Public Health

Why has East Asia tackled COVID-19 better than most Western countries?

 Western countries dominated a list of 15 countries with the most confirmed COVID-19 cases by early May.

China was the only Asian country on the list, compiled by Johns Hopkins University in the United States.

As early as the beginning of April, Jeffrey Sachs, a leading American academic, noted that East Asian countries were “outperforming the United States and Europe in controlling the COVID-19 pandemic, despite the fact that the outbreak began in China, to which the rest of East Asia is very closely bound by trade and travel”.

Sachs, professor of health policy and management at Columbia University’s School of Public Health, urged the West to “learn what we can from East Asia as rapidly as possible”.

However, in Southeast Asia, there are big differences in case fatality rates  – over nine percent in Indonesia, well under one percent in Singapore and, as of the first week of May, zero deaths in Vietnam.

The Financial Times of London praised Vietnam as “a model in containing the disease in a country with limited resources but determined leadership”.

According to Zachary Abuza, a professor at the National War College in Washington, D.C., the difference between success and failure on COVID-19 is down to four factors: leadership, transparency, legitimacy, and planning and preparedness – including the state of a nation’s public health system.

Decisive leadership

Abuza said leaders who took the advice of public health and medical officials have done best.

Vietnam and Singapore – at least during its first wave of the pandemic – did particularly well because their governments acted decisively, he said.

They quickly implemented public health screening and contact tracing measures, shut down international and domestic travel, and closed non-essential businesses.

By contrast, it took the US federal government two months to recommend social distancing rules after the US confirmed its first case on 20 January.

Ooi Eng Eong, a professor in emerging infectious diseases at the National University of Singapore, told the ABC his country’s containment measures kicked in as soon as the first case was detected and were scaled accordingly.

However, Singapore’s fast initial actions were undermined by a second wave of infections, which spread among its 300,000 poor migrant workers who live in cramped and sub-standard conditions.

This was a reminder that “public health is determined by the lowest common denominator,” Abuza commented.

“If the poorest and most marginalised within a society are not protected, then no one is.”

Transparent communications

Abuza said governments that admitted the problem early and communicated with citizens in a transparent manner tended to quickly win public confidence.

Greater trust led to much greater social compliance when it came to wearing face masks, social distancing, and sheltering in place.

In late April, UK-based researchers Robyn Klingler-Vidra of King’s College London and Ba-Linh Tran of the University of Bath reported that Vietnam had managed to avoid any deaths thanks to a three-pronged government strategy: temperature screening and testing, targeted lockdowns and constant communications.

The government texts citizens with information on symptoms and protection measures every day and “Vietnam’s cities are adorned with posters that remind citizens of their role in stopping the spread of the virus,” they said.

Legitimacy through results

When it comes to fighting a disease, being a democracy has not necessarily made a government legitimate in the eyes of the public, Abuza argues.

“The Philippines and Indonesian governments may have come to power via elections, but their incompetent handling of the pandemic has weakened their legitimacy,” he said.

“Indonesia has been a spectacular failure despite the fact the president won re-election in mid 2019 with over 55 per cent of the vote.

“The Vietnamese and Singaporean governments garner their legitimacy via performance, not polls.”

Planning and preparedness

Recent experience is a major factor in how a government and its citizens respond to a pandemic.

The best-performing govern-ments developed a pandemic response plan incorporating lessons learned from other pandemics.

American epidemiologist Gary Slutkin told the ABC that SARS (Severe Acute Respiratory Syndrome) in 2003 and MERS (Middle East Respiratory Syndrome) in 2015 were “very instructive” for East Asian countries and meant they were prepared to respond to a serious respiratory pathogen.

Jeffrey Sachs noted that the result of East Asia’s greater awareness was “a much higher national alert level throughout the region when China first publicly reported an unusual clutch 
of pneumonia cases in Wuhan on 
31 December”.

However, in Europe and the US, “concerns over SARS, Ebola, Zika, and dengue fever seemed far away”.

As well as careful planning, successful Asian governments also stockpiled PPE and maintained the capacity to do rapid and mass testing and contact tracing.

And they made sufficient investments in public health.

Abuza pointed out that governments who starved their public health system of resources fared poorly.

He makes a clear distinction between public health and the medical sector.

“Vietnam’s medical sector is really quite rudimentary. Yet they have extremely good public health because it is cost effective,” he said.

“Prevention is pennies on the dollars of the cure. Testing, contact tracing, thermometers are really cheap compared to ICUs 
with ventilators.

“Vietnam has conducted well over 200,000 tests, or 2.1 tests per 1000 people. In contrast, as of 19 April, Indonesia had conducted under 50,000 tests, only 0.15 per 1000.”