Vaccines can't come soon enough for Southeast Asia (SEA), with more than 2.5 million Covid-19 cases, 54,000 deaths and deep economic contractions in the pandemic's first year. To achieve successful national vaccination programmes, SEA countries can be guided by three overarching strategies for vaccine supplies, confidence and delivery.
Firstly, SEA nations must implement multi-stage solutions to increase vaccine supplies. Unfortunately, there is still a global shortage, despite ramped up production globally. This shortage is dramatically evident when the European Union continues to restrict vaccine exports to even ostensible allies like Australia. Worse, shortages could become a long-term issue, especially if Covid-19 becomes endemic and annual vaccinations become necessary. Therefore, SEA countries must implement solutions to increase supplies.
In the short-term, continuous vaccine procurement in the global markets should continue, but with new strategies. Additional contractual terms may be needed today to secure future supplies for new vaccine variants that cover new virus variants. Regulatory agencies in SEA can consider a "new variation approval pathway" for new Covid-19 vaccine variants. This can be modelled on how annual variations of the flu vaccine are approved in Europe and North America. Fast regulatory approvals make contracts and delivery schedules more predictable, making it easier to procure vaccines.
In the medium-term, entities like Asean can consider leading efforts for pooled purchasing for 650 million Southeast Asians. This can increase purchasing power, strengthen bargaining positions and reduce unit costs. In the long-term, domestic or regional manufacturing can increase vaccine independence, for example by leveraging on the Siam Biosciences deal with AstraZeneca. This will require SEA countries to actively participate in efforts to reform intellectual property rights and the political economy of global health, instead of being a passive recipient of decisions made in Geneva or New York.
Secondly, countries must increase vaccine confidence through multi-stakeholder coalitions and making difficult political decisions. Trust is fundamental for successful public vaccination programmes. Therefore, all SEA countries must continually build trust through multi-lingual and multi-platform messages delivered by familiar and trustworthy people, such as community religious leaders or sports personalities. Indeed, vaccine confidence efforts for Covid-19 may have positive spill-overs to increasing trust in other vaccines and in science and facts. However, vaccine confidence is a complex landscape that can be divided into three broad categories of people who are supportive, hesitant or opposed. These three categories require three separate sets of solutions, instead of a one-size-fits-all solution. Those who support vaccines can be further trained or given new tools to become vaccine ambassadors in their communities. Those who are hesitant must be engaged with science, facts and appropriate emotional or psychological reassurance. These interactions must always be based on evidence and compassion, and free from judgment or criticism.
Managing the last category of vaccine opponents will be technically and politically challenging, requiring nuance and judgement. For vaccine opponents, there are three crucial policy questions to be answered: what separates someone who simply chooses to decline a vaccine with someone who actively propagates anti-vaccination material, what are the intentions of sanctions, and to what extent should sanctions be.
These three policy questions are bound with legal and public health questions like whether vaccines should be made mandatory, what are the right trigger points to consider making vaccines mandatory, and who should enforce it. These are further bound with philosophical and ethical questions like the balance between a person's right to bodily autonomy and free expression with their duty to protect others and to express themselves in responsible and truthful ways.
Unfortunately, despite their relatively small numbers, anti-vaxxers do cast significant influence over the vaccine discourse. Given the effects of fake news and vaccine hesitancy, SEA governments must consider legal remedies for the small minority who actively and maliciously propagate vaccine disinformation or misinformation.
The right intention and threshold for action will depend on different societies, legal systems and public health needs, with the right level of sanctions being equally sensitive to local contexts.
Thirdly and finally, vaccine delivery can still be strengthened throughout all points of the vaccine delivery chain, especially in partnership with the private sector. For a start, cold chain facilities remain important, although the US Food and Drug Administration recently made temperature requirements for the Pfizer vaccine more flexible and although more thermo-stable vaccines are approved globally. SEA countries must deliver vaccine equity, manage public expectations that the vaccine is not a magic solution, and ensure that the vaccination programme supports the overall pandemic strategy.
Dr Swee Kheng Khor is a Malaysian physician specialising in health systems and policies.