adult Immunisation Schedule (NAIS) to better guide vaccinations for adults, aged 18 and above. Annual influenza vaccination was recommended for persons aged 65 years and above and for all other susceptible adults with indicated medical conditions. Similar age criteria and indications apply to pneumococcal vaccinations (PCV and PPSV23). In 2025, the new PCV20 vaccine was added to the NAIS, alongside further recommendations for those who had previously completed 1 dose of PCV 13 or PPSV23 vaccination. As part of Singapore's drive toward better preventative care, all citizens and permanent residents aged 40 and above are encouraged to enrol in the HealthierSG programme. Under this initiative, health plans are tailored according to individual risk factors following a health review by family physicians. Vaccinations under the NAIS are a key component of tailored health plans as all enrolees are eligible for free influenza and pneumococcal vaccines in their respective HealthierSG clinics. Overall vaccination rates have increased steadily. However, there is a significant proportion of enrolees who have declined vaccinations or have not followed through with health recommendations, citing difficulties with changing lifestyle habits or prioritising other commitments such as work and caregiving 5. As such, although current incentives improve accessibility to vaccinations, it appears that work to motivate healthy lifestyle behaviour and choices is necessary. In face of emerging challenges, Singapore remains committed to population lung health with timely review and revision of policies and implementation supported by evidence. Professional societies like Singapore Thoracic Society strive to play their part by encouraging research activities that may inform policy, and by providing a platform for continuing medical education and promoting collaboration with regional lung health experts. The authors have nothing to report. The authors declare no conflicts of interest.
Ng et al. (Fri,) studied this question.
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