As COVID surges, Southeast Asia struggles to vaccinate citizens

Despite successfully staving off significant COVID-19 outbreaks in 2020, many countries in Southeast Asia are now reckoning with a new surge in infections and deaths, driven by highly contagious variants of the coronavirus.

Myanmar social media has been flooded with desperate pleas for oxygen, Thai healthcare workers have been forced to store dead bodies in refrigerated containers as morgues are overwhelmed, and Vietnam has deployed troops to enforce a severe lockdown in Ho Chi Minh amid panic buying.

The situation has been exacerbated by sluggish vaccine campaigns marked by a lack of supply and hesitancy influenced by distrust of authorities and of China – the main vaccine supplier to the region.

Nowhere is this more pronounced than Myanmar, where a military coup and a subsequent bloody crackdown has decimated the healthcare system. Prior to the February 1 putsch, Myanmar had only reported about 3,000 deaths from COVID-19. Today, the official death toll is more than 14,000, with most health experts estimating the true count is far higher. Doctors and nurses have been at the forefront of the resistance to the coup, with approximately 60 to 80 percent of the public healthcare force on strike in defiance of the military – a move that has crippled the healthcare system. The military has meanwhile cracked down on parallel healthcare structures set up by striking workers.

According to the military’s official numbers, about 8 percent of Myanmar’s estimated 54 million people have received at least one dose. The country has mostly turned to vaccines developed by China, Russia and India for its inoculation programme.

‘Most politicised healthcare environment’

Jason Mills, deputy head of mission for Doctors Without Borders in Myanmar, said the country has “probably the most politicized healthcare environment in the world right now”. He said distrust of the military has been a “real issue” in terms of getting healthcare workers vaccinated.

“Trust is the foundation of all successful vaccination campaigns,” Mills said, adding that the military’s health ministry must “give parallel health actors space to vaccinate populations who trust them independent of affiliation with the de facto authorities”.

So far, the military has shown little willingness to do so. In July, security forces fabricated a fake COVID-19 emergency and reported it to a clinic run by striking doctors in Yangon, arresting five of them. In August, the head of a charity organisation was detained at a vaccination centre after being lured there for a shot.

Protest leader Thinzar Shunlei Yi said she and many others are “determined not to get vaccinated from the murderous junta” to avoid legitimising the military government.

“I won’t blame those who can’t afford to choose” where to get vaccinated, she added. But she did demand that international humanitarian agencies engage with the vaccination programmes established by a rival government set up by deposed legislators, rather than the military.

The National Unity Government (NUG), formed by politicians who were elected in the 2020 election, which the military has refused to recognise, recently set up a COVID-19 Task Force (CTF) with plans to vaccinate people, starting in territory controlled by ethnic rebel groups. According to one ethnic health group, initial preparations are being made to vaccinate 80,000 people. The head of the CTF recently met with the United States ambassador to the UN, who pledged $50m to support general humanitarian efforts, including the COVID-19 response.

The fact that many of the vaccines are supplied by China and Russia, which have shielded Myanmar from stronger criticism at the UN Security Council, has only further exacerbated the trust deficit.

“I heard it is not good,” said a Yangon resident of the Chinese-made vaccine, Sinopharm. “I am afraid of it … my wife also got the Sinopharm vaccine, when I looked at her arm, I feel a little nervous. I don’t feel totally safe under the healthcare of junta,” he said.

While the World Health Organization has approved Sinovac and Sinopharm “for emergency use”, the Chinese-made vaccines have lower efficacy rates than other vaccines like Pfizer and Moderna, which were developed by companies in the US and Germany.

A king’s vaccine

A similar situation has developed in Thailand.

In 2020, the country recorded less than 7,000 cases of COVID-19. But as of today, it has seen more than 1 million cases.

Yet, recent polling showed only 63 to 66 percent of Thais are willing to get vaccinated. According to Thai government numbers, nearly 9 percent of the population is fully vaccinated, while almost 40 percent have received at least one dose.

As in Myanmar, part of the problem is a lack of vaccines perceived as more reliable.

Thailand has mostly depended on vaccines developed by China’s Sinovac and the United Kingdom’s AstraZeneca.

One Bangkok resident said she has been “unhopefully waiting” for the government to import mRNA vaccines like Pfizer or Moderna. “I am afraid of Sinovac side effects because I personally don’t trust Chinese,” she said, referring to both the vaccines and the government in general. “So, I reserved for Moderna, but I don’t know when we can get it,” she added.

Pita Limjaroenrat, leader of the opposition Move Forward Party, said the party’s position is that people should get whatever vaccine they can, but blamed the government for failing to provide diverse options for the public.

“I myself got two shots of Chinese vaccines because I think that’s a moral obligation towards my co-workers and my family,” he said. But he criticised the government for a “systematic failure of the entire vaccine value chain” starting from the initial vaccine procurement strategy.

Pita said the government put “all our eggs in one basket” by planning to produce AstraZeneca vaccines in Thailand, but the company “failed to deliver the contract amount”.

The AstraZeneca vaccines are produced by Siam Bioscience, owned by the royal family, which has been the subject of protests demanding curbs to the monarchy’s power. Disappointment with the government’s COVID-19 response has now merged with long-simmering demands for reforms to the royal institution and military-led government, spurring on new protests that have been met with police crackdowns.

Siam Bioscience’s failure to deliver the expected number of vaccines left Thailand scrambling for more supplies, turning to Chinese-made vaccines, but the rollout remains inconsistent.

Earlier this month, dozens of vaccination sites in Bangkok temporarily closed due to a lack of supplies, while government data shows huge fluctuations in the number of vaccines administered each day. For example, more than 640,000 doses were administered on August 6, followed by less than 200,000 the next two days.

Pita said there was “no apparent logic” to the government’s vaccine allocations for provinces. He said the biggest clusters are usually driven by factories, where many workers live in close quarters, including migrants from outbreak countries like Myanmar.

“These provinces should be prioritized … However, it’s not the case. That’s something that the government needs to explain,” he said.

As of August 10, the provinces with the highest rate of vaccinations were Phuket, Bangkok, Rayong and Phang Nga, while the provinces with the most cases were Bangkok, Samut Sakhon, Samut Prakan, Chonburi and Nonthaburi, many of which host large factories.

Paul Chambers, a political analyst at the Center of ASEAN Community Studies in Naresuan University, said the vaccination rollout in Thailand has largely been hampered by distrust of Chinese-made vaccines and “disgust” with the government.

“Part of the big problem in Thailand has to do with the fact that now most Thais must pay large sums of money to Siam Bioscience, the palace-owned distributor of COVID vaccines,” he said via email. “Several Thais I met sadly joked to me, saying: ‘Our country is probably the only one in the world where we have a king making profits from the COVID pandemic and a government forcing its citizens to pay for their own survival.’”

Distrust of China

Vietnam’s vaccine rollout has arguably stumbled even more.

Only 1.5 percent of its 96 million people have received two doses of a vaccine despite surging infections. The country recorded 1,500 cases last year but has seen more than 345,000 cases this year.

The main issue is a lack of vaccine supply.

Vietnam has been primarily reliant on AstraZeneca, with some observers saying it seems reluctant to become too dependent on Chinese vaccines.

Dr Thu Anh Nguyen, an infectious disease and public health researcher at the University of Sydney, said vaccine acceptance in Vietnam “in general is quite high”, but hesitancy towards Chinese-made vaccines specifically is also high.

She said there is a “distrust on the safety and effectiveness” of Chinese vaccines.

“As a health expert, I think the Vietnamese should take any vaccines that were approved by WHO and by the government of Vietnam,” she recommended.

“Vaccination speed in Vietnam has increased rapidly recently,” she added, saying in some districts of Ho Chi Minh City, 70 percent of the population have gotten at least their first dose. Now she said the challenge to maintaining this is actually getting more vaccines.

“There is a plan to vaccinate 2 million doses a day if the vaccine is available,” she said.

Josh Kurlantzick, senior fellow for Southeast Asia at the Council on Foreign Relations, said there were “real questions about the efficacy” of Chinese-made vaccines in Southeast Asia.

“I think a good deal of this lack of trust in the Chinese vaccines is because of this lack of information showing they are highly effective; such information, if it existed and were released, would probably ease some minds in Southeast Asia. But it may not exist simply because the Chinese-made vaccines aren’t as effective as the ones made by Moderna and Pfizer,” he said.

Kurlantzick said China’s “increasingly assertive regional behaviour in recent years” could also be playing a role in increasing scepticism. He said fears that China could use vaccine diplomacy for political leverage in the future is likely a “factor in the places where the public has the most negative views of China”, like in Vietnam and parts of Myanmar or Thailand.

“China has shown a willingness to use a wide range of tools to coerce regional states in recent years,” Kurlantzick said, but added that he thought using vaccines this way would be “a bridge too far even for China”.