Mpox: Can ASEAN Build Resilience to Tackle Health Threats?

On 14 August 2024, the World Health Organization declared mpox a public health emergency of international concern (PHEIC). The mpox virus had been detected in multiple countries outside Africa, including Sweden, the Philippines, Pakistan, India, Malaysia, and Thailand, as well as in a US prison. Although experts believe that mpox poses a low risk to the general public, particularly in developed countries like Singapore and the US, the uncertain nature of virus outbreaks and mutations necessitates careful monitoring. Southeast Asian governments have responded to the new threat by swiftly ramping up border controls, like in Indonesia, Malaysia, Vietnam, and Singapore. Yet how has ASEAN as a group addressed health security threats and what does this mean for regional cooperation?

In 2023, the mpox virus killed its first Thai victim: an untreated and undiagnosed HIV patient. Since the lifting of the mpox global emergency PHEIC status in May 2023, there has been a notable surge in mpox cases across the ASEAN region. As of September 2024, there were 1,200 new cumulative mpox cases in ASEAN between 2023 and 2024, according to the ASEAN BioDiaspora Virtual Centre (ABVC) report. The report also noted that the ASEAN regional case fatality rate (CFR) stands at 1.52 per cent, higher than Africa’s rate of 0.41 per cent and the global rate of 0.22 per cent. The discovery of the more dangerous and contagious Clade 1b strain of the mpox virus in Thailand makes it even more compelling for national authorities to watch for possible virus mutations and to strengthen the region’s health preparedness, monitoring, and response.

Given the region’s vulnerability to virus outbreaks, ASEAN’s role in safeguarding the regional health system is critical. The rapid growth and diverse challenges facing ASEAN countries — from overpopulation and rapid urbanisation to inequitable access to healthcare — complicate the region’s ability to effectively respond to new health threats. The existing burden of non-communicable and communicable diseases, compounded by the impacts of climate change and natural disasters, further strains national health systems across the region.

ASEAN’s political commitment to collective action provides a foundation for addressing these health challenges. The ASEAN Health Sector’s ongoing efforts, as outlined in the ASEAN Post-2015 Health Development Agenda, emphasise the importance of regional cooperation in responding to all hazards and emerging threats. The establishment of the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), aimed at enhancing regional capacity for preventing, detecting, and responding to public health emergencies, the ASEAN Institute for Disaster Health Management (AIDHM) for training, academic, and research programmes, and the ASEAN BioDiaspora Virtual Center (ABVC) for big data analytics and visualisation for disease surveillance, evince this commitment.

Drawing on lessons learned from the Covid-19 pandemic, ASEAN can now leverage these mechanisms to effectively address mpox and future outbreaks.

Drawing on lessons learned from the Covid-19 pandemic, ASEAN can now leverage these mechanisms to effectively address mpox and future outbreaks. ASEAN has refined its approach to effectively address health security threats. For instance, Malaysia, leading the ASEAN Emergency Operations Centre (EOC) Network, utilised WhatsApp to facilitate rapid information sharing, a practical decision considering the platform’s widespread use among public health stakeholders throughout the region. Additionally, ACPHEED operates under a tripartite structure, with its secretariat located in Bangkok, Thailand, but functional roles such as preparedness and prevention, detection and risk assessment, and response spread across Vietnam, Indonesia, and Thailand, respectively. Since January 2020, the ABVC, led by Indonesia, has provided hundreds of weekly regional situational reports on virus outbreaks, making vital information easily accessible to the ASEAN public.

These initiatives show a proactive and collaborative approach to health security, indicating a more coordinated and responsive ASEAN. However, they also reveal challenges. Using WhatsApp for information sharing is efficient for timely communication. Yet, it raises concerns about data security, the potential for misinformation, and the sensitivity needed in managing health crises. While ACPHEED’s tripartite structure enables specialised functions, this may result in coordination challenges when considering resource allocations and health system disparities across countries. Furthermore, sustained engagement with stakeholders is essential for ABVC’s success but achieving this engagement can be challenging, particularly in the context of competing priorities and limited public awareness of the ABVC’s role. Moreover, the region’s often limited financial and human resources influence the ABVC’s capacity to carry out thorough surveillance and reporting.

The OECD defines health system resilience as the capacity to anticipate, withstand, recover from, and adapt to various disruptions, including pandemics, climate change, geopolitical conflicts, and cyber threats. The ASEAN Socio-Cultural Community Trend Report No. 2 (2024) highlights a significant gap in policies addressing resilient adaptation and the absence of specific Resilient Health System (RHS) initiatives in the region. It emphasises the need for a holistic approach to tackling complex health resilience challenges. Furthermore, ASEAN needs to address the underlying social determinants of health, such as poverty and access to healthcare, and the commercial determinants of health, such as supply chains and commercial activities, which are critical for ensuring health equity.

The recent mpox outbreaks serve as a reminder of the complex and interconnected nature of global health, and our shared responsibility to prevent and control the spread of infectious diseases in an increasingly borderless world. For ASEAN, regional solidarity and the improved capacity to act swiftly and harmoniously against new health security threats are key strengths. However, ASEAN needs to continue to adapt existing practices tailored to the region’s health challenges.

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