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Addressing the Impact of COVID-19 on Southeast Asian Public Health Systems

4 November 2021

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Jakarta/Manila, 4 November 2021:  Asia’s think tanks play an increasingly important role in shaping the future of the region.  Over the past several years their numbers have been growing – and with covid-19, policymakers across the region have turned to think tanks for support in designing policies that will aid regional recovery. This is particularly true in the area of health policy.

Dr Antonio Villenueva, Senior Advisor on Healthcare Policy at ERIA, addressed these topics as a presenter on the first panel (‘The Impact of COVID-19’) at the Asia Think Tank Summit, virtually hosted by the Think Tanks and Civil Societies Program at the University of Pennsylvania.  Dr Villanueva’s presentation covered the impact of the pandemic on public health with a focus on Southeast Asia.  The following is excerpted from his presentation: 

For the past 2 years, most will agree that the impact of COVID-19 on health and health systems has been OVERWHELMING … at the individual, family, community, local government, national, regional, and global levels … and from social, cultural, educational, economic, scientific, and spiritual perspectives.

Individually, more people have grown more aware of their immune system health status now, responsibly moving forward with proactive health trends in nutrition and exercise and work-life balance, and avoiding potential COVID cluster areas … good behavior for anyone before, during, and after any pandemic.

As families, spending more time together, many have grown more aware of preventive and protective health measures, from wearing face masks correctly at appropriate times to maintaining general home hygiene to caring for our vulnerable.

As communities, in Asia we’ve been reminded how to respect each other’s safety and how to maintain a clean environment more, to not go to work or to school or to church or out on dates or to travel … IF WE ARE SICK. An anecdote: We’ve even seen in one country where kids know how to fake a positive COVID antigen test to avoid going to school.

From the local government units to the national, regional, and global levels, health SYSTEMS have been impacted in varying degrees, depending on socio-cultural practices, educational awareness, and positive regard for balance between health and economy as well as science and religion.

Before continuing more with the impact on the region’s health systems, a few success cases. In the ASEAN region, two countries whose health systems were able to overcome COVID initially early-on before vaccines were Singapore and Viet Nam. Singapore’s healthcare system of course is top of the line in quality, whereas Viet Nam as a low-to-middle-income country (LMIC) was better PREPARED because of its past experience with SARS and therefore its immediate early action. Both offered free testing and treatment and respected their citizens, therefore gaining trust while minimizing excessive pandemic profiteering.

Singapore’s strengths appeared to be mass testing and cluster announcements. Viet Nam, on the other hand, emphasized cultural behavior and implemented contact tracing.

So, while these two nations’ approaches differed, the approaches were appropriate for their sovereign borders, with common strategies being heightened AWARENESS and RESPONSIBLE citizenry.

Unfortunately, it’s seemed to be a losing battle for most of our political, economic, and health leaders who have been chained to wave after wave of variants because regardless of the pandemic measures taken, alongside the evolving scientific explanations, the shape of a wave is exactly that --- a wave, lasting anywhere from 2 to 3 months or so to dissipate, as we have witnessed recently in Indonesia, Malaysia, the Philippines, Thailand, and Viet Nam. Hospitals have been overburdened, especially because frontline healthcare workers’ numbers have decreased due to deaths, burnouts, inadequate protection or compensation, transfers, and migration. I would just like to mention at this point how some countries have solved inadequate numbers of medical and health personnel in the past.

Tanzania, for example, has successfully trained underboards (meaning not yet licensed) for special healthcare needs through modular programs thereafter granting ‘junior licenses. Why couldn’t this be done for emergencies and pandemics, kind of like a reserve health corps?

Reserve health corps have also been created through service organizations, where medical and health professionals volunteer their services part time or for a month or two every year, a kind of direct ‘giving back to the community’. 

Regional health systems have been plagued further with lawsuits for mismanagement and corruption.  As mentioned earlier, it is really very difficult for any government to battle against a pandemic amidst changing science, … also eager mass media, and impatient political forces and populations.

Regarding political issues, I suggest public and transparent tracking of donations of health funds.

Regarding daily dissemination of COVID figures, I suggest reporting real values as percent population rather than absolute figures. Larger populations will definitely present with higher case numbers. Further, what’s more important are the hospitalisations and deaths, where or how they are being acquired and by which groups … And of course, the transmission rate.  And not only of COVID but other diseases as well. 

For the statisticians, are we correct in comparing hospitalisations of vaccinated vs unvaccinated while the unvaccinated population is bigger? Would it be more discerning, as new data evolves, to compare the hospitalizations and deaths of a wholly vaccinated area in the near future to the wholly unvaccinated group during the early pandemic?  

We would expect all of these numbers to be more serious in the urban areas as compared to the rural, so why all the fear and mandate requirements across the board? In fact, a long-awaited exodus would be for companies and populations to move away from the congested cities toward the suburbs and countrysides.

Which brings us to the health economics of travel. To make a long story short, not everyone can take vaccines, variants are susceptible in varying degrees, efficient and effective rapid diagnostic tests are available, COVID is not the only transmissible disease, airport and airlines safeguards are in place, the percent of new cases from such international travelers in many countries is now extremely low especially compared to the community transmission, and economic health is suffering, which causes other kinds of deaths.

We physicians have integrated telemedicine tremendously through this pandemic, and are often requested to certify fit to work, fit to compete, fit to climb Mt Fuji, etc. … why not just accept a medical certificate for fit to travel? A travel medicine physician, a quarantine physician, an airport physician, an infectious disease specialist, a primary care or family physician, any appropriate physician will be signing his or her license on that paper, using the guidelines and evidence provided … with the significant touch of personally knowing the traveler. Even before the pandemic, wouldn’t fit to travel make sense? 

The international community of nations, especially within ASEAN, although able to form working collaborations against COVID, has understandably prioritized on battling COVID internally. As has been valuable in this venue, the SHARING OF BEST PRACTICES in international conferences can better prepare all of us moving forward through future variants and pandemics.

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