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  • By Dr. Takeshi Kasai

What we must do to contain Covid in 2021: Lessons for the Western Pacific region from 2020

Dr. Takeshi Kasai

Compared to other parts of the world, the Western Pacific region has been comparatively fortunate. Although the region's 37 countries and areas are home to more than a quarter of the world's population, they have reported just 1 percent of globally confirmed cases to date. Most countries have avoided the so-called red line, or the point where critical care needs surpass health care capacity, large numbers of health care workers are infected, service quality declines and deaths rapidly increase. Of course, 2020 was still a very difficult year—in particular, for health care workers, and for those who have lost loved ones and livelihoods. My thoughts are with the families of these people every day, and with the health care workers who have been working so hard over the past year. We all need to remain vigilant, in order to keep case numbers down, and health systems operating, and as far as possible, the transmission of the virus in check. At the end of 2020, there are still many unknowns about Covid-19. However, it is still useful to reflect on some of the lessons that can be learned from our experiences and what we can take forward into 2021. There are several reasons why the Western Pacific region has fared relatively well, and important lessons that can be learned from countries in our region's experience. Clearly, long term investment is critical. Countries in the region have spent more than a decade preparing for events with pandemic potential by strengthening their health systems in anticipation of an event like the Covid-19 pandemic. Under the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies, or APSED, now in its third iteration, countries developed their response plans and, crucially, the capacities and systems to implement them. Under this shared strategy, systems were set up—such as for contact tracing which have proved to be critical in the Covid-19 response. We also saw in places such as South Korea, the importance of quickly scaling up testing and linking this to the public health response. South Korea also fully utilized its experience from the MERS outbreak in 2015 in responding to Covid-19. Countries that have successfully controlled Covid-19 had a very strong public health plan to manage positive cases. Most countries were able to scale up the right mix of public health interventions at the right time, to avoid health systems being totally overwhelmed. While countries were always prepared for the worst-case scenario, widespread community transmission was not inevitable. China showed us early on that this virus could be suppressed with the right set of public health interventions. Australia and New Zealand's experience have reinforced this. In the Pacific, where there are some of the few remaining countries in the world yet to record a single case of Covid-19, countries and areas continue to prepare their health systems. Strong public health measures, proactive communications with their public, combined with stringent border quarantine measures, have slowed or stopped the spread of Covid-19. Fiji and New Caledonia, for example, which reported cases of Covid-19 in

the community earlier in 2020, have now gone more than 250 days without reporting a case outside of border quarantine.

From Japan, we learned the benefits of using a cluster-based approach. And of course, Japan also taught us about the renowned three Cs. I understand that now, even small children in Japan know about the three Cs: avoiding closed spaces, crowded places and close-contact settings.

There are many other important factors: for instance, good systems for multi-source surveillance have been crucial to enable countries to monitor trends, assess risks and adapt response strategies accordingly.

Communication from trusted sources including governments, health care workers and scientists has also been so important for establishing and sustaining social norms around protective behaviors, and building community support for public health measures. We have been observing very effective communication in many countries including Vietnam, Singapore and New Zealand. I have been impressed so many times with the communication of those countries. I have also observed in many countries a strong community commitment to protecting the most vulnerable.

I am also very proud of the spirit of solidarity that characterized interactions between countries of our region in 2020 -- from technical exchanges on issues such as laboratory testing and clinical management to working together in joint incident management teams, and commitments to support equitable access to COVID-19 vaccines. Countries in the region really have come together, borne out of a recognition that no country is safe until every country is safe.

Of course, none of the things I have described are unique to the Western Pacific region. But they came together in 2020 in a unique way -- sparing us from the scale of devastation that we are currently sadly seeing in other parts of the world. But this is obviously no time to be complacent: the pandemic is far from over, and how Covid-19 evolves in 2021 depends on all of us. Our individual and collective actions will determine the course that the pandemic takes next.

Dr Takeshi Kasai is the regional director for the WHO Western Pacific.

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