This Special Feature examines the COVID-19 context in Southeast Asia and looks at potential ways forward, in terms of reducing cases and ensuring long-term preparedness.

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Southeast Asia has recently experienced surges in COVID-19-related deaths. We explore the situation in the region. Image credit: Ezra Acayam/Getty Images

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It has been over a year since the first outbreak of COVID-19, back in December 2019. Yet COVID-19 cases continue to rise in nations throughout the world as they face increasing spread, more contagious variants, and slow vaccine rollout and engagement.

In this feature, we explore the ongoing efforts to control the spread of COVID-19 in Southeast Asia. Medical News Today also reached out to two experts in the field of global health, Dr. Krutika Kuppalli and health equity legal expert Priti Krishtel, for further insight into the situation.

Dr. Krutika Kuppalli is an infectious diseases physician and vice chair of the Infectious Diseases Society of America Global Health Committee.

Priti Krishtel is a lawyer who specializes in health justice and the cofounder of I-MAK, a nonprofit that works to “challenge systemic injustice and advocate for health equity in drug development and access.”

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According to the Center for Strategic & International Studies, the COVID-19 death rate has been skyrocketing in multiple Southeast Asian countries since July 2021, with record high case numbers over the past month.

And with the recent emergence of the Delta variant, which may have increased transmissibility, the number of new COVID-19 cases has increased. This has led to a reimplementation of lockdown measures.

On August 9, Indonesia had a COVID-19 death rate of 392 per million, one of the highest in the region. Malaysia and the Philippines had similarly high rates, of 334 and 262 per million, respectively.

Meanwhile, Malaysia’s parliament is currently in a 2-week lockdown due to four cases of Delta variant infection among its staff. In the public sphere, tensions are growing, as lawmakers criticize the lockdown, saying that it is part of an attempt by the government to avoid taking responsibility for their handling of the pandemic response.

And for most of the month of August, the Manila metro region of the Philippines has implemented strict lockdown measures.

On August 9, Brunei, Singapore, and Laos reported lower death rates, of 7, 7, and 1 per million, respectively. Singapore also has one of the highest vaccination rates, with 66% of the population fully vaccinated.

But Thailand and Vietnam, both of which had maintained relatively low case numbers, which can be attributed to continued testing and distancing measures, saw a sharp increase in cases in July.

Thailand’s foreign ministry has implemented new travel limitations in tourist regions for the first half of August. Travel curbs and curfews are also in effect in Bangkok and other regions with high case numbers until the end of the month.

Vietnam, where only 1.03% of the population is fully vaccinated, continues to receive additional vaccine doses through the COVAX initiative.

Ineffective vaccine distribution, under-resourced healthcare systems, and vaccine hesitancy all contribute to the current record COVID-19 case numbers in the region.

Healthcare infrastructure

A lack of resources throughout healthcare systems, particularly in low-income countries, have limited the ability to prevent and treat COVID-19 cases.

Dr. Kuppalli explained to MNT that “There was a false narrative after the first surge last year that India had ‘beaten’ the pandemic, and there was a premature relaxing of public health measures” in the area.

While many national and local public health responses were effective in dealing with the first wave of COVID-19, further efforts were needed to ensure long-term protection.

Dr. Kuppalli urged increases in “infrastructure for testing, sequencing, and healthcare capacity,” as well as engaging rural communities with education about COVID-19 symptoms and providing better access to care.

“All of these things would have made a large difference in how the second surge was handled — but also as we look ahead to other surges that might occur,” she added.

Insufficient vaccine distribution

The World Health Organization (WHO) stated that as of August 2021, a total of 618.5 million vaccines had been administered in Southeast Asia, which translates to 146 million people being fully vaccinated.

Dr. Poonam Khetrapal Singh, the WHO’s Southeast Asia regional director, commented that the region is on track to meet vaccination goals, with a target of 40% of the population fully vaccinated by the end of 2021.

Despite these hopeful figures, ongoing efforts are needed to promote vaccine equity and ensure widespread vaccine distribution.

At the Global Health Summit 2021, in May, specialists noted that a mere 0.3% of the total number of administered vaccines had gone to lower-income countries. The remaining went to higher-income countries, including the United States, the United Kingdom, Canada, and Germany.

Priti Krishtel, of I-MAK, commented on this situation:

“We have a market-based global health model in which wealthy countries and pharmaceutical companies have hoarded knowledge, in terms of how to produce vaccines, and have also gobbled up supply while those in low- and middle-income countries are needlessly dying and could wait years to get vaccinated. Currently, 55% of people in high-income countries have received at least one vaccine dose, compared to only 1% of those in low-income countries.”

In addition, conflicting information about the safety and efficacy of COVID-19 vaccines has prompted uncertainty and hesitancy.

China’s Sinovac COVID-19 vaccine has played a significant role in the vaccine landscape. In July, almost 90% of the vaccines in Indonesia were from Sinovac.

However, people are expressing hesitancy about this vaccine, though it has emergency use authorization from the WHO. A poll conducted in the province of Jakarta showed that a third of residents were undecided about whether to have the vaccine, driven partially by concerns about its efficacy.

The COVAX initiative, a collaboration among the WHO and other health bodies, is seeking to address shortages and the cost of vaccine supply in an effort to protect those most at risk — with a goal of producing 2 billion more vaccines by the end of 2021.

In addition, India and South Africa have called for a waiver of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. This was established in 1995 as part of the efforts of the World Trade Organization (WTO) to guarantee further protections for individual intellectual property.

Waiving the TRIPS agreement would promote the distribution of vaccines and related manufacturing processes and technologies. While this step has been supported by 100 countries, including the U.S., it is still facing resistance from several of the wealthiest nations.

“We need other G7 countries to join the U.S. in supporting the WTO TRIPS waiver so that global vaccine production can be massively scaled up. Without swift action by drug manufacturers and wealthy governments to share knowledge — much of which their taxpayers funded — we will be in the current situation of the virus ravaging huge swaths of the world for the next several years,” said Krishtel.

“This also affects high-income countries, as variants will become more prevalent and make their way into countries with higher levels of vaccinated people, as we’re already seeing with Delta. Vaccinating the world is the only way out of this pandemic,” she emphasized.

Dr. Kuppalli agreed that more nations need to back the TRIPS waiver for countries to build the necessary vaccine manufacturing and distribution infrastructure.

Both experts also supported the WHO’s recent call for a moratorium on booster shots until the end of September, at the earliest, in order to combat the vaccine shortage in several nations.

“Just look at what has happened over the last year,” remarked Dr. Kuppalli. “We have the original strain of the virus, which then mutated to the Alpha variant and now the Delta variant, which is 40% more transmissible than the Alpha variant. If we do not get this under control, we will develop even more transmissible and dangerous variants.”

Government agencies and communities must collaborate to ensure that vaccines are accessible and that precautionary distancing and mask measures continue.

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