Lancet cites 10 Asia Pacific nations in fight against COVID-19, warns against ‘medical populism’

Ten countries in the Asia Pacific region, with six coming from Southeast Asia (SEA), have topped the ranking of nations that successfully suppressed the novel coronavirus disease (COVID-19) pandemic, according to The Lancet COVID-19 Commission statement on the 75th session of the United Nations (UN) General Assembly.

Taiwan, Thailand, and Vietnam are in the top three spots, followed by Laos, China, Myanmar, Malaysia, New Zealand, Uganda, Togo, Pakistan, Latvia, Luxembourg, Uruguay, South Korea, Finland, Cuba, and Rwanda. [Lancet 2020;doi:10.1016/S0140-6736(20)31927-9]

Singapore ranked 57th while the Philippines ranked 66th out of 91 countries based on incidence or the number of new cases per million population per day. On the other hand, other SEA countries such as Indonesia and Timor Leste were not included in the list. [https://rb.gy/rjejhu]

The Lancet COVID-19 Commission defined suppression as having five or fewer new cases per million population per day (in August), provided that the testing rate was enough. An ample testing rate was characterized by at least 20 tests per new case. The Commission also assessed mortality rates, tests performed, and effective reproduction rates (ERR).

Last month, however, 11 countries incurred very high transmission, six of which are in the Americas: Bolivia, Spain, Kuwait, the United States, Argentina, Israel, Brazil, Bahrain, Colombia, Panama, and Maldives.

The Lancet highlighted the “stark and remarkable” difference across countries in the transmission rate of the virus, ranging from less than one to several hundred new cases per million population per day. This huge range indicated that countries with high or very high transmission are failing to undertake enough nonpharmaceutical interventions (NPIs) to control the pandemic.

“The pandemic can be controlled, as shown clearly by the countries that have largely suppressed it,” The Lancet wrote, noting NPIs such as “effective community health services… to be followed by the introduction of effective and safe vaccines as rapidly as science permits.”

Other NPIs that countries must implement are as follows: face mask wearing, social distancing, banning of large public events, protecting members of the vulnerable population, and providing social support for those in isolation, among others. [https://rb.gy/rjejhu]

Medical populism

The Philippines, alongside Brazil and the US, was specifically mentioned by The Lancet COVID-19 Commission in their UN report due to its “populist” approach in controlling the pandemic.

The Philippines was classified as having “moderate transmission,” with 37.5 new infections and 0.5 new deaths per million per day in August. Last month, the country has performed 8.2 tests per case daily and had an ERR of 1.2. As of this writing, the Philippines has logged close to 300,000 infections, the highest across SEA.

“One reason for failure to suppress the epidemic is a style of political leadership that has been called medical populism,” The Lancet said.

Medical populism was defined as “simplifying the pandemic by downplaying its impacts or touting easy solutions or treatments, spectacularizing their responses to crisis, forging divisions between the ‘people’ and dangerous ‘others,’ and making medical knowledge claims to support the above.” [Glob Public Health 2020;doi:10.1080/17441692.2020.1807581]

The study mentioned three cases in point: US President Donald Trump, Philippines President Rodrigo Duterte, and Brazil President Jair Bolsonaro.

“Not only does medical populism frustrate the implementation of NPIs, but it also stokes opposition to simple measures such as wearing face masks, and it breeds misinformation and rumour trafficking,” according to The Lancet.

The Commission then stressed the urgent need for “improved and intensified data collection, more extensive testing in general, and coherence across countries in the science-based metrics of COVID-19 cases, deaths, and other epidemiological parameters (including behavioural parameters such as face mask wearing, physical distancing, contact tracing, isolation and quarantining, and other relevant data).”

“We also note that politicians might aim to subvert transparent data reporting to suppress information on the extent of the epidemic or deaths due to COVID-19, and such efforts should be strongly resisted,” it added.