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Coronavirus exposes Southeast Asia's public health shortfalls

Experts say health infrastructure remains 'systematically underfinanced'

TOKYO/PHNOM PENH -- The death of a Chinese man in the Philippines from the novel coronavirus has made the public skeptical of the government's capacity to handle a public health emergency -- a sentiment echoed across Southeast Asia.

The 44-year-old died from severe pneumonia in Manila's San Lazaro Hospital on Feb. 1, making him the first victim of the novel coronavirus outside China -- and the Philippines' second confirmed case of infection. The country's health department did not announce his death until the following morning.

The anxiety partly stems from health budget cuts over the past three years under President Rodrigo Duterte.

"Budgets for health were cut in favor of law enforcement, so what can the Department of Health do when it really does become an outbreak?" asked Raven Lingat, 22, a marketing professional in Manila. "Unlike China, this country can't build a hospital in a week."

With the coronavirus looking likely to become a pandemic, a spotlight has been cast on the ability of Asian countries to respond. The vastly different levels of health care in the region raise questions about the capacity of some countries to catch up with -- and stem -- the deadly virus.

"Nobody puts enough into public health until there is a catastrophe like this," said Laurie Garrett, a former senior fellow for global health at the Council on Foreign Relations in New York.

Officially, more than 1,300 people have died and 60,000 cases have been reported -- mostly in China. Experts warn the actual figure could be much higher, with some countries lacking the resources to adequately screen, diagnose and survey cases. Should more emerge, some health services could be quickly overwhelmed.

"It's a big test of the institutions and main political actors in the region," said Richard Coker, a Bangkok-based professor emeritus of public health at the London School of Hygiene and Tropical Medicine. "If it moves into the region anything like it's been moving through China, then I think Southeast Asia is going to struggle."

For a region whose warmer climate renders it prone to diseases originating from animals, Southeast Asia is ill prepared to mount an emergency response to viral infectious diseases. Researchers at the health security company Metabiota found a "systematic underfinancing" leading to a concentration of weakly prepared health systems in the region.

"When ministries make allocative decisions, they're trying to balance between present tense needs, especially in Asia where pockets of poverty are acute, and the need to protect against future threats," said Ben Oppenheim, senior director of product at Metabiota. "The tendency is for the future tense not to be prioritized, but the cost is significant in terms of lives and economic loss."

Because of Asia's growing share of the global economy, the International Monetary Fund has warned that the novel coronavirus's economic repercussions will be worse than the SARS epidemic in the early 2000s.

World Health Organization guidelines recommend that countries build up disease surveillance, diagnostics and response capacities. Laboratories in the Philippines had to wait for coronavirus test reagents to arrive from Japan, according to health department spokesman Eric Domingo.

With no cases so far confirmed in Indonesia, the public is questioning the capability of health officials to screen and detect infections.

While N. Paranietharan, the country's WHO representative, said last week that his organization had "no specific concern" about the country's measures to check for the virus, analysts take a different view.

Ascobat Gani, a University of Indonesia professor in public health, said the country has the regulatory framework to deal with the outbreak, but "the problem is the execution." He pointed out that there were not enough surveillance officers, epidemiologists and sanitarians to properly monitor and handle an epidemic in the archipelago nation of 270 million people.

Similar concerns exist in Cambodia, where Prime Minister Hun Sen declared the country coronavirus "free" after its one confirmed patient -- a Chinese man on vacation -- recovered. Some 3,000 Chinese from Wuhan visited Sihanoukville and Siem Reap during the Lunar New Year.

"The number of cases reported is undoubtedly an underestimate," said Coker, discussing the virus' spread in the region.

Governments in Asia have faced criticism for their handling of the outbreak. Some have been accused of overreaction, others of underreaction.

Australia sequestered evacuees and travelers from China on Christmas Island, and more than 50 countries have imposed travel restrictions on people coming from China. Japan, on the other hand, allowed two evacuees from the virus epicenter of Wuhan to return home without undergoing the recommended 14-day quarantine.

Oppenheim singled out Thailand for making health system investments that are helping it manage the coronavirus outbreak.

"Thailand's made significant investments in surveillance and public health response to this kind of threat," said Oppenheim. "It's observable in the current crisis -- they've received cases and they've managed those cases seemingly fairly adeptly."

Even so, the dynamics of viral outbreaks mean that strong public health systems are no guarantee of avoiding outbreaks.

"During SARS the country that stopped its outbreak the fastest was Vietnam," said Garrett. "Nevertheless, you can't assume a country will do a better or worse job based on its GDP. Canada, a very wealthy country with universal health coverage, struggled for months to eliminate SARS from Toronto hospitals."

Japan and Singapore, two leading Asian economies that both have universal health coverage, have confirmed more cases outside China than many Southeast Asian nations. The Japanese government is also struggling to manage the outbreak aboard a cruise ship docked in Yokohama.

A critical part of managing a crisis is effective communication.

"All of this hinges on the government's ability to communicate what the risk is and how to think about it so that people don't get overly anxious," said Oppenheim. "Fear in itself causes economic damage, and may not lead to the right behavioral changes to limit risk."

Additional reporting by Erwida Maulia

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