Dr. Terawan Agus Putranto

As the deadline for the ASEAN Post-2015 Health Development Agenda is approaching by the end of 2020, one of the priority goals for Indonesia’s AHMM Chairmanship for 2020-2021 is to accelerate the implementation of the current ASEAN Health Cluster Work Programme and develop the Work Programmes 2021-2024 in which promoting effective Governance and Implementing Mechanism (GIM), including digital health figure prominently. Furthermore, we are also targeting to establish a Health Sector Knowledge Management System.

Inresponse to the current challenges , as the chair of AHMM, Indonesia is working to synergise and scale-up ASEAN health mechanisms and platforms in preparedness and response to the COVID-19 pandemic future public health emergencies in a more coherent ASEAN way.

I believe that at the outset of the crisis, there was no country, including the ASEAN Member States, that was well prepared for this COVID-19 pandemic, even though every country has its core capacities to implement the International Health Regulation (IHR) 2005.

The unprecedented scale of COVID-19 and its impact on the health systems of ASEAN Member States come in different stages for each country; particularly it adversely impacts health services delivery, the health workforce, and financing.

With regard to the health service delivery, some countries are facing difficulties related to the inadequate number of referral hospitals with its bed capacity and other required equipment, laboratories, and essential medical supplies. The limited availability of test kits for the COVID-19 is also a challenge as the number of patients might be more than the numbers indicated. As for the health workforce, short supply of health personnel and front-liners made the burden even harder. Due to the rapid increase of infections, the ASEAN Member States also encountered massive strain in health financing which led to prioritising their national budget for the handling of COVID-19.

Eventually, we realised that the pandemic has affected every country irrespective of the state of development and the need for stronger national health systems and regional approach. Accordingly, we have identified the weaknesses and are working on addressing them systematically. It has made all realise the critical importance of robust primary health care comprised of disease prevention, health education, and community empowerment in practicing a healthy lifestyle. All these aspects are part of whole health system that support one another to achieve more resilience and sustainable ASEAN health systems.

This experience also taught us the need to ensure the sustainability of health financing by establishing national health insurance programs and working towards Universal Health Coverage (UHC) for our people, particularly disadvantaged and vulnerable groups.

Each country has a different policy approach based on its specific problems. Aside from the different national responses, ASEAN managed to activate its regional mechanisms and platforms in responding to the COVID-19 pandemic.

These  mechanisms are ongoing: ASEAN Emergency Operations Centre (ASEAN EOC), Network for Public Health Emergencies, ASEAN Plus Three Field Epidemiology Training Network (ASEAN+3), ASEAN BioDiaspora Virtual Centre for Big Data Analytics, ASEAN Risk Assessment and Risk Communication (ARARC), the Regional Public Health Laboratories Network (RPHL), Human and Animal Health Collaboration, ASEAN Vaccine Security and Self-Reliance (AVSSR), Regional Collaborative Strategy on ASEAN Drug Security and Self-reliance (ADSSR), Biosafety and Biosecurity training and networks.

These mechanisms and platforms enable the ASEAN health sector to address gaps and improve the ASEAN Member States’ health system by conducting rapid information sharing and technical exchanges, risk assessment, risk communication, contact tracing, exchange of laboratory readiness and response action, and capacity strengthening.

As the ASEAN Health Sector continues its response according to the evolution and trajectory of the outbreaks in Member States, the ASEAN Health Ministers convened a special video conference on 7 April 2020 among ASEAN Health Ministers and with Plus Three, and also on 31 April 2020 with the United States, to review the current situation and response, outline priority policy and strategic directions for the ASEAN Health Sector, and enhance cooperation with partners. The mandates are, among others, to sustain and institutionalise the existing regional mechanism, mobilising timely technical, material and financial resources critical to sustaining national health system response including drug and vaccine security and self-reliance, and ensuring access to essential health care services.

Indonesia’s COVID-19 responses are reflected in the steps taken by the government to flatten the curve of COVID-19 transmission. Our first   approach is in the public health sector, where we control the spread of COVID-19 by testing, tracing, isolating, and treating the patients. The next step taken is in the socio-economic sector in which we prepare a social safety net for the poor household to meet their basic needs and protect the vulnerable group from falling into poverty. Further, we are committed to supporting the business sectors, especially micro-, small, and medium enterprises, so that they could continue to operate during this difficult time.

Prior to the first case of COVID-19 detected in Indonesia on 2 March 2020, Indonesia’s government had preparedness measures in multiple points of entry , considered as having high mobility. Several days after WHO declared COVID-19 as a pandemic, President Joko Widodo established a Task Force to accelerate all prevention measures. The government officially declared COVID-19 as a national public health emergency, followed by the issuance of a Presidential Decree that directed large-scale social distancing measures. The subsequent declaration of COVID-19 as a national disaster enabled the government to reallocate all resources and activate the emergency fund for COVID-19 handling.

Since early June 2020, Indonesia has adapted the “new normal” concept by applying strict health protocols in people’s daily lives. . It was then followed by the issuance of a presidential decree creating the COVID-19 Handling and National Economic Recovery Committee to support the revival of businesses and prevent further economic downturns.

On 11-14 August 2020, Indonesia conducted the Intra Action Review (IAR) as a follow up to the 4th Meeting of the WHO Emergency Committee, which is a comprehensive multi-sectoral qualitative review of the ongoing COVID-19 response to identify gaps and opportunities to learn and improve Indonesia’s COVID-19 response. There are many other measures taken such as the establishment of hotline services, daily media briefings, cross-ministries collaboration, the establishment of a COVID-19 laboratories network across Indonesia, setting up referral hospitals, emergency temporary hospitals such as Wisma Atlit in Jakarta and Galang Island, the deployment of additional human resources for health, and forging public-private partnerships, among others.

Since the beginning of the outbreak, we realised that it would not be easy.Through the IAR, we learned our lessons identified challenges and put more efforts into addressing them:

• Capacity enhancement for contact tracing and surveillance in which we are now collaborating with local government to apply decentralisation and recruit volunteer;
• In terms of testing kits enhancement, we are establishing government to government, government to person, , and government-to-on-government collaboration;
• To address the gaps in lab capacity, we are doing some capacity building in which we are partnering with cross-sector lab, the development partner, and utilising the digital platform;
• We realised that our infrastructure is still considered inadequate considering that Indonesia is a big country, therefore as of now, we have expanded 422 laboratories and 920 referral hospitals;
• We are also still experiencing logistics challenges, and as such, we are working to simplify the medicines and medical supplies importation mechanism. We are also undertaking government to government and business to business (B to B) collaboration, and partnering with other non-government bodies such as the UN and Non-UN.

The COVID-19 pandemic needs robust health systems to respond adequately, both in mobilising resources for handling COVID-19 pandemics and handling the decline of essential public health services. The lessons learned from this pandemic include the need to stimulate health system reform and build resilient health systems in anticipation of future outbreaks and pandemics. The areas of health system reform are education and deployment of human resources in line with future health problems; strengthening of primary health care, upgrading health facilities in isolated, border and geographically remote areas, building self-reliance of pharmaceuticals and medical devices, reinforcing health security, improving communicable diseases prevention and control, including immunisation, boosting health financing and the use of information technology, and raising community empowerment practice healthier lifestyles.

Most importantly, we will ensure the availability of vaccines and medicines for the prevention and treatment of COVID-19 by participating in solidarity trials, research and development, and vaccine provision, once these are available.

We have seen the importance of collaboration to overcome the challenges in combating COVID-19 among government bodies, the private sector, civil society organisations, other countries in the region, as well as our international development partners.

We are aware that global crises require global cooperation. In light of this, we enhanced our engagement with external and development partners, which delivered several initiatives that aim to enhance the current response and ensure future preparedness.

In view of these considerations, , we are currently establishing new initiatives that intend to have ASEAN’s comprehensive approach in responding public health emergencies and other future emerging and re-emerging infectious diseases threats, namely:

• The establishment of ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED) which is intended to enhance integrated and sustained ASEAN’s preparedness, response and resilience to public health emergencies, particularly on emerging and re-emerging infectious diseases; partnering with Japan in carrying out the feasibility study and preparing forits establishment. We also welcome future collaborations with other partners once the Centre is established;
• ASEAN Portal for Public Health Emergencies, in collaboration with Canada and Germany. This portal will later serve as the platform for public information to step up knowledge and experience sharing within the region;
• ASEAN-Canada has developed the Mitigation of Biological Threats Programme, whichprepares and responds to outbreaks and emerging dangerous pathogens, and now focuses on the COVID-19 outbreak;
• ASEAN Public Health Emergency Coordination System, in collaboration with the USA. This initiative will also provide support for ACPHEED once the ASEAN Centre is established.

Since public health emergencies and pandemics can recur many times in the future, ASEAN needs to fortify the region’s security against future public health threats. We also realise the importance of collaboration, not only within the ASEAN Health Sector, but also with other non-health sectors and partners. In view of this, we are at the helm of some projects and activities initiated by the non-health sectors and supported by external partners. These include :

• COVID-19 ASEAN Response Fund and ASEAN Regional Reserve of Medical Supplies for Public Health Emergencies (RRMS), initiated by the non-health sector to step up our response to COVID-19, particularly in filling health system gaps faced by ASEAN Member States.
• ASEAN Travel Corridor Arrangements (TCA), a post-pandemic recovery plan to restore ASEAN’s connectivity, business and prevent further economic downturns. The TCA will facilitate essential business travel among ASEAN Member States under strict health protocols and public health regulations.
• The development of the ASEAN Strategic Framework for Public Health Emergencies and upcoming Standard Operating Procedure on Public Health Emergencies as core documents that guide ASEAN cooperation in enhancing regional preparedness, detection, response, and resilience to public health ,

Apart from these new initiatives, we are also taking on these activities that were supported by Partners:

• Enhancing the Detection Capacity for COVID-19 in the ASEAN Member States with the Republic of Korea (ROK);
• Technical assistance and exchanges, and provision of medical supplies and equipment at bilateral and regional levels with China, ROK, Canada, and Germany;
• Expert Panel on COVID-19, as supported by GIZ through European Union funding, will be implemented soon once the project team has been put in-place;
• Developing the ASEAN Health Protocol as a preventive measure;
• Noting that ASEAN has a good and close working relationship with the WHO WRPO and WHO SEARO, they are now proposing cooperation that includes activities in the ASEAN Member States and a component of support to regional coordination in the region for better response to COVID-19;
• A series of discussions with multilateral key-actors, such as officials from the GAVI, the Vaccines Alliance on the Global COVID-19 Vaccine Access Facility to ensure COVID-19 vaccine supplies and distribution for the region.

ASEAN is working at different levels to augment each Member State’s national capacity to handle the challenge posed by the pandemic . We are enhancing regional cooperation and adapting approaches that adapt to the cross-border and cross-sectoral nature of the pandemic. We are also strengthening cooperation with our international partners and external organisations, Ddalogue, and development partners to support ASEAN’s current efforts to build capacity in handling future threats.