- Vaccination rates in capitals and industrial areas are substantially outpacing the countryside in several countries.
- The goal is to be able to keep economic centers open as much as possible, even if subsequent outbreaks were to occur.
- Rural resentment could increase, especially if both economic and healthcare outcomes diverge significantly.
There are currently two broad epidemiological trends among the larger, emerging market economies of Southeast Asia. On one side are Malaysia and Thailand, which have continued to post new daily records over the past week, and the Philippines, which may be dealing with a delta variant outbreak that is still on the upsurge. On the other are Indonesia, where the national new daily case number has dropped by more than a third, and Vietnam, where the rate of increase has flattened off. Significantly, the trends in their capital and main industrial areas are declining in these two latter countries even though new daily case detections are still rising in other provinces.
However, what has become more common in the region is that governments are also increasingly focusing their vaccination efforts on their population and economic centers, modifying the vulnerability-based plans they had earlier this year. For instance, Jakarta and Kuala Lumpur have administered first doses equivalent to more than 100% of their target population, i.e. those eligible for the vaccine, compared with a national rate of 19% for those who have received at least one shot in Indonesia and 50% in Malaysia. Both Bangkok and Metro Manila have given first doses to about 65% — 70% of their targets and are likely to hit the same levels by October, while the Philippine national first dose rate is 13% and that of Thailand is 25%. Vietnamese Deputy Prime Minister Vu Duc Dam yesterday announced the government’s plan to vaccinate 70% of Ho Chih Minh City’s target population by the end of the month, although Vietnam’s national rate of those with at least one shot is only 11%. Our sense is that these current vaccination percentages for the cities have to be adjusted slightly downwards because the shots that have gone to temporary migrant workers, military personnel registered elsewhere, as well as those who may have crossed over from neighboring regions are being counted against the initial target population counts of residents in these cities.
Not only are national governments focusing on the large metropolitan areas to speed up their overall vaccination rates, since both the cold chain and vaccine administration infrastructure are better in cities, but also to gain more leeway in keeping their most economically important geographies open in case of future spikes. The near-term goal is to improve the probability of economies staying open during the fourth quarter holidays. Specifically, they are hoping that while future spikes remain possible, the vaccination benefit of less severe infections would allow them to manage lockdowns based on hospital and emergency room capacity instead of new daily case metrics, as has been the case of much of the past year. Another goal is to make these cities — where most inbound and outbound national travel happens — buffers against the spread of future variants.
So noticeable is the shift in policy that governments are rolling out their available vaccines as quickly as they can while hoping that suppliers deliver their second shot doses in time. This has sometimes resulted in second-dose shortages, which delay the subsequent shot or result in early mixing and matching. In the Philippines, for instance, the government is considering AstraZeneca as a second dose for Sputnik recipients because Russia has warned of a delay in deliveries of second doses beyond the time limit. Vietnam could offer the Pfizer vaccine to those who had received an AstraZeneca vaccine first to similarly make up for potential shortages. In Thailand, citizens who have received Sinovac’s CoronaVac are being considered for either AstraZeneca second shots or boosters because of reports of its lower level of protection.
With urban locations in focus, rural areas are therefore only likely to be vaccinated well into 2022, especially since urban residents may start to demand booster shots by early next year. This could increase urban-rural resentment should economic growth between these areas diverge. The disenchantment could eventually play out in elections in the Philippines in May 2022, anti-government protests in Thailand, and possible early elections in Malaysia.