Regional vaccine approach is imperative

Regional vaccine approach is imperative

A shipment of 600,000 doses of Covid-19 vaccines donated by China arrives at Phnom Penh International Airport in February. (Photo: Reuters)

As vaccine diplomacy thrives and vaccine nationalism rears its head, it has become clear that the ideal global solution to the collective action problem of the coronavirus pandemic is for all countries to put their eggs in the same basket. If all countries are forced to rely on the global vaccine alliances’ and the World Health Organization’s Covid-19 Global Vaccines Access (Covax) plan, whereby any vaccine for one means an available antidote for all, the post-pandemic recovery would arrive faster and smoother with more promising prospects. But short of the ideal solution, the global health system is largely based on self-help, each country mapping its own plan for recovery with a mix of procurement strategies.

For Thailand, the virus stage last year was well handled. The Thai strategy of minimising case numbers while waiting for the vaccine appears to have been vindicated. For much of last year, Thailand stayed open internally, maintaining a domestic bubble while letting few outsiders in. But as the vaccine rollout started around the world early this year, Thailand was caught out, worsened by a virus spike. The government chose not to join Covax, which is subscribed to by the rest of Asean and almost all other countries, and placed its eggs on a direct tie-up between AstraZeneca and Siam Bioscience, supplemented by China’s Sinovac. Not a day goes by without public criticism of the folly of this strategy and the government’s gross vaccine mismanagement and apparent cover-up.

What needs to be considered now, even while Thailand grapples with a new wave and uncertain prospects, is to regionalise the vaccine available in the Mekong region of mainland Southeast Asia in the near future. Vaccination in Thailand will create limitations for the economic recovery in the longer term unless Cambodia, Laos, and Myanmar can also reach similar herd immunity due to labour market integration and trade and investment enmeshment. The economy has benefited from fast-growing neighbours next door. Unless their economies can expand together, the region’s economic performance will be subpar.

After more than a year of global contagion, Covid-19 has persisted virulently in the Mekong region, with adverse social and economic impacts and mixed recovery trajectories. As Covid-19 moves from the virus stage to vaccination and herd immunity, the Mekong countries risk being left behind. Vaccine diplomacy from China and Russia and vaccine nationalism among countries that may not recognise each other’s jabs will be critical in how mainland Southeast Asia emerges out of the Covid-19 doldrums.

Already, economic contractions that were projected six months ago have even worsened, with knock-on effects on social conditions, such as poverty and greater unemployment. It is instructive to note Covid-19 patterns and trends between virus and vaccine stages. One remarkable trend is that some of the countries that fared poorly in the initial pandemic months, particularly the United States, the United Kingdom, and much of the European Union, have had impressive vaccine rollouts, and are likely to reach herd immunity earlier than others who did well at first but later fell behind on both renewed waves and vaccine delays.

The Mekong countries fall into this category. While infection numbers were relatively low last year, the Mekong countries’ vaccine access and rapid inoculation are uncertain and likely to take longer than anticipated, thereby hindering recovery and a full resumption of economic activity.

The relative virus containment successes in the Mekong region seem to render vaccination less urgent, compared to other countries where case numbers have been much higher. Yet the ongoing virus bursts, especially in Thailand as a regional hub, suggest that expeditious inoculation drives are needed to ensure economic recovery and capacity to move beyond Covid-19 on a solid footing. But in the global rankings, all of the Mekong countries are well down the table on vaccination.

According to global health data, their vaccine choices are also telling. The UK’s AstraZeneca is the common jab for Cambodia, Myanmar, Thailand and Vietnam, whereas Laos uses China’s Sinopharm and Russia’s Sputnik. Cambodia and Thailand also have received China’s Sinovac and Sinopharm, but Myanmar and Vietnam have deployed only AstraZeneca so far. As its batches are a goodwill gesture from India, Myanmar’s supplies are likely to decline as India scales up production for its own people. Partly due to bilateral tensions with Beijing, Vietnam has avoided the Chinese versions. Recipient countries of AstraZeneca in the Mekong region are members of Covax, with the conspicuous absence of Thailand.

The diverse vaccine procurement among Mekong countries reflects geopolitics. China’s vaccine diplomacy works more in Cambodia, Myanmar, and Thailand but less in Myanmar and Vietnam. AstraZeneca is sought after by all Mekong countries but not Laos. The US-made Pfizer, Moderna and Johnson & Johnson, on the other hand, are currently not in the Mekong vaccine cabinets. Thailand’s monopoly aim of securing AstraZeneca’s manufacturing licence only for Siam Bioscience also poses risks for mainland Southeast Asia. While it was supposed to be the regional manufacturing centre for AstraZeneca’s rollout in Southeast Asia, the royally owned Siam Bioscience is behind schedule, with growing question marks about what happens next. The firm could come through very soon but, if it does not, the delay will have adverse repercussions for the region.

The vaccine world, in turn, appears divided into three distinct groups with overlap. Developed countries in the vaccine “First World” are fast approaching herd immunity by mid-2021. Russia and China’s vaccine brands are reaching countries in the “Second World” where Moscow and Beijing are geopolitically influential. Vaccines in “Third World” countries appear restricted to those with limited access and with not much option but to rely on the Covax scheme and vaccine donations.

Because the Mekong countries are spread out among the last two groups with varying means of affordability — Laos in the second set and Myanmar in the third — vaccine regionalisation is imperative. Vaccines for one country should mean antidotes for the entire Mekong region in view of their land connectivity, intra-regional trade, and labour market integration. Moreover, regionalising vaccine procurement, production and distribution will be vital to reopening and recovery. While Singapore joins the US and UK as advanced countries reaching herd immunity by end-2021, the Mekong countries lag behind. According to Economist Intelligence Unit data, Vietnam and Thailand are on course to emerge from Covid-19 earlier than Cambodia, Laos, and Myanmar. However, Thailand needs its next-door neighbours to also reach herd immunity in order to fully revive economic activity in view of labour migration, border trade, and the potential for renewed virus outbreaks and/or variants from Cambodia, Laos, and Myanmar. It is conceivable that Cambodia, Laos and Myanmar will not sufficiently shake off Covid-19 until 2023 or beyond.

Post-coup Myanmar with spiralling violence and civil war is vulnerable to an even longer recovery time. In other words, the Covid-19 crisis may well last up to five years from outbreak to “new normal”. As both the virus and vaccine challenges have further reinforced the Mekong mainland countries’ “regionness,” it behoves the governments involved to focus on a vaccine regionalisation approach and the acceleration of Covax AstraZeneca availability and access for all five countries.