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By Kate Mandeville, Vikram Rajan, Aparnaa Somanathan, Anthony Oundjian, Emily Serazin, and Qahir Dhanani

When COVID-19 hit East Asia and the Pacific (EAP) in early 2020, many countries in the region successfully limited its spread through aggressive deployment of tools such as public health measures, border controls, and monitoring systems. (Exhibit 1.) As the pandemic continues, however, the continued application of these tools is challenging, as can be seen from recent surges in Vietnam, Thailand, and Singapore. Supply constraints mean that many countries may not fully vaccinate their populations until 2024, even as new variants emerge against which existing vaccines may be less effective. Beyond the targeted response, many countries are now looking to defray the accumulated costs of the pandemic through re-opening and rejuvenating their economies and societies.   

With such a dynamic situation, countries need to continuously learn from each other and adapt their responses as new tools become available. The recently concluded COVID-19 Workshop Series was an opportunity to hear from global and regional experts about different approaches to ¡°respond, re-open, and rejuvenate¡± in EAP.  Over the course of the series, seven key themes emerged:

(1)  We are in a race between vaccines and variants

More transmissible new variants may overwhelm health systems and/or render vaccines less effective, creating the imperative for a globally coordinated response.

(2)  The policymakers¡¯ toolkit has expanded, and choosing between these tools has become more complex

Vaccination, while critical, is an addition to the original COVID-19 response toolkit. The emergence of new tools may lead to the evolution of others, such as the addition of to border measures. However, the virus¡¯ ability to fight back means that more sophisticated versions of the original tools are also needed, such as genomic surveillance to track variants.

(3)  The endgame remains clear, with endemic or zero COVID-19 both possible scenarios for the region

Some experts argue that the convergence of (1) vaccines not providing sterilizing immunity; (2) new variants¡¯ increasing transmissibility; and (3) vaccine hesitancy limiting high vaccine coverage may result in . Others point to the success of EAP countries in achieving elimination through crush and contain strategies and argue that in the longer term through high levels of vaccination.

(4)  Proponents of both scenarios agree on the critical importance of rapid vaccination

At the global level, further redistribution of resources via COVAX (including funding for procurement and vaccine donations) is critical to ensure supply availability. In parallel, countries can prepare for high throughput before supplies arrive, especially given the sharp increase in COVAX supply volumes that is anticipated in the second half of 2021. On the demand side, policy makers must demonstrate trustworthiness, clearly communicate the risks and benefits for individuals, and emphasize community as well as individual benefits.

(5)  Vaccination rollout and other tools to combat COVID-19 can provide entry points for addressing neglected health system challenges.

The lessons learned from the pandemic point to the critical importance of strengthening of public health systems and fast-tracking universal health coverage. This agenda can leverage the data and delivery systems demanded by vaccination rollouts.

(6)  Countries will need to make difficult choices and trade-offs against a backdrop of constrained fiscal space

We know that has not only hurt government revenues and budgets, but also household employment and income levels. Countries can efficiently utilize scarce resources by leveraging global and regional infrastructure (e.g. regional surveillance networks in Africa and the Caribbean), partnering with local universities and the private sector, transitioning from campaign mode to routine services, and leveraging COVID-19 financing for broader investments in health systems strengthening.

(7)  Adaptive policymaking will be a critical success factor

Developments surrounding variants, vaccine effectiveness, and vaccination strategies are being reported daily. For example, several countries have now approved COVID-19 vaccination for adolescents. Others are considering booster shots and . This rapid evolution means that ¨C an approach which is flexible, data-driven, and responsive to emerging best practice will be critical to exiting the acute phase of the pandemic.

Overall, there are reasons for optimism, with vaccination accelerating as supply constraints ease and a unique opportunity to build stronger and more resilient health systems. Countries will need to continuously adapt their toolkit in a context of constrained fiscal space and growing complexity. As the pandemic has repeatedly shown us, this will require collaboration and solidarity at regional and global levels. No one is safe until everyone is safe.

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Last updated: July 2021

These workshops are targeted at current and imminent challenges facing governments in managing COVID-19, with guidance from global experts and reflections from prominent policymakers in the region. 

Workshop 1: Tuesday, May 18, 2021 
7:30 ¨C 9:00 AM ET | 7:30 - 9:00pm SGT

Responding amid evolving complexities 

Discuss strategies for effective COVID-19 responses as vaccines roll out and policy decisions grow more complex. How should COVID-19 strategies adapt as vaccine campaigns ramp up and population behaviors change? How can policymakers navigate key uncertainties, such as new variants, vaccine hesitancy, and an evolving supply landscape?

Workshop 2: Tuesday, May 25 (ET)/Wednesday May 26 (SGT), 2021

9:00 ¨C 10:30 PM ET |9:00 - 10:30 AM SGT

Re-opening safely

Examine the policy-makers¡¯ tool-kit to re-opening the broader economy, while continuing to keep transmissions in check. What are the key indicators for re-opening, both domestically and internationally? What are global best practices for phased re-openings, including vaccine passports and industry prioritization?

Workshop 3: Tuesday, June 1 (ET)/Wednesday June 2 (SGT), 2021

8:00 ¨C 9:30 PM ET | 8:00 - 9:30 AM SGT

Rejuvenating in the new reality 

Discuss the COVID-19 pandemic¡¯s evolution into the new reality and how governments can prepare for this future. What will endemic COVID-19 look like and what does it mean for economies and society? How can a response to endemic COVID-19 be integrated into health systems more broadly? 

EAP Vaccination Planning

Authors: Kate Mandeville, Vikram Rajan, Aparnaa Somanathan,  Anthony Oundjian, Emily Serazin, Qahir Dhanani

As we head into the second half of 2021, well over a year after the global spread of Covid-19 and its precipitous impact on lives and livelihoods, a few countries can now see some light at the end of the tunnel. Fourteen vaccines have been approved for full, emergency, or limited use. Based on trial data and real-world evidence, all candidates appear highly effective in protecting against severe COVID-19. 

Countries in the East Asia and Pacific region were particularly effective in the early stages of the pandemic in ¡°crushing and containing¡± the virus. Having made tough choices on lockdowns and travel restrictions, some countries also implemented strong ¡°testing, tracing and isolation¡± strategies. Countries are now shifting focus ¨C to varying degrees of aggressiveness ¨C on vaccinating their populations to reopen and continue efforts to recover from the economic fallouts. Countries in the region have made steady progress, with over a billion doses already administered in the region, including over 320 million in China and 750 million in the rest of the region.

Yet while vaccines offer hope, they also add complexity. With delays in vaccines delivered through COVAX, many countries have sought other sources of supply. Identifying, negotiating, and deploying multiple vaccine supplies can be challenging in the current global climate. The spread of new variants and local outbreaks raise concerns about the effectiveness of current vaccines. Meanwhile, rare adverse effects following vaccines are inevitably contributing to increased vaccine hesitancy. Responding to these challenges requires adaptive leadership informed by global evidence.  

While vaccines garner much of the attention, they continue to be just one element of the broader COVID-19 toolkit. As countries start to re-open, policymakers will need to carefully balance the priority placed on vaccines against other effective measures such as public health measures (such as social distancing, masks, and avoiding large gatherings), increased testing, effective clinical care, and phased restrictions. Novel tools such as vaccine passports and travel corridors can help to support lifting of domestic and international restrictions, yet there are many unanswered questions in their implementation. Re-opening safely will necessitate a broad-based, flexible response buttressed by close monitoring of key indicators. 

Finally, while the current roll-out of vaccines is a cause for optimism, it is difficult to discount the possibility of endemic COVID-19, whereby COVID-19 will continue to circulate in parts of the world for years to come. Some countries have taken an elimination approach ¨C will this be sustainable as countries start to open up? If endemic COVID-19 becomes a reality, what does mean for health systems, economies, and societies? Countries may need to prepare for significant ongoing investment in vaccines (including boosters), health systems, and the broader toolkit such as public health measures and surveillance. Rejuvenating societies and economies in this new reality will take innovation, strategic thinking, and determination.  

To assist EAP countries better plan and strategize for COVID-19 adaptive responses, safe re-openings, and long-term rejuvenation, the World Bank will hold three workshops for leaders across the region:

• Session 1: Responding amid evolving complexities (May 18 EDT/May 19 EAP) will examine critical questions for effective COVID-19 responses as vaccines roll out, population behavior changes, and policy decisions grow more complex. It will also explore how leaders can navigate key uncertainties, including new variants, vaccine hesitancy, and an evolving supply landscape.
• Session 2: Re-opening safely (May 25 EDT/May 26 EAP) will discuss the key levers and the broader toolkit to manage phased re-openings. Key indicators to identify readiness for and promote the safety of both domestic and international re-openings will be discussed, along with global best practices such as vaccine passports and travel bubbles.
• Session 3: Rejuvenating in the ¡®new reality¡¯ (June 1 EDT/June 2 EAP) will explore what endemic COVID-19 would look like and its implications for health systems, economies and societies. The additional pressures on health systems from endemic COVID-19 will be described, as well as how planning for sustainable capacity in these areas could support broader rejuvenation. Yet endemic COVID-19 may not be inevitable, and the series will conclude with a debate as to whether countries should be aiming for zero COVID (i.e. elimination) versus endemic COVID.

These workshops will complement previous learning events by updating leaders on emerging challenges and broadening the perspective beyond health systems. With an effective strategy, robust planning, and adaptive leadership, countries will more effectively weather these challenges. Our workshop series aims to support this journey with technical insights, practical evidence, and lessons learned from around the world.