The 7th Dr. Thanat Khoman Speech:
Medical and Public Health Collaboration in the ASEAN Community
H.E. Dr. Suriya Jindawong
Thai Ambassador to Singapore
October 6, 2020
Dr. Thanat Khoman ASEAN Studies Center, PSU
Our speaker Dr. Suriya Jindawong received his PhD from the Fletcher School of Law and Diplomacy at Tufts University, Massachusetts, USA. He later became an assistant manager of Global Finance in the Asia Division at Citibank in Bangkok, before joining the Ministry of Foreign Affairs where he was rapidly promoted to become the Director General of the Department of ASEAN Affairs. Starting from January 18th he became the ambassador of the Kingdom of Thailand to the Republic of Singapore.
He was one of the key officers responsible for Thailand's success as the chair of ASEAN which included the launching of seven ASEAN centers in Thailand.
Thank you for graciously extending an invitation for me to speak in the seventh lecture of the Dr. Thanat Khoman series.
I would like to talk about an issue which is very close to my heart professionally and personally as well as to more than 650 million people here in Southeast Asia. The topic is medical and public health cooperation in the ASEAN community.
Since this talk is part of the Dr. Thanat Khoman lecture series, it is only appropriate that I begin by recalling the last conversation I had with Dr. Thanat, the former foreign minister of the Kingdom of Thailand and one of the five founding fathers of ASEAN. Indeed, he initiated the ASEAN idea. I last talked to him face to face in 1991, almost 30 years ago.
I was finishing my dissertation and wanted to interview him about ASEAN. I had about ten questions, and began with "Why did you create ASEAN?" He took one hour to explain it all, and I didn't need to ask any more questions after his wonderful answer.
He spoke of what had happened in 1967, over 50 years ago, but many things he said are still relevant today.
I asked him why we needed a regional organization, since we already had very close ties with many western countries. Remember that we were in the midst of the Cold War, so why was it necessary to create something regionally? In summary, his answer was that the region needed to find its own voice. We had to start looking to ourselves and our neighbors within the region, and create a common future together.
If I may briefly refer to the Bangkok Declaration, or what called the ASEAN Declaration when ASEAN was established in 1967. It talks very much about a regional identity, about coming together. Security for the region means security for our people and posterity means that future generations will also be secure, which will lead to the blessings of peace, freedom, and prosperity.
A greater regionalism was the only way to address the competition amongst the major powers that was the Cold War.
One of the most important aspects of human security is public health, the medical well-being of the people of Southeast Asia.
In 1967, a seed was planted for regional cooperation, to advance human security, and to create a people-centered region. What can we do to ensure better livelihoods and security? I'm not talking only about defense, although that is important, but the public health of the peoples of our region.
A people-centered community is very much a part of the policy of ASEAN, since at least the time when the ASEAN charter was adopted in 2008-2009. Today it is a central theme of ASEAN's community strategic direction.
As we seek to overcome the pandemic challenge of Covid-19, and look forward to the post-covid era, how can we collaborate in the public health area?
My discussion will start with the Covid-19 situation, but public health and medical cooperation within ASEAN isn't just limited to Covid-19. There were, and will be, other pandemics, and there are many other medical and public health issues to consider in the short and long run.
I will look at Covid-19 from an ASEAN perspective here in Southeast Asia. In the words of many leaders and policy makers, it is a "once in a generation" crisis. This makes it different from other pandemics and indeed from other challenges that the region and the world has faced in the recent past.
There are many unknowns related to this virus, many questions about its characteristics. Scientists are working around the clock, all around the world, but we still don't really know all the facts.
Compared to other pandemics that ASEAN and the world has faced, such as SARS, Ebola, Zika, and Avian flu, we are living in a much more connected world. Not only physically, but in terms of information, with the greater risk that pandemics can be quickly disseminated. It has been said several times that Covid-19 is a "global problem without a passport". It doesn't recognize boundaries, spreads easily, and is very comprehensive. The medical and public health challenges are great, and it will have major economic and social consequences.
The WHO estimates that the virus may have already infected one out of every ten people on this planet.
ASEAN has done quite a bit as a regional organization to enhance the coordination between the medical and public health professions. This has been happening for some time, since at least the appearance of SARS and Avian flu. Working together has included the real-time sharing of data and best practices. This includes ASEAN health ministers' meetings and the setting up of various bodies supporting cooperation in the medical and public health fields. This has extended beyond ASEAN to our partners, including Asian+3 which includes China, Japan, and the Republic of Korea.
Of course, the pandemic paints a different picture in different countries – it manifests as a diversity of conditions even within the ten ASEAN countries. This is due to such things as geography, population densities, and different policies.
ASEAN is both flexible and pragmatic, and the key view is that this type of challenge is one that no country can deal with alone. It is absolutely necessary that we enhance cooperation at the regional level, and ASEAN provides the foundations, mechanisms, principles and standard operating procedures, to enhance such cooperation.
National measures, which will vary from country to country, will be reinforced by regional cooperation and regional measures. Such cooperation must be carried out on a voluntary and consensual basis, but ASEAN provides a very strong regional identity and a sense of mutual benefit. For example, the measures must be guided by the needs of sustainability, which was a key theme during Thailand's ASEAN chairmanship in 2019.
There is no quick fix for this pandemic challenge: it is a marathon not a 100-meter sprint. We need sustainable solutions for these public health issues.
What of the economic consequences of the pandemic? How do we link supply chains in a sustainable way since livelihoods are just as important as people's health? The public health issue, economic livelihood, and social stability must go hand in hand. However, in this speech, I will focus on public health.
For concrete policies, we need policy leadership at the highest levels within the ASEAN countries. Each ASEAN country has their own national policies but the impetus for regional cooperation must come at the highest levels. Fortunately, the special ASEAN summit in April and the formal ASEAN summit in June set policy directions for enhanced cooperation for dealing with Covid-19. We now have intense high-level policy coordination and timely data sharing, consistent with the WHO protocols.
ASEAN emergency operations centers have been set up for public health emergencies. We now have an ASEAN BioDiaspora virtual center to help in risk assessments on a region-wide basis. We have very close cooperation with the ASEAN+3 countries, China, Japan, and Republic of Korea, in a field epidemiology network. The ASEAN coordinating council is dealing with policies related to the Covid-19 challenge, supported by the ACC, the ASEAN Coordinating Council working group.
One of the key Thai initiatives, which has been fully endorsed by other ASEAN partners, is the extension of the Covid-19 ASEAN response fund. It invites collaboration and contributions from ASEAN partners to fund the production and purchase of PPEs, protective equipment, and other essential medical supplies.
The sheer number of vaccines required means that there will be no single company that can make them all. It is to everyone's advantage to share production, and to share the vaccine as a global public good.
We need to secure supply chains, including those for PPEs and medical supplies. ASEAN is promoting a regional reserve of medical supplies for public health emergencies and standard operating procedures. This will ensure that people are protected, especially the medical profession.
We are also looking to develop an ASEAN center on public health emergencies and emerging diseases, and developing a comprehensive recovery framework. This will address other issues related to the pandemic aside from public health, such as economic livelihoods and social stability.
Of the seven ASEAN centers created last year, one of them is the ASEAN center for military medicine. It is now carrying out major research to help better prepare national agencies to deal with this pandemic.
The whole region has been fully mobilized under what we call the ASEAN socio-cultural community pillar, one of the three pillars of ASEAN.
However, let us all remember that the primary task of dealing with this pandemic is a national effort. This is the right approach since the pandemic is very different in Thailand, Singapore, Lao PDR, the Philippines, and other countries. The national effort must come first and each country should also form bilateral cooperation with their neighbors. We must recognize that ASEAN is not a political union, but rather an organization of ten sovereign countries. This implies that the regional level must reinforce and support but not overtake national efforts.
At the regional level, one of the priorities is to strengthen health systems and access to care. We are promoting universal health coverage within the ASEAN context, and are considered by various organizations as a leader in this area. I'm talking about how ASEAN can ensure that the aging population of Southeast Asia are taken care of, and better integrated into society. This has become even more important recently since these groups are more vulnerable to the pandemic. Unfortunately, public health is very expensive, so we must create a balanced health care system in terms of cost and other aspects. This led to the establishment of the ASEAN center for active aging innovation in Thailand last year during our chairmanship.
Another issue that Thailand attaches great importance to within ASEAN is disaster health management. ASEAN adopted a declaration on disaster health management cooperation last year as a major policy initiative under our chairmanship.
Another related issue is food security which addresses malnutrition in our region. We also initiated this policy while ASEAN was under our chairmanship.
Something that is very relevant right now is the promotion of vaccine security and self-reliance. This relates to my earlier comment about vaccines as a global public good. It is being developed into a regional strategic and action plan for 2021 to 2025.
I've given you a broad sweep of the many forms of ASEAN cooperation for dealing with the Covid-19 pandemic challenge. It is a problem without passports, which requires cross-border global regional collaboration on the basis and principles of sustainability. Medical and public health cooperation and collaboration will remain an important pillar of the ASEAN community. We have no other choice when dealing with a once-in-a-lifetime problem. Also, it will mean that ASEAN will be better prepared to deal with other pandemics in the future by building on the foundation of a people-centered community that promotes human security, and the health and safety of its peoples, as a core value.
I would now be very happy to take any questions.
Prof. Dr. Teerapol Srichana, Director, Research and Development Office, PSU
You mentioned medical and public health collaboration among ASEAN in terms of technology transfer. In more general terms, how can ASEAN encourage the distribution of other advanced technologies, so the richer, more advanced members of ASEAN can help the poorer ones?
This is a fundamental question that involves not only public health but touches on many other issues. The basic question is how do we deal with gaps – gaps in technology, gaps in capabilities, gaps in awareness and knowledge? Of course, this is a problem not only among countries in Southeast Asia but also within countries.
The decision on how we address these gaps in each country must be a national policy. The member states must also decide what ASEAN can do to facilitate exchanges.
Technology transfer is a very tricky issue. For example, there are many private hospitals and medical institutions that will not want to share their intellectual property.
As a region we are only as strong as our weakest link. This connectivity is why one country affected by the pandemic, affects all of us. One solution would be to close our borders but we know that's not sustainable. A country will have to open its borders at some point based on a good balance of medical advice, policies, and interests.
Boonprasit Kritpracha, M.D., Vice President for Human Resources and Quality Development, PSU.
How can ASEAN encourage collaboration when accessing scarce resources such as vaccines?
I think ASEAN collaboration is ongoing at many different levels. Let me underscore just a couple of points that I made earlier. It is critically important to share timely information and best practices, and this has been going on even before the pandemic began, since the time of SARS. SARS really brought ASEAN and ASEAN+3 together to collaborate in these areas.
I've also already mentioned the Covid-19 ASEAN response fund and various other initiatives. Crucially, ASEAN has agreed that vaccines should be treated as a global public good. This is a strong Thai position, shared by all the countries of ASEAN. Sadly, the reality is that vaccines are developed by private companies and some governments and there are obviously some IPR issues to consider. But the broad picture is that no single company or country will develop vaccines alone. There must be collaboration in terms of production. For example, one of the policies in Singapore is called vaccine multilateralism. The country is offering its medical and production capacities to foreign medical pharmaceutical companies to encourage them to locate their manufacturing capacities in Singapore.
Asst. Prof. Dr. Supatra Davison, Director of the Dr. Thanat Khoman ASEAN studies center at Prince of Songkla University.
Since Thailand is doing so well in dealing with Covid-19, how do you think we can help other ASEAN countries deal with their pandemic problems?
One of the initiatives that the Thailand has been pursuing since the special summit and the virtual summit is the ASEAN Covid-19 response fund. This will help ASEAN countries acquire PPEs and other essential medical supplies more effectively.
Vaccine development is also something that ASEAN is pursuing, including the development of a long-term vaccine strategy. I assume that Thailand will be part of that because we have good production capacities for vaccine development, manufacturing, and shipping.
It is in our interests to help neighboring countries control the pandemic since our economy relies on workers from neighboring countries. We should try to ensure those workers are healthy.
For example, around 250,000 to 300,000 people move across the border between Singapore and Malaysia every day. This has stopped of course because of the pandemic, but the movement of people must eventually resume because the economies of both countries rely upon them. There are plans to develop a rapid testing system for perhaps 250,000 to 300,000 people per day. In addition, there are already green lanes for business people travelling between Singapore and Malaysia which have less restrictions.
This is something that will have to be done bilaterally, with ASEAN providing an overall framework.
Boonprasit Kritpracha, M.D., Vice President for Human Resources and Quality Development, PSU.
What should Thailand do to maintain our lead in the area of medical tourism?
Let me divide my answer into two parts. The first considers the normal situation and the second considers the effects of the pandemic.
Medical tourism is very strong in Thailand, Singapore, and Malaysia, but those countries tend to cater to different target groups. Thailand's strengths are a combination of professional world recognized medical services at competitive prices plus wellness tourism, and other things.
The question of medical tourism during a pandemic must focus on safeguards. Each country will do things differently. For example, Thailand has imposed a very strict 14-days of quarantine. But the need for medical services will continue to grow, and will slowly return to normal. We don't know when that's going to happen but until then each country must decide on policies related to medical tourism and visits. These should take into account both the medical prerequisites for the safety and security of people within Thailand, combined with the need to further strengthen economic activities, of which tourism plays an important part.
Asst. Prof. Sunton Wongsiri, M.D., Vice President for Research and Innovation.
What should we do post-covid to prevent another virus causing so many problems?
Planning for the future, or scenario planning, was one of the themes of sustainability of the ASEAN chairmanship by Thailand. We must reinforce the importance of the timely sharing of information and SOPs. Although, to be fair, this was already well in place since the time of SARS. But it must be refined continuously. For instance, how do we ensure that the necessary essential medical supplies and PPEs are in place?
This was a big issue in Singapore as regards the shortages of masks. Although, many companies owned production facilities, they were located outside Singapore. This made things difficult once those countries banned the export of PPEs.
In the future, we will have to create more efficient and connected supply chains, that are sustainable and secure within the region. We will have to look at issues such as regional stockpiles of PPE medical supplies.