Closing the Vaccine Inequality Gap in Southeast Asia

Authors: Chen Wei Li and Kowsalya Ganesan

Editor & Region Head: Gingee Babu Sasthaa (Uday)

COVID-19 and Growth Prospects in Southeast Asia

While Southeast Asia was initially lauded for its COVID-19 management and recovery efforts (The Economist, 2021), the recent resurgence of infections has dampened growth prospects. As the highly infectious Delta variant continues to ravage the region, the imposition of stringent stay-at-home orders severely impede regional growth. Experts have slashed growth forecasts for the region; for example, Goldman Sachs has reduced its 2021 forecasts by over 100 basis points for countries including Indonesia, Malaysia and Philippines (Lee, 2021). Yet, the situation across Southeast Asia is not homogenous, and countries such as Singapore have recently upgraded its GDP growth forecast (MTI, 2021), driven by a rapid vaccination rollout. This disparity is most clearly indicated by the stark differences between countries in terms of the number of COVID-19 cases and deaths, as well as vaccination rates across the region (Figures 1 and 2).

Figure 1: Confirmed Cases and Deaths per Million Population in Selected SEA Countries (as of Sep 16)

(World Bank & John Hopkins University, 2021)

Figure 2: Share of Population Fully Vaccinated in Selected SEA Countries (as of Sep 15)

(Our World in Data, 2021)

Vaccination: The Road to Normalisation

Although vaccinations are not a panacea to the pandemic (CFNU, 2021), there is growing clinical evidence that vaccinations offer protection both in terms of lowering risk of contracting the virus as well as reducing the severity of illness and death (CDC, 2021). Against the Delta variant, studies have shown that vaccines are less effective in preventing infection but continue to reduce the likelihood of severe illness and death (Hopkins & Toy, 2021). This provides an explanation for the loose correlation between confirmed deaths and cases per million population in certain countries (Figure 1). For example, Singapore has an extremely low number of deaths at 10.17 yet records a relatively high number of confirmed cases at 12,972 per million people. In comparison, Vietnam has half the number of confirmed cases per million people at 6,693, but 16 times the number of deaths. A plausible justification for this is that the confirmed cases in Singapore exhibit reduced severity of symptoms having received the jabs, given that over 81% of the population are fully vaccinated. In contrast, less than 6% in Vietnam are.

Vaccination Inequality in Southeast Asia

Singapore enjoys the highest rate of complete vaccinations worldwide (Reuters, 2020), far exceeding its peers in the region. This is made possible from efforts to procure supplies in the early stages of the pandemic (Yeung & Olarn, 2021), a privilege that low-income countries with limited resources cannot afford. State-owned investment company Temasek has targeted multiple biotechnology companies like BioNTech for investments since the very beginning of the pandemic in 2020 (Shaffer, 2020), which was a crucial reason why Singapore was able to get its hands on a reliable supply of vaccines early on and have a head start at its vaccination process. The correlation between income and resources is apparent globally; as of August, approximately 1% of people in low-income countries have received at least one dose of the vaccine, compared to 55% in high-income ones (Dangor, 2021).

However, Cambodia is an outlier in the region. As a low-income country that records one of the highest vaccination rates in Southeast Asia (Yang, 2021a), Cambodia has already fully vaccinated over 58% of the population (Figure 2). Approximately 90% of its vaccine supplies are from China (Vannarith, 2021a), a proportion of which are donations by the Chinese government (Yang, 2021b). The remaining 10% largely consist of supplies from COVAX (Vannarith, 2021b), the global initiative to redistribute vaccines and promote equitable access.

On the other end of the spectrum lies Vietnam, where less than 6% of its population is fully vaccinated (Figure 2). The country mainly relies on COVAX for its vaccine supplies, and the US and China have both delivered vaccine doses to the country (Sheng, 2021). Indonesia and Philippines also have low vaccination rates, with 13% of the population fully vaccinated. Similarly, both countries have applied for COVAX, but the facility has failed to acquire sufficient doses (Neo, 2021) to meet mounting demand.

Meeting Regional Vaccine Demands

At present, Southeast Asia continues to depend on other countries for vaccine supplies, either through sales or donations; the majority of vaccine supplies in the region include AstraZeneca from the EU, Sinopharm & Sinovac from China, as well as Moderna, Pfizer & Novavax from the US (Zaini, 2021a).

Meanwhile, the race for a home-grown vaccine has emerged in Southeast Asia, as countries including Vietnam and Thailand seek to address their vaccine shortage and achieve vaccine security (Do as cited in Tan & Tan, 2021a). However, regional vaccine development efforts continue to lag behind those of vaccine powers (Tan & Lim, 2021). This is explicable as vaccine research & development as well as production generally have long gestation periods, and require sizable economic resources and scientific expertise.

Vaccine Diplomacy in Southeast Asia

Vaccine diplomacy being practised by global superpowers has become increasingly evident. Southeast Asia is a prime recipient of Chinese vaccines, accounting for 29% of China’s total vaccine donations and 25.6% of its vaccine sales worldwide (Zaini, 2021b). However, China’s vaccine diplomacy campaign has lost its initial traction as questions regarding the efficacy of Chinese vaccines arise (Chandler & McGregor, 2021). China’s vaccine outreach was heavily facilitated by its “first-mover” advantage and regular supplies, but this advantage has diminished as Western countries have started distributing their spare vaccine inventory (Zaini, 2021c). Thus as more countries turn away from China, the US capitalises on this by ramping up its vaccine donations to compete with China (Hutt, 2021a). Their vaccine aid presents itself as an opportunity to restore relations in Southeast Asia (Yong, 2021). The Biden administration recently sent over senior officials, including Vice President Kamala Harris, who visited Singapore and Vietnam, to present their vaccine pledges to Southeast Asia (Wee & Myers, 2021). Direct donations to the region include the Philippines, a US treaty ally; Vietnam, one of US’ most important geopolitical allies in the region in recent times; and the traditionally pro-US Indonesia (Hutt, 2021b). Given that Asia is not a vaccine priority for the EU (Hiep as cited in Hutt, 2021c), it has fallen behind.

Undoubtedly, it has to be acknowledged that the distribution of vaccines via vaccine diplomacy, from these growing vaccine powers, is a key reason why we were able to address supply gaps and reach the vaccination rates that we have even achieved thus far. But there is a catch: this endowment does come at the cost of increased dependency on these mightier nations – and this assistance may ostensibly be used as an attempt to advance their political agenda and gain a stronghold in the Southeast Asian region. A vaccine-dependent relationship between Southeast Asia and any of the ascending vaccine powerhouses outside the region may become a significant factor in influencing geopolitical relations and inciting potential vulnerability (Fidler, 2021).

Conclusion – Moving Forward...

Vaccine independence is the most sustainable solution, directly engendering vaccine security. The surge in Covid-19 infections, supply shortage of vaccines, and uncertainty surrounding the efficacy of current vaccines against new variants are driving the search for home-grown solutions (Tan & Tan, 2021b). Although efforts are underway, the process can be sped up and made more efficient by tapping on the niche areas of nations, coupled with the collaborative support of ASEAN. For instance, Singapore can harness its strength in R&D to develop the vaccine, while Malaysia and Thailand can utilise their extensive factory capacities for large-scale production of the vaccines. Southeast Asia has made some headway in its collective response towards Covid-19; the next step is to embark on the path towards vaccine independence.

That being said, vaccine independence is a long haul and Southeast Asia will remain dependent on vaccine diplomacy in the near future. Nevertheless, the key to healthy dependence is: portfolio diversification and vaccine multilateralism. While looking towards China as a major source of vaccine supplies, most Southeast Asian countries have sought to diversify their vaccine portfolios as they do not want to hedge all their bets on Chinese vaccines (Zaini, 2021d). Quoting Singapore’s Prime Minister Lee Hsien Loong, countries should strive towards “vaccine multilateralism” (Lee, 2020); it is of utmost importance for Southeast Asia to consider a more concrete and united approach in combating the pandemic. It is not a race against countries, but rather a race against time. Ultimately, as emphasised by WHO Director General Dr Tedros, “No one is safe until everyone is safe” (Ghebreyesus, 2020).


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