Developing resistance: Emergent nations and Covid-19

In the middle of this pandemic, every vaccine is precious. Australia should give its spare locally-made AstraZeneca vaccines to friends in Indonesia.

Indonesia has a vacuum of need for vaccines that is predominantly being filled by China, and yet Australia happens to have millions of spare doses that could save thousands of Indonesian lives. In these circumstances, it is in Australia’s interest to be confident and generous in the Indo-Pacific.

Australia’s first priority with vaccination aid was to support the Pacific. Yet the Pacific’s supply is now guaranteed, and Australia still has surplus doses.

Besides, the challenges that face Pacific nations are not just supply, but also the logistics of distribution to very remote and, at times, hesitant populations. The largest Pacific population, Papua New Guinea, has been a major target of vaccine aid from Australia and New Zealand. Unfortunately, PNG has been unable to distribute their vaccines fast enough and has even been forced to transfer some to other countries to avoid wasting their supplies.

At home, Australia started its vaccine rollout far too late, but is now on a journey to reach some of the world’s highest vaccination rates. Despite having a shortage of supply during the crucial winter months that led to extended lockdowns for major cities, Australia now has the reverse dilemma – a growing stockpile of over six million doses of AstraZeneca vaccines sitting in fridges and an ongoing production of one million doses a week.

Australia must not let what is a remarkably good and overwhelmingly safe vaccine expire. It would be negligent to hold onto the millions of spare AstraZeneca doses while friends are battling this pandemic without enough protection. From a purely self-interested perspective, Indonesia is a close neighbour, friend, strategic partner and the world’s third largest democracy.

Indonesia has only fully vaccinated a little under 20 per cent of its population, with around 35 per cent having received at least one dose. That leaves nearly two-thirds of its population without having had any vaccine.

Complicating Indonesia’s rollout further is the fact that it is an archipelago. Given Australia still faces significant challenges reaching some remote populations, it’s easy to imagine the logistical hurdles facing a nation with the world’s fourth largest population spread across so many islands.

Despite this, Indonesia is still administering approximately 1.2 million doses a day and at that rate would be able to use Australia’s surplus vaccines within a week.

Thus far, Indonesia’s vaccination needs have been filled by the Chinese-made Sinovac and Sinopharm vaccines. Indonesia has supplemented these vaccines by prioritising its limited supply of Moderna to its most at-risk healthcare workers, but the overwhelming need for more vaccines remains.

Other countries, especially in Southeast Asia, are already supplementing their Chinese-made vaccines with other recognised options. Thailand already uses AstraZeneca as a booster to their Sinovac vaccines.

Despite early supply constraints, the AstraZeneca vaccines are more efficacious than the Chinese vaccines and make Australia an attractive partner for Indonesia and its largely unvaccinated population.

Indonesia has already suffered a deadly second Covid wave, peaking in July of this year, and the risk of a third one is on the horizon. Indonesia’s death rate grew to more than 2,000 cases a day in July, and its cumulative death rate of over 500 per million ranks it among the highest in the region.

At the time, the Morrison government did announce it would donate 2.5 million doses to Indonesia in July, delivering only around 500,000 by September.

Unfortunately, successive Coalition governments also dramatically cut Australian health programs in Indonesia prior to the pandemic. This diminished Australia’s capacity to help Indonesia combat communicable diseases prior to the Covid-19 pandemic.

But limiting Australia’s assistance in Indonesia not only limits the country’s influence, but it also increases the likelihood of local Indonesian outbreaks of various diseases arriving on Australian shores. This year has served as a reminder that until the virus is quashed everywhere, it’s always at risk of spreading. And as global experts have warned, a country cannot afford to only vaccinate itself – getting on top of this virus means a need to vaccinate the world.

So, for all the debate about when to ease restrictions at home, Australia is in the fortunate position to be able to help its neighbours. The more Indonesia and other neighbours are protected, the safer Australia will be from future incursions and potentially new variants.

The Morrison government has been, in my view, short-sighted about the potential benefits of Australian aid to generate influence overseas – but donating surplus vaccine supply is a perfect opportunity to change that.

Indonesia could use the help and it’s clearly in Australia's interest to support the region achieve high vaccination rates, especially when Australia has the luxury to offer help. More than that, it’s the right thing to do.

Street art has been much discussed across Indonesia’s airwaves in the last couple of months. Three spray-painted murals expressing a critical perspective on the government’s handling of the Covid-19 pandemic were quickly covered over by officials, igniting heated debates about free expression and the role of street art in national politics harking back to the country’s independence struggle.

Although the graffiti controversy has dimmed slightly in recent weeks, the debate could soon surge again with the potential for a third wave of the pandemic in Indonesia – with the country already an epicentre for the virus and one of the biggest contributors of daily cases globally.

The murals appeared in the context of complaints about official responses to Covid-19, with many of the problems in the health sector still to be addressed. The most controversial street art was painted in a tunnel on the outskirts of Jakarta, depicting a figure that resembled President Joko Widodo with his eyes covered and captioned “404: Not found”. Evidently a reference to the internet standard “404” error when a hyperlink is broken, the image has become a symbol for many in Indonesia disenchanted with the government, while the phrase “404: Not found” has turned into a rallying cry for freedom of expression. The street art ruffled the feathers of authorities, who claimed it insulted the President as “a state symbol”, leading police to search for the unknown creators.

Two other murals fed the polemic. Graffiti with the words “Tuhan Aku Lapar” (God, I’m Hungry) and “Dipaksa Sehat di Negara Yang Sakit” (Forced to be Healthy in a Sick Country) were also later censored.

The administration is seemingly sensitive to the shortcomings in its handling of the Covid-19 crisis, which has been widely criticised as inadequate. But the crackdown has only drawn more attention to it. The chasing down of street artists has prompted the university students alliance Gejayan Memanggil in the city of Yogyakarta to call for mural contests, giving rise to aspiring Indonesian Banksys.

“This should be seen as policy feedback for government,” Adinda Tenriangke Muchtar, Executive Director for Jakarta-based think tank The Indonesian Institute, told me in an interview. “When we talk about democracy and abiding by the law, we need to question whether there is discrimination in society that incites this kind of expression – simply because people don’t have avenues to be heard or [responses to] their aspirations are tone deaf when submitted through formal political channels.”

The feedback reached the top. In his State of Union address in August, Jokowi, as the President is widely known, said he was aware that the government had received criticism for failing to resolve a number of problems. He thanked the people for their feedback and called them to continue to build a “democratic culture”.

Police subsequently announced that they would no longer pursue the creators of the “404: Not Found” mural, describing it as a “work of art”. Instead, they announced a mural contest with a Chief-of-Police Cup as a trophy. But observers saw this move as far too late. The threat of criminal charges had already been made and the desired “chilling effect” already achieved. Citizens will undoubtedly be much more hesitant about similar public expressions of criticism in the future. But then again, the writing has long been on the wall in Indonesian politics.

Murals feature in Indonesia’s political tradition stretching back to the pre-independence era in 1945. The most iconic example was the phrase “Freedom is the Glory of any Nation. Indonesia for Indonesians!” captured by Dutch photographer Cas Oorthuys. Historian JJ Rizal explained that the mural became an outlet for people in the newly-born nation to despise colonialism. The kind of work that Oorthuys’ camera recorded has long been both a means of mass communication and a valuable propaganda tool.

Other murals in West Java shot by photographer J. C. Taillie in 1947, such as “Terus Berjuang oentoek Keselamatan Bersama” (Keep Fighting for Our Safety), depicted pro-independence spirit, whereas graffiti scrawled on the wall of a house in West Java that same year called for “Full Independence and International Brotherhood of All Freedomloving Peoples”.

Indonesia’s street arts became a distinct subculture in the New Order era under Suharto, where a group of artists in Yogyakarta called Taring Padi created several murals as avenues to give voice to public critics. After Reformasi in the late 1990s, street art flourished in the country, with Respecta Street Art Gallery (RSAG) establishing Indonesian Street Art Database, a network of independently managed, community-based efforts towards a more comprehensive historical archive of murals, accessible not only to passers-by, but also to the public at large.

There seems no doubt that murals will continue to play a crucial role in Indonesia’s political discussions.

In July, Indonesia was dubbed one of the global epicentres for Covid-19. Media reports warned of a health system collapse and cemeteries overwhelmed with burial demands. But a little more than a month later, Indonesia’s situation seems to be improving. The second week of September marked seven consecutive weeks of falling case numbers.

Those headline figures can obscure local challenges. The latest figures from the World Health Organisation suggest that the situation has improved nationally but concerns remain about the possibility of a prolonged outbreak outside Java, where health infrastructure is poor. Gaps in vaccination rates between regions and continuing issues with testing mean that Indonesia still has challenges ahead.

Last month, presenting the 2022 budget to the parliament, Indonesia’s Finance Minister Sri Mulyani emphasised that the proportion of money allocated to the health sector in the next year will comprise 9.4 per cent of total spending, much higher than the minimum of five per cent mandated by law. While a significant part of the health budget will be allocated to deal with Covid-19, the Minister highlighted that there will also be support for health system reform. A particular aim will be strengthening health promotion and preventive functions.

But it would be misleading to suggest that the pandemic has unmasked the vulnerabilities in the health system. Many chronic problems in Indonesia’s health system, including gaps in health infrastructure, the availability and quality of health workers, inequities in access to health care, to name a few, have long been apparent. A major review of the Indonesian health system published in 2017 outlined a comprehensive list of necessary reforms.

Indonesia has been consistently underinvesting in its health sector, spending only about three per cent of its GDP on health. Decentralisation in 2001 shifted much of the control of public expenditure on health and service delivery to local governments, leading to arguments about geographical disparity in health infrastructure and service delivery. Other indicators point out the persistent gender disparities in health.

The years since 2001 have seen a series of reforms in the health sector, including efforts to improve the quality of health workers in 2013, and most importantly the adoption of universal health care in 2014. However, experts continued to argue that more reforms are needed to address the challenges posed by the country’s changing demographic and epidemiological landscape.

For example, despite a decline in infant and child mortality rates and a corresponding increase in life expectancy over the past five decades, stunting among children and anaemia among women continues to be a problem, indicating underinvestment in improving nutrition as well as challenges related to food security. Questions have also been raised about the sustainability of universal health care, particularly with high costs of treatment and economic loss due to non-communicable disease, such as diabetes and cardiovascular illness.

Covid-19 has amplified the specific vulnerabilities in Indonesia’s health systems in need of urgent attention. Disruptions to health services including essential services to children and mothers and services for people suffering non-communicable diseases in the early days of the pandemic have been widely documented.

The expanded public expenditure budget on health for 2022 reflects the increased priority, at least in the short term, on the health sector. Yet many difficult trade-offs remain. A large proportion of the health budget for the coming year will still be allocated to dealing with the Covid-19 pandemic. The emphasis on strengthening and transforming primary care, aligned with a call by the World Health Organisation, may come at the expense of secondary and tertiary care. Beyond expenditure issues, health reforms will likely also require regulatory changes, including those governing the production and distribution of pharmaceuticals and medical equipment, and licensing of the health workforce.

More importantly, many regulations and policies that affect the health system are outside the sector. One example is trade policy. Only last month, the government threatened to impose new restrictions on the import of medical equipment and supplies that can be produced domestically. This approach is reminiscent of the government export ban on medical supplies in March 2020, which ended up backfiring.

A further challenge is the lack of high-quality data necessary to mount an effective response to the pandemic. A weak system for collecting vital statistics meant Covid case numbers and fatality rates went under-reported, and complicated the vaccination roll-out.

Such problems in Indonesia’s health system have been known for years. What has changed is that the pandemic has sounded a clarion call for urgent action.
 

This theme will be discussed at the Australian National University’s 2021 Indonesia Update, In Sickness and In Health: Diagnosing Indonesia, to be held online from 15–17 September. The Update will feature leading scholars and practitioners discussing the ways Indonesia and Indonesians have encountered, navigated, and overcome the challenges of achieving longer and better quality of life. Information and registration details can be found here.

A worsening third wave of Covid-19 is a cruel new blow in Myanmar, still reeling from the human costs of the coup on 1 February, and with a military junta more focused on combatting dissent than combatting the virus.

Thousands of new cases have arisen since late May, and the Delta, Alpha and Kappa variants have been detected. From 1 to 11 July, the junta-run health ministry reported almost 35,000 cases nationally and over 500 deaths. But low testing rates, and the regime’s haphazard pandemic response more broadly, mean these figures only provide a partial picture.

Cases have been reported among people detained in Yangon’s overcrowded Insein Prison; among border guard police in western Rakhine State; and in the town of Myawaddy on the border with Thailand. In Mandalay, Myanmar’s second-largest city, the six hospitals accepting Covid patients are reportedly at capacity.

In Kalay, a town in northwest Myanmar where locals have fiercely resisted army rule, aid workers and residents have estimated hundreds of Covid-related deaths and pictures on social media show people queuing to replenish scarce oxygen supplies. One local resident told Radio Free Asia that a local crematorium was overwhelmed and people were having to fend for themselves.

People in Kalay queue to fill their oxygen cylinders on July 7. Yesterday, 42 people were died believed to be infecting #COVID19.

Photo: Yin Suu Pusue. pic.twitter.com/g9fSTXdt0r

— Eric Black  (@ericblack3742) July 7, 2021

The outbreak has also breached Myanmar’s borders, with parts of Ruili, a city in China’s Yunnan Province bordering Myanmar, sent into lockdown after a string of cases were detected, including among several Myanmar nationals.

The Myanmar junta has progressively announced a patchwork of restrictions, including stay-at-home orders for a number of townships in the commercial center of Yangon, the capital Naypyidaw, and across at least six other states and regions. On 8 July, schools were ordered to close across the country for two weeks to stem infections.

But given the extent to which the military has terrorised the population to cement its rule in the months since 1 February, trust in the regime’s pandemic response is understandably low.

After the coup, testing, surveillance and vaccination all fell away, according to UNICEF’s Myanmar office. As Covid spread silently, state media spent more time denouncing dissenters and extolling the regime’s imaginary achievements than on urgent public health messaging.

Under Myanmar’s civilian government, Dr Htar Htar Lin was in charge of the country’s vaccine rollout, which had begun only days before the military seized power. In mid-June, she was arrested in downtown Yangon (along with her husband and seven-year-old son) for her involvement in the nationwide civil disobedience movement.

The detention of a high-profile health professional, while the country grapples with its worst surge in Covid-19 cases since the pandemic began, gives a sense of the junta’s priorities.

With the overlapping crises of the coup and Covid-19, United Nations agencies estimate that over 6 million people in Myanmar are in urgent need of food aid. The military crackdown itself has left almost 900 people dead, more than 5,000 detained, and some 200,000 people internally displaced. Parts of the country, in both urban and rural towns, have seen armed resistance; decades-old conflicts continue in ethnic nationality areas; and a collapsing economy is pushing more people into poverty.

Any country would struggle to contain the current Covid outbreak, but in post-coup Myanmar the challenges appear particularly acute. High among them is the junta’s relentless pursuit of its critics at all costs, including the continued targeting of medical workers – further damaging an already struggling health system.

Healthcare workers have been at the forefront of workers’ strikes in protest at army rule, placing them in a difficult bind as rising numbers of people seek medical treatment for Covid-19. Some medics have resorted to providing care in secret.

The junta’s response has been brutal. At least 240 attacks on healthcare facilities, personnel, ambulances and patients have been recorded since the coup. Twelve healthcare workers have been killed, hospitals taken over, and more than 150 medical personnel arrested, according to Insecurity Insight, an organisation specialising in risk assessments. As Physicians for Human Rights noted, “the human rights emergency of the coup is morphing into a public health disaster.”

Like all countries that don’t produce vaccines, Myanmar will need to scramble to secure doses in the months ahead. But the junta’s plans are typically opaque.

Myanmar had secured an initial batch of vaccine from India prior to the coup, some of which were then reportedly appropriated by the military. But supplies from India dried up as that country focused on its own severe outbreak. China has since donated 500,000 doses and the junta recently revealed it is negotiating with Russia to purchase a supply of the Sputnik vaccine.

The country’s vaccine rollout is also complicated by the fact some people are rejecting vaccination in protest at the regime. Aung San Suu Kyi, the country’s ousted de facto leader, detained since February and only sighted in a few brief court appearances, has reportedly had her two doses.

As Myanmar’s Covid crisis deepens, its neighbours may not be in a position to offer much assistance, with countries across Southeast Asia, from Thailand to Vietnam, Cambodia and Indonesia, all experiencing their own worst outbreaks to date. As has invariably been the case under decades of military rule, Myanmar citizens are being left to draw on their own strength and resources.

More than a year into the Covid-19 pandemic, how much outside financial support is the Pacific receiving and how far does this go in helping the region weather the crisis?

This time last year in The Interpreter we took stock of the provision of Covid-19 related external financial assistance to the Pacific. Back then, the pandemic was rapidly taking hold but the international community’s response was only just getting started. Announced support had reached US$570 million or 1.7% of the region’s GDP – far below what was needed given the scale of the pandemic shock to the Pacific’s small and vulnerable economies. Additional support was also available from the International Monetary Fund via its expanded rapid financing windows. But only Samoa and Solomon Islands had been able to access this at the time. 

After avoiding the worst for many months, Covid-19 outbreaks are now underway in a number of Pacific countries. So where do things stand in terms of the provision of international financial assistance?

The multilateral development banks have scaled up their support significantly over the past year, with over $1 billion in Covid-19 related support. Bilateral donors have also responded with about $700 million, mostly in the form of cheap loans from Japan and Australia. The G20 Debt Service Suspension Initiative (DSSI) first announced in April last year has now been extended by a year to the end of 2021, allowing Pacific governments to in total defer $480 million (1.5% of regional GDP) otherwise due to bilateral creditors. Curiously, however, there has been limited uptake of the expanded IMF rapid financing windows despite their large potential scale. Only PNG and Tonga have also turned to the IMF since our last stocktake, with Tonga accessing half of its annual quota.

The big recent news is the expected allocation of $650 billion in new IMF Special Drawing Rights (SDRs). SDRs come with no conditionality and can be readily exchanged for hard currency. Calls for a new SDR allocation have been made since the start of the pandemic but were blocked by the Trump administration, a position the Biden administration has now reversed.

The new SDR allocation is expected to be completed by late August. The Pacific should be among the biggest beneficiaries relative to economic size, receiving around $700 million in new SDRs – equal to about 2% of regional GDP. The Pacific might also benefit substantially further depending on what happens with plans for richer countries to channel their own new SDRs to poorer and more vulnerable countries that need them more.

Overall, the scale of external financial assistance to the Pacific now looks very sizeable, as shown on the chart below. Including the expected allocation of new SDRs, and only including IMF rapid financing amounts that have actually been accessed, the total scale of external financial support to the Pacific now amounts to $3.3 billion or around 10 per cent of the region’s annual GDP. And, unlike at the time of our previous stocktake, the majority of this constitutes new money in response to the pandemic, rather than reprioritised or frontloaded financing that the Pacific was going to get anyway before Covid-19 struck.

There is, however, a lot of important variation across countries. The scale of support is very large in many of the smaller Pacific economies but relatively low in PNG, the largest country in the Pacific by a wide margin.

How far does all this go towards meeting the Pacific’s financing needs?  

In December last year we published a Lowy Institute Policy Brief estimating that the Pacific required at least $3.5 billion in additional recovery financing over the next three years in order to avoid a lost decade due to the pandemic. Crucially, this additional financing needed to be above and beyond that which the Pacific had either already received or was otherwise expected to receive in our baseline scenario. Although total Covid-19 related external assistance has now reached $3.3 billion, most of this was already incorporated into our baseline at the time. That largely leaves only the expected $700 million allocation of new SDRs as true additional financing for the Pacific that should be counted towards our estimate of the required amount.

Nonetheless, the new SDR allocation will be significant – on its own taking the Pacific about a fifth of the way towards the $3.5 billion figure we estimated was needed over the next three years for the region’s recovery. There is also the potential that sizeable additional amounts might be made available if richer countries follow through on plans to channel their own new SDRs to poorer countries.

How much the new SDRs do to lift the Pacific’s outlook will depend on whether and how effectively countries are able to capitalise on this to expand government spending on healthcare (including vaccine rollouts) and support to households, firms, and the economy in general – rather than mostly use the new SDRs to bolster central bank reserves (though in some cases this may be necessary).

Unfortunately, it is important to recognise that the outlook in the Pacific has also darkened considerably since we estimated the region’s recovery financing requirements late last year.

After having avoided the worst of the virus for so long, widespread vaccination is critical, but progress is mixed and most countries in the region are struggling. Vaccine supply and access now seem much more uncertain and difficult than what we assumed last year. And vaccine rollouts in Australia and New Zealand are also moving slower than expected – pushing back when the region’s vital tourism industry can hope to restart.

All of this bodes ill for the Pacific’s outlook and consequently how much external financial help it will need.

The bottom line? A lot of financial help is flowing to the Pacific and more is on its way. The scale up in international support to the region has so far been substantial. But there is no question vastly more is needed.

Main photo used with permission from United Nations in PNG via Flickr.

Thailand emerged from the first year of the Covid-19 pandemic as one of the best performing countries in the world in terms of minimising cases and deaths. But 2021 has been a different story.

A surge in infections since the beginning of April has seen thousands of new cases each day and a spike in deaths. While authorities moved to close parks, gyms and cinemas (although shopping malls stayed open), mandated face masks in public and tightened quarantine requirements for travellers, the virus was already rampant in settings where social distancing wasn’t possible, including the country’s notoriously overcrowded prisons.

More than 17,000 people in prison have contracted Covid-19 in this third wave in Thailand, and the tally is rising daily. On 25 May, the Thai health ministry reported 882 new cases in prisons in the preceding 24 hours (alongside more than 2300 new cases among the general population). Prisons across greater Bangkok have been hit particularly hard, but cases have also been reported at prisons in Narathiwat in the south and Chiang Mai in the north.

As of 17 May, people in prison made up more than 70% of the 9635 new cases reported nationally that day. At one prison in Chiang Mai, some 61% of offenders tested positive.

It takes little imagination to comprehend the heightened health risks faced by people detained amid a global pandemic. Unsafe and unsanitary conditions, poor ventilation, overcrowding and limited access to health services are issues in prisons around the world, and the physical and mental health of people in prisons is typically well below those living on the outside. Infections may be spread within and between prisons through new admissions, prisoner transfers, visits and staff deployments across multiple prisons, affecting people in prison, staff and the community.

Serious Covid-19 outbreaks have been reported in prisons in India, Pakistan, South Africa, South Korea and the United Kingdom, to name a few. In the United States alone, as of 18 May, just under 398,000 people in prison had tested positive, with an estimated 2680 deaths, according to The Marshall Project, a not-for-profit group focused on reporting on the US criminal justice system. The figures are even higher when accounting for people across all detention settings, as tracked by the New York Times.

In Thailand, which has consistently had one of the highest incarceration rates in the world, the risk of an outbreak was always high. With a total prison population currently estimated at over 307,000 – three times larger than the country’s official prison capacity – Thai prisons are chronically overcrowded. At one facility, the Thailand Institute of Justice recently reported that 35–45 people were forced to share a single cell, sleeping shoulder to shoulder. The country’s strict drug laws are a key factor fuelling imprisonment rates, with more than 80% of people estimated to be detained on drug-related offences.

The full scale of the current outbreak in Thailand’s prisons was only brought to light after several prominent student activists involved in anti-government protests last year, and detained on charges of insulting the king, revealed they had tested positive to the virus. Among those infected were Panusaya “Rung” Sithijirawattanakul, who made headlines last year after publicly calling for reform of the monarchy, human rights lawyer Arnon Nampa, and several others who are now out on bail.

After being slow to act, Thai authorities are now scrambling to respond. Measures flagged to address the outbreak across multiple prisons include the ramping up of testing and vaccinations for people detained, an increase to the quarantine period for new prisoners to 21 days, a halt to prison transfers and consideration given to the early release of 50,000 people. Prison authorities were also instructed to establish field hospitals to treat patients.

However, few officials are sounding optimistic. “Prisons are overcrowded,” Aryut Sinthoppan, director-general of the corrections department, told reporters this month. “So there are limitations to hygiene and disease control efforts.”

Although Thailand’s prison population has in fact declined over the past year (by 16%, according to one estimate) as a result of two mass releases in 2020, this has clearly done little to alleviate chronic overcrowding, or to ameliorate the health risks for people detained.

Prisons are not the only sites that have seen major outbreaks during this third wave. Factories and construction workers’ camps that include many migrant workers, as well as dense urban communities without adequate housing, have also been disproportionately affected. More than 2000 cases were detected at a single factory in Phetchaburi, south-west of Bangkok, more than half of whom are migrant workers from Myanmar.

Thailand’s vaccine roll-out is also attracting widespread criticism, with concerns over supply and distribution, and the urgent need to vaccinate people most at risk. An estimated 1.94 million people have received at least one Covid vaccine dose (either AstraZeneca or Sinovac) to date. Prime Minister and former coup leader Prayuth Chan-ocha is one of the lucky ones – earlier this week, he posed for the cameras with his vaccination certificate after receiving his second dose of the AstraZeneca vaccine.

Fiji’s capital Suva has been in and out of Covid lockdowns over recent weeks, and my Netflix got a workout. I watched a TV show called “Cooked with Cannabis”. Admittedly there were a few baked hippies, but the cooking was good. Jokes aside, the show revealed the sophisticated and lucrative global cannabis industry, projected to grow to an extraordinary US$90.4 billion internationally by 2026.

Watching the show also got me thinking about Fiji’s economy as the country fights through a second wave of the pandemic via containment measures and a vaccination drive. Fiji has taken an almighty hit. GDP was slashed to approximately $4.3 billion in 2020, with growth falling by 19%, according to the International Monetary Fund. Foreign tourists have vanished, all non-essential businesses have been forced to close, and the much mooted Pacific travel bubble is likely to be off the cards for the immediate future. With national debt levels soaring, a nasty storm is brewing.

Fiji needs to diversify its economy away from a reliance on tourism. Despite the government’s best efforts to provide relief through food ration deliveries and a $90 emergency payment to families affected by Covid, these well-intentioned initiatives have arguably fallen short. Many people complained that calls to the food-ration hotline went unanswered, or the deliveries never arrived, while the need for Fijians to provide tax details in order to claim the relief payments meant those in the informal sector were all but left behind.

That’s where cannabis presents an opportunity.

Currently marijuana or saba (pronounced “samba”, yes, like the dance) is illegal in Fiji. But of course the leaf is grown. One of my favourite news pieces from 2020 was about villagers shooting down police drones with spear guns to hide their marijuana plantations on Kadavu, an island south of Suva. The police still managed to haul in crops said to have a street value of FJ$86 million (A$50 million) in a four-week operation and amount to the largest seizure ever in the country. 

But it seems ironic that at a time when some families can’t afford to put food on the table, millions of dollars worth of this currently illegal crop would be uprooted.

The over-reliance on tourism, comprising almost 40% of Fiji’s GDP before the pandemic has left economic void. Rebooting the agricultural sector is an area the Fijian government has identified as one which could be strengthened. Fiji has a solid history of agricultural exports. In the 1970s sugar exports accounted for 70% of the country’s export earnings. More recently, yaqona (kava) has been targeted as a growth opportunity in the sector, due to its widespread use in the region for relaxation and stress relief. Unfortunately, yaqona takes several years before it can be harvested. Like other agricultural products, it is also exposed to heightened risks of environmental damage, for example cyclones.

But “weed” is different. As the name suggests, cannabis is a resilient crop and capable of harvesting after three months. As the “spear gun incident” attests, it clearly grows well in Fiji.

With an ideal climate, remote islands capable of quarantining cannabis operations, a world renowned “brand Fiji” offers a special opportunity for economic diversification. Just look at Fiji Water.

The idea of a marijuana industry in Fiji is not new. The idea was debated most recently in March at a Nadi Chamber of Commerce roundtable. The government was adamant in response it has no plans to legalise marijuana.

But “legalisation” need not mean we all get “cooked with cannabis”. Fiji could do what other countries have done, legalising marijuana for medicinal and hemp fibre production, while banning recreational use. Such a move would follow similar regulation in countries including Malawi, Lesotho and Uganda, as well as Thailand in Southeast Asia, among others.

A permit system could be created for growing marijuana on designated islands in Fiji. Alternatively, the government could create a stated owned company to manage production ­– afterall if there is a Fiji Sugar Corporation, why not a Fiji Cannabis Co.?

A cannabis industry in Fiji would not be limited to growing the crop. A whole value-add supply chain could be created, for example, through hemp fibre production (Fiji’s garment manufacturing industry has also felt the pinch under Covid), as well as labs to extract the valuable CBD oil, which is used for pain relief and various other ailments. This could all be carried out in Fiji and create jobs for Fijians.

There will be concern about any partial legalisation leading to greater recreational use of cannabis among the local population. It cannot be ruled out, but the same “slippery slope” argument can also apply to tobacco and alcohol as gateways to substance abuse. Those partial to the saba are still likely to partake, whether it is legal or not. These are the types of risks the government should be able to manage with responsible regulation and enforcement.

From a business perspective, there is a chance for Fiji to be the region’s “first mover” in the cannabis industry. Research and a feasibility study should be first undertaken to determine the viability and opportunity that a cannabis industry could present. From there, a better judgement can be made about what would be required to regulate it.

And just maybe the volatility of the pandemic could be the catalyst for Fiji to innovatively diversify the economy and generate a new export market to its advantage.

Images of the pandemic in Delhi that currently saturate the international media depict ailing patients struggling to find beds, oxygen and medical attention. Amid a highly privatised healthcare terrain with underfunded public hospitals, access to Delhi’s hospitals has long depended on one’s own jugaad (capacity to develop “workarounds”), personal networks and ties to “big men” who lean on hospital officials to provide beds – characteristics that have played into Delhi’s pandemic scenario in a disastrous way.

As the second wave of Covid-19 sweeps south, there is hope that the different nature of South India’s health system will prevent the pandemic from taking hold in the same way.

Tamil Nadu, the state in which I live, has long had a clear commitment to providing quality health services at affordable cost, which stems from its history of democratic action and inclusive social policies. Access to hospital care is more equitable and transparent than in the North, and the state’s public health insurance is higher than in most other states (at approximately A$2500 per year).

Tamil Nadu has a streamlined model of centralised purchasing and distribution of essential medicines. This reduces the black market for medicines, as illustrated currently by the long queues to buy antiviral drug Remdesivir at regulated prices at government pharmacies in the state’s cities. Rural health infrastructure is more developed than in the northern states, which removes pressure from city hospitals. The neighbouring state of communist-led Kerala shares many of these characteristics.   

While the 2020 Covid wave was fairly well controlled in Tamil Nadu, with cases peaking at 600 per day, the second wave poses more of a challenge. This wave appears to be largely driven by a virus variant found in India determined by the World Health Organisation as of “global concern”, and the rising caseload in Tamil Nadu currently sits at 29,000 per day.

Since Tamil Nadu’s recent change of government – a coalition led by the Dravida Munnetra Kazhagam party was sworn in on 7 May, following April elections – the existing Covid measures have been expanded. The state has implemented a Covid command centre modelled on Mumbai’s “war room” initiative, which manages an online system of triage to track hospital bed availability and funnel patients to them. Oxygen buses have been established outside hospitals in the state’s capital city Chennai, and a full lockdown began this week throughout the state. In rural areas, health officials have been posted in each district to implement Covid measures and oversee village health workers. Hospitals are full, yet there is an absence of stories of people being unable to access beds or oxygen.

While these characteristics may make the Tamil Nadu healthcare environment appear more resilient and able to manage a predicted further upswing in Covid cases, local beliefs and practices pose a significant challenge to the course of the pandemic here.

In the villages near me outside Pondicherry, there is a diversity of beliefs, largely divided along generational lines. Middle-aged and elderly people ­– who are generally illiterate or semi-literate in this area – tend to believe that Covid is not a serious illness, given that the first wave in 2020 did not amount to much in this area. Election rallies held in March and April this year were strongly attended throughout Tamil Nadu, with few people wearing masks. Distancing is generally not practised in daily life, and community transmission is now widespread. Older people largely distrust vaccines and feel that vital information about side effects is hidden from them. Some believe coronavirus has been created or leveraged by authorities in order to reduce the population. Covid-positive deaths that occur in vaccinated people – whether in the village or among Tamil celebrities – reinforce the belief that vaccines are dangerous.

Younger people feel torn between different belief systems. They are mostly high-school and university-educated, and their access to technology exposes them to an array of ideologies. Government messaging interrupts mobile phone calls with upbeat audio messages encouraging people to wear masks and get vaccinated. Information circulated on WhatsApp mostly promotes traditional immune-boosting supplements that are popular in the South (turmeric, neem, ginger). Less benign memes shared on social media promote anti-masking, anti-vaccine messages and big-pharma conspiracies.

As one university-educated youth told me, “We’re totally confused. We’re getting two types of information and don’t know what to believe. We were born at home with the help of traditional midwives and ‘grandmother’s medicine’ [local remedies]. We’re wary this is a medical scam of big companies, to get people to buy medicines.”

Public-health measures in rural areas reinforce the fear of stigmatisation of being identified as Covid positive. For example, health workers in a nearby village place wide circles of sanitising white power around the homes of people identified as Covid-positive, which visibly marks a family and home as a site of contagion. It’s therefore understandable that villagers decline testing, and pass off their coughs and fevers as just a cold. Now that community transmission is widespread, contact tracing becomes mostly a matter of encouraging close contacts to self-isolate.

Tamil Nadu’s health system holds the promise of greater resilience than North India’s health sector, yet it remains to be seen in the weeks ahead how it will withstand the anticipated upswing in demand. Australians of Indian background have been vocal on social media recently, expressing their deep distress about loved ones unable to access healthcare in North India. Hopefully, South India’s health system will withstand this Covid wave better, and Australians of South Indian background will not experience the same sense of helplessness and frustration for their relatives.

A handwritten slogan can be spotted on cardboard posters at stalls across the Philippines: “Give according to your means, take according to your need.” These are makeshift community pantries, ad hoc efforts that provide free items such as rice, vegetables, canned goods and even facemasks that benefit millions of Filipinos. And while there are food banks in countries across the world, the community pantry in the Philippines has come to represent so much more. It is not only an expression of compassion for the poor, but a political statement against the state – a symbol of national solidarity in a country struggling to survive the pandemic.

The double economic burden of job losses and rising prices of commodities has afflicted the Philippines, which has yet to recover from one of the world’s longest and strictest Covid-19 lockdowns. Goods from community pantries can therefore mean the difference between life and death for many Filipinos. Most contributions flow from the rich and the middle class. But people who are struggling financially are also donating what little cash or groceries they can share. Some even come from rural areas to give – fishermen give away their catch while farmers donate baskets of their produce.

Community pantries not only exhibit generosity, they also demonstrate respect and consideration for others. Most of those who line up for hours take just enough for themselves and their families, mindful that others behind them are also in need. There is no sign of the type of hoarding that was evident in supermarkets across the world at the onset of the pandemic. Instead, the system is built on what Filipino sociologist Randy David describes as “faceless giving and discreet receiving”. The community pantry, David says, “offers no space for the self-promotion and obligatory acknowledgments that usually accompany the mass distribution of emergency assistance”.

But this is more than a noble instrument to help others. The community pantry also sends a political message of public frustration about government ineptitude in providing for the nation. The Philippine government provided only up to PHP 8,000 (A$215) in 2020 and a maximum of PHP 4,000 ($107) this year for each of the country’s 18 million low-income families, not enough to buy their daily essentials. Ana Patricia Non, the 26-year old lady who first started a pantry in her neighborhood that inspired replicas nationwide, explained the reason behind her initiative: “I’m tired of complaining. I’m tired of inaction,” she said. “The fact that this has gone viral, it means this is a gut issue.” As it inadvertently exposed institutional shortcomings, the boom in community pantries should therefore serve as a wake-up call for the government to do more for its people.

The community pantries in the Philippines can also be seen as a political statement repudiating government malice towards charity and volunteerism. A few days after Non’s community pantry spread far and wide, the national police openly linked it to the communist movement and accused it of being a vehicle to recruit members. In keeping with President Rodrigo Duterte’s resolve to quell the long-running communist insurgency in the country, those “red tagged” as communists by the police often end up dead. Fearing for her life and the lives of other volunteers, Non was forced to close her community pantry after police officers visited her and started asking questions. It took assurances from the city mayor and the head of the country’s Department of the Interior and Local Government for her to reopen.

The temporary closure of Non’s pantry prompted public outrage, which unexpectedly resulted in more food and cash donations, which she used to support other community pantries. Its growing support tacitly indicates the Filipino public’s pushback against the Duterte administration’s unwarranted intimidation.

Because of limited government assistance, community pantries symbolise national unity born out of necessity – of weary folks finding solace in helping others. From just one community pantry in Metro Manila, by the end of April there were 358 community pantries scattered across the Philippines. Such initiatives are essentially a stopgap measure to help more people survive the socio-economic crisis plaguing the country. The community pantries essentially target these Filipino families who have gotten used to not knowing when their next meal will be. As Non puts it: “If the items in the community pantry ran out, that is a good problem. The goal is for the food to be consumed, not to be displayed.”

But as with other charities, these community pantries may eventually suffer from fatigue and slowly fizzle out, as their sustainability and longevity are not guaranteed. Yet community pantries in the Philippines demonstrate a revolutionary expression of human compassion, political activism and national solidarity that will continue to bring out the best of Filipinos during the worst of times. Philippine Senator Francis Pangilinan regards such initiative as a form of people power against hunger: “It warms the heart. It fills the tummy. I believe that there's no greater power than a united, empathetic action altogether toward one goal.”

India was proud to boast about being the “world’s pharmacy” as the coronavirus pandemic unfolded, particularly after other members in the Quadrilateral Security Dialogue asked India to mass-produce Covid-19 vaccines for export across the world. Indeed, high-minded government decrees about India’s exceptionalism have become familiar to close observers in recent times, whether about India becoming the vishwaguru (world teacher) or India transforming into a global economic power. But the bragging has suddenly quietened now.

Less than two months after the Quad leaders gathered, a desperate India, devastated by a mix of arrogant misgovernance and an official aversion to scientific advice, resembles something more like an empty drugstore, run-down and ramshackle as the government pleads internationally for life-saving anti-Covid medicines and regular supplies of oxygen.

New Delhi’s mishandling of the second wave of the pandemic has resulted in a humanitarian disaster. The virus has proved relentless and levelling, poor and privileged alike struggling to find doctors, hospital beds and oxygen, or even the wood and space in crematoriums to burn the dead.

The health crisis has reinforced a sceptical view that despite the bold claims, India is not on the rails to becoming a world economic power. India spends a paltry 1.5% of its GDP on healthcare – some estimates put the figure as low as 0.34%. Either way, the spending falls far short of any of India’s partners in the BRICS grouping and nowhere near the 17.7% spent by the United States. Even before the pandemic, figures indicated the rate of poverty and unemployment in the country was at its highest in 45 years.

Covid has crushed all pretence. In March 2020, the sledgehammer lockdown wasted the country’s much-vaunted demographic dividend by precipitating the largest exodus of internal migrants in India since the 1947 partition. Rather than a government caring for its citizens to showcase strength, the image presented to the world was one of administrative incompetence, shambolic health facilities and economic weakness.

The crisis has exposed a ruling Bharatiya Janata Party government bedevilled by skewed priorities. Massive rallies, for example, were allowed with barely a face mask in sight in the vain hope of snaring power in state elections. In another instance, more than 9 million pilgrims were permitted to attend a Hindu religious gathering. As recently as 22 April, when Delhi’s lockdown was already one week old, the government was touting a US$3 billion project to build a new central vista as a seat of government, including a new parliament and prime ministerial residence, describing the construction as an essential service.

India’s pressures are mounting. Despite border clashes with China last year, money requested to modernise military equipment was cut by 38% in this year’s budget. The decision to remain aloof from economic groupings such as the Regional Comprehensive Economic Cooperation Partnership now look even more foolhardy and together with the Covid crisis could stunt the government’s Indo-Pacific ambitions. China’s latest defence budget is forecast to be US$209 billion, while India’s is $65.9 billion. A long-standing economic advantage has given China a military one.

But the government does not relish such facts. Regrettably, the suppression of the truth, which was a characteristic of Beijing’s tactics to cover up the outbreak of coronavirus in late 2019, is now a method used by New Delhi to hide its own negligence. It recently ordered Twitter to remove posts critical of the government. And people complaining about oxygen shortages have been threatened with seizure of property. But those who failed to build sanctioned oxygen plants seem have got off scot-free.  

New Delhi has also passed the buck to its counterparts at the state level. The central government initially fast-tracked emergency approval for anti-Covid vaccines used in Western countries and Japan, but only a fortnight later, as the number of dead rose, it decided not to import vaccines, saying the states could. But many states do not have the cash to pay for vaccines, having already been entangled in a dispute with the central government over the share and distribution of revenue from the general services tax. Meanwhile, the self-styled global pharmacy has struggled to ramp up vaccine production to meet the urgent demand in India alone.

India’s humanitarian catastrophe is simultaneously a big foreign policy blunder. The innumerable pyres of Covid victims now glowing in India’s summer skies will put an end to the bragging about the country’s global power. A crisis compounded by ineptitude has cruelly increased India’s dependence on foreign assistance and swept away all illusion.