Asia's COVID-19 Vaccination

: Path & Challenges

Junwon Hun, PhD (Research Professor, Seoul National University Asia Center)

Abhisheka Dubey (PhD Student, SNU Department of Political Science)

(Posted : April, 16, 2021)

Current situations by continent (2021.3.28)

Timeline of Vaccination

Vaccine manufacturers

Procurement Trend : Manufacturer

Procurement Trend : Population

✔ Vaccination Priority Criteria

Frontline workers and essential service workers (health care workers, law enforcement officials, emergency response workers, armed forces and guard)
High exposure risk (bus, port and airport etc)
Persons who live in group residence (residents and staff in residential facilities, correction facilities
Senior citizens and high-risk groups with chronic diseases

But, Cambodia, China, India, Laos, Pakistan, Sri Lanka, & Vietnam no senior citizens in Phase 1 group.

Some countries prioritize people likely to travel outside the country (diplomats and their families, study abroads, athletes, etc) - Brunei, China, Taiwan, Thailand, & Vietnam
Bangladesh & the Philippines includes migrant workers in Phase 1 group
Indonesia has regional priority (e.g. Java, Bali)

✔ Key Issues

1. Vaccine Shortage

1) Sufficiency

Central question: have countries procured enough vaccines to meet the aim of achieving herd immunity?
The Philippines, Indonesia, Thailand, Pakistan: face worries about shortage
Nepal: indefinitely halted its immunization program
India has blocked all major exports of AstraZeneca vaccine, delay delivery to COVAX: reaction to US exports ban to prioritize Pfizer

2) Pace of Rollout

Vaccine rollout is slower than expected amid high levels of vaccine hesitancy
Governments are more concerned with the successful implementation of the vaccination strategy and vaccine acceptance than just shortage

3) Vaccine Acceptance

Shortages have influenced public acceptance of vaccines, and how governments purchase or accept donations
The Philippines: healthcare workers pressured into accepting Sinovac despite concerns of effectiveness, safety
Nepal: government is reluctant to accept vaccines from China for fear of increasing vaccine hesitancy

2. Vaccine Hesitancy

: Vaccine hesitancy is one of the top ten global health threats (WHO, 2019)

1) Religious Elements

Misinformation that the vaccine is haram because it contains pig gelatin.
On March 20, Indonesia’s Ulema Council declared the vaccine haram for containing pig derivatives but approved its use by Muslims because of COVID-19’s emergency.
2018 measles-rubella vaccination campaign: Indonesia’s Ulema Council declared the vaccines contained pork gelatin and were therefore haram. This led to a nearly 68% drop in immunization.

2) Conspiracy Theories

Absence of geographic location and timeframe on posts, text message and videos have allowed misinformation across countries, shared with the assumption that it is “recent.”
Common conspiracy theories:

- claims that the vaccine will implant chips, causes infertility, alter a person’s DNA

- viral videos of “after effects” of vaccines or lockdown were taken out of context from other countries and other issues

Countries most affected include Malaysia, Vietnam, the Philippines, Indonesia (Kaspersky)

3) Low Perception of Risk

China, Taiwan: Good response to COVID-19
India, China: Belief that they may have already reached herd immunity
Pakistan: Low rates of COVID-19, leading to denial of COVID-19
Bangladesh: Beginning of the vaccine rollout has given the public a false sense of security

4) Safety Concerns

➀ Rapid approval process

India: domestic Covaxin

➁ Based on perceptions of other countries

“Anti-Chinese” or “Anti-Western” instead of “Anti-Vaccination”
Hong Kong: Sinovac
Pakistan: Pfizer or Moderna

➂ Mistrust in the government shaped by government handling of the pandemic in early stages

The Philippines

5) Previous History

Indonesia: 2018 measles-rubella vaccination campaign
Japan: 1980s MMR vaccination campaign, 2013 HPV vaccination campaign
China: 2016 illegal vaccine manufacturing, 2018 vaccine manufacturer was accused of faking data

Govt. Response

Punishing misinformation: Thailand, Singapore, Cambodia, Malaysia
Making inoculation compulsory: Indonesia
Expanding priority groups: Nepal, Hong Kong
Public representatives have volunteered to be vaccinated publicly with vaccines that are relatively not trusted: India, Malaysia, Thailand, the Philippines

3. Inequality

1) Private Sector Purchases

To address concerns of shortages, reopening the economy and the pace of vaccination, some governments have allowed controlled private sector import and sale of vaccines
Increased concerns about the inequality in distribution, vaccine rollout and worsening of vaccine shortages
Indonesia: “Vaksinasi Mandiri”
Pakistan: price cap on imports

2) Private Sector Distribution

Private sector has been included in the rollout to increase the pace, scope and reach of the vaccination
Used to overcome logistical challenges
India: private hospitals allowed to vaccinate from Phase 2
Indonesia: Grab is coordinating with the government to expedite rollout

4. Logistical Challenges

1) Distributional challenges have been about accessibility, physically and digitally

Reaching rural regions: Pakistan, Nepal, Indonesia, Cambodia
Vaccinating refugee, migrant and vulnerable populations: Bangladesh, Pakistan, India
Shortage of medical equipment: Japan (low dead space syringes)
Digital Illiteracy: India, Malaysia, Bangladesh

2) Despite concerns of inter-regional and intra-regional inequality, countries appear willing to cooperate with each other at least for economic reasons

Singapore is vaccinating Malaysian cargo workers who regularly visit Singapore
Cambodia, Laos and Vietnam have agreed to vaccinate nationals of each other’s countries who reside in their country

✔Passport to back to normality?

1) Insufficient scientific evidence

How much protection vaccines offer against transmission?
How effective against variants?
The duration of immunity through vaccination (vaccine-based immunity vs infection-based immunity)

2) Disparity in distribution

“perfectly coordinated global vaccination can end the pandemic” - local landscape of immunity
No vaccine for children

3) “Vaccine passport is inevitable”

To protect vulnerable population: Nursing home patients, cancer patients, newborns, etc

4) Change Human Behavior

Very hard to keep vaccinated people reverting to pre-pandemic behavior
Some US states already lifting social distancing bans, even though a sizeable population remains unprotected.
Non-pharmaceutical interventions are still crucial

5) Challenges to government

Prioritizing who gets the vaccine first
Ensuring equitable access to vaccination
Reassuring the vaccine-sceptical