As governments worldwide increase their COVID-19 vaccination coverage, COVID-19 vaccination certificates (CVCs) are making headlines as a possible answer to the question of how to reopen economies safely. While countries like Israel and Estonia are well advanced in introducing CVCs, developing countries, as with their vaccination rates, are further behind. In especially interconnected developing regions like Southeast Asia, CVCs present unprecedented collaboration challenges, including that of coordination and trust.
We believe governments in Southeast Asia can build on the example of another integrated bloc in designing a regionwide CVC: the European Union’s planned “Digital Green Certificate.” As we explain here, the EU’s approach offers a possible framework for implementation, addressing the dual challenges of coordination and trust. The EU’s CVC, which could be operational as soon as next month, could also hold lessons for other countries and regions as they seek to mitigate the impact of COVID-19 on their economies and societies.
The long road ahead to vaccine coverage
Southeast Asian countries have a long way to go to reach full vaccination coverage, giving them the opportunity to learn from how other countries are handling CVC and time to get organized. Given current trends, no developing country in Southeast Asia will complete vaccinations in 2021, with forecasts showing least two more years are required in some countries. Cambodia leads the pack with around 11 percent of the population having received one dose, while Laos and Indonesia have reached around 5 percent, and Thailand and Vietnam record under 2 percent (as of May 13, 2021).
Amid low vaccination rates, the poorest populations live in extremely precarious situations, with many locked down and unable to earn a wage. Those who can, often work in low-paid, high-risk jobs that require frequent contact with the public, such as in the hospitality and tourism sectors, or in crowded, poorly ventilated conditions, including the manufacturing, textile, and garment industries. Furthermore, people in Southeast Asia are highly mobile and cross borders often on a daily or weekly basis. In 2019, Thailand recorded 4.9 million non-Thais in the country, most of whom came from neighboring Cambodia, Laos, Myanmar, and Vietnam. Migrant workers contribute up to 6.6 percent of Thailand’s GDP and send approximately $10 billion in remittances when informal flows are taken into account.
The case for collaboration
Southeast Asia, along with the European Union, is among the most interconnected regions in the world in terms of economic integration, intraregional trade, and cross-border movement. At the same time, however, countries in the region differ in their levels of economic growth, labor mobility, health system capacities, digital preparedness, and COVID-19 responses and outcomes. While countries have learned lessons from cooperating in previous health crises, like the SARS pandemic, the topic of CVCs present a new type of collaboration challenge.
Governments in Southeast Asia understand the need for a credential that spans the countries making up the Association of Southeast Asian Nations (ASEAN), to kickstart economies and increase the movement of goods and people. In March, ASEAN leaders announced they were considering introducing a digital vaccination certificate to boost labor mobility, trade, and tourism. The ASEAN Comprehensive Recovery Framework outlines broad strategies for long-term socioeconomic recovery and response, which include the need to strengthen human and health security while maximizing the potential of intra-ASEAN economic integration that draws upon innovative digital solutions. But to date, little is known about how each country intends to approach CVC, let alone within and across the ASEAN bloc.
Challenges in introducing a regionwide CVC
The time is now for Southeast Asian countries to think through how they can best use CVCs to promote the safe opening of economies. This will not be a simple task. Governments will need to coordinate and agree with each other and key stakeholders within their own boundaries on the objectives of credentials; the types of data to be collected and shared; available digitalization options; and so on. In other words, they need to navigate the lay of the land and agree on a common framework and mechanism.
Beyond coordination problems, trust in the capacity of health systems and their responses to COVID-19, including their ability to provide reliable vaccination credentials, remain a critical gap. Health system capacities vary throughout the region. Thailand achieved universal health coverage and even has a health insurance system for migrants, while Vietnam has a robust social health insurance system and strong primary healthcare system that has responded well so far to COVID-19. Indonesia is well on its way to reaching universal health coverage, but the pandemic threatens to derail efforts. Laos and Cambodia both have improved their health system capacities significantly in recent years, but segments of the population, particularly those in rural areas, women, and children, face difficulties in accessing healthcare and suffer worse health outcomes than the rest of the population.
With such divergence in health system capacity, will governments trust each other’s standards for certificate-issuing authorities? How will governments decide which vaccines are considered safe and efficacious across the region when different countries have been using different vaccines? How can countries harmonize health standards in a fair and equitable manner? What form can certificates take given limitations in infrastructure and capacity, and how do we ensure their authenticity and how will credentials be verified? Will interoperability of CVCs be possible when health standards, particularly digitalized health standards, also differ significantly?
The EU example
We believe that the European Union’s Digital Green Certificate (DGC) could provide answers to some of these challenging questions and a workable framework for an ASEAN equivalent. The DGC is broader in scope than other “vaccine passport” initiatives; it is a verifiable credential of COVID-19 status (vaccinated, negative, or recovered) that would be important for countries where vaccination rates will remain low for the foreseeable future, such as those in the ASEAN region.
The DGC is a significant step away from country-level restrictions that are currently in place (like the UK’s Red List, for example), towards individual-level verification, as individuals may enter the EU if vaccinated, regardless of COVID-19 outbreak levels in the country of departure. The DGC will also allow people to enter the EU if they have received, at least 14 days before arrival, the last recommended dose of a COVID-19 vaccine that has received marketing authorization in the EU, or a vaccine that has completed the World Health Organization’s Emergency Use Listing process. In addition to vaccination status, the DGC will carry information on whether an individual has received a negative test result or recovered from COVID-19, which will aid member states to waive requirements for additional test results or quarantine. By creating these types of “rules of the game” and corresponding verification mechanisms, the DGC enables a range of digital credentials to be acceptable to all in the bloc, which helps to address the coordination problem.
The DGC also addresses the issue of varying degree of trust across different jurisdictions through its corresponding trust framework, which defines the rules, policies, protocols, formats, and standards needed to ensure that COVID-19 health certificates are issued in such a way that their authenticity and integrity can be verified and trusted. The framework further ensures that databases backing the DGC do not need to be EU-wide but should allow for decentralized verification of digitally signed interoperable certificates. These principles could be adapted for countries in Southeast Asia facing technical and policy challenges as they move towards a regionally acceptable credential of COVID-19 status. It would also be an incentive for countries to shore up the credibility of their health systems, especially the COVID-19 testing infrastructure, bringing them in line with international standards and using digital tools to verify authenticity and prevent fraud.
The EU has a diverse range of economies, health system capacities, and levels of COVID-19 vaccination rates, much like Southeast Asia. If the DGC proves successful in the EU, there is every possibility that a version of such a model will also work for Southeast Asia. We’ll be closely watching progress of the EU DGC going forward, and in parallel, start to collate information from Southeast Asian countries on their status and plans for CVC in the coming months.
With many thanks to Alan Gelb for his insightful comments.