Bony Wiem Lestari, Aly Diana, Adriana Viola Miranda, and Fadilah Fitri Arsy call for ASEAN countries to enhance regional collective actions for future health preparedness.
Health issues are increasingly recognised as security threats to Southeast Asia. Due to its tropical climate, rapid socio-economic advancement, urbanisation, and shifting environmental conditions, the region is a hotspot for public health emergencies. The risks of emerging infectious diseases and the global mortality rate in Southeast Asia are among the highest globally, mainly due to natural disasters. Furthermore, the region is not spared from the rise of the global epidemiological transition from infectious diseases to noncommunicable diseases (NCDs), such as cardiovascular diseases and stroke. These issues are exacerbated by ever increasing consequences of climate change.
The impact of health challenges on regional security cannot be overstated, as a population’s health has long-term socio-economic impacts. Notably, ASEAN recorded a total of US$91 billion in disaster-related economic losses between 2004-2014. NCDs and infectious diseases have also become major economic burdens, as these events often lead to out-of-pocket expenditure for medical care, intangible caregiver burden, and long-term productivity loss. The COVID-19 pandemic has cost governments unprecedented economic loss due to public health responses, border closures, and travel restrictions. Against this backdrop, health security, defined as “measures required to minimise the vulnerability to public health events that endanger lives across borders,” is critical to ensure ASEAN’s security. This can be achieved by creating a resilient, secure, and sustainable regional health architecture.
Major Health Threats in ASEAN
Southeast Asia is vulnerable to various health threats. First, the region is an epicentre for emerging and re-emerging infectious diseases, including the two major outbreaks of Avian Influenza A (H5N1) and COVID-19. At the same time, antimicrobial resistance, which occurs when bacteria, fungi, and other pathogens acquire resistance to currently available drugs, is on the rise due to overuse, underuse, and misuse of antimicrobials. The rise of NCDs related to rapid urbanisation and lifestyle changes further threatens health security in ASEAN.
The region is also prone to disasters. Between 2004-2014, more than 50% of global disaster-related casualties were recorded in ASEAN countries. The risks of health threats are increased with worsening climate change. According to the ASEAN State of Climate Change Report 2021, health has been identified by all ASEAN countries as a sector that is most vulnerable to climate change impacts.
Regional Health Security in ASEAN
Before the COVID-19 pandemic, ASEAN had reported major advancements in health security and emergency preparedness. For instance, the ASEAN Agreement on Disaster Management and Emergency Response (AADMER) and the AADMER Fund were launched in 2005 to improve regional disaster preparedness. This was followed by the 2016 declaration on ‘One ASEAN, One Response’. These mechanisms provided relief and humanitarian assistance, including medical aid to address various disasters, as demonstrated in the 2018 tsunami in Indonesia and the 2021 Super Typhoon Rai in the Philippines.
Unfortunately, public health capacity gaps are still prevalent. When the COVID-19 pandemic hit the region, many ASEAN states were unable to manage the large influx of patients. Unclear coordination mechanisms, inadequate surveillance measures, shortage of healthcare workers, and lack of health emergency funding were also observed. As a result, ASEAN countries’ responses to the pandemic varied significantly according to their capacities and risk tolerance. ASEAN’s principle of non-interference in domestic issues has been cited as hampering effective regional disaster responses and public health emergencies. This principle was put to the test during the pandemic, when ASEAN countries unilaterally closed and opened their borders according to their countries’ readiness, rather than coordinating with their neighbours or within ASEAN.
But the COVID-19 pandemic experience brought about positive impact. Most ASEAN countries increased their emergency preparedness spending after the pandemic. According to the 2021 Global Health Security (GHS) Index, seven out of 11 Southeast Asian countries (including Timor-Leste) had overall preparedness scores that were higher than the global average. All ASEAN countries, except Timor-Leste, had higher scores in the detection and reporting categories, having put in place active systems for real-time surveillance and case reporting.
Various efforts to curb the pandemic were also evident at the regional level. In 2020, the COVID-19 ASEAN Response Fund was established. Since then, the fund has assisted ASEAN countries in procuring COVID-19 diagnostics tools and vaccines. ASEAN also strengthened its information-sharing and capacity-building programmes, partly in collaboration with external partners such as the European Union and the World Health Organization. The fund will be renamed the “ASEAN Response Fund for Public Health Emergencies and Emerging Diseases” (or “ASEAN Response Fund” in short) to address future public health emergencies when COVID-19 is no longer deemed a threat in the region.
ASEAN has also enforced the ASEAN Comprehensive Recovery Framework and the ASEAN Post-2015 Health Development Agenda, which include strengthening health systems and essential health services as key priorities. In November 2022, the association established the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), a centre of excellence and regional hub to fortify ASEAN’s regional public health emergency preparedness. The ACPHEED Secretariat has been established in Bangkok.
Collective Actions for Future Health Preparedness
While the pandemic has improved ASEAN’s commitment to regional health security, some gaps remain to be addressed. First, despite the reported improvements, emergency preparedness disparities among ASEAN countries are still evident. The 2021 GHS Index reported that infection control practices and equipment availability in seven ASEAN states were suboptimal. Furthermore, most countries have insufficient capabilities to access or develop vaccines, therapeutics, and diagnostics (VTD) tools. Most efforts to strengthen these capabilities are hindered by limited access to capacity and resources, high reliance on imported materials for VTD tool development, and limited awareness and acceptance among the public. The region also has difficulties developing robust intelligent surveillance systems due to health system disparities, fragmented data gathering, and discrepancies in administration standards.
Addressing these barriers through ASEAN is crucial. It is time to recognise the need and the potential of managing healthcare from a regional perspective, as the pandemic teaches us valuable lessons that remain relevant. Strengthening regional health architecture should be prioritised by creating clear operationalisation strategies, like a Regional Action Plan for Health Security, and conducting information sharing, capacity-building, technology transfer, and digital health transformation. The scope of the ‘One ASEAN, One Response’ concept should be widened to cover other public health emergencies, including future pandemics. Furthermore, ASEAN governments should follow the post-COVID commitment to strengthen their respective healthcare systems. The public health-related regional bodies, such as ACPHEED, should have the capacity to develop tools, training curricula, and surveillance strategies required to advance regional health security.
There is a need to ensure the sustainability of the ASEAN Response Fund as the endowment fund for future public health emergencies. ASEAN governments should continue their funding commitments displayed during the pandemic and foster collaborations with external funders. It is also crucial to continuously identify potential threats to regional collaboration. In terms of the principle of non-interference, it may nevertheless serve as a springboard for continuous collaboration – as geographic boundaries do not delimit health threats, the urgency for collective action remains.
In conclusion, mitigating and effectively addressing complex and multidimensional health threats, including future pandemics in ASEAN, require an agile and collaborative regional health system.
This is an adapted version of an article from ASEANFocus Issue 1/2023 published in March 2023. Download the full issue here.
Bony Wiem Lestari is a Lecturer at the Department of Public Health, Faculty of Medicine, Universitas Padjajaran, Indonesia.
Aly Diana is a Lecturer at the Department of Public Health, Faculty of Medicine, Universitas Padjajaran, Indonesia.
Adriana Viola Miranda is Research Fellow at the Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Indonesia.
Fadilah Fitri Arsy is Research Officer at the Resilience Development Initiative, Indonesia.