What’s Behind Mainland Southeast Asia’s Surprising Success Against COVID-19

With the exception of Thailand, the five countries of mainland Southeast Asia are some of the poorest in the Asia-Pacific region. According to the World Bank, Cambodia has a per capita GDP of around $1,600, while Myanmar’s is roughly $1,400. Laos and Vietnam fare only marginally better, each at around $2,500. Their political systems run the gamut from semi-democracies to authoritarian one-party states. Yet despite some initial missteps, they have all largely suppressed COVID-19, proving far more effective in addressing the pandemic than most developed countries, including the United States.

Vietnam, a country of roughly 95 million people, has reported a handful of deaths and only 784 total cases, as of Sunday. It has seen a recent surge, centered on the coastal city of Da Nang, but even that outbreak remains small by global comparison. Its neighbors have done nearly as well. Thailand, which has a population of just under 70 million, has not had locally transmitted cases in weeks, and only around 3,300 cases in total. Many aspects of life are returning to normal in the capital, Bangkok, and in other parts of the kingdom. By comparison, Florida, with a population of around 21 million people, has recently been averaging about 6,600 new cases per day.

Cambodia, meanwhile, has had only around 200 confirmed cases, and is even allowing in Americans, a risk few countries are willing to take right now. Laos and Myanmar have had only 20 and 358 confirmed cases, respectively. While the real number of cases is likely higher in all of these countries, their performance still stands out as a bright spot in the global fight against the coronavirus. Many of their maritime Southeast Asian neighbors, particularly the Philippines and Indonesia, are struggling with high caseloads.

Few observers predicted mainland Southeast Asia’s success against COVID-19. Back in February, I criticized the region’s initial response to the pandemic; even several months later, I did not imagine how effective these countries would be in containing the virus. While Vietnam quickly responded to COVID-19 with border closures, lockdowns and a major public health campaign, Myanmar, Thailand and Cambodia were slow to stop all travel to and from China, the initial source of the epidemic, and some of their officials shared misinformation about the virus.

Thailand, however, soon righted its approach. It imposed a state of emergency in late March, and launched a national task force to combat COVID-19. While the Thai government has used the state of emergency to suppress dissent—authorities arrested multiple opposition activists last week—it also appears to have helped slow the virus’s spread. Moreover, early lockdowns in Vietnam and Thailand probably helped smaller countries in the region like Cambodia, which did not impose restrictions quickly but may have benefited from having fewer travelers from its neighbors.

More recently, mainland Southeast Asian countries have been world leaders in getting near-universal compliance with mask wearing, in many cases very early in the pandemic. At least 95 percent of Thais and 94 percent of Vietnamese wear masks in public. In some cases, like Vietnam, this is because the government imposes tough fines on anyone not wearing a mask in public. Other states have relied more on longstanding social norms promoting the use of face masks when sick.

Countries in the region, even the repressive ones, have also displayed impressive levels of transparency about COVID-19 and the government response—even while they stifle dissent and limit the flow of information about topics other than the virus. In Vietnam, where the ruling Communist Party controls all aspects of political life, the Ministry of Health is putting case information online. Laos has embarked on a national public information campaign that is extremely transparent by the standards of one of the most autocratic one-party states in the world. To be sure, Vietnam’s response has built on years of “efforts to improve governance and central-local government policy coordination,” as Edmund Malesky and Trang Nguyen note in a recent report for the Brookings Institution.

Many governments in mainland Southeast Asia have also worked to ensure that their coronavirus response measures impose minimal financial costs on their populations—critical moves to getting broad public buy-in. As Nguyen and Malesky note, Vietnam’s policy is to cover most costs for citizens related to the response to COVID-19, including quarantines, coronavirus tests and hospitalizations. Cambodia, in turn, has relied on aid from the World Bank and other overseas entities to help ensure that people are not opting out of COVID-19 restrictions due to an inability to bear the cost.

Some of these strategies should be replicable in other developing countries, given enough political will. Masks are cheap and effective, and many other states could copy the combination of pressure and skillful public campaigns to get as many people to wear masks.

Other hybrid or authoritarian states would do well to heed Vietnam’s example, which has shown that transparency about COVID-19 doesn’t necessarily endanger the state’s dominance over politics. In other words, if they come clean with their publics about the spread of COVID-19 and their responses to it, they are not necessarily setting themselves up for a broader political backlash. Likewise, other developing countries may be able to copy efforts from mainland Southeast Asia to ensure that COVID-19 quarantines and treatment remain free or highly inexpensive, which is the best way to get people to take tests, isolate and go for treatment.

Beyond these clear strategies, some residents of the region, including several medical researchers, have suggested that mainland Southeast Asia may have benefited from unique cultural practices that make contagion less likely. For instance, many people in mainland Southeast Asia do not greet each other with handshakes or hugs, but instead with a palms-pressed-together gesture, while standing apart from the other person. Taweesin Visanuyothin, the COVID-19 spokesperson for Thailand’s Ministry of Public Health, told the New York Times that Thailand’s success “has to do with culture. Thai people do not have body contact when we greet each other.”

However, in large, packed cities like Bangkok, Yangon and Ho Chi Minh City, people walk close together, jam into buses and other public transportation, and generally come quite close to each other. They may greet each other without body contact, but the sheer size of these places makes it hard to practice real social distancing. Thus, the true reasons for these countries’ success in containing the virus likely have more to do with their policy responses.

Other researchers speculate that some people in mainland Southeast Asia may have some natural immunity to COVID-19. In one study from southern Thailand, more than 90 percent of people who tested positive for COVID-19 remained asymptomatic, a much higher share than normal. The reasons for this finding, however, remain unclear.

One thing that is certain is that Thailand and its neighbors, which have had experience fighting other infectious diseases like SARS and dengue fever, have collectively emerged as a rare pocket of resilience in the face of the coronavirus pandemic. As similarly low-to-middle-income countries in Latin America are hit hard by the coronavirus, and nations across Africa brace for a surge in cases, their governments could benefit from looking eastward and taking lessons from mainland Southeast Asia’s response.