Southeast Asia falls behind COVID-19 vaccination target: What must be done?

Half of Southeast Asian countries are lagging in vaccinating people against COVID-19, with Myanmar, the Philippines, and Vietnam being the top three worst performers after having fully vaccinated only 8.3 percent, 19 percent, and 23 percent of their total population, respectively, as of 27 October 2021.

In contrast, Singapore, Cambodia, and Malaysia have already achieved the 70-percent vaccination target, with 80 percent, 77 percent, and 74 percent of their population receiving the second dose of COVID-19 vaccine.

These figures were imparted by Dr Thu Anh Nguyen, managing director at Woolcock Institute of Medical Research in Vietnam, during the 2nd ASEAN Webinar Series, entitled ASEAN Vaccine Talk: Towards Vaccine Security and Self-Reliance for All, held on 3 November 2021.

In her presentation, Nguyen stresses the high rate of COVID-19 mortality in the region, with Malaysia, Indonesia, and the Philippines topping the list at 874, 517, and 382 deaths per 1 million population.

Low- and middle-income countries, such as those mentioned, find it difficult to access vaccines, leaving people vulnerable to the new COVID-19 surge, according to Nguyen. For instance, one in two people (63.52 percent) in high-income countries have received at least one dose as of 27 October 2021, whereas the proportion in poor countries is only one in 21 people (4.75 percent).

There are several reasons why many Southeast Asian countries fall behind in terms of COVID-19 vaccination. Some of them have failed to secure contracts with manufacturers early, leading to a delay in vaccine delivery. Additionally, the cost of vaccine is too steep for low-income countries ($2–40 per dose plus $3.7 distribution fee).

Based on data provided by UNICEF COVID-19 Vaccine Market Dashboard, high-income countries must increase their healthcare spending by 0.8 percent on average to cover the cost of vaccinating 70 percent of the population. On the other end, low-income countries need to increase it by a whopping 56.6 percent to achieve the target.

Other constraints in vaccine supply and distribution include restrictions on exports of both raw materials and finished vaccines from key vaccine-producing regions, limited capacity to develop home-grown vaccines, and poor planning for vaccination at a large scale.

“Where should we go from here?” Nguyen asks. “First, we should agree that COVID-19 will stay for a while and we should prepare for uncertainty; no one is safe until we all are safe.”

Moreover, she emphasizes the need for evidence-based policy, long-term self-reliance vaccine strategy, and vaccines with higher efficacy.

Global support

Richard Maude, executive director at Asia Policy Institute in Australia, supports the points raised by Nguyen, noting the global support for boosting vaccine security and self-reliance in Southeast Asia.

However, vaccine inequality persists. “Globally, only 20 percent of low- and lower-middle-income countries have received a first dose of vaccine compared to 80 percent in high- and upper-middle income countries,” Maude says, citing September data from the COVAX facility.

He also points out that self-reliance, while necessary, is unlikely to happen in Southeast Asia in the near and medium term. To achieve this, vaccine production needs to be closer to the point of distribution.

“Local production protects against export bans and further vaccine nationalism,” says Maude, noting that building a vaccine technology base is vital for managing booster shots and dealing with new COVID-19 variants.

Beyond self-reliance, Maude highlights other measures that can be done to ensure vaccine security. For instance, wealthy nations must do more to bridge funding gaps for vaccine supply and therapeutics for less-developed countries. There is also a need to fight misinformation and overcome vaccine hesitancy.

Maude also underscores supporting economic recovery of many Southeast Asian countries through the following: debt relief, emergency loans and special drawing rights to free up public spending, human capital, infrastructure for a green recovery, and technical advice of social support programmes.

Next pandemic

Moving forward, Ken J. Ishii, professor of Vaccine Science at University of Tokyo in Japan, makes a case for the availability of vaccines in the first 100 days of a future pandemic.

He states that, during peace time, governments and institutions across the globe should prepare a mock-up vaccine, develop artificial intelligence (AI)-assisted immunomics, and design vaccines with three modules (ie, antigen, adjuvant, and delivery).

“Human immune responses are so diverse that we need single cell-based and AI-supported, multi-dimensional immunomics to identify the Achilles’ heel of the pathogen and smarter vaccine design,” Ishii says. “We will take a new strategy to split the vaccine elements into modules … to design an arrow (vaccine) to shoot the Achilles’ heel of the target pathogen.”