Public health in Asia during the COVID-19 pandemic: Global health governance, migrant labour, and international health Crises By Anoma P. Veere, Florian Schneider, Catherine Yuk-ping Lo (Eds.), Amsterdam: Amsterdam University Press. 2022. pp. 272. E 117,00 (Hardback). ISBN: 9789463720977

Abstract

Although COVID-19 may soon be history, gaining a better understanding of its origins and how to address the multidimensional challenges it has raised will keep scholars busy for years. However, one of the challenges for policy-makers will be to select the appropriate measures necessary to address public health issues in ways that are efficient while maintaining trust with public authorities. This book is timely and offersed some pointers in that direction, but it left open some important gaps that I wish could have been better addressed. The texts presented in this book offered much analysis of the major public health issue that has affected the world since January 2020, in conjunction with one key aspect of the global political economy, labor migration, that has complexified the spread of the contagion. The selection of case studies, circumscribed regionally, included cases that are too extremely dissimilar to generate feasible policy prescriptions. On the other hand, the discussion of migrant labor that is announced as a key dimension of global health governance, did not include mention of some of the key actors.

Most of the case studies assembled here, included in the series “Health, Medicine, and Science in Asia,” have been found in East Asia, except for Indonesia and Malaysia. Two chapters each dealt with China, Taiwan, South Korea, Japan, and Vietnam, and three chapters dealt with the response of international organizations. The overarching argument presented by the authors was that Asia is diverse and therefore that countries in the region have offered a wide range of responses to the pandemic. This wide-open conclusion called for more research and more structured comparisons that could address more specific issues, such as trust in health authorities, improvement in global health governance, access to all for public health, and reform of labor migration. The selection of case studies presented in this book would have been better if it had adopted a most comparable cases research design, with smaller but more useful case selections, more suited to identify appropriate policies. Hence, while measures adopted in Taiwan and South Korea can yield useful lessons for policymakers in other pluralist democracies in Europe and North America, the Chinese and Vietnamese cases would be less likely to do so.

On the other hand, the inclusion of Indonesia and Malaysia in this book begged the question of the noninclusion of other major countries such as India, Pakistan, Bangladesh, and the Philippines, which are among the top 10 sending countries for migrants worldwide. Since the book announced a discussion of transnational labor migration in relation to public health in Asia, it would have benefited from the insights gained from these countries. I am aware that these additions could have made for a more voluminous book, but as pointed out above, only one chapter per country would have left space for these very important issues. Another limitation of the book was the brevity of the chapters, which left little room for policy prescription and analysis. With these limitations in mind, the fact remains that the countries in East Asia demonstrated early on a remarkable state capacity in their response to the pandemic. None of the authors, thankfully, has resorted to the facile argument that a shared Confucian heritage, and the presumably greater likelihood that citizens would be willing to comply with authorities, could explain the performance of these states. Rather, the different chapters stressed different dimensions of state capacity facilitated or impeded by a few key policy choices. As is often the case with edited volumes with many contributors, this collection of texts presented a variety of perspectives on a common theme. Written mostly by experts working in the region, with the notable exception of the three coeditors, who do have credential for research on public policy, global health, and political communication in East Asia, they have produced very short and factual chapters with an unusual amount of up-to-date online references. The lack of expertise of the editors in migration studies may perhaps explain why only two of the four chapters in the section on transnational migration really addressed the issue.

The first three chapters represented the strongest part of the volume, as it contextualized the policies of the Asian government in a global context. The first chapter by Haruko Satoh noted that despite its economic growth during the early stage of the pandemic, China has failed to emerge as a credible alternative to the United States as a world leader. The global competition between China and the United States, notes Kei Koga, has presented an eye-opening opportunity for the Association for Southeast Asian Nations (ASEAN) countries, which have realized that they would be better off learning from each other than relying on outside great powers. Yumi Ishikawa and Miki Kohara, in their analysis of the long-term consequences of the SARS' sudden spread two decades ago in Asia, found that scientific cooperation with the WHO mitigated the loss of trust in governments that followed the outbreak of the epidemic. The following four chapters added important nuances to that narrative. I wished the editors had included a chapter about how South Asian societies have managed to face COVID-19 in the most difficult circumstances of widespread poverty and limited state capacity, and yet despite these handicaps, they have managed surprisingly better than many much wealthier countries. Surely those are lessons of importance for all developing societies.

Responding to the widespread criticism that the WHO's mistakes in the early stage of the COVID-19 outbreak resulted from a too heavy influence of China on its decision, Gong Xue and Li Xirui countered that China's contribution to the organization was too little to sway it in its direction. They added that its fragmented and illiberal governance prevented China from exercising a timely and efficient response to the pandemic and that its assertive health diplomacy proved counterproductive. Brendan Howe argued that although the great powers had made difficult the management of the pandemic by the WHO, middle powers such as South Korea seized the opportunity to shine in the international arena by applying its directives rigorously, and with great success. The case of Taiwan presented by Lo Yuk-ping presented an even more telling paradox: it succeeded in containing the pandemic despite its exclusion of the world body because of the pressure from China. Taiwan did not wait for the WHO to declare the outbreak of a Public health emergency of international concern (PHEIC) before implementing necessary measures, thereby making the case for its tangible participation in the world body. In his chapter, Anoma van der Veere explained the mistrust of Japan towards the WHO by the delay before the issuance of the PHEIC, which led to the public perception that the world body is too deferential to China. The key take-away from these four chapters was that although the WHO has suffered greatly reputational damage from a lack of trust because of great powers' actions, it could contribute to world governance with cooperative actions between smaller countries.

The third part of the volume tackled domestic responses to COVID. Nurliana Kamaruddin and Zokhri Idris highlighted the importance of professional civil service in holding together the country during a political crisis. They also noted that the pandemic has woken up political leaders to the necessity of paying attention to the rights of migrant workers if they want to reconcile the objectives of health security, political stability, and economic growth. Kim Eun Mee and Song Jisun reiterated the point made above about the Korean government's embrace of multilateralism and cooperation with the WHO in its response to COVID-19, but with the big caveat that the public lacks trust on the WHO. Nguyen Anh Tuyet noted that Vietnam, like Taiwan, took measures early on to limit moves across its border with China, before the WHO issued its warning about COVID-19. This early action explains the relative success of the country in limiting the contagion, but concerns remain that underinvestment in the care of vulnerable populations such as the elderly will make it difficult to sustain that achievement. Mirjam Le and Franziska Nicolaisen have looked at the relationship between society and state in Vietnam during the pandemic and found that mobilization of the population through nationalist appeals ensured compliance to public measure to limit the pandemic worked very well and reinforced regime legitimacy but reached similar conclusions as Nguyen when they noted that lack of transparency and insufficient care for populations that suffer economically risk undermining these gains. The selection of case studies for this section weakened its value: two chapters look at the same country, and the other countries examined have so little in common that it becomes impossible to parse a usable lesson in terms of the most effective policies to address a health crisis such as COVID-19.

The last section of the book is the least effective: it promised to examine the effect of the pandemic on the global economy and international migrations but only two chapters deliver on that promise. Catherine Lo underlined how much the measures to tackle COVID-19 have threatened the CCP performative legitimacy, and how far the confinement imposed on the country risks undermining the “dual circulation strategy” of economic growth envisaged by Li Keqiang, which had proposed to rely more on domestic consumption and less on exports. This chapter did not address the issue of transnational migration, which was a major casualty of the COVID-19 pandemic. The next two chapters addressed the issue of transnational migration head-on. Liu Mei-Chun pointed to the vulnerability to Taiwan's public health caused by the lack of health coverage for migrant live-in care-givers who look after elderly people. She argued that Taiwan needs to fill that gap to contain the contagion successfully and safeguard public health. Sylvia Yazid looked at the other end of the labor migration, in sending countries. She noted that Indonesia had to tackle simultaneously the domestic outbreak of cases and the risk of contagion posed by workers coming back home. However, the chapter by Saori Shibata, which discussed the neoliberal economic reforms implemented in Japan, is misplaced. She rightly points to a major obstacle to the implementation of the WHO recommendations: the growth of social inequalities caused by the reforms, which disproportionally affect women. This is an important argument, but that case study belongs to the third section. This section, in fact, would have benefited from the inclusion of Singapore and Hong Kong, as two major destinations of the Asian migration corridor that links these wealthy city-states to sending countries with large populations such as Indonesia and the Philippines.

To sum up, one of the limitations to this otherwise excellent collection of essays was the imbalance in the case studies: one chapter each for the countries included would have sufficed. The additional value of two chapters for any of these countries cannot compensate for the insight we could have gained from the experience of other major countries in Asia that have defied expectations by being less affected by the pandemic that what their conditions led many to expect. An account of the policies of India, Pakistan, Bangladesh, the Philippines, and Thailand would have been most welcome. Each in their own way, these five countries have achieved remarkable results. In the case of the three populous South Asian countries and Thailand, they have done better than Japan, South Korea and Taiwan, in terms of deaths per 100 K people, and the level of casualties suffered by the Philippines is close to that of Japan.¹ Despite the relatively low levels of public spending on health care, these countries have been spared the magnitude of death experienced by far more wealthier countries in Western Europe. Keeping in mind that the numbers may not accurately reflect the spread of the cases, these cases nevertheless deserve more attention. To reiterate the point made at the onset, the inclusion of China as a case study would indeed beg for the inclusion of India, a country similar in so many respects due to its sheer size, the complexity of its multiscalar governance. That comparison, perhaps, could be the subject of a different book that compares within each country's different states and provinces or comparisons between Indian states and Chinese provinces.

Such additional comparative studies would reinforce the main point made by the authors at the onset about the diversity of approaches by the variety of Asian governments. However, the structured and controlled comparison suggested here would allow policy analysts to better identify what obstacles prevent the implementation of policies decided by central governments. A variant of such structured comparison would look at the effects from learning within regional institutions such as ASEAN or the South Asian Association for Regional Cooperation, even though such regional association is lacking in East Asia. I see a value in this edited volume to the extent that it should trigger interest in deepening the study of the overall successful responses of Asian countries to the worst health crisis of this century and encourage deeper studies about the right policy mix that can ensure robust public health in the context of increasing transnational migrations generated by demographic transitions.