Strengths and Vulnerabilities in Southeast Asia’s response to the Covid-19 Pandemic
Three weeks have gone by since we penned a commentary analyzing the initial policy responses of Southeast Asian nations grappling with the rapid spread of the novel coronavirus. What is becoming clearer is that the impact of this pandemic will be hard-hitting and long-lasting in Southeast Asia, along with much of the rest of the world. Countries that earlier stood out as global leaders in “flattening the curve” are now grappling with massive new outbreaks; Singapore, for example, is grappling with a new wave of cases tied to its large migrant worker population. For other countries, such as Indonesia and the Philippines, the slow government response to the crisis and weaknesses in their public health systems are beginning to take a toll. The economic impact, which I wrote about last week, will be massive for a region that is widely under lockdown and heavily dependent on trade and tourism. This commentary provides updates on the public health impact of Covid-19 on Southeast Asia and the steps that governments in the region are taking to deal with it.
Southeast Asia has been hit hard by the novel coronavirus, with a surge of new cases over the past week in Indonesia, the Philippines, Malaysia, Myanmar, and Singapore (for the latest numbers, see our CSIS Southeast Asia Covid-19 tracker). Only Thailand and Vietnam saw the number of daily cases drop. Indicating they may be making progress in flattening the curve. Even with this recent surge, the number of cases in many countries is still at the early stages of what is likely to be a steeply rising curve. The region’s vulnerability to the spreading pandemic is unsurprising given the geographic proximity and close trade and tourism linkages to China. Like other regions that have been heavily impacted, including Europe, Northeast Asia, and the United States, we are witnessing a range of country experiences in Southeast Asia based on the onset of the crisis, initial government responses, the capacity of public health systems, and broader societal and political factors.
Singapore and Vietnam got off to a very early start in responding to the initial outbreak, which initially seemed to have kept the epidemic under control. These countries were the first to shut down travel with China back in early February, and both countries enacted extensive surveillance, monitoring, contact tracing, and isolation of those infected or in contact with the disease—albeit in strikingly different ways. Singapore relied on widespread temperature-taking, testing, meticulous contact tracing, and targeted quarantine measures for confirmed cases, those in contact with them, and returning travelers. Singapore has also utilized high-tech tools to trace the virus, such as mobile apps that aid in contact tracing, and developed its own testing kits and antibody tests. These measures were sufficient in the early months of the crisis to enable Singapore to remain largely “open for business,” with schools and businesses operating more or less normally, although travel was difficult due to mandatory two-week self-quarantine for visitors or returning citizens.
By contrast, Vietnam has relied on mobilizing its society and on massive social closures and extensive surveillance of citizens. From the early onset of the pandemic, Vietnam shuttered non-essential businesses and schools and enacted large-scale quarantines—the entire province of Vinh Phuc, north of Hanoi, was put under a 21-day quarantine starting February 13, and tens of thousands of citizens have been placed in “quarantine camps” run by the military. Vietnam’s aggressive monitoring and surveillance of citizens has been supported by the government’s large network of informants, which has helped to identify and quarantine those suspected of infection and those who have been in contact with them. The government also mobilized retired doctors and nurses and medical students to join the fight against the virus, while some entrepreneurs have set up “rice ATMs” to help people out of work. Vietnam has weathered the epidemic remarkably well, with only 268 cases out of a population of 95.5 million people, and not a single reported death.
Despite their markedly different approaches, Singapore and Vietnam share some important characteristics that have shaped their responses. Both countries were among the hardest hit by the SARs outbreak in 2003 and were determined to better prepare for the next pandemic. Both governments are highly centralized, unified, and well organized. Vietnam’s “culture of surveillance” and Singapore’s “nanny state” are both highly effective in monitoring and communicating with their citizens, and these systems have publics that are broadly accepting, or at least accustomed to, this level of intrusiveness.
And yet, the huge spike in cases in Singapore over the past week has upended Singapore’s status as a global leader in containing the coronavirus epidemic. On Monday, April 20, Singapore reported 1,426 additional new cases, a record daily jump that puts Singapore ahead of Indonesia in terms of the largest number of confirmed cases in Southeast Asia. Most of the new cases are foreign workers living in crowded dormitories with shared kitchens and bathrooms—a key group of residents that was overlooked by a government. The government is now scrambling to contain the outbreak by putting the dormitories in lockdown and relocating some workers to reduce overcrowding. Singapore’s failure to focus early on worker dormitories as potential hotspots of infection underscores how government priorities can lead to a myopic and uneven response, making even uber-efficient Singapore vulnerable to setbacks in containing the epidemic.
At the other end of the spectrum in terms of mobilization and early response to the emerging epidemic are countries such as the Philippines and Cambodia, whose leaders were not only slow to respond but also actively downplayed the risks. Both President Rodrigo Duterte and Prime Minister Hun Sen take pride in their close relations with China, and both leaders went out of their way in the early days of the pandemic to dismiss concerns about the virus and the risk posed by maintaining unrestricted travel linkages with China. Hun Sen refused to evacuate Cambodian students from Wuhan and chided journalists from wearing face masks at press conferences. Hun Sen even traveled to Beijing to meet Xi Jinping in early February as a sign of solidarity, making him the first foreign leader to visit China since the coronavirus outbreak began in Wuhan.
In the Philippines, President Duterte mocked those who were urging social distancing, telling one audience, “You are too scared of this corona epidemic. They are discouraging long meetings and large congregations. Don’t be fools by believing it.” Yet just a few days later, Duterte gave a rambling nationally televised address that announced a lockdown of Metro Manila, one of the largest megacities in the world, and the entire island of Luzon. This was followed by a series of unclear and contradictory government announcements about how the quarantine would be implemented, leading to public confusion and chaos as Metro Manila residents tried to prepare for strict curfews and travel restrictions. Duterte has deployed the police and military to enforce the curfew, with orders of “shoot to kill” any violators. The curfew has hit the urban poor in Metro Manila very hard, with thousands of people arrested for violating the curfew. Last week Duterte threatened to order a tougher crackdown that would be “like martial law” in one of his televised addresses to the nation. Despite these draconian restrictions, which may have come too late to be truly effective, cases of coronavirus are now surging in the Philippines, straining the under-resourced health care system and overwhelming hospitals in Manila.
Indonesia has also been relatively slow to mount a comprehensive response. The Jokowi government has been criticized for a decentralized and uncoordinated approach and a lack of effective communication about the need for social distancing. It has often been unclear who is in charge of the response, and the government has generally erred on the side of protecting the economy in the near term, with some in the government fearful of civil unrest if economic conditions worsen. Indonesia has become one of the region’s hotspots for the virus, and as of this writing, the country now leads the region in terms of the number of deaths, with the death toll still likely substantially underreported, even in Jakarta. This trend may accelerate in the coming weeks, as millions of Indonesians consider making annual homecoming trips at the end of Ramadan, known as mudik. The Jokowi government decided not to ban mudik out of economic considerations, despite calls from regional government leaders and public health experts who fear the mass movement of people from urban areas to rural villages will accelerate the spread of the virus. Instead, the government is seeking to discourage people from travel, with pollsmixed on the question of how much these warnings are resonating.
Meanwhile Myanmar seemed in denial of the pandemic as late as mid-March, when the government appeared to suggest that Myanmar would somehow be immune to coronavirus despite its long border with China. Government spokesman Zaw Htay declared that the country had no cases of the virus, which he attributed to the “lifestyle and diet” of Myanmar’s people as well as their use of cash rather than credit cards in economic transactions. The Myanmar government has also threatened to crack down on “fake news” reports in media and social media that do not align with official reporting on the pandemic. Meanwhile, with thousands of Myanmar migrant workers returning to their villages from Thailand, the virus has begun to spread, with 107 confirmed cases reported as of April 20—a number that is surely vastly understated due to the lack of testing (over 4,000 people have been tested, a big jump from 80 tests performed two weeks ago, but still a tiny proportion out of a population of 54 million people). Fear is growing that Myanmar could suffer an extremely high mortality rate in the face of a major outbreak. Despite opening up to the world a decade ago, which has ushered in several years of impressive economic growth, Myanmar remains an impoverished country, and its health care system is one of the poorest in the world, after suffering years of neglect under military rule. Hospitals are not equipped with masks and other personal protective equipment (PPE), and many villages lack running water, making even washing hands difficult. Concern is even greater for internally displaced people with limited access to health care in overcrowded camps in Rakhine, Kachin, and northern Shan states.
Thailand offers a model of both the best and worst aspects of Covid-19 response in Southeast Asia. Despite public criticism for its initially lackluster response at the onset of the crisis, the Thai government snapped into action in late March when Prime Minister Prayuth announced one of the most comprehensive national lockdowns in the region and declared emergency powers. The government canceled the Songkran water festival, Thailand’s national new year’s celebration, and banned alcohol nationwide. However, the reason Thailand stands out as a regional leader in its effective containment of the epidemic may have more to do with its model health care system and its investment in health security capacity, in areas such as monitoring and tracking cases of infectious disease, epidemiological training, lab testing, and electronic surveillance reporting. These health care and health security capabilities put Thailand in the highest tier of the Global Health Security Index, which ranks Thailand at sixth overall, the only middle-income country to rank in the top tier of 13 countries and the clear leader in Southeast Asia. An indeed, Thailand’s capacity in dealing with infectious disease appears to be paying off, with the curve flattening over the past two weeks as the average daily number of steadily declines.
However, the Thai response also underscores the deeply disturbing trend in Southeast Asian responses to the virus, as leaders use the crisis as an opportunity to grant themselves sweeping powers that sharply curtail civil liberties and can be used to stifle dissent and political opposition. Along with restrictions over the movement and numerical gatherings of citizens, which can be justified given the gravity of the public health care threat, Prime Minister Prayuth has joined the ranks of Hun Sen, Duterte, the leaders of Myanmar, and most recently Vietnam in declaring new powers to combat “fake news” related to Covid-19 and the government’s response to the epidemic, including censoring media, social media, and personal communications. In Thailand, the new emergency powers extend to arresting and detaining those charged with sharing false information, which critics fear will be used liberally against political opponents.
Despite the slow start at the onset of the crisis by many governments in the region, all countries in Southeast Asia are now in some form of lockdown, although to varying degrees. Yet, we see the virus still spreading rapidly, and only time will tell if lockdowns and other containment measures are sufficient to slow transmission and contain the spread of the epidemic. It is difficult to assess the extent of the health care crisis in the region because we are still in an early stage of the pandemic, and assessments are clouded by the lack of transparency and lack of capacity, in terms of testing, in many countries. Some early optimism that Southeast Asia may have geographical or demographic advantages in the Covid-19 battle have not born out—the warm, humid weather that some researchers initially thought may counteract the virus has not stopped the spread in tropical Southeast Asian countries. Indonesia’s Coordinating Maritime Affairs and Investment Minister Luhut Panjaitan cited Indonesia’s hot, humid weather as one reason not to ban travel for the mudik, claiming it would slow the virus—a claim which was quickly debunked by the World Health Organization. In terms of demographics, at least for Indonesia, the large percentage of young people who would be expected to be less susceptible to the deadly impact of the virus is offset to some degree by the fact that Indonesia has one of the highest smoking rates among men in the world. The pollution in megacities such as Jakarta, Manila, and Bangkok may also exacerbate the vulnerability of millions of residents.
As of this writing, the main concern for the health impact of the crisis is that major outbreaks in the region’s megacities will overwhelm hospitals, raising death tolls and leading to further economic impacts. There is also concern that overly restrictive lockdowns and market disruptions in the food supply chains will lead to hunger and malnutrition among the urban poor, which could, in turn, cause social unrest and political violence. For the rural poor, the food situation may be more manageable, but the lack of capacity in the local health care systems in rural regions will be severely challenged. The final concern is focused on the second wave of infections that we are seeing in Singapore and other parts of Asia that were hit early with Covid-19 cases, like Hong Kong and Taiwan. Singapore’s soaring infection rates after the government’s misstep on foreign workers offer a cautionary tale about the vulnerability of even the most capable bureaucratic systems. The region needs to prepare for second and additional waves of infection, which will further complicate government strategies and deepen economic impacts. Ultimately, while other global hotspots, particularly the United States and Europe, appear to be turning the corner, this story is still only beginning to be written in Southeast Asia, with profound public health, economic, and political impacts close on the horizon.
Amy Searight is senior adviser and director of the Southeast Asia Program at the Center for Strategic and International Studies (CSIS) in Washington, D.C.
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