Southeast Asia’s Success In Dealing With The Covid-19 Pandemic: Lessons Learnt And The Way Forward

Amidst the carnage wreaked upon many countries in the developed world by the Covid-19 pandemic, some countries in Southeast Asia have shown impressive results in managing and controlling the pandemic.

While the USA, UK, Spain, France and Italy struggle with the majority of global cases and fatalities, Singapore, Thailand, Vietnam and Cambodia, for example, have performed well. Beyond Southeast Asia, South Korea, Japan and Taiwan have also been held up as examples of success in managing the pandemic.

Of the total number of more than 20 million cases and 740,000 deaths globally at the time of writing, Southeast Asia recorded approximately 301,000 cases and 7,800 cases deaths which represents only 1.7%  and 1.1% of globally confirmed cases and deaths respectively.

Tellingly, Southeast Asian countries[1] also have a significantly lower case fatality rate averaging 5.8 deaths/million population as compared to a rate of 552 deaths/million population in the six most affected countries in the developed world[2].  At the same time, it should also be pointed out that some Southeast Asian countries, like Indonesia and the Philippines, continue to struggle with controlling the pandemic which seems to be escalating within their national borders.

[1] Indonesia, Malaysia, Singapore, Philippines, Brunei, Thailand, Vietnam, Cambodia, Laos, Myanmar

[2] United States of America, United Kingdom, Spain, Italy, France, Brazil

What are the main reasons for the success, and failures, of these countries in handling the pandemic?

First, speed of reaction and anticipation which is based on some key strategies: extensive testing, isolation and  quarantine, diligent contact tracing, treatment of severe cases, social distancing, the banning large gatherings (e.g. sporting events, religious gatherings, music concerts, etc.), movement and travel restrictions (‘lockdowns’) and the use of protective masks.

Second, and most importantly, was the political will and commitment on the part of governments. Successful countries have demonstrated strong, firm, decisive, cohesive and evidence-based government action and directives which have been largely free from political interference.Third, the above factors are supported by a system of good governance characterized by unity of action, common purpose and coordination at all levels (national, provincial, local). In Singapore, for example, a Multi-Agency Task Force co-chaired  by the ministers of health and national development, acted as an integrated, single focal point for the country’s responses to the pandemic. It operated with a high level of transparency and accountability with frequent and detailed communications to the public on the situation in the country.

Fourth, success was in no close measure due to populations which trusted the government, which are cooperative and compliant to directives, and, importantly, placed the safety of the community above other, individual interests.  Some have argued that a sense of social responsibility is  stronger in Asian societies compared to the developed countries of the West which places higher priority on the rights of individuals and freedom of choice.

Fifth, these successful countries have been well prepared and quick to implement, and provide the necessary infrastructure, for the use of digital health strategies in mitigating the effects of the pandemic, including big data analytics, artificial intelligence and mathematical modelling.

These digital technologies and platforms have been applied effectively in surveillance and monitoring of cases where, for example, data is integrated between departments of health and immigration. It has also been invaluable in contact tracing and even for fair distribution, for example, of protective masks.

In contrast, countries which have been less successful in managing the pandemic have shown weak links in implementing some of the above strategies.

Indonesia, for example, has had difficulty in accessing sufficient diagnostic tests, a population which has been less than compliant and cooperative in observing social distancing measures, and a governance structure which is poorly coordinated between the central and provincial governments.

The Philippines was slow to react to the potential magnitude of the pandemic and in imposing strict restrictions and, later, lifted restrictions prematurely. It also suffered from testing gaffes and failures in quarantine protocol in the face of over 100,000 overseas workers arriving back home after losing their jobs in other countries.

What may be the future path of the pandemic and what may be needed to maintain & sustain these good practices and control measures?

Based on what we know now, and the general opinion of scientists and public health experts, it is likely that the Sars-CoV2 virus will not disappear completely. Rather, it will become endemic in most, if not all, affected countries. The ‘new normal’ will most likely see localised clusters of outbreaks during the second (or third) waves of the pandemic as has been seen recently in Vietnam, Singapore, Thailand and Philippines.

Such clusters are linked to both local transmission as well as imported cases. As such, countries will need to adapt and learn to live with the virus and sustain those policies and strategies which have proven successful during the first wave of the pandemic. Six priorities are particularly important.

First, governments must continue to be willing to make tough policy choices to protect public health, including re-instating restrictions if needed. Though these restrictions are likely to be targeted and localised, rather than country-wide, it may still face resistance and protest from the population. As Einstein once observed “what is popular is not always right, and what is right is not always popular”.

Second, and closely related to the above, there is an important need to sustain and enhance  a sense of social discipline and responsibility among the community. This can be achieved through a mix of ‘carrots’ and sticks’ – education and communication strategies and strict enforcement of restrictions, including punitive measures if necessary.

Third, the ability to detect and respond to ‘fires’ and clusters of outbreaks is critically dependent on effective, real-time and robust surveillance and monitoring systems for early detection of potential ‘hot spots’ and rapid institution of public health measures before widespread dissemination of the virus occurs among the general population.

In addition to the digital tools mentioned above, the value of a ‘grassroots’ approach, where communities, and even neighbourhoods, play a ‘sentinel’ role in early detection of potential cases, should not be underestimated. As expressed by Guenael Rodier, former director of World Health Organization’s (WHO) department of Country Health Emergency Preparedness and International Health Regulations, “the best way to prevent the global spread of diseases is to detect and contain them while they are still local”.

Fourth, and at the same time, there is a constant and critical need to ensure protection of front-line health workers who are dealing with symptomatic cases of Covid-19 disease. Tragically, many of these front-line health workers have died in Indonesia and the Philippines during the pandemic as a result of shortages of personal protective equipment.

Fifth, countries must ensure that robust health systems are in place so that non-COVID-19 risks to public health can be managed. Several Southeast Asian countries, Indonesia, Thailand and Singapore, for example, have seen a surge in cases of dengue fever. The WHO has also also warned of a dangerous drop in childhood vaccination rates as countries’ health resources are diverted to fighting the Covid-19 pandemic.

Sixth, countries must manage and control what scientists believe were the ultimate origins of SARS-CoV-2 and other pathogenic viruses: wildlife markets which freely exist not only in China but in many countries in Southeast Asia, including Indonesia and Thailand. It has been estimated that more than 60% of pathogens[1] which have caused global epidemics of human disease have zoonotic origins with bats, primates and rodents being the most prominent sources.

While we can speculate on the future path of the pandemic, there is still much we do not know about the biology of the virus and, therefore, the future trajectory and dynamics of the pandemic. At the same time, countries all over the world have learnt valuable lessons during the past eight months and, arguably, are better prepared to deal with future crises.

There is also much we do know now. Unlike the situation at the onset of the pandemic, there has been significant advances in understanding the epidemiology of the disease – for example, the important role of asymptomatic carriers in spreading the virus.

Progress has also been made in identifying useful therapeutic interventions for severe cases of Covid-19 (these include Remdesivir, dexamethasone, antibodies from recovered patients, and monoclonal antibodies).

Importantly, intensive research and development activities have been ongoing in the development of vaccines against SARS-CoV-2 using various approaches. Advanced clinical trials are already underway with some candidate vaccines. However, at this point, we have no assurance as to when a safe and effective vaccine will be available, and how to ensure its efficient and equitable distribution.

[1] Bacteria, viruses, fungi, parasites.

What about the importance of global solidarity and the role of external partners in dealing with the pandemic?

Countries in Southeast Asia which have successfully contained the pandemic have shown global and regional solidarity based on their adherence and compliance to international agreements such as the International Health Regulations developed by the (WHO).

This has facilitated collective action based on trust and sharing of data, knowledge and experiences as countries in the region have realized their interdependence as a result of extensive trade, migrant workers and leisure travel across national borders.

External partners have also been prominent in the Global Health Security Agenda (GHSA) and, more recently, the Act Accelerator initiatives. The GHSA, an initiative led by the United States under the Obama administration,  has close partnerships with many Southeast Asian countries to help them better prepare for, and respond to, infectious disease pandemics.

The well-funded Act Accelerator initiative, led by the WHO and the World Bank, has multiple partners committed to the accelerated development of vaccines, diagnostics and therapeutics against Covid-19.

Closer to the Southeast Asia region, Australia’s COVID-19 Development Response, led by its Department of Foreign Affairs and Trade, focuses on the Indo-Pacific region, particularly the Pacific, Timor-Leste and Southeast Asia. Its objective is to partner with the Indo-Pacific in responding to and recovering from COVID-19, in support of the region’s, and Australia’s, security and economic recovery.

Beyond the shores of Southeast Asia, and as eloquently expressed by Kishore Mahbubani, a former senior Singaporean Government official: “coronavirus is telling us to be a citizen of our country, and our world. The disease has shaken the human species to the core, but we must grasp the metaphysical messages it is sending. To survive in the short term, we need national solidarity – but to survive in the long term, we need global solidarity”.

Rather than the pandemic portending the end of globalization, as some have suggested, it has starkly illustrated the interdependence between nations and the need for future solidarity based on trust and collective action to save humanity.