Lessons from Vietnam

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Irawan Ronodipuro INDEPENDENT OBSERVER

IO – Indonesia’s health crisis with Covid-19 continues to worsen by the day. Total cumulative infections are now more than 200,000 and there have been more than 8,000 deaths, making Indonesia the second hardest-hit country in Southeast Asia after the Philippines in terms of total cases and the worst in terms of the number of deaths occuring in reported cases. Given the fact that the number of daily cases are spiking, epidemiologists are now predicting the total number of cases in Indonesia could reach as high as half a million before year’s end. 

It is an unfolding tragedy, and like in other countries that have poorly handled the pandemic, a lot of deaths and suffering could have been avoided had the government been better prepared and a more robust response strategy were in place. 

To be fair, part of the lack of preparedness can be explained by the failure of previous governments, not only the current administration, to invest more in the public health system. In practically every category on a per capita basis–the number of doctors, nurses, hospital beds and intensive care units–Indonesia has ranked last or near the bottom in comparison to other countries in the region. 

Indonesia’s relatively underfunded and weak public health infrastructure can explain in large the relatively high mortality rates—yet, there is no doubt that there is much more the government could have done–and more importantly–should be doing to keep infection rates under control. 

Out of all the countries to look at for clues on how Indonesia could better manage the on-going crisis, Vietnam is probably the best example. With a large and high-density population (nearly 100 million people) and demographics similar to Indonesia, the differences in how Covid-19 has affected the two countries are stunning. With only 1,054 infections and 35 deaths since the outbreak began in Wuhan, the Vietnamese government’s handling of the crisis has been exemplary. 

It is worth noting that Vietnam has a history in successfully managing public health crises, dating back to the SARS epedemic in 2003 when it was the first country to be recognized by the World Health Organization to be free from the disease. 

And, much to its credit, the Vietnamese government didn’t become complacent after the SARS epidemic ended. Instead, the government increased its investments in its public health infrastructure, including a national emergency operations center in 2013 and four regional centers in 2016. The centers, run by highly-trained epidemiologists, have frequently run simulation exercises with government stakeholders in preparing for and responding to disease outbreaks such as measles, Zika, MERS and Ebola. Unlike in most countries, when Covid-19 first erupted, Vietnamese government officials knew exactly how to respond. 

But Vietnam’s preparedness didn’t stop there. It also had built a world-class surveillance system with the ability to collect and aggregate data on public health in real time. Since 2016, Vietnamese hospitals have been required to report notifiable diseases within 24 hours to a centralized database. In 2018, the Vietnamese government went even further and created a surveillance program empowering teachers, pharmacists, religious leaders and community leaders to report public health events and therefore enable the central government to identify clusters of people who have similar symptoms that might suggest an outbreak is emerging. 

Given these programs, Vietnam was extraordinarily well prepared when the first Covid-19 case appeared on 23 January. Vietnanese officials immediately rolled out its emergency plans with travel restrictions and closing its borders with China. As early as mid-March, which was when other countries such as Indonesia were just starting to take the virus seriously, Vietnam was already sending everyone entering the country or in contact with a confirmed case to quarantine centers. 

It is interesting to note that Vietnam has never had a national lockdown. This is because the government acted swiftly to close its borders and its surveillance programs enabled it to quickly identify emerging clusters. Once an emerging cluster was identified, such as in Son Noi, more than 10,000 people living in the area were sealed off, as was the case with the Ha Loi commune near Hanoi and more recently in the city of Danang. 

Now, while Indonesia struggles, Vietnam continues to contain Covid-19. Over the period of August 25-September 7, for example, Vietnam reported only 25 cases, while in Indonesia there were over 42,000 cases. 

Of course, some of the lessons from Vietnam can’t possibly be applied to Indonesia, at least in the short-term. For example, emergency centers and surveillance programs take time to develop, and even if Indonesia were to start soon it would be several years before it had anything comparable to Vietnam. 

But there are important lessons that can be applied for now. One is that Vietnam showed us that wide-scale testing, contact tracing, quarantines and lockdowns in emerging clusters are key success factors in containing the spread of the virus. Acting swiftly without delay and ruthlessly imposing lockdowns where needed is especially important. 

Some politicians might be hesitant to take such measures for fear of losing their popularity, but Vietnam leads the way again: because the government’s response to the pandemic has been so successful, the majority of Vietnamese in recent polls agreed that the government properly handled the situation, even when it involved city lockdowns. It is a lesson that Indonesia’s leaders should keep in mind.