Malaysia, Thailand, and Vietnam are moving away from their zero-Covid strategies, but experts caution that they may not yet be ready to fully reopen their economies.

After enduring months of strict lockdowns, parts of Southeast Asia are transitioning away from the zero-Covid approach and exploring how to live with the virus – though experts warn that it may still be too soon for such a shift.

This summer, Covid-19 rapidly spread across the region, exacerbated by the highly contagious Delta variant, with cases spiking in July and peaking in most countries by August.

Countries like Indonesia, Thailand, and Vietnam are now aiming to revive their economies, particularly the key tourism sector, by reopening borders and public spaces. However, experts fear that low vaccination rates across the region and the widespread use of less-effective vaccines like China’s Sinovac could lead to disastrous outcomes.

Yanzhong Huang, a senior fellow for global health at the US-based Council on Foreign Relations, warned that if vaccination rates remain low and high-efficacy vaccines aren’t widely available before restrictions are eased, Southeast Asia’s healthcare systems could quickly become overwhelmed.

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“We’re likely to see a surge in severe cases that will overwhelm ICU capacity… there will be a shortage of beds and ventilators,” he warned.

For much of the public and many regional leaders, there seem to be limited alternatives. Vaccines are scarce, and mass vaccination across Southeast Asia appears unlikely in the near future. Meanwhile, as people lose jobs and remain confined at home, families are struggling with hunger.

Jean Garito, a diving school owner in Phuket, Thailand, expressed that small- and medium-sized businesses are urgently hoping for borders to reopen. He questioned how much longer the country’s tourism industry could survive under current conditions.

“If governments fail to properly compensate businesses for their short- and long-term losses, then yes – if they don’t fully reopen, we’re all in trouble,” Garito warned.

The end of ‘zero Covid’ policies

From June to August, many Southeast Asian nations imposed stringent restrictions in an effort to curb the Covid surge.

Malaysia and Indonesia enforced nationwide lockdowns, while Thailand and Vietnam implemented regional lockdowns in areas with high infection risks. Under these measures, millions were ordered to stay home as much as possible, domestic travel was banned, schools were closed, public transportation halted, and gatherings prohibited.

Since the lockdowns, new daily cases have dropped across the region, though they remain significant. Data from Johns Hopkins University shows that the Philippines is still reporting nearly 20,000 new cases daily, with Thailand, Vietnam, and Malaysia each seeing around 15,000 daily. Indonesia has experienced the greatest decline, now reporting only a few thousand cases per day.

The worst of the peak may be over, but vaccination rates remain alarmingly low in some areas – yet some governments are already moving forward with reopening plans.

Vietnam intends to open its Phu Quoc resort island to international tourists next month, as reported by Reuters. Authorities cited economic strain as a driving factor, with the tourism minister acknowledging the severe impact of the pandemic on the industry. As of now, less than 7% of the population is fully vaccinated, far below the 70% to 90% needed for herd immunity, according to Dinogo’s global vaccine tracker.

Thailand plans to reopen Bangkok and other major tourist destinations by October, aiming to rejuvenate its struggling tourism sector, which contributed over 11% to the nation’s GDP in 2019, Reuters reported. About 21% of the Thai population is fully vaccinated, according to Dinogo’s vaccine tracker.

Indonesia, which has vaccinated over 16% of its population, has begun relaxing its restrictions, allowing public spaces to reopen and factories to operate at full capacity. Foreign visitors may be permitted in specific regions, such as the tourist hotspot Bali, by October, according to Reuters.

Malaysia, which boasts one of the highest vaccination rates in the region, with more than 56% of its population fully vaccinated, reopened Langkawi – a group of 99 islands and the country’s top holiday destination – to domestic tourists last week. Many states have also started easing restrictions for vaccinated individuals, including allowing indoor dining and interstate travel.

In some respects, the region’s swift reopening mirrors the “living with Covid” strategy seen in Western nations like the United Kingdom and parts of the United States, where daily life has largely returned to normal.

Among Southeast Asian nations, Singapore has taken a clear stance in moving away from its former ‘zero-Covid’ approach, according to Abhishek Rimal, regional emergency health coordinator at the International Federation of Red Cross. While other countries haven't formally announced similar changes, their rapid reopening indicates that governments are beginning to reconsider the long-term viability of the zero-Covid strategy.

“Global discussions among scientists are ongoing about Covid's future,” said Rimal. “One possibility is that it could become an endemic disease… we seem to be moving towards Covid becoming a regular part of life.”

The risks of reopening too soon

Experts caution that low vaccination rates in parts of Southeast Asia, including the Philippines, Indonesia, and Thailand, make reopening far more dangerous compared to countries in the West.

Many Western nations have already vaccinated a large portion of their populations, with the United Kingdom at 65% and Canada approaching 70%.

Although Western countries are still seeing some cases and occasional spikes after reopening, the number of Covid-related deaths and hospitalizations has remained low, underscoring the effectiveness of vaccines.

In Southeast Asia, test positivity rates remain alarmingly high. The World Health Organization advises countries to maintain a positivity rate of 5% or lower for at least two weeks before reopening, but many Southeast Asian nations are experiencing rates between 20% and 30%, according to Rimal.

“This clearly shows that the reported Covid case numbers are not an accurate reflection of the true situation, due to insufficient testing and contact tracing,” he explained. “The recent Covid-19 surge has made one thing clear – we must not let our guard down.”

The WHO has outlined additional criteria for reopening, such as ensuring that transmission is under control and that health systems are equipped to detect, test, isolate, and treat cases. Some countries that are reopening have not met these standards, raising the risk of a Covid resurgence, Rimal warned.

However, many Southeast Asian governments may have little choice. Vaccine supplies in the region remain limited, compounded by global shortages and delays. Some countries were slow to secure vaccines, leaving them unprepared when the latest wave hit. Additionally, some middle-income nations, like Thailand and Malaysia, are ineligible for subsidized vaccine rates through COVAX.

Waiting for global demand to decrease and supply chains to improve is not a viable solution; the livelihoods and lives of millions have already been severely impacted for almost two years, and further delays could have devastating effects if people are not allowed to resume their lives.

“Millions are struggling to meet basic needs,” said Rimal. “A large portion of the workforce in Asia relies on daily wages, and they are being hit hard by the ongoing economic downturn.”

As the pandemic stretches on, with communities repeatedly lifting and reimposing lockdowns every few months while families face hunger, there’s also growing pandemic fatigue. Beyond economic hardship, governments are facing mounting public pressure to reopen.

This is the “major dilemma” confronting scientists, policymakers, and leaders in Asia, Rimal noted. “We know vaccines are a key solution, but we don’t have access to them, and meanwhile, people continue to suffer and lose their jobs.”

That’s why organizations like the Red Cross are urging world leaders to increase vaccine deliveries to low-income and heavily impacted countries in South and Southeast Asia, he said. However, in the meantime, if countries decide to proceed with reopening, they must strengthen other pandemic measures, such as public health protocols, testing, and contact tracing.

“If we don’t take action now, we will certainly witness a surge in cases in the coming days or weeks,” he warned.

Vaccine challenges

One significant factor that could complicate the region’s shift to living with Covid is the type of vaccines available.

Many Southeast Asian countries have largely relied on Chinese-made vaccines, which generally offer lower efficacy compared to those developed by Western companies.

According to Duke University, Thailand has procured over 40 million doses of the Sinovac vaccine, while the Philippines and Malaysia each have around 20 million doses. Cambodia has purchased another 16 million.

Indonesia has secured 15 million doses of the Sinopharm vaccine, while Malaysia has obtained an additional 5 million doses.

While many experts agree that any available vaccine is better than none, Chinese-made vaccines generally have lower efficacy compared to Western options like Pfizer or Moderna.

Brazilian trials have shown that Sinovac has around a 50% efficacy against symptomatic Covid-19, but is 100% effective at preventing severe cases, according to trial data submitted to the WHO. Sinopharm, on the other hand, has about a 79% efficacy for symptomatic and hospitalized cases, according to WHO.

In contrast, the Pfizer and Moderna vaccines show more than 90% effectiveness. China’s Foreign Ministry spokesperson Wang Wenbin previously dismissed concerns over the efficacy of Chinese vaccines as a “bias-driven smear.”

Huang, from the Council on Foreign Relations, warned that reopening with fewer than half the population vaccinated and relying on less effective vaccines could lead to a surge in cases, overwhelming hospitals and potentially forcing the reintroduction of restrictions.

Not all Southeast Asian countries have relied on Sinovac or Sinopharm. For instance, Singapore, which boasts one of the highest vaccination rates globally at over 77% fully vaccinated, primarily uses Pfizer and Moderna vaccines.

Other nations have begun moving away from Sinovac due to concerns about its efficacy. In July, Malaysia announced it would discontinue the use of the Chinese-made vaccine once its remaining 12 million doses were used up.

Similarly, Thailand stated it would revaccinate its healthcare workers with the Pfizer vaccine once new doses arrived, despite having already fully vaccinated them with Sinovac in the past.

“If they manage to use the more effective vaccines as boosters and vaccinate a large portion of the population, reopening would certainly be more justifiable,” said Huang.

However, for this transition to take place, global supply pressures must ease, or wealthier nations with surplus doses need to assist – something that is not happening fast enough.

“It’s crucial that high-income nations quickly distribute vaccine doses to South and Southeast Asia so these regions can overcome the pandemic and return to normalcy,” said Rimal. “This is one of the key solutions we have.”

For Garito, the diving school owner in Thailand, the need for reopening is urgent. “We have families to feed, including our children,” he said.