Asia Pacific - Held back by the lack of vaccines

With many times the daily confirmed cases of the Philippines', the UK is mulling a slow reopening plan for its economy. In contrast, in metro-Manila, the unwinding of the lockdown has been pushed out once again, meaning that it will have lasted a full year by the middle of this month.

The Philippines may be an extreme example of Asian governments' reactions to Covid-19, but it is not totally out of line with the rest of the region. Singapore, for example, which has averaged less than one community case a day in recent weeks, has said that it is not about to move out of phase three restrictions any time soon, at least until more widespread vaccinations have been rolled out across the population, their effectiveness has been proved, and the rest of the world has Covid-19 under control.

With much of the region taking a similarly cautious approach and resting the case for any reopening on the vaccine rollout, this has highlighted a glaring problem. That is that Asia has, for the most part, been extremely slow to roll out its vaccination programme.

Even compared to the dithering and mismanagement evident in Continental Europe, Asia is lagging globally. Japan, for example, had, as of 1 March, vaccinated fewer than 30,000 of its population. For comparison, the latest United Kingdom figures showed a daily vaccination total of 530,000 the day before.

There are several reasons why Asia is lagging behind the rest of the world in vaccinating its populations. Here are our top four:

• Queue jumping by others

There has, without much doubt, been a degree of queue jumping by some countries. Those at the very front of the queues argue to have taken a risk in paying up for vaccines before they were even proven. This gamble seems to have paid off, with countries like the UK, UAE and Israel getting access to the vaccines they paid up for in advance, especially as many of them achieved successful phase three trials and received accelerated regulatory approval by local medical bodies.

• Lack of locally produced vaccines

The US and UK also benefited from having substantial vaccine production facilities within their countries which surely helps. But so do India and China, yet they are still falling behind (though India is having a fairly decent go at rolling out vaccines to their population). With billion-plus populations, their goal is admittedly a more challenging one than for most European countries. Europe too has extensive vaccine production facilities on-site, so there is a limit to how much weight we can put on this excuse. We have to look elsewhere for the causes of failure.

• Widespread vaccine mistrust/anxiety

Population mistrust of vaccines is arguably a bigger problem in Asia than in some other parts of the world. Japan has endured a fraught history of alleged and real adverse reactions to various vaccines over the years, including the combined MMR vaccine. And the government has variously supported the vaccines' safety before withdrawing them and then re-introducing them. Not surprisingly, faith in government advice on vaccines is very low, with people more prepared to get their advice from friends and the internet. In the Philippines, Sanofi's Denvaxia vaccine for Dengue fever, a mosquito-borne killer in the tropics, was approved and then subsequently linked to the deaths of children and subsequently withdrawn. That vaccine had been in the works for 20 years. Understandably, there may be anxiety about vaccines that have been cooked up in less than a year combined with a lack of trust in government advice.

• Legal framework for litigation of side-effects

The vulnerability of vaccine makers to class action lawsuits in the event of real or alleged serious side-effects means that not only have the medical regulatory bodies been languid to provide their approval for vaccines, but the developers have also been in no rush to deliver physical vaccines to a region with relatively low Covid-prevalence, matched with an equally low appetite for vaccine risk. In some countries, the rollout has been delayed while legislation is passed to protect the vaccine companies from litigation in problems.