Rows of restaurant booths for take-away and delivery food orders in Central Department Store since no dine-in was allowed during some periods of the COVID-19 outbreak. Photo: Onfoot / Dreamstime
As the COVID-19 pandemic continues to wreak havoc globally, some countries in Southeast Asia have shown impressive results in managing and controlling the pandemic. Singapore, Thailand, Vietnam, Malaysia, Cambodia, Laos and Brunei, for example, have been largely successful in managing the pandemic. The lessons learnt from these countries have important implications for public policies in the healthcare sector and beyond, and also underscore the need for international cooperation and solidarity to collectively act to control the pandemic.
Effective public policies are particularly crucial as the battle is far from over. 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, Malaysia and Myanmar. 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 policies and strategies which have proven successful during the first wave of the pandemic.
Six lessons are particularly important for effective public policies. First, governments must continue to be willing to make tough policy choices to protect public health, including reinstating restrictions if needed. Evidence from many countries strongly indicate that, for example, lockdowns are effective in reducing the spread of infections. Though these restrictions are likely to be targeted and localised, rather than country-wide, they may still face resistance and protest from the population.
Second, closely related to the above, there is an important need to sustain and enhance a sense of social discipline and responsibility in 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.
Indonesia suffered its first recession in over two decades in the third quarter of 2020 and millions of people lost their jobs over the past year as the COVID-19 pandemic battered Southeast Asia’s largest economy. Photo: Dita Alangkara / AP Photo
Third, the ability to detect and respond to 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 Guenael Rodier, the former director of the World Health Organization’s (WHO) department of Country Health Emergency Preparedness and International Health Regulations, said, “The best way to prevent the global spread of diseases is to detect and contain them while they are still local.”
Fourth, at the same time, there is a constant and critical need to ensure protection for frontline health workers who are dealing with symptomatic cases of COVID-19. Tragically, many of these frontline 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 warned of a dangerous drop in childhood vaccination rates as countries’ health resources are diverted to fighting the 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 that have caused global epidemics of human disease have zoonotic origins, with bats, primates and rodents being the most prominent sources.
Kuala Lumpur, Malaysia
Barbed wire fencing with armed guard at the entrance to a wet market in Chow Kit as part of tightened security control under the Movement Control Order (MCO). Photo: Abdul Razak Abdul Latif / Dreamstime
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 ten 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 have been significant advances in understanding the epidemiology of the disease – for example, the important role of asymptomatic carriers in spreading the virus.
There has been progress in identifying useful therapeutic interventions for severe cases of COVID-19 (these include Remdesivir, dexamethasone, antibodies from recovered patients and monoclonal antibodies). Much progress has also been made in terms of management of severe cases, such as less reliance on invasive ventilators and more reliance on close monitoring of oxygen saturation levels through pulse oxymeters.
Importantly, intensive research and development activities have been continuing in the development of vaccines against SARS-CoV-2 using various approaches. Of the nearly 200 candidates being pursued globally, 30 have shown early promise and eight or nine of them are in advanced clinical trials with results expected by the end of 2020. However, at this point in time, we have no assurance as to when a safe and effective vaccine will be available, and how to ensure its efficient and equitable distribution. The WHO estimates that June 2021 will be the earliest date a vaccine will become available. In spite of this reality some countries, for example, Indonesia, are already developing vaccination plans.
However, the excitement around the possibility of a vaccine acting as a ‘magic bullet’ must be tempered by actions which continue to emphasise the importance of well-proven and tested public health measures. A vaccine will not end the pandemic unless the three critical public health strategies are maintained: wear a mask, watch your distance and wash your hands frequently. As the Director of the US Centers for Disease Control and Prevention (CDC) Robert Redfield famously said recently, “The best vaccine is the face mask.”
While there are many examples of Southeast Asian countries doing well in managing the pandemic, there are two exceptions, in the Philippines and Indonesia, where the pandemic continues to escalate. The situation in these two countries illustrates weaknesses and failures in policy responses, namely, delayed and uncoordinated response at different levels of government, premature lifting of movement unless the three critical public health strategies are maintained: wear a mask, watch your distance and wash your hands frequently. As the Director of the US Centers for Disease Control and Prevention (CDC) Robert Redfield famously said recently, “The best vaccine is the face mask.”
While there are many examples of Southeast Asian countries doing well in managing the pandemic, there are two exceptions, in the Philippines and Indonesia, where the pandemic continues to escalate. The situation in these two countries illustrates weaknesses and failures in policy responses, namely, delayed and uncoordinated response at different levels of government, premature lifting of movement restrictions, difficulties in implementing social distancing measures, limited guidance from national regulations, and limited testing, tracing and treatment capacities. Compared to other countries in Southeast Asia, these two countries arguably face many more daunting challenges due to logistic difficulties related to their archipelagic nature, but can certainly learn from their more successful neighbours in terms of successful strategies to control the pandemic.
The Philippines, which has the second-most number of confirmed coronavirus cases and deaths in Southeast Asia, is racing to lock in vaccine supplies as it targets to immunise a third of its 108 million population. Photo: Aaron Favila / AP Photo
Countries in Southeast Asia that have successfully contained the pandemic have also shown global and regional solidarity based on their adherence and compliance to international agreements such as the International Health Regulations (IHR) developed by the WHO. The WHO’s Global Outbreak Alert and Response Network (GOARN) has played a central role as a clearing house for reliable and timely data and information on the pandemic. It is also likely that the IHR will undergo revision and improvements in the future, based partially on lessons gleaned from Southeast Asian countries, as happened following the SARS (Severe Acute Respiratory Syndrome) outbreak in 2003.
The global policy guidance provided by the IHR has facilitated collective action based on trust and sharing of data, knowledge and experiences, as countries in the region have realised their interdependence as a result of extensive trade, migrant workers and leisure travel across national borders.
Chiang Mai, Thailand
People stepping up to lend a helping hand to those whose livelihoods have been affected by the pandemic. Some volunteers, restaurants and businesses are offering free meals to make sure the community stays safe and healthy. Photo: Amonsak Sriwilai / Dreamstime
At the same time, the WHO is also open to reviewing the way it responded to the pandemic. During the 73rd World Health Assembly in May 2020, the WHO Member States adopted a landmark resolution that called on the WHO to initiate an independent and comprehensive evaluation of the lessons learned from the international health response to COVID-19. Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO stated, “This is a time for self-reflection, to look at the world we live in and to find ways to strengthen our collaboration as we work together to save lives and bring this pandemic under control. The magnitude of this pandemic, which has touched virtually everyone in the world, clearly deserves a commensurate evaluation.”
Beyond the setting of global policy and standards to respond to pandemics, the WHO has also been a lead agency in the future development and deployment of vaccines to prevent COVID-19 infection and disease. Together with the Global Alliance for Vaccines and Immunization (GAVI), Coalition for Epidemic Preparedness Innovations (CEPI) and the World Bank, it is a key player in the COVAX initiative, a multi-agency initiative to facilitate equitable access to affordable COVID-19 vaccines, especially in developing countries. At the regional level, ASEAN also has an important role to play in promoting cooperation and sharing of knowledge among its members, as has been reiterated at the Special ASEAN Summit on Coronavirus Disease 2019 (COVID-19) in April 2020.
Beyond the shores of Southeast Asia, and as eloquently expressed by former senior Singapore government official Kishore Mahbubani:
“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 globalisation, 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.
Data and information cited in this article are current at the time of writing in November 2020.
PROF TIKKI PANGESTU
Prof Tikki Pangestu is Visiting Professor at the Yong Loo Lin School of Medicine, National University of Singapore (NUS). Prior to this, he served as Director of the Research Policy & Cooperation department at the World Health Organization (WHO) for 13 years. Prof Pangestu’s research interests are in infectious diseases, health research policy and global health governance. To date, he has published more than 250 scientific articles in his areas of expertise, and was the lead author in major WHO reports such as the World Health Report 2013, Knowledge for Better Health, and Genomics and World Health. Prof Pangestu holds a Ph.D in Immunology from the Australian National University, and is currently a Fellow of the Royal College of Pathologists (UK), American Academy of Microbiology (USA), Academy of Medicine Malaysia, and Academy of Sciences for the Developing World (TWAS).