Can a Regional Public Health Emergency Centre Work for ASEAN?

Without adequate collaboration on public health emergency responses, ASEAN will not be able to coherently reopen its regional economy. That was the central proposition of the 15^th ASEAN Health Ministers Meeting (AHMM) held in Bali on 14 May 2022. 

The meeting was held at a critical juncture. Since last year, Cambodia and Thailand have embraced the resumption of pre-pandemic activities, putting tourism front and centre of economic recovery efforts with their ‘sandbox’ scheme and ‘green tourism’ campaigns. Singapore and Malaysia lifted pre-flight Covid-19 tests for incoming and outgoing fully vaccinated travellers in April 2022, while Indonesia, Laos, Myanmar, and Vietnam followed suit in May. Most recently, Myanmar announced that international tourists will be allowed to apply for visas to travel to the country.

The AHMM discussed at least three strategic public health priorities. First, ASEAN member states (AMS) must ensure the resilience of travel lanes. While there is still concern over new variant outbreaks, AMS need to sustain their economic activities. Therefore, ASEAN needs to accelerate the creation of a system for AMS to mutually recognise one another’s national vaccine certificates or establish a regional vaccine certificate to facilitate seamless travel across the region.  

Second, AMS must support vaccine distribution and medical supplies procurement. While ASEAN successfully established the Covid-19 ASEAN Response Fund when the pandemic emerged in 2020 and garnered support from its Dialogue Partners, the region’s governments still need to collaborate on technical aspects such as vaccine swaps and building an efficient mechanism for fund utilisation. 

Third, the ASEAN Centre of Public Health Emergencies and Emerging Diseases (ACPHEED), which has been proposed since Vietnam’s chairmanship of ASEAN in 2020, must be launched. Like the United States’ state and federal Centers for Disease Control and Prevention, the ACPHEED can help to standardise and accelerate the implementation of health protocols across the region. 

The current plan to operationalise ACPHEED shows that the region’s health officials will finally take a meaningful step forward.

Citizens and some commentators have criticised ASEAN since the beginning of the pandemic for its inconsistent responses in mitigating the pandemic. For instance, some AMS were slow to close their borders and suffered high numbers of Covid-19 cases and deaths, exacerbated by their inadequate public health responses. The uneven reactions across ASEAN to the pandemic belied the region’s rhetoric of ‘one community’, and eroded somewhat ASEAN’s credibility, which was built on its past experience managing pandemics such as the 2003 SARS and multiple avian flu crises. The current plan to operationalise ACPHEED shows that the region’s health officials will finally take a meaningful step forward.

But it remains to be seen if such a public health emergency centre can help to orchestrate coherent health responses in a highly fragmented region with different national public health capacities, risk tolerances, and interests. 

The AHMM convener, Indonesian Health Minister Budi Gunadi Sadikin, articulated the operational challenges for ACPHEED. Citing the different national health protocols, such as outdoor and indoor mask mandates in Indonesia and Singapore, he acknowledged that ASEAN countries had varied health protocols and risk tolerances. The ultimate aim is for ACPHEED to standardise these different public health procedures or at least inform AMS policymakers on what steps to take in future health crises. 

Another challenge includes funding mobilisation for ACPHEED. The governments of Japan and Australia have pledged support amounting to US$50 million and US$15 million respectively for the operationalisation of the centre. The ASEAN+3 Health Ministers Meeting has also endorsed its establishment. Unfortunately, ASEAN has not yet allotted regional funding to support ACPHEED. As the centre will work beyond the Covid-19 crisis to deal with other issues like non-communicable diseases and building up regional public health knowledge and preparedness, all AMS should invest in sustaining the operations of ACPHEED. 

It is envisaged that ACPHEED will be supported by a tripartite mechanism. Vietnam, Thailand, and Indonesia, the three hosts of the centre, will be assigned roles based on three pillars of pandemic management: detection, surveillance and response and risk management. Trilateral mechanisms seem to have gained popularity in ASEAN’s arsenal for crisis responses. The so-called ASEAN Troika — comprising the previous, current, and incoming Chairs of ASEAN – for Myanmar was proposed by Cambodian Prime Minister Hun Sen to ensure the continuity of ASEAN’s commitments in mitigating humanitarian crises, although it failed to garner support. As early as 1997, a trilateral programme to accelerate the Regional Haze Action Plan (RHAP) – an Asian Development Bank-backed initiative to address transboundary haze – stipulated that Malaysia would take the lead in prevention, Indonesia in mitigation, and Singapore in the monitoring of fires and haze affecting the three countries. 

From a managerial perspective, a tripartite system could act more swiftly, mainly by avoiding the involvement of all ten AMS in minor technicalities. A trio could theoretically accelerate essential programmes and share the burden of work more efficiently than ten, and streamline ASEAN bureaucracy and governance. However, the whole of ASEAN must be vigilant as health emergencies like pandemics are more porous, transmittable, and affect all AMS in some way, unlike regional issues that are more limited in geographic scope (such as the haze). ASEAN must make sure that all AMS’ concerns are met when ACPHEED starts its operations.

It will be a challenging step for ASEAN to establish ACPHEED as a centre of excellence for public health emergencies amid competing priorities and resource constraints. Nevertheless, the AHMM announcement is a welcome first step towards mobilising the requisite resources to establish such a centre. The plan to launch ACPHEED is a light at the end of the long pandemic tunnel, even if no one knows when ASEAN will finally emerge from it.

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