Reinforcing Health Security in ASEAN

By Centre for Non-Traditional Security (NTS) Studies

S. Rajaratnam School of International Studies (RSIS)

Singapore

With the recent rise of emerging and re-emerging infectious diseases such as Middle East Respiratory Syndrome, Ebola, multi-drug resistant tuberculosis, it is important to further reinforce ASEAN’s preparedness to tackle infectious diseases.

Cooperation on Health Security

Has there been progress in terms of health security in ASEAN? The past fifteen years highlight two critical milestones for cooperation on health security in ASEAN. The first milestone was triggered by Severe Acute Respiratory Syndrome (SARS) in 2003 which effectively securitised infectious diseases in ASEAN. After SARS and a series of avian influenza outbreaks (H5N1 and H1N1), a number of regional mechanisms were put in place, including the Highly Pathogenic Avian Influenza (HPAI) Task Force (2004), a host of ASEAN Plus Three (APT) mechanisms that emerged from the Emerging Infectious Disease Programme (2004) including the Field Epidemiology Training Network, Emerging Infectious Disease website and the Partnership Laboratories. SARS and avian influenza were the impetus for the regional health agenda to be primarily concentrated on infectious diseases with pandemic potential.

Another milestone is the ASEAN Socio-Cultural Community Blueprint in 2009 that laid out 55 health action lines which were further operationalised in the ASEAN Strategic Framework on Health Development (2010-2015). The framework explicitly charted a multi-sectoral and multi-stakeholder approach including collaboration, cooperation and partnerships on health which were outlined into five areas that include, but are not limited to, capability building in communicable disease control, enhancing food security and safety; providing access to healthcare and promoting healthy lifestyles; building disaster-resilient nations and safer communities and ensuring a drug-free ASEAN. Some of these action lines are implemented with other working groups in other ASEAN Community pillars which further reinforce the need for cooperation with the political and economic spheres of community building. Various aspects of disease prevention and control, disaster resilience and the eradication of drugs require not only health-centred approaches but also political and economically-motivated solutions – interventions that are not centred solely on access to a global public good but also in the responsibility to protect at-risk communities and vulnerable groups of society.

Communicable Disease Control: Vital Progress but Substantive Gaps

ASEAN clearly have the appropriate regional frameworks and mechanisms for collaboration, cooperation and partnerships on health security, however there are still substantial gaps among ASEAN member states in terms of globally required core capacities.[1]

Despite the WHO-led Asia Pacific Strategy for Emerging Diseases (APSED) that supported ASEAN programmes for capability building in communicable disease control, the International Health Regulation (IHR) core capacity gaps within ASEAN are still of substantive concern. Based on the rationale for the ASEAN Community building, the less developed CMLV group (Cambodia, Myanmar, Lao PDR and Vietnam) needs to be integrated with the more developed ASEAN6 (Brunei, Indonesia, Malaysia, Philippines, Singapore and Thailand). In terms of the eight core capacities, the CMLV group is almost at par on average with the ASEAN6 group on surveillance and legislation, but the gap in terms of coordination, preparedness, response, laboratory and human resources is still substantial (see Figure 1). The CMLV group is also almost at par with ASEAN6 in terms of zoonosis and food safety, but it still has considerable capability building needs forchemical and radionuclear health hazards and public health events at points of entry (see Figure 2). Gaps in critical capacities such as coordination and preparedness, and capabilities for public health events at points of entry pose serious threats to regional health security, as viruses know no political boundaries.

Health Security beyond 2015

There has been substantive regional effort into developing core capacities for international public health emergencies. However, with the funding of capacity building and training programmes hinged on three to five year cycles, sustaining the momentum and avoiding pandemic fatigue is indispensable. Including the IHR core capacity index to measure the region’s capability to control communicable diseases in the ASEAN Community Scorecard is critical. Aside from ASEAN dialogue partners and their aid agencies, a number of nongovernment organisations, philanthropic foundations, the private sector and academic communities, have all significantly contributed to regional health activities, from setting up collaborative surveillance mechanisms to supporting training networks. Thus, ASEAN would not need any new mechanism for communicable disease control as it already has the regional framework for it. The only thing needed is to reinforce and sustainably support existing mechanisms to strengthen health security in the region.

ASEAN has come far in terms of the progress that has already been made in building its IHR core capacities. Addressing the capacity gaps for health hazards and public health events at points of entry will need a more comprehensive approach that entails all three ASEAN Community pillars. ASEAN cannot be complacent in terms of closely assessing and improving its capacity to tackle public health emergencies that not only endanger regional health security but also multiply political and socio-economic insecurities.

Recommended Readings

• Mely Caballero-Anthony and Gianna Gayle Amul, 2015, Health and human security: Pathways to advancing a human-centred approach to health security in East Asia, in Simon Rushton and Jeremy Youde (eds.), Routledge Handbook of Global Health Security, London and New York: Routledge.
• World Health Organization, 2008, International Health Regulations (2005), 2^nd ed, Geneva.

[1]A critical indicator of the status of health security is the International Health Regulation’s (IHR) Core Capacity Index based on 28 indicators for eight core capacities (as shown in Figure 1) that measure national, intermediate and community response levels to public health risks and public health emergencies of international concern (PHEIC). In addition to monitoring these capacities, human health hazards (zoonosis, food safety, chemical and radionuclear) and public health events at points of entry (PoE) are also monitored.