Lessons from East Asia

The Covid-19 pandemic has highlighted inadequacies in the global health system, but harnessing the growing health diplomacy of East Asia could go some way towards realising Health For All

Covid-19 has shone a spotlight on the current state of global health, revealed inadequacies, and taught lessons that need to be learnt and acted on to realise Health For All. I focus here on East Asia, where I live and work, and which has become the most important global economic engine in recent decades and has the potential, as well as the responsibility, to lead in strengthening global human security.

East Asia, generally comprising the 10 members of the Association of Southeast Asian Nations, China, Japan and the Korean peninsula, has achieved relatively good outcomes during the ongoing Covid-19 pandemic. This can be explained, in part, by sociological imprinting of and learning from past outbreaks as well as competence in governance (see Figure).

Covid-19 revealed four main East Asian characteristics that may be relevant to improving global preparedness and responding to future outbreaks. Above all are the critical importance of maintaining high levels of preparedness, and the willingness and ability to respond swiftly and robustly to suppress an epidemic very early in its course. Contrast the East Asian response during the first quarter of 2020 with the European and American first waves. 

A second lesson is the need to adapt strategies swiftly and innovate as more became known about the virus and its spread. 

Third, East Asia demonstrated how the extensive application of technology, data fusion and analytics can contribute substantially to suppressing the spread of this highly infectious virus. 

Fourth, Covid-19 has highlighted the importance of strong political leadership, coupled with a collective societal receptiveness to adhering to wide-ranging public health measures.

However, lessons from East Asia should be understood in context. In addition to valuing experiential learning through sociological imprinting by past outbreaks, East Asian societies tend to value collective well-being sometimes at the expense of individual liberties. Pre-existing social structures to enforce mass lockdowns are difficult to replicate elsewhere, as are the ubiquitous deployment of digital tracing tools. Of particular note, a ‘zero Covid’ approach might have saved hundreds of thousands or even millions of lives in 2020 or 2021, but this success has paradoxically delayed vaccine acceptance despite adequate access, and poses an ongoing conundrum of how best to safely exit towards endemicity.

Lacking shared strategy

East Asian countries have also been expanding capacity in global health development and diplomatic outreach, although there is as yet no coherent regional vision, shared strategy or common set of operating principles, thus limiting synergistic impact.

Until the 1990s, Japan was the only major donor in East Asia, and the majority of East Asian economies were recipients of development assistance for health. This has changed substantially and rapidly since the mid-2000s, with China and Korea increasing the size and scope of development assistance for health. This trend is grounded in both an altruistic concern for the most vulnerable populations and an understanding among countries that in today’s interconnected, globalised world, a health crisis anywhere can affect one’s own population. Accordingly, national interests associated with global health have shifted from the development context to cover both economic and security perspectives. Likewise, the scope of global health has broadened from service delivery to include discovery and development of interventions. Therefore, the pivot of global health and development leadership from post–World War Two institutional arrangements towards Asia preceded the current pandemic but was also hastened by it.

However, thus far there has been little regional coherence, or tendency to foster this, among the bigger players in Northeast Asia (China, Japan and Korea) or within ASEAN, let alone across the region. Where bilateral actions currently predominate, there remains much room for synergistic impacts through multilateralism, perhaps in ways different from today’s post-war institutions. A shared vision that can be operationalised through common principles and goals would be a prerequisite.

How to boost cooperation
Concrete steps to bolster cooperation and extend influence could include the establishment of an East Asian Centre for Disease Control, joint work in health and human security by the Asian Development Bank and Asian Infrastructure Investment Bank, and a region-wide research funding programme.

But much depends on evolving geopolitics writ large, notably the increasing bipolar reorientation of global alliances, which has the potential to split geographically neighbouring East Asian states. Rather than accentuating the contextual differences between East Asia and the rest, in attempting to explain and replicate recent Asian successes in human security, we should focus on embracing diversity in circumstances and histories by presuming commonalities. Health diplomacy for global human security can become a stabilising influence and be a topic around which all actors can more comfortably rally. This way we could better harness the burgeoning health diplomatic outreach of East Asia amid shifting geopolitics and chart a new course towards a common, secure and healthy future of globalism 2.0. ▪

Please refer to journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003939 for a full exposition of the ideas in this article.