Commentary: Southeast Asia’s mixed success with adapting to fast-evolving COVID-19 war

SINGAPORE: Any defence planner worth his salt would be wary about preparing for the next war by studying the last.

When war conditions change, what accounts for success in a past war could well be the cause of failure in the next.

Military history is replete with examples of this, yet the strong human tendencies driving it are hard to guard against.

While the war against COVID-19 is very different from a military campaign, it has shown the same human weaknesses with devastating results.

It is more like a series of wars rather than a single one because the enemy, the “weapons”, and the context in which the disease operates have all changed rapidly over the course of months.

The Delta variant is more transmissible and lethal than the original COVID-19 virus. Both are different from the Severe Acquired Respiratory Syndrome (SARS), H1N1 and Ebola viruses that were the basis for earlier plans against infectious diseases in Southeast Asia.

Medical tools to deal with the disease in the form of diagnostic kits, treatment protocols, vaccines and anti-viral drugs have evolved rapidly.

The state of knowledge about the disease and speed at which medical studies are conducted and shared have also advanced at such a rapid rate as to be unrecognisable.

EVOLVING COVID-19 STRATEGIES

In this changing environment, the strategies for dealing with the disease have also had to evolve. In the beginning, the appropriate strategy was one of containment using travel bans, border controls or a combination of both.

And when that line of defence was breached, it became a race to flatten the infection curve by slowing down community spread through social distancing and lockdowns.

When effective vaccines became available and lockdowns became unsustainable except at very high economic cost, the race became one to inoculate the population.

Now, with the Delta variant, it is becoming apparent that even high vaccination rates will not totally stop its spread in dense urban environments unless it is combined with boosters and some level of herd immunity.

The saving grace is that vaccinations have been able to bring down the incidence of serious illness and death due to infections. With sufficient vaccinations, the current race is to re-open the economy and live with the virus at a level that the medical system can cope with.

MIXED SUCCESS AT BEST

The continual need for adaptation of strategies is something that countries in Southeast Asia have had at best mixed success in.

Of the early pandemic successes in 2020, Vietnam stood out for being most adept at containment at the borders and in precincts where local cases appeared, lessons it learnt from SARS. It did not suffer many (or indeed any) deaths for much of the early phase and its people were not even placed under many restrictions.

The Vietnamese economy benefited from this, and it kept growing through 2020. An over-reliance on this formula made it conclude that there was no need to prioritise or prepare for mass vaccinations.

However, with the arrival of the Delta variant, everything changed. Infections and deaths have since soared, extended lockdowns in large areas have caused significant hardship and damage to industrial output, and the economy is now expected to experience a reversal in 2021.

According to the John Hopkins University’s Coronavirus Resource Center, the COVID-19 death rate has climbed to 21.31 per 100,000.

While not spared a roller-coaster ride, Singapore has been more fleet-footed. Having gone from early success due to its SARS experience to a cautionary tale when the virus spread like wildfire in its foreign worker dormitories, it already had to overcome one setback in 2020.

Once the vaccination strategy became salient, it pivoted quickly to a new strategy and ramped up vaccinations as it had anticipated the need to do so.

Now one of the most highly vaccinated countries in the world, some believe that it has been too cautious in re-opening as shown in the Bloomberg Resilience Ranking.

However, its early caution saved many lives compared to countries that avoided lockdowns to go straight for vaccinations or herd immunity.

Fatality rates per 100,000 population (as of Oct 12) of similar-sized countries with strong health systems like Sweden (144.91) or Israel (87.48) that did so are tens of times higher than Singapore’s (2.84).

Even a country that tried lockdowns with some travel controls like Denmark has a markedly higher fatality rate of 45.90 due to slower and less effective measures. This gap in fatality rates will narrow in the months ahead as Singapore re-opens, but it is unlikely to be fully closed.

FATALITY RATES CREEPING UP

Brunei, having done well before Delta, has also lost ground significantly since. With 64 deaths among its small population, the deaths per 100,000 have risen to 14.77.

Similarly, Cambodia, another early success with a young population and a successful vaccination programme, has a death rate of 15.20 per 100,000 now because of the Delta variant.

Only Laos, with a youthful and less urbanised population, has been less hurt by Delta, managing to keep fatalities at 0.36 per 100,000.

Thailand and Malaysia were in the middle group of Southeast Asian countries in dealing with COVID in 2020.

Thailand remains in that position now. Its vaccination programme got off to a slow start due to vaccine supply issues and, despite a pickup since, it is still lagging with about 33 per cent fully vaccinated to date and 50 per cent having at least one dose.

While cases surged due to the Delta variant, the accessibility and strength of its medical system kept its fatality rate at a relatively low 25.41 per 100,000.

Malaysia, on the other hand, has seen a huge surge that has pushed its fatality rate to 85.54 per 100,000, the highest official figure in the region. It struggled to control the onslaught of the Delta variant due to political infighting and incoherence in policy messaging.

A prolonged lockdown also caused widespread hardship to lower-income groups, making it necessary for community self-help groups to step forward to provide desperate households with basic essentials.

UNDERESTIMATED FIGURES IN THE PHILIPPINES AND INDONESIA?

The Philippines and Indonesia were the worst hit regional countries in 2020 but were still in better shape than many countries outside the region then.

It is unclear if this remains the case now. The Philippines struggled to get enough vaccines and now has an official death rate of 36.65 per 100,000.

Indonesia was the global epicentre of the virus for a period when its daily case numbers soared. With many actions at the municipal level and the momentum of vaccinations now building up, it has reported an official fatality rate of only 52.71 per 100,000.

However, many believe the official figures for both the Philippines and Indonesia to be significantly underestimated. There may be some truth in this as The Economist sets their possible figures at a much higher level – 83 to 210 per 100,000 for the Philippines, and 110 to 410 per 100,000 for Indonesia.

The situation in Myanmar is clouded by even more serious data issues, making analysis about how it is doing difficult, if not impossible.

While opening up is now the growing trend all over Southeast Asia, it is unclear how long more the COVID-19 pandemic will last.

One cannot discount the possibility that another new variant could arise later to displace the Delta variant, necessitating the adoption of new strategies yet again and perhaps making new vaccination programmes necessary.

Meanwhile, governments in Southeast Asia will need to re-tool themselves with a more agile and flexible mindset in order to stay ahead of the game.

Choi Shing Kwok is Director and Chief Executive Officer of ISEAS – Yusof Ishak Institute and Head of ASEAN Studies Centre. This commentary first appeared on ISEAS – Yusof Ishak Institute’s blog, Fulcrum.