Building Resiliencethrough a whole-of-society approach:
COVID-19 pandemic response
in East Asia
Interim report of the East Asian response to COVID-19 Project
18 October 2022

Yoshiyuki Sagara, Thomas Stables, and Lauren Baehr
Asia Pacific Initiative
The International House of Japan

About the Asia Pacific Initiative (API)Asia Pacific Initiative (API) is a Tokyo-based independent think tank and a program
brand of the International House of Japan (I-House). Based on I-House’s mission
to “contribute to building a free, open, and sustainable future through intellectual
dialogue, policy research, and cultural exchange with a diverse world,” API esfocus
on its work in the areas of 1) international relations, regional studies, and geopolitics
and 2) social systems, governance, and innovation.

About the Authors
Yoshiyuki Sagara is the Senior Research Fellow at API, where he focuses on healthsecurity policy including COVID-19 response, international conflicts, economic
statecraft, and Japan’s foreign policy. Before joining API in 2020, Mr. Sagara had
15 years of career experience working in the Japanese government and the United
Nations system, as well as in the technology industry. From 2018 to 2020, he served
as Assistant Director of the Second Northeast Asia Division (North Korea desk) at
the Ministry of Foreign Affairs of Japan. From 2015 to 2018, he served in the Guidanceand Learning Unit within the Policy and Mediation Division of the UN Department of
Political Affairs in New York, where he analyzed and disseminated best practices andlessons learned from UN preventive diplomacy and political engagements, such as in
Nigeria, Iraq, and Afghanistan. From 2013 to 2015, he served in the International
Organization for Migration (IOM) Sudan, based in Khartoum. As a project development
and reporting officer in the Chief of Mission’s Office, he developed and implemented
peacebuilding and social cohesion projects in conflict-affected areas of Sudan,
especially Darfur. While serving in the Japan International Cooperation Agency (JICA)
Headquarters from 2012 to 2013, he managed rural and fishery development projects
in Latin America and the Caribbean region. From 2005 to 2011, he worked at DeNA
Co., Ltd. in Tokyo and engaged in expanding tech businesses. Mr. Sagara co-authoredThe Independent Investigation Commission on the Japanese Government’s Response to
COVID-19 (API/ICJC): Report on Best Practices and Lessons Learned (Discover 21, 2021).
Thomas Stables, Research Intern, API
Lauren Baehr, Research Intern, API

About API’s “East Asian response to COVID-19” Project
Since 2020, API has reviewed how East Asian countries confronted COVID-19, andgood practices and lessons learned to share with the world. The project covers sevencountries/regions: Japan, Singapore, Vietnam, South Korea, Taiwan, Thailand, andHong Kong. The project will provide recommendations on how to prepare not only
for the current COVID-19 response, but also for Disease X, a serious infectious
disease that could cause outbreaks by a pathogen currently unknown, including thenext highly lethal coronavirus (COVID-X).

Table of contents
02	Summary04	Introduction
05	Response framework
06	China, Europe, and the United States:
spread of lockdowns and lack of public trust08	East Asia’s resilient whole-of-society approach:activating a comprehensive response
12	Providing operational knowledge
1 5	Reducing vulnerability
17	Adjusting healthcare capacity & resources
19	Conclusion

Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

Summary	The COVID-19 pandemic is the most devastating global health crisis in overa century. During the crisis, East Asian countries and regions, except China,
were able to provide effective operational knowledge to the public, reduce
national vulnerabilities, and adjust healthcare capacity and resources inways that created public trust and a sense of legitimacy in the competencyof the governments’ strategies. This created and maintained a whole-ofsociety response, which allowed East Asia to build resilience and effectively
control the COVID-19 pandemic. Such responses bought these governments
time by keeping infections relatively low until vaccines were available.

	East Asian countries and regions — Thailand, Japan, South Korea, Hong
Kong, Taiwan, Vietnam, and Singapore — successfully detected the first
COVID-19 cases in January 2020 and gained early control over the virus,
which enabled the countries and regions to learn more about its
epidemiology, raise awareness among their citizens, and develop informed
strategies. Overall, this allowed East Asian countries and regions tominimize deaths and severe infections. Crucially, this also increased
public trust in government measures over the long term, allowing thesecountries to control the virus while they awaited the arrival of vaccines.

	Other factors included creating mechanisms for a swift national shift into
an efficient and organized pandemic response, which benefited immenselyfrom East Asia’s past experiences with SARS and MERS. East Asia has
experienced several epidemics of infectious diseases since 1997, including
the Highly Pathogenic Avian Influenza A(H5N1), SARS, and MERS.
Having dealt with the outbreaks of pathogens, many East Asian countries
had a preparatory advantage in terms of infectious disease control andpeople’s awareness of potential dangers, assisting governments with theircitizens’ willingness to comply with public health instructions.

2Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

	In East Asia, vaccine rollout was implemented with less controversy
and division. As a result, many East Asian countries have either matchedor surpassed the vaccination rates of their Western counterparts, despite
getting access to those vaccines at a later stage of the pandemic.

	The reduction of vulnerability is fundamentally about removing thebarriers to active public participation in the pandemic response, which can
act as a bolster to operational knowledge. One advantage of thegovernments mentioned above is that they all have some form of Universal
Health Care (UHC) available to the population, even if limited in scope.
This has created societies generally less vulnerable to infectious disease,accustomed to government involvement in medical care, and withpre-existing avenues for the universal distribution of medical care. During
a pandemic, however, a nation must go beyond UHC, as vulnerabilities in
the public make for much larger potential infection vectors andcompromise any potential control over the viral spread.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

Introduction
The COVID-19 pandemic is the most devastating global health crisis in over a
century. The virus, SARS-CoV-2, rapidly spread from Wuhan to the rest of theworld. In the initial few months, little was known about the virus. The disease
spread through many nations which were ill-prepared for a pandemic. As aresult, most countries across the world experienced major outbreaks, causing
millions of people to tragically lose their lives to the virus. As of 30 September
2022, there were 6.5 million confirmed deaths from COVID-19¹. It has been aprofound tragedy.
When the virus hit mankind, the global economy had become increasingly
reliant on international migration flows, cheap and highly interconnected air
travel networks, and the movement of people across borders. As we approachthe end of 2022, the COVID-19 pandemic continues to threaten people’s
lives and livelihoods, with developed countries suffering some of the highest
mortality figures in the world. The United States’ cumulative deaths stand at
more than 1.06 million², the highest confirmed deaths in the world.
Life expectancy at birth in the U.S. declined nearly a year from 2020 to 2021.
That decline – 77.0 to 76.1 years – in 2021, along with a 1.8 year drop in 2020,
was the biggest two-year decline in life expectancy since 1921-1923³.
During the COVID-19 crisis, in maintaining a balance between saving lives,
minimizing economic and social disruption and respecting human rights,
East Asian countries have largely avoided the social and economic turmoil
experienced by many countries and regions around the world, as well as
maintained the trust of their public vis-a-vis their pandemic response.
East Asian countries and regions — Thailand, Japan, South Korea, Hong Kong,
Taiwan, Vietnam, and Singapore — successfully detected early COVID-19 cases
in January 2020. This allowed the governments to devise and implement
effective and targeted policy tools before the virus reaches a point of critical mass.
The world has drawn its attention to how East Asia has managed the risk of
COVID-19 and controlled the potential damage. Case studies by governments

1	Hannah Ritchie, Edouard Mathieu, Lucas Rodés-Guirao, Cameron Appel, Charlie Giattino, Esteban

Ortiz-Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser, “Coronavirus Pandemic(COVID-19)”. Published online at OurWorldInData.org. https://ourworldindata.org/coronavirus.
2	Ibid.
3	CDC, “Life Expectancy in the U.S. Dropped for the Second Year in a Row in 2021,” 31 August 2022.

4

Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asiaand experts have been accumulating. COVID-19 is an ongoing crisis with no end
in sight. As such, it would be useful for policymakers and experts worldwide
to review their national responses and identify best practices and lessons
learned in East Asia’s preparedness for and response to infectious diseases.
This paper seeks to highlight from a regional perspective some of the common
themes of pandemic response in East Asian countries. We have found thatthrough activating a comprehensive response which lead to a shared set of
conditions upon first contact alongside a common response framework, East
Asian countries were able to provide effective operational knowledge to the
public, reduce national vulnerabilities, and adjust healthcare capacity andresources in ways that maintained trust in the competency of the government’s
strategy. This created and maintained a whole-of-society response, whichallowed these countries to effectively control and manage the pandemic.

Response framework
It is extremely difficult to contain COVID-19, a disease in which pre-symptomatic
infected people can transmit the virus. Unlike Ebola and SARS, symptoms are
mild or asymptomatic in the majority of COVID-19 cases. Moreover,individuals with COVID-19 become infectious from two days prior to theonset of symptoms until approximately seven to ten days after those
symptoms take effect. Yet, the most contagious period tends to occur aroundthe initial phase of infection, and before the onset of those symptoms, leading
to the majority of new cases stemming from stealth infections⁴. Only testingand isolation of symptomatic cases is not a sufficient strategy for suppressing
the transmission of COVID-19.
In pandemic response analysis, ‘resilience’ has been a core concept used toevaluate response success. A broad definition of resilience is the ability of
institutions’ and health actors’ capacities to prepare for, recover from, andabsorb shocks, while maintaining core functions and serving the ongoing
and acute care needs of their communities.⁵ Here, the relevant element ofresilience is shock absorption. In particular, how the behaviors of East Asian

4	Nandini Sethuraman, et al. Interpreting Diagnostic Tests for SARS-CoV-2. JAMA.

Published online 6 May 2020.

5	Victoria Haldane, Chuan De Foo, Salma M Abdalla, Anne-Sophie Jung et al., “Health Systems Resilience inManaging the COVID-19 Pandemic: Lessons from 28 Countries,” Nature Medicine 27, no. 6 (June 2021): 964-980,
https://doi.org/10.1038/s41591-021-01381-y.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

countries and regions built whole-of-society responses along with public trustand compliance.
Also, a whole-of-government response is applied to relatively successful
responses that mobilized their governments far beyond their specificinfectious disease and public health apparatus. Yet, for many, the goal was
more ambitious, creating what amounted to a whole-of-society response⁶.
East Asian countries have managed to maintain whole-of-society responses
over time and despite rapidly changing circumstances. The pandemic called
for societal mobilization and coordination, demanding a full commitment of
national resources to emergency public health management measures.
Building from and modifying the resilience elements of highly effective
national responses identified by Haldane et al. in “Health systems resiliencein managing the COVID-19 pandemic,” this targeted analysis of selected East
Asian countries will identify the characteristic elements of a comprehensive
response. Such measures include response activation, healthcare capacity andresource adjustment, operational knowledge, and the reduction of vulnerability.

China, Europe, and the United States:
spread of lockdowns and lack of public trust
As of 2 October 2022, the United States and the U.K. have suffered fromcumulative deaths per million standing at over 3,000, some of the highest
cumulative rates of mortality per million in the world. Close behind, Italy
suffered at a rate of 2,990 per million people, with France and Germany
standing at 2,301 and 1,799 respectively⁷. By contrast, Taiwan’s cumulative
confirmed deaths stands at 467 per million people, Vietnam at 442, Thailand
at 457, Japan at 357, and Singapore at 297 deaths per million people⁸.
One of the greatest mistakes the United States and many European countries
made at the outset was implementing COVID-19 public health policies on
the belief that it would likely be manageable in a similar way to the Ebola and6	Walaiporn Patcharanarumol, “Thai UHC and Health Systems for COVID-19 Responses” (JICA Webinar, 8 April

2022), slide 10, https://www.youtube.com/watch?v=7s3uOEvl9lM.

7	Our World in Data
8	Ibid.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

SARS outbreaks. As a result, the U.S. and many European countries repeatedly
experienced large-scale rises in infections followed by harsh lockdowns,
creating a significant impact on social and economic activities, and worsening
to intense social divisions.
Wuhan was the first to implement a lockdown, followed by China’s all-in
approach of closing borders and isolating people by stay-at-home orders.
European countries and the United States emulated some of Chinese restrictive
measures; over time their citizens became fatigued due to living under suchdraconian measures.
Ultimately, a lack of serious surveillance and integrated coordination
overwhelmed Europe and North America in the early stages of the pandemic.
This caused major stress on healthcare systems, and led to a sense of distrust
amongst citizens of European countries and the U.S.
Also in East Asia, Hong Kong’s initial response was promising, but was
ultimately constrained by political conditions from the mainland China.
This eroded trust in government amongst Hong Kongers, and thus underminedthe coordination of a long-term resilient response. On 16 February 2022,
Hong Kong’s deaths per million people stood at just 30⁹. Due to a low degreeof public trust in the government as a result of the suppression of democratic
protests, as well as the subsequent implementation of the sweeping National
Security Law, Hong Kongers were distrustful of the government’s vaccine
scheme – even though they had an option to get Fosun Pharma (Shanghai
Fosun Pharmaceutical) – BioNTech mRNA vaccines. In particular, many had ambivalence towards vaccines sourced from the mainland China. For example,
the day after a man was reported to have died after taking a Sinovac vaccination
shot on 3 March 2021, data reportedly published by the government ofHong Kong displayed a decrease of 10,300 appointments for the vaccine¹⁰.
Since March 2022, Hong Kong’s mortality rate has tragically risen to 1,288
deaths per million people¹¹.
While the U.S. and Europe’s responses differed sharply from China’s, theoutcomes of both share a failure of resilience, leading to a breakdown inpublic trust, and an inability to utilize the whole-of-society towards a

9	Ibid.
10	Timothy McLaughlin, “The Place With Surprisingly High Vaccine Capacity”, The Atlantic, 1 April 2021.

https://www.theatlantic.com/international/archive/2021/04/hong-kong-trust-vaccine/618469/.

11	Our World in Data

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Building Resilience through a whole-of-society approach:
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common goal of containing the virus. Despite very different strategies incontaining the virus, a breakdown of public trust in each region complicatedthe national government’s ability to control the virus, while exacerbating
tensions and increasing social divisions. The West was successful in producing
safe and effective vaccines, such as mRNA vaccines, essential to eventuallyliving with the virus; both respective political systems failed to produce a
resilient response to the pandemic.

East Asia’s resilient whole-of-society approach:activating a comprehensive response
East Asian countries took significantly different approaches and strategies intheir efforts to control the COVID-19 pandemic. The initial response to an
emergency situation can be instructive of sufficient preparedness of acountries’ strategy in the short to medium term. As mentioned, East Asia
countries and regions successfully detected the first COVID-19 cases inJanuary 2020 and gained early control over the virus, which enabled thecountries and regions to learn more about its epidemiology, raise awarenessamong their citizens, and develop informed strategies. Overall, this allowed
East Asian countries and regions to minimize deaths and severe infections.
Crucially, this also increased public trust in government measures over thelong term, allowing these countries to control the virus while they awaited
the arrival of vaccines.
Other factors included creating mechanisms for a swift national shift into an
efficient and organized pandemic response, which benefited immensely from
East Asia’s past experiences with SARS and MERS. East Asia has experienced
several epidemics of infectious diseases since 1997, including the Highly
Pathogenic Avian Influenza A(H5N1), SARS, and MERS. Having dealt withoutbreaks of pathogens, many East Asian countries had a preparatory
advantage in terms of infectious disease control and people’s awareness ofpotential dangers, assisting governments with their citizens’ willingness tocomply with public health instructions.

8Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

Indeed, such was the memory of SARS in Hong Kong that despite initialinaction from the central government, civil society actors mobilized andpressured the central government to close Hong Kong’s borders with themainland. This was despite citizen-state tensions from the aftermath of aclampdown on pro-democracy protests. Hong Kong’s Steering Committee
ultimately implemented widespread mask-wearing measures in January 2020,
six months before the WHO updated its advice in June that year¹².
The ability to effectively control the virus during the early stages of theoutbreak created a sense of trust in government public health provisions,which in the eyes of citizens throughout the pandemic helped to maintain asense of legitimacy in government institutions vis-a-vis those public healthmeasures. This not only generated but sustained a whole-of-society approachthroughout the pandemic, which was crucial in maintaining a sense of personal
responsibility among citizens in following public health rules.
Due to this higher sense of trust in government, vaccine rollout was also
implemented with less controversy and division. The result is that many East
Asian countries have either matched or surpassed the vaccination rates of their
Western counterparts¹³, despite getting access to those vaccines at a later stageof the pandemic. As of 28 August 2022, Singapore’s share of its population witha full initial protocol of vaccinations stands at 92%. The U.S. by contrast had
only achieved 79% according to Our World in Data¹⁴.

Early border control and quarantine: One of the first steps of successful
early pandemic responses was timely border control and early quarantine.
These measures delayed the arrival of COVID-19 and prevented the virus
from hitting a point of critical mass, at which point stopping its spread would
become impossible, as happened in Italy during the early stages of the pandemic.
Border control and early quarantine provided time for epidemiologicalinvestigations while protecting the public. As early as 31 December 2019, Taiwan’s
government recognized the potential threat of the virus to its citizens, andbegan to quarantine passengers from Wuhan and study the COVID-19 virus¹⁵.
Thailand activated a national lockdown and total border closure¹⁶.

12	Wilson Wong, “When the state fails, bureaucrats and civil society step up: analysing policy capacity with

political nexus triads in the policy responses of Hong Kong to COVID-19”, Journal of Asian Public Policy, 15:2,
198–212, 2022. DOI: 10.1080/17516234.2021.1894314
13	https://ourworldindata.org/COVID-vaccinations.
14	Ibid.
15	Chen, Chien-Jen, “Taiwan’s Response to COVID-19.” Johns Hopkins Bloomberg School of Public Health
Webcast, 25 April 2020. https://www.youtube.com/watch?v=ReI6ROZNbkk&t=115s.
16 Patcharanarumol, op. cit.

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Building Resilience through a whole-of-society approach:
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Singapore used a “circuit-break” meant to cut the country off from potential
sources of infection¹⁷. Hong Kong began implementing border measures in
February 2020, and on 25 March banned non-resident arrivals¹⁸.

Choosing & implementing a pan-governmental response strategy: Based onearly information, a government must choose and comprehensively pursue
its initial pandemic response strategy. An example of this was Singapore’s
early “circuit-break” measure, implemented with the core policy of preserving“lives and livelihoods.”¹⁹ In contrast to other countries with lockdown
strategies and aggressive containment policies such as Vietnam with its
stringent measures, South Korea pursued a comprehensive “social distancing
policy” in combination with mass testing and screening with epidemiologicaltracking to ensure adequate surveillance infrastructure was in place at theearly stages of the pandemic²⁰. It also updated legislation to enable a flexible
response and systematic adjustment, such as widely-sourced data collection
and disclosing crucial health information and advice to the public about
appropriate preventative measures. For example, Hong Kong’s Centre for HealthProtection (CHP), established during the SARS crisis, implemented real-time
surveillance, as well as quickly setting up quarantine facilities and hospitals²¹.
Flexible policy response: Many East Asian countries’ pandemic policy response
was decisive and thorough. Crucially, however, their models contained
significant flexibility, and were therefore able to change course based on
evolving circumstances. An example of this was Singapore’s COVID-19 policy
response. After the circuit-breaker shut down all but eliminated imported andcommunity-spread cases, Singapore began a containment policy with strict
physical distancing restrictions. It was adjustable and calibrated according
to severity and sustainability, measures scaled based on case numbers andeconomic health²². In 2022, with the help of data analytics, they pursued a“near-normal” in which COVID-19’s status as a disease shifted from being
considered a global pandemic the government was aiming to eradicate fromits jurisdiction, to endemic in Singapore’s population.²³ The purpose of this17	Teo, Yik-Ying, “Leveraging Data Analytics to Inform Policy Response to COVID-19: A Case Study fromSingapore.” HDR UK Scientific Conference - Data Insights in a Pandemic, 23 June 2021.
https://www.youtube.com/watch?v=U1H_16oTBkg.
18	“HK to ban non-resident arrivals”, Government of Hong Kong, 23 March 2020.
https://www.news.gov.hk/eng/2020/03/20200323/20200323_164827_699.html.
19	Yik-Ying, op. cit.
20	Taejin Lee, “Korea-WBG Partnership on COVID-19 Preparedness and Response: Case Study of the Republic ofKorea.” World Bank Group Korea Office & Health, Nutrition and Population Global Practice Webinar, 26 April 2022.
https://www.worldbank.org/en/events/2022/04/14/korea-wbg-partnership-on-COVID-19-preparedness-andresponse-webinar-series.
21	Simon Cartledge, “So What? Hong Kong’s COVID-19 Success Won’t be Why It Remembers 2020,”
The Asia-Pacific Journal, 15 July 2020. https://apjjf.org/2020/14/Cartledge.html.
22	Yik-Ying, op. cit.
23	Hsu Li Yang, “Overview of COVID-19 Situation and Response in Singapore.” HITAP Thai webinar, 24 Feb 2022.
https://www.youtube.com/watch?v=l7WgJSAggpU.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

measure was to shift not only the threat perception from the general public,
but also to adapt from the containment approach to a more long-term,
suppression approach. The gradual transition began with reduced mask
requirements, and relaxed testing and border control policies. It is crucial tonote that Singapore’s government nonetheless remained prepared tore-escalate prevention measures in the case of a significant rise in cases²⁴.
Other East Asian states displayed this measured flexibility. Vietnam shiftedfrom its initial containment strategy by introducing mass vaccination via
donations, adopting an ethos of “Safe adaptation, flexibility, effective control”
in 2021²⁵. Later, Vietnam transitioned into “fully open for development.”²⁶South Korea started the pandemic by implementing a significant social
distancing and mass testing approach, focused on vaccination when it became
available, before shifting into a “gradual return to normal” starting inNovember 2021.

Create national teams for response implementation and public
communication: One of the first steps towards creating a coordinated national
response is the creation of a lead team dedicated to the transition into apublic health crisis, along with later teams and subcommittees to support thatshift between various government branches and sectors of public life. Someof this took the form of activating or redirecting existing institutions, as was
the case for Taiwan’s activation of its Central Epidemic Command Center(CECC)²⁷ and South Korea’s Central Disaster and Safety Countermeasure
Headquarters (CDSCHQ), alongside its Disease Control and Prevention
Agency (KDCA)²⁸. Such agencies can have distinct and important roles:
CDSCHQ took on a character of combined central and medical leadershipwith the Prime Minister at its head, while the KDCA provided the responsewith key technical information. On the other hand, Thailand’s Center for
COVID-19 Situation Administration (CSSA)²⁹ and Vietnam’s Steering
Committee for COVID-19 Prevention and Control were created specificallyfor pandemic response³⁰. This recentering of power and expertise into
specialized authorities signaled action on the belief that a protracted yetconcentrated crisis like the COVID-19 pandemic requires specialized
leadership and attention.

24	Ibid.
25	Pham Quang Thai, “COVID 19 Pandemic Preparedness and Response: Vietnam Case Study.” World Bank

Group Korea Office & Health, Nutrition and Population Global Practice Webinar, 29 June 2022.
https://www.worldbank.org/en/events/2022/06/20/korea-wbg-partnership-on-COVID-19-preparedness-andresponse-webinar-series-2.
26	Ibid.
27	Chien-Jen, op. cit.
28	Lee, op. cit.
29	Patcharanarumol, op. cit.
30	Thai, op. cit.

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Building Resilience through a whole-of-society approach:
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Tracing, testing, and treatment system: Within the first three months of thepandemic, many East Asian countries had implemented a comprehensive
contact tracing program. South Korea centered its early pandemic response
towards a comprehensive mass testing and tracing system that complemented
its decision to pursue social distancing measures rather than lockdown³¹. In
Singapore, the government implemented comprehensive contact tracing
measures, ring-fencing of high-risk people³². The four pillars of its strategy
were enhanced surveillance, containment, active case finding, and reducing
case importation³³. Thailand had Surveillance and Rapid Response Teams(SRRT) at the district level, and monitored COVID-19 rates as closely as
possible to manage a near full medical care capacity, as well as using PCR
testing for its confirmed case number tracking³⁴.

Providing operational knowledge
Operational knowledge constitutes the competent communication ofactionable response strategies to the public, alongside useful information thatencourages the public to act on those strategies. The most important form
this takes is in information specifically tailored to activate certain behaviors
in the public and in institutions not under government purview. The second
form is situational knowledge: how the pandemic is progressing in a particulartime and place, what is being done, and what the public should do at thatmoment. Finally, epidemiological knowledge can help the public know how
best to behave in certain circumstances. All of this can be further reinforcedby the strength of pre-existing public health education.

Empower the public with clear messaging to enable basic public
protective action: When it comes to engaging and prioritizing specific behaviors
in public engagement, clear and simple publicity can be extremely effective.
The greatest example of this in the whole of East Asia was likely Japan’s“avoiding the 3Cs” (i.e., closed spaces with poor ventilation, crowded places
with many people nearby, and close-contact settings such as close-range
conversations) campaign. On 9 March 2020, the Novel Coronavirus Expert
Meeting (the Expert Meeting) presented its assessment that environmental
settings with “3Cs” were associated with the occurrence of clusters of31	Lee, op. cit.
32	Li Yang, op. cit.
33	Ibid.
34	Patcharanarumol, op. cit.

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Building Resilience through a whole-of-society approach:
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COVID-19 cases. The initial concept of Japan’s strategy was to conduct
intensive retrospective investigations on clusters of COVID-19 cases to
identify the original source(s) of infection in the cluster and understand the
dynamics of spread within it as well as external to it. Experts also looked into
the secondary effects of suppressing COVID-19 transmission by informing
the general public of the environmental settings in which COVID-19 clusters
were more likely to occur (i.e., environments with the 3Cs) and urging themto adopt behavioral changes and avoid those settings³⁵.
In a similar vein, Vietnam had its own “5K” response, corresponding to fiveactions beginning with K in Vietnamese, as well as the “V2K” strategy(vaccination, masks, disinfection) meant to replace it if cases declined.
Within its response forces, Vietnam also had the motto “four on the spot,”emphasizing the immediate presence of command, forces, facilities, andlogistics in on-the-ground response efforts. An adjacent kind of communication
meant to prime the public for continued vigilance was Singapore’s strategic
delay in declaring COVID-19 “over.”³⁶ This was meant to prevent the loss of
public compliance that would result if re-introducing increased measures wasnecessary going forward after the pandemic is declared “over.”Guidelines for response: Clear and effectively communicated response
guidelines to healthcare workers and the general public can provide detailed
direction specific to particular scenarios and parties such as hospitals andbusinesses. Such guidelines create a set of clear standards and lift complex
logistics burdens. An example of this is the Vietnamese planning andresource guidelines for potential scenarios and consistently updated technicalguidelines for healthcare networks throughout the pandemic³⁷. Later, theVietnamese government provided guidelines and training for implementing
and using six types of COVID-19 vaccines. Broad guidelines for the public canalso be useful, as they were in Taiwan, where the government provided clear
community transmission prevention guidelines, surveillance, and information
management³⁸. The value of guidelines holds true for pandemic-era training
and re-training in Vietnam, where ICU workers, commune health workers,
and mobile teams were trained for COVID-19 treatment and handling.

35	Atsuna Tokumoto, Hiroki Akaba, Hitoshi Oshitani, Kazuaki Jindai, Koji Wada, Tadatsugu Imamura,Tomoya Saito, and Yugo Shobugawa, “COVID-19 health system response monitor: Japan,” World HealthOrganization Regional Office for South-East Asia (WHO SEARO), January 2021.
https://apo.who.int/publications/i/item/9789290228264.
36	Li Yang, op. cit.
37	Tranh Thi Mai Oanh, “Vietnam’s Health Service Delivery System from Experience of COVID-19” (Webinar,
JICA Webinar, 8 April 2022). https://www.youtube.com/watch?v=7s3uOEvl9lM.
38	Chien-Jen, op. cit.

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Risk communication through providing regular pandemic updates: Regular,
clear updates on the national pandemic situation serves to encourage trust in
government authorities (as a show of trust in providing information inspires
reciprocation), remind people of the importance of following response
guidelines, and allow the public to proportion their pandemic anxieties toreality. Taiwan’s CECC provided daily press livestreams with Q&A sessions
that anyone could directly ask the experts about their concerns³⁹.In Vietnam,
government media and private media worked together to provide effective
risk communication. For example, infographics created by the private sector
helped to spread COVID-19 information and raise public awareness.
Crucially, Singapore’s clear and regular public communication also allowed
for the effective management of post-vaccination transition towards livingwith the virus. Once 96% of eligible citizens had received some form ofvaccination and 50% received some exposure to the vaccine, the Singaporean
government communicated clearly that people were no longer required towear masks in open spaces, yet emphasized that COVID-19 was not “over”.
This was further underscored by the government declaring several times thatmeasures would be re-imposed if cases rose once again⁴⁰.
Mobilizing campaigns to meet specific goals: A brand of communication
similar to, yet distinct from ubiquitous public action slogans were concentrated
campaigns to meet particular goals within certain timeframes. Singapore’s
early circuit-break strategy was most effective in the service of vaccination
goals, such as Singapore’s “last mile vaccination” outreach. Also, Vietnam
implemented the “Vaccination - keep the faith” media campaign.
Healthcare & volunteer personnel recruitment and reallocation: A sign of acompetent response is an understanding and use of national human resources,
including the recruitment of retired or in-training medical personnel, as wellas positioning present professionals where they may be able to most contributeto the response. Vietnam mobilized its medical and nursing students forsupervised COVID-19 response work⁴¹. South Korea mobilized recruiting for
epidemiological investigation personnel and healthcare providers⁴².

39	Ibid.
40	Teo, Yik-Ying, “WEBINAR SINGAPORE EXCERPT: YIK-YING TEO in TOWARDS THE END OF THE

COVID-19 PANDEMIC [新型コロナ パンデミックの終焉に向けて]”, Tokyo Foundation for Policy Research[東京財団政策研究所], June 2022. https://www.youtube.com/watch?v=E5w9hagexwk.
41	Ibid.
42	Lee, op. cit.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

Additionally, recruiting volunteers within communities alleviates the burden
on professionals with more urgent concerns, gives the response a familiar
face for members of local communities, and even reduces some of theemployment difficulties stemming from pandemic era business downturns.
Taiwan implemented a community-based monitoring/surveillance network⁴³.
In Thailand, over one million community health workers (CHWs) disseminatedand amplified the government’s public health messages, mobilizing village
health volunteers. In Singapore, volunteers were deployed to educate seniors
and provide for their basic needs⁴⁴. In Vietnam, mobile medical stations werealso deployed for communes, wards and townships with the participation of
medical forces, military medics and volunteers providing testing, vaccinations,referral support and home treatment bags.

Creating apps and websites for public engagement: With the right investment
and effort, technology can play a huge role in engaging active public involvement
and compliance with the pandemic response. It can be a place to easily allow
public access to the aforementioned communications and data, but it canalso be an additional source of data for the government from the public, ameans for vaccinated status identification, and even an avenue for the public
to provide feedback on the pandemic itself. In South Korea, this included a
Self-Diagnosis Mobile Application and a public mask-purchasing system. In
2021, Vietnam launched a centralized COVID-19 app for travel and vaccine
tracking, contact tracing, vaccine reporting, and more. Hong Kong’s government
implemented a public information campaign on Telegram, which included
an Interactive Map Dashboard. The app was designed to serve as a one-stop
platform to supply citizens with the latest COVID-19 related updates, while
addressing and clarifying areas of public concern⁴⁵.

Reducing vulnerability
The reduction of vulnerability is fundamentally about removing the barriers
to active public participation in the pandemic response, which can act as abolster to operational knowledge. One advantage of the governments
mentioned above is that they all have some form of Universal Health Care
(UHC) available to the population, even if limited in scope. This has createdsocieties generally less vulnerable to infectious disease, accustomed to gov-

43	Chien-Jen, op. cit.
44	Li Yang, op. cit.
45	Anti-epidemic Info Channel launched, news.gov.hk, 21 February 2020

https://www.news.gov.hk/eng/2020/02/20200221/20200221_212816_106.html.

15

Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asiaernment involvement in medical care, and with pre-existing avenues for theuniversal distribution of medical care. During a pandemic, however, a nationmust go beyond UHC, as vulnerabilities in the public make for much larger
potential infection vectors and compromise any potential control over theviral spread.

Nationalize and increase access to medical countermeasures: During apandemic, medical systems and the public cannot rely on prior rates of
medical product acquisition and consumption. An example of this during
COVID was the skyrocketing global demand for medical-grade face masks.
To compensate for this, some governments began their own domestic
production. Singapore, along with building national medical supply stockpiles,
acquired masks by restarting domestic production and personnel support.
Alternatively, South Korea accessed masks through government requisition,
export restrictions, price incentives, and personnel support. Likewise,
Thailand centralized the procurement and distribution of medical supplies
and technology through its Ministry of Public Health.
Subsidize testing and treatments: Minimizing the costs of care and prevention
also minimizes the possibility of people concealing infection (expensive
treatment), not knowing they have an infection to begin with (expensive
testing), or not bothering with prevention measures (expensive supplies).
South Korea provided free testing and treatment for the public as thegovernment mandate is to fund communicable disease treatment. It also
implemented price controls on medical masks.⁴⁶ Thailand provided free testing,treatment, isolation and quarantine to all. It also developed an emergency
Additional Budget for a prevention and promotion program, screening,
testing and tracing, home/community isolation programs, and compensation
for people with adverse reactions to vaccines.
Protect vulnerable communities: Vulnerable communities are less likely toafford or receive appropriate medical care during the pre-pandemic phase,creating a predisposition towards higher vulnerability during a pandemic,
and therefore a critical weak point of focus for pandemic response measures.
Utilizing local communities is consequently crucial. Due to the potential
underlying vulnerabilities of such groups, most crucial of all is a fast andeffective vaccine rollout strategy. Vietnam prioritized the elderly for46	Chien-Jen, op. cit.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

vaccinations and made efforts to protect the homebound unvaccinated elderly.
It also provided regime-based subsidies and free testing and treatment forpoor and migrant workers. Thailand expanded its UHC system to include
resident non-citizens. It also developed a list of vaccine priority groups which
expanded as vaccine access increased: first were frontline health professionals,
then the elderly, patients with comorbidities, pregnant, non-Thai adults, andfinally adolescents and young children.
One group particularly vulnerable and negatively impacted by pandemic isschoolchildren. Singapore protected the education and wellbeing of students
with a sliding scale of face-to-face, blended, and home-based learning
supported by a combination of public health and educational measures⁴⁷.
This policy was based on the great costs school closures have on student
welfare and the disproportionate impact felt by vulnerable groups.

Providing a safety net for the consequences of national response measures:
Societal mobilization can interfere significantly with the lives and livelihoodsof its citizens. In order to mitigate some of these effects, Taiwan provided
compensation for epidemic prevention that included a daily allowance, free
Wi-Fi, care packages, food and medical services for those living alone⁴⁸. It
also made services available during quarantine, including contact with thelocal government for questions, access to family, and meal packages. In South
Korea, socially distanced production and business continued with the support
of a relief fund and an expansionary fiscal policy cushioning the impact of thepandemic on the public. Such countermeasures decrease the burden ofcompliance and increase public trust.

Adjusting healthcare capacity & resources
The process of adjusting capacity and resources involves comprehensive
response activation. While there was significant variation with regard to thisin every country in East Asia we analyzed, some marks of exceptional andcommitted responses were the reorganization of care systems, the mobilizationof civilian volunteers, and the triage of strained medical resources.

47	Wong, Yee Lok. “First-Year Under COVID-19: School Closures in Hong Kong and Singapore.” Lee Kuan Yew

School of Public Policy Panel Discussion, 25 June 2021. https://www.youtube.com/watch?v=BeBlCfCrqlM.

48	Chien-Jen, op. cit.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

Tiered/designated hospital/treatment system: A tiered or flow-model hospital/
treatment system can concentrate the treatment of moderate and severecases of COVID-19 in the hands of those professionals and facilities mostequipped to handle them. Vietnam organized a tiered treatment that wasorganized into three levels, corresponding with mild, moderate and severecases, based on concentric levels of local, province and city, and finally central
healthcare facilities⁴⁹. Thailand had a similarly tiered system, while Taiwan
created a list of designated hospitals for COVID-19 isolation, in order toprevent collateral infection of non-infected patients⁵⁰ ⁵¹.
A triage to preserve limited medical, hospital, and personnel resources: In the
countries studied, as the pandemic progressed to approximately an 80% majorityof asymptomatic and mild COVID-19 cases, it became viable to offload thecare for such cases from the overburdened mainstream medical system,
thereby relieving pressure on hospital capacity. South Korea used a Living
Treatment Center (LTC) for quarantine of low-risk/asymptomatic COVID-19
patients with at-home isolation capacity⁵². Singapore implemented facility-based
quarantine, along with home-isolation and self-testing⁵³. In Vietnam, grassrootscommunity health stations were responsible for mild or asymptomatic cases,
and mobile medical stations mobilized at the local commune, ward andtownship levels⁵⁴. These stations used virtual consultations of Tier 3 and 2
workers for lower-tier workers to support community health workers andprevent unnecessary cases from being elevated to the more in-demand
specialists and hospital beds⁵⁵.
Supporting the medical care system with technological information systems:
Technological information systems can alleviate some burdens of humanrecord-keeping and allow for swift information sharing between COVID test
records, healthcare providers, and the government. Digital technology inSouth Korea included an ICT-based network, the Smart Quarantine Information
System (SQIS), and a QR-code digital entry-exit list system. Taiwanesetechnology networks included a government open data platform, its national
testing network and contact tracing, and a digital quarantine system⁵⁶.

49	Thai, op. cit.
50	Patcharanarumol, op. cit.
51	Chien-Jen, op. cit.
52	Lee, op. cit.
53	Li Yang, op. cit.
54	Thai, op. cit.
55	Ibid.
56	Chien-Jen, op. cit.

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Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

Despite having less access to a thriving technology sector equivalent to adeveloped economy such as South Korea, Vietnam was also able to develop anational database for COVID-19 vaccination.

Public-private partnerships: In sectors important to response efforts butwith significant private ownership, public-private partnerships can aligninterests and ensure a comprehensive response. South Korea, built its
formidable diagnostic capacity through the collaboration of the public andprivate lab systems, namely the KCDC and the Society for Laboratory Medicine.
Together they structured the testing system with agreements on issues suchas lab accreditation standards and processes, and the preferred type of virus
testing. In Vietnam, there was collaboration between Vietnamese government
agencies and private companies to cope with the outbreak of COVID-19,
particularly in contact tracing.

Conclusion
This paper has demonstrated that East Asian countries and regions were able
to provide effective operational knowledge to the public, reduce national
vulnerabilities, and adjust healthcare capacity and resources in ways thatcreated public trust and a sense of legitimacy in the competency of thegovernments’ strategies. This created and maintained a whole-of-society
response, which allowed East Asia to build resilience and effectively control
the COVID-19 pandemic. Such responses bought these governments time bykeeping infections relatively low until vaccines were available.
Perhaps most importantly, through highlighting the whole-of-society approachin East Asia, countries are not bound by a binary choice between locking up
their citizens against their will and shutting down their economy, or letting
the virus tear through the population. Such a binary choice implies thatgovernments are forced to choose a lesser of two evils. Yet, we havedemonstrated that empowering citizens with the latest available scientificadvice — operational knowledge — and trusting them to implement clearlycommunicated and necessary measures, importing the most scientifically19Building Resilience through a whole-of-society approach:
COVID-19 pandemic response in East Asia

effective vaccines for the specific disease rather than favoring national
champions, maintaining moderate restrictions until a sufficient level of
immunity is developed, and listening to the public is demonstrated here to be
not only more effective at saving lives but also less harmful to the economy
and society in the long-term. Our analysis demonstrates that a morecompassionate approach that aligns controlling COVID-19 effectively withminimizing human suffering and governing by popular consent is possible.

20About “The Independent Investigation Commission on
the Japanese Government’s Response
to COVID-19 (API/ICJC)”
API established “The Independent Investigation Commission on the Japanese Government’s
Response to COVID-19” in July 2020 to examine how Japan responded to the COVID-19 crisis,and published a report titled “The Independent Investigation Commission on the Japanese
Government’s Response to COVID-19: Report on Best Practices and Lessons Learned” inJapan in October 2020.
On 8 January 2021, API published the English version of the Commission Report .
Under the guidance of the Commission, which consisted of four leading experts, the Working
Group (WG) composed of 19 experts in medical, law, public policy, crisis response, health security,and international relations, conducted 102 interviews with 84 government officials and experts,
including the Prime Minister Shinzo Abe, the Chief Cabinet Secretary Yoshihide Suga, theMinister of Health, Labour and Welfare Katsunobu Kato, as well as numerous other senior
government officials who provided insight on the background of the events.
The full report is available online.
https://apinitiative.org/en/project/covid19/

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API and I-House do not express opinions of their own.
The opinions expressed in this publication are the responsibility of the authors.
© Asia Pacific Initiative, I-House, 2022

Cover image: COVID-19 Omicron variant detected in Hong Kong, China - 28 November 2021
Photo: Budrul Chukrut/SOPA Images via ZUMA Press Wire/KyodoNewsImages

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