Philippine economy

[ANALYSIS] ASEAN’s homework for rebalancing post-COVID-19 global health

Renzo Guinto

This is AI generated summarization, which may have errors. For context, always refer to the full article.

[ANALYSIS] ASEAN’s homework for rebalancing post-COVID-19 global health
'For ASEAN to enhance its visibility and influence, the region must put additional investments in global health policy and diplomacy'

 

This piece was first published on the Strategic & Warfare Studies Initiative’s official site. 

By now, the COVID-19 pandemic, which started in China, has already swept the entire world, with the United States as its new epicenter. But before SARS-COV-2, the virus responsible for this pandemic, reached the West, it first infiltrated China’s neighbors in the East. 

From Wuhan, the virus was then exported to nearby capitals – from Bangkok and Taipei to Singapore and Seoul. Applying past lessons learned from SARS and avian flu, these Asian governments were quick to respond, mounting science-based measures for early detection and containment, including testing and aggressive contact tracing. As a result, epidemic curves were immediately flattened, and impending healthcare system crash was prevented. These timely actions during the initial phase of the epidemic ensured that when the second wave arrived, the system had built enough absorptive capacity.(READ: Rappler Talk: Taiwan’s Ambassador Peiyung Hsu on fighting the coronavirus)

Meanwhile, as the weeks went by, the world has seen the Italian healthcare system reach near-collapse, the British National Health Service become overwhelmed, and America’s fragmented health system continue to be shaken. Western countries that topped assessments of pandemic readiness, such as the Global Health Security Index developed by Johns Hopkins University (Table 1), failed to meet expectations. Today, European countries and even American states are starting to ease travel restrictions and reopen economies, though a long and arduous recovery awaits their shattered health systems and severely injured societies.

Table 1. Global Health Security Index* Rankings and Scores of ASEAN Member States and selected countries 

Rank

Country

Overall Score

1

United States

83.5

2

United Kingdom

77.9

6

Thailand

73.2

9

South Korea

70.2

18

Malaysia

62.2

21

Japan

59.8

24

Singapore

58.7

30

Indonesia

56.6

31

Italy

56.2

50

Vietnam

49.1

51

China

48.2

53

Philippines

47.6

72

Myanmar

43.4

73

Laos

43.1

89

Cambodia

39.2

128

Brunei

32.6

155

Papua New Guinea**

27.8

166

Timor-Leste**

26.0

* The full report can be accessed here.

** ASEAN Observer States

COVID-19’s effects on the global health regime

COVID-19 is a humbling experience for the West, putting to test their perceived superiority even in the realm of public health. For instance, at the start of the pandemic, the West prescribed against travel bans. Meanwhile, the East did not listen, and instead bought the West more time – precious time that was not maximized especially by the United States. In the past, Asia was patronizingly called the “Orient,” viewed as backward and inferior. This colonial thinking is even mirrored in health rankings such as the Global Health Security Index, which reflects more Western conceptualizations of security and tells less about local needs and capacities elsewhere. Now, the Orient has become a wellspring of lessons for fighting the virus, with Asian public health leaders invited to speak in webinars held in the Occident.

Perhaps the only “Westerner” not taking this realization to heart is President Donald Trump, who has for months been obsessed with the “Wuhan virus” and deflecting blame toward the World Health Organization (WHO) to cover up for his administration’s delayed and lackluster response. But President Trump’s disinterest in global health and hatred toward multilateral organizations did not happen overnight. Upon entering the White House, he threw out of the window an Obama-era pandemic playbook and dissolved the very office supposed to advise him on health security matters. The Republican-dominated Senate also never bothered to confirm a US permanent representative in the WHO’s Executive Board. COVID-19 just made visible America’s gradual surrendering of its global health leadership role which began since President Trump assumed office. 

To make things worse, President Trump initially threatened to withhold US funding to WHO, an act described by a medical journal editor as a “crime against humanity.” On May 29, he announced the final nail in the coffin – that the US will sever its ties with WHO. A global health system without the US – WHO’s biggest partner and financier to date – will jeopardize the global response to this current pandemic and will be lethal to overall health improvement in the long run. It can only be hoped that this decision will be reversed by its domestic checks and balances, or by the election of former Vice President Joe Biden in November.

Meanwhile, China, as a rising superpower, might see this US departure as golden opportunity for assuming a greater leadership role in global health. In recent years, China’s global health investments have dramatically increased – its financial contribution to WHO now half of the amount coming from the US. During the first-ever virtual World Health Assembly held in May, President Xi Jinping even announced a $2 billion donation toward fighting the coronavirus. 

But if China desires to be global health’s new trusted steward, it must first truthfully answer questions pertaining to their alleged COVID-19 cover-up. It must also exhibit appropriate behavior expected from global health leaders – both internally with regard to its domestic human rights record, and internationally in terms of its sidelining of Taiwan in WHO membership and its neocolonial approach to development aid in Africa, among others. New global health players are welcome, but external pressure will surely come from veterans such as the European Union, whose Coronavirus Global Response pledging initiative launched in early May already raised $10 billion.

Is there a place for ASEAN in global health?

Where do countries of the Association of Southeast Asian Nations (ASEAN) come in this changing global health landscape? One may think that ASEAN is just small fish in the big pond of other large predators. If COVID-19 is a teaching moment for the West, it should be for the East as well. And ASEAN must use this window of opportunity for exerting positive influence in global health – while some of its Member States like Singapore and Vietnam still enjoy international commendation for their effective pandemic response so far.

When it comes to health security, ASEAN as a whole is not starting from scratch. Some of its individual countries learned their lessons from SARS and avian flu many years ago. In her book Containing Contagion: The Politics of Disease Outbreaks in Southeast Asia, Sara E. Davies describes how ASEAN was able to successfully “regionalize” the International Health Regulations (IHR), the legally-binding instrument governing the international management of disease threats such as infectious pathogens and other biochemical hazards. In contrast to its usually nonconformist attitude toward globally-imposed norms, the regional bloc outright adopted the IHR but did it in an “ASEAN way” – characterized by its long-held tradition of noninterference and consensus building.

Recently, there has been much media fanfare about how “Asian values” shaped the early success of several Asian countries in pandemic response. However, it must also be remembered that Asia in general and even ASEAN in particular are not homogenous groups, even in the arena of health and healthcare systems. In 2011, the medical journal The Lancet described Southeast Asia as a “microcosm of global health.” ASEAN Member States represent a wide spectrum of countries mirroring the global health situation – from prosperous Singapore that enjoys high life expectancy and immense healthcare resources comparable to those in Western Europe, to post-authoritarian Myanmar with health indicators and health system infrastructure as rudimentary as those in Sub-Saharan Africa (Table 2).

Table 2. Selected Health and Health System Indicators and COVID-19-Related Metrics in ASEAN Member and Observer States

Country

Life expectancy at birth (years)**

Universal healthcare service coverage index**

Density of medical doctors (per 10,000 population)**

COVID-19 cases (as of May 31, 2020)***

COVID-19 deaths (as of May 31, 2020)***

Brunei

76.4

81

16.1

141

2

Cambodia

69.4

60

1.9

125

0

Indonesia

69.3

57

4.3

26,473

1,613

Laos

65.8

51

3.7

19

0

Malaysia

75.3

73

15.4

7,819

115

Myanmar

66.8

61

6.8

224

6

Papua New Guinea*

65.9

40

0.7

8

0

Philippines

69.3

61

6.0

18,086

957

Singapore

82.9

86

22.9

34,884

23

Thailand

75.5

80

8.1

3,081

57

Timor-Leste*

68.6

52

7.2

24

0

Vietnam

76.3

75

8.3

328

0

* ASEAN Observer States

** World Health Statistics 2020 from the World Health Organization

*** COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

The diversity in disease profiles and health system capacities is reflected in the region’s tentative COVID-19-related outcomes. Singapore has built a sophisticated and well-resourced healthcare system that can robustly detect cases and dramatically reduce the risk of death. Similarly, Vietnam is lauded for its immediate deployment of effective public health measures resulting in an exceptionally low number of cases and still zero casualty. Meanwhile, the larger democracies of Indonesia and the Philippines continue to be criticized for their limited testing capacity and uneven and decentralized response complicated by local politics and questioned use of military force, among others. (READ: Rappler Talk: Guy Thwaites on Vietnam’s effective strategy against coronavirus)

With these patchy results in mind, the next phase in the region’s saga toward enhanced health security must focus on strengthening national healthcare delivery systems, which are the vehicle for domestic pandemic response. Almost every country in ASEAN has embarked on the journey toward universal healthcare in recent years, starting at varying levels (Figure 1), but COVID-19 has disrupted progress and perhaps made its achievement more difficult. The task at hand now is not for health systems to recover to their past state, marked by poor resources, weak governance, and implementation inefficiencies, but to leapfrog toward a much better state that is universal and more equitable, high quality and responsive to people’s needs, and ready for future shocks whether it is another pandemic or a natural disaster due to climate change.

Figure 1. ASEAN Member States in different phases of healthcare development

(Source: The Economist Intelligence Unit, 2016)

Actualizing this common goal of health system leapfrogging means that ASEAN will need to harness its existing regional mechanisms and informal relationships. Previous experiences may provide some template. For instance, Davies describes the early success of the Asia Pacific Strategy for Emerging Infectious Diseases (APSED) in creating “peer pressure” among ASEAN Member States to diligently report the occurrence of outbreaks. This is a good first sign, as Southeast Asia is a known hotspot for emerging infectious diseases due to its geography, climate, demography, and other factors. This current pandemic may have erupted in Wuhan, but it is just a matter of time when the next epidemic starts in ASEAN.

ASEAN as both bridge and countervailing force

Parallel to intraregional health system strengthening, ASEAN must also amplify its voice in the broader global health landscape. Being the region at the heart of the tug-of-war between US and China, ASEAN can play important collaborating, bridging, and neutralizing roles. The temporary exit of the US from the global health room opens some space for regional blocs such as ASEAN to influence global health strategy and decision-making. Meanwhile, ASEAN can also be a “critical friend” to ambitious China when seated together around the global health table.

Figure 2. ASEAN Member States – countries in red circles are under the WHO South East Asian Regional Office (SEARO); the rest are under the Western Pacific Regional Office (WPRO)

While the US leaves WHO and China seeks to dominate it, ASEAN can serve as WHO’s kindred partner. Within the WHO’s regionalized system, ASEAN Member States are split into two – Indonesia, Myanmar, and Thailand belong to its South East Asian Regional Office (SEARO) headquartered in Delhi, and the rest report to the Western Pacific Regional Office based in Manila. This split has always been viewed as a liability, rendering coordination between WHO and ASEAN difficult. But ASEAN must see this arrangement as a huge advantage instead, as it gives the regional bloc not just one but two avenues for shaping the regional and global health agenda. 

For ASEAN to enhance its visibility and influence, the region must put additional investments in global health policy and diplomacy. At the country level, closer ties between ministries of health and foreign affairs must be forged to align priorities and co-devise advocacy strategies. ASEAN Member States must also allocate more resources for regional “public goods” such as the Jakarta-based ASEAN Secretariat. Unfortunately, the Secretariat’s health team has only 5 technical personnel, tasked with the responsibility to convene 10 Member States, coordinate with dozens of multilateral organizations like WHO, and advocate for the health of more than 650 million people. This is in stark contrast with the European Union, which has a way bigger budget for regional and global health activities and a much more sophisticated infrastructure of agencies governing various aspects of health improvement such as the European Center for Disease Prevention and Control (similar to the US CDC) and European Medicines Agency. 

It will surely take more time, resources, and political capital for ASEAN to build a similarly advanced regional health architecture. But COVID-19 may now serve as an impetus for ASEAN countries to consider investing in regional capacity building for meaningful and proactive global health engagement within the region and with the rest of the world – in this time of the coronavirus and beyond. – Rappler.com

A Filipino physician, Renzo Guinto, MD DrPH is the Chief Planetary Doctor of PH Lab – a “glo-cal think-and-do tank” for advancing the health of both people and the planet. An Obama Foundation Asia-Pacific Leader and Aspen Institute New Voices Fellow, Renzo recently finished his Doctor of Public Health degree at Harvard University and previously worked for the World Bank, World Health Organization, and Philippine Department of Health.

Add a comment

Sort by

There are no comments yet. Add your comment to start the conversation.

Summarize this article with AI

How does this make you feel?

Loading
Download the Rappler App!