Vietnam’s Effective and Low-Cost Response to COVID-19
By Shona Schonning
Vietnam has been praised globally for its response to the COVID-19 epidemic. A densely populated country that is home to nearly a hundred million people, Vietnam, by the end of August 2020, had a total of only 1038 detected cases and only 31 deaths. It had one of the world’s lowest numbers of COVID-19 deaths per million people, ranking at 183 out of 209 countries as of August 29, 2020. The proactive and strategic response of the Vietnamese government and people is credited for this result. Vietnam showed that a quick, strategic response can be effective in slowing and eliminating the spread of the virus and also in limiting the need for prolonged lockdown and the social and economic hardships that often accompany it. Moreover, Vietnam, classified as a lower-middle-income country by the World Bank, demonstrated that an effective response can be mounted in a resource-constrained setting.
Timeline of Vietnam’s COVID experience
Vietnam saw its first two cases of coronavirus infection on January 23. Only seven days later, on January 30, when Vietnam still had only two confirmed cases, it set up the National Steering Committee on Epidemic Prevention which included representatives from various government ministries and agencies, enabling broad engagement of the government in responding to the epidemic. As the Vietnamese new year holidays came to an end on February 1, the government announced that schools would remain closed. On February 14, a cluster of cases was found in the northern commune of Son Loi, near the capital city of Hanoi, and the government immediately implemented a policy to detect cases and contain the epidemic. Barricades went up around the Son Loi commune in what was the first mass quarantine to be implemented outside of China. Inside Son Loi, testing and contact tracing were carried out and people who tested positive for the virus were isolated and people known to have been exposed to the virus were institutionally quarantined in camps. When community spread of the virus was no longer detected, the quarantine of Son Loi was lifted on March 4.
As the epidemic spread, commune-level lockdowns, sometimes, even the cordoning off of small areas in cities was implemented as and when cases of community spread were detected. The public was involved in the response from the start. The government communicated transparently and regularly with people, providing updates on the situation and information about how to stay safe and contribute to fighting the epidemic. Masks were required in public places. Social marketing campaigns spread messaging about proper hand-washing and social distancing as well as the importance of exercise and a healthy diet to maintain a healthy immune system. The Vietnamese Ministry of Health (MoH) commissioned a famous pop singer to produce a song encouraging good hygiene accompanied by a viral TikToc challenge that quickly racked up millions of views and even got international attention. A mobile application was released enabling people to provide health status information and to potentially identify possible exposures.
A new phase of the epidemic started on March 6 when the virus began to be detected among travellers on flights from countries with outbreaks. Vietnam continued to implement a policy of strategic detection and containment, testing international flight passengers and locating people who had been in contact with people who had tested positive. When community spread was detected, commune-level lockdowns were implemented.
Preventive measures and spread
Vietnam’s ‘Third Degree Contact Tracing’ approach is unique. Patients who tested positive were labelled ‘F0’ and epidemiologists worked with them to identify all the people they had been in close contact with over the past 14 days. Epidemiologists proactively reached out to people identified by FOs. Additionally, detailed information about the movements of F0s was published in local media (with confidentiality maintained) so that if people had been in contact with a category F0 person (defined as having been within 2 meters of the person or within an enclosed space for more than 30 minutes), they could come forward for testing. These contacts, the F1s, were tested and quarantined.
Close contacts of F1s (F2s) were also traced and tested and asked to quarantine at home. Vietnam has a relatively low level of testing per capita compared with other countries but a very high rate of tests per positive case compared with other countries because testing was so carefully targeted. This approach contributed to Vietnam’s progress towards containing the spread of the virus using a minimal investment of resources.
Vietnam began to restrict the entry by citizens of countries heavily impacted by the epidemic and, on March 22, it restricted arrival from all countries, only allowing Vietnamese citizens and people with special permission to enter. All people arriving were quarantined for at least 14 days in quarantine facilities. On April 1, with only 212 cases confirmed, a national lockdown was announced which was lifted on April 22. Starting on April 15, Vietnam began to enjoy a period in which no new confirmed cases of community transmission were detected.
For the next 99 days, there were no new cases of community transmission. Vietnam proudly remained among the few countries that had zero deaths from COVID-19.
On July 25, a new case of SARS-COV-2 was confirmed in the city of Danang signalling a fresh outbreak of unknown origin. The city of Danang was ordered to quarantine and intense contact tracing, testing, quarantine and isolation were implemented throughout the country. Vietnam recorded its first death from COVID-19 on July 31. The government implemented third-degree testing among people in Danang and people who had travelled there within the past month. By the end of August, confirmed cases had been identified in 15 cities. In Danang, in addition to third-degree testing, an initiative to test one representative in each household has been implemented to search more deeply for undetected spread before lifting the lockdown. Vietnam’s quick response to its second wave seems to have slowed the epidemic with the number of daily cases steadily declining from a peak of 50 on July 31. At the time of writing this (August 31), there have been no new cases reported in the last 48 hours. As of August 29, there had been 1026 confirmed cases in Vietnam and as of August 31, there were 32 confirmed deaths.
Elements of Vietnam’s success
Vietnam’s response to the COVID-19 pandemic has been lauded as exemplary having drawn attention in the international media and praise from the World Health Organization. While the Vietnamese success may not be replicable in all countries due to differing contexts, nonetheless, there are many valuable lessons from what made Vietnam’s success possible. These include a strong commitment by the government at the highest level to effectively combat the epidemic; engagement of the government at all levels; involvement of communities in the response to the epidemic, and; mitigation of harms related to the response. Vietnam has shown to the world that proactive, evidence-based policy can be effective even at a relatively low-cost in a resource-constrained environment. Vietnam also stepped up to offer its assistance to the international community.
High-level commitment and leadership
From the outset, Vietnam’s Prime Minister, Nguyen Xuan Phuc stated repeatedly that the Government is prepared to sacrifice economic gains to protect the health of the public. Prior to the COVID-19 pandemic, Vietnam had already demonstrated its commitment to public health. Health spending per capita in Vietnam has more than doubled since the year 2000. Since the early 1990s, the health status of the Vietnamese population has been steadily improving with drastic improvements in life expectancy, maternal and infant mortality.
When SARS broke out in 2003, Vietnam contained and eliminated the epidemic becoming the first affected country to be declared SARS-free, giving hope to a world faced with a pandemic. Vietnam also mounted a successful response to the Avian Influenza in 2004-2006 initially through massive culling of livestock followed by a massive vaccination campaign. Its response to the avian flu was held up as a model for other countries to learn from. After these epidemics, Vietnam increased its investment in public health and developed a national public health emergency operations centre and a national public health surveillance system. Many believe that Vietnam’s successful experience in countering SARS and avian flu contributed to its preparedness and determination to effectively counter the outbreaks of SARS-COV-2.
Engagement of political system and community
As noted above, high-level commitment is an important feature of Vietnam’s success but this feature is complemented by a system that engages commitment and the knowledge of resources at every level to achieve success. The National Steering Committee on Epidemic Prevention that was formed almost immediately after the first case of coronavirus was detected involved a broad range of ministries and agencies. Moreover, decision-making on the response was simultaneously top-down and bottom-up. Provincial and commune-level authorities participated in decision-making and implementation of measures to counter the epidemic. Transparency in communication about the epidemic and response facilitated the cooperation.
Communities were engaged in the response, which was given the motto, ‘fighting the epidemic is like fighting against the enemy’. Recalling Vietnam’s long history of successfully defending itself from attacks by formidable foreign aggressors, people were reminded that everyone had the agency to contribute to victory. The government communicated openly and frequently with communities creating a vision that success was possible and that everyone had a role to play in it. People in Vietnam generally felt very positive about their government’s response to the epidemic, which was ranked the highest among 45 countries in a global study on public opinion, a study which included other ‘model’ countries like Singapore and South Korea.
Mitigation of harm caused by the response
Throughout the world, measures to contain the epidemic have caused immense harm. An unavoidable dynamic, some of these were seen in Vietnam as well, but the country was strategic in mitigating these. First, Vietnam’s response was designed to minimize large-scale lockdowns by quickly implementing quarantine of smaller groups of people. As the epidemic began, and demand for face-masks sored, the government was quick to issue a statement and mandate fines for price gouging. There are penalties for spreading false information. Measures were taken to counter the economic hardship caused by the epidemic. In cities throughout the country, ‘rice ATMs’ sprouted up offering families in need rice free of charge. Some venders offered masks free of charge. Since the tourism industry was hit especially hard by the closure of the borders, during the period when there was no community spread reported, the government encouraged domestic travel, even mandating a special school holiday so that families could travel. During the phase of the epidemic when most of the new cases were ‘imported’ from countries experiencing outbreaks, there were cases of xenophobia and discrimination against foreigners and the government was quick to issue a statement reminding that discrimination was unlawful. The government provided economic assistance to people affected by closures of businesses.
Perhaps the most important way in which Vietnam mitigated potential harms from the response to the pandemic was to implement measures to contain it quickly and strategically. Extensive contact tracing, quarantine, isolation and in some cases, lockdowns were implemented precisely and quickly. Lockdowns were designed to be minimal in terms of time and geography, sometimes with only part of a city or province being cordoned off. This enabled economic activities to continue in parts of the country unaffected by an ongoing outbreak. The lockdowns were lifted once there was a certainty that outbreaks had been contained.
AUTHOR
Shona Schonning is a freelance consultant who currently lives in South East Asia and has been working to promote health and rights for key populations since 1994.
Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.
