Asia

SOUTHEAST ASIA: Vaccination outlook for H1 2021

Bob Herrera-Lim

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( 5 mins)
Indonesia leads the larger countries in confirmed vaccine supplies, both on absolute terms and as a percentage of its vaccination targets, for the next few months.The rest of the region promises a catch-up but vaccine deliveries in March and April will be the key.Political instability in Myanmar threatens to significantly slow down its vaccination rate.Local manufacturing capabilities could provide an advantage for Indonesia and Thailand by mid-year.Initial vaccines doses will have arrived in all Southeast Asian countries by the end of the February, but except for Indonesia, the confirmed and reported deliveries will be at most for a few hundred thousand recipients. The rural cold-chain infrastructure and vaccine hesitancy are real concerns for several countries, but there is enough low-hanging fruit in the urban areas and with government, education and health care personnel that are the priority targets that vaccinations can proceed apace for the next few weeks or couple of months with the anticipated near-term deliveries. Therefore, for the next three months, the rate at which supplies are replenished will likely be the main constraint for most countries and this could lead to swings in population vaccination rates.From a supply standpoint, Indonesia will have around 30 million doses in the next few weeks and seems best-positioned to accelerate its vaccination program through the first half of the year. However, the only gradual increase in its vaccination rate over the past five weeks will have to be watched even more in the next month because it could be signaling other non-supply issues.Thailand, Vietnam and Malaysia are now only starting their rollouts with limited supplies of several hundred thousand doses, which could limit their vaccination programs through March. Their governments are saying that additional deliveries are imminent, but the lack of large stocks on hand, unlike in Indonesia, could cause vaccination rates to fluctuate until larger shipments arrive.The Philippines will be playing catch-up starting in March as vaccine supplies are only expected to arrive near the end of the month, the last in Southeast Asia. Compared to the previous countries, its H1 2021 supply outlook is less certain because of delays in procurement.Myanmar had already started vaccinations, but both its current status and outlook have become highly uncertain because of domestic political instability. This, combined with the also uncertain status of testing, could cause neighboring countries to tighten border controls with Myanmar.
Both the Philippines and Indonesian private sectors have been authorized to procure vaccines and while this may help accelerate the vaccination process by the end of the second quarter, it could highlight social inequalities and generate resentment should there be delays in the broader public sector-provided vaccination program. Indonesia has required companies participating in the private procurement scheme not to purchase from companies currently supplying the Indonesian government’s vaccination drive.Indonesia will be the key country to watch, not only because of its size but to determine whether the flattening of its vaccination rate from 300 people per million to 250 people per million in the past week reflects multiple issues (which could affect the Philippines, Thailand, Vietnam and Malaysia down the road) or is primarily the result of distribution and supply challenges, which should ease in the coming weeks as locally manufactured vaccines are distributed.
Beyond vaccine supplies, challenges for later in the year; Filipinos appear most unwilling to be vaccinatedBeyond the first half of the year, Indonesia and Thailand appear to be better placed because their domestic manufacturing capabilities reduce supply uncertainty. However, while the capabilities of Indonesia’s domestic licensee for Sinovac, PT BioFarma, has been established, there is still some skepticism in Thailand regarding the facilities of Siam Bioscience, the authorized local manufacturer of AstraZeneca, upon which the bulk of the country’s vaccination campaign will rely for the rest of the year.The Philippines, Vietnam, Malaysia, and Myanmar will be dependent on vaccine imports, including the WHO Covax facility, as well as the supplies they are currently negotiating. For instance, it remains unclear how Serum Institute’s announcement that it would be prioritizing India’s vaccine needs could affect its deliveries down the road. The political uncertainty will be a key unknown for Myanmar, especially with western governments increasing sanctions.In terms of vaccine hesitancy, the data is highly variable both within countries and across time, possibly reflecting how perceptions can quickly change depending on the main narratives in the news and the demonstration effect. Anecdotally, vaccine hesitation seems higher in Indonesia and the Philippines compared to Malaysia and Thailand. For instance, one late January survey pegs approximately 46% of Filipinos as unwilling to be vaccinated, with another 36% being uncertain, bringing the country’s vaccine hesitancy total to more than 80%. Only 19% of participants in this survey reported being openly willing to be vaccinated. However, other surveys had substantially higher rates in the 30s.Based on a December survey, 17% of Indonesians said they would not be vaccinated while 40% were uncertain, bringing Indonesia’s vaccine hesitancy total to 57%. Only 37% said they would be vaccinated. However, the government has put penalties on those who refuse to be vaccinated and the recent vaccination of high-profile public officials and religious leaders may improve public attitudes. In Malaysia, roughly 30% signified their unwillingness to be vaccinated, roughly similar to the 24% of Thailand. In Vietnam, vaccine hesitancy is unlikely to be a factor.The vaccination infrastructure for rural areas could also be a challenge for Indonesia and the Philippines given their archipelagic nature and land size. Not only is it unclear how dispersed these countries’ cold chains are, but vaccine hesitancy may also be higher in the rural areas. However, these may only start to factor in the vaccination roll out later in the year.
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