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COVID 19 Erfolgsgeschichten
Emerging COVID-19 success story: Vietnam’s commitment to containment

This is a guest post by Todd Pollack (i), Guy Thwaites (ii), Maia Rabaa (ii), Marc Choisy (ii), Rogier van Doorn (ii), Le Van Tan (ii), Duong Huy Luong (iiia), Dang Quang Tan (iiib), Tran Dai Quang (iiib), Phung Cong Dinh (iv), Ngu Duy Nghia (v), Tran Anh Tu (v), La Ngoc Quang (vi), Nguyen Cong Khanh (v), Dang Duc Anh (v), Tran Nhu Duong (v), Sang Minh Le (vii), Thai Pham Quang (v), Vu Duong (viii), and Exemplars in Global Health (see institutional affiliations1).

As of December 31, 2020, Vietnam had reported 1,465 laboratory confirmed cases of COVID-19 and 35 deaths.2 This success has been attributed to several key factors, including a well-developed public health system, a decisive central government, and a proactive containment strategy based on comprehensive testing, tracing, and quarantining.
Detect: Vietnam has taken a targeted approach to testing, scaling it up in areas with community transmission. Contact tracing is comprehensive, with three degrees of contacts traced for each positive case.
Contain: As a result of its detection process, hundreds of thousands of people, including international travelers and those who had close contact with people who tested positive, were placed in quarantine centers run by the government, greatly reducing both household and community transmission. Hot spots with demonstrated community transmission, including Da Nang during its outbreak in July and August 2020, were locked down immediately, and the government communicated frequently with citizens to keep them informed and involved in the public health response.
One of the reasons Vietnam was able to act so quickly and keep the case count so low is that the country experienced a severe acute respiratory syndrome (SARS) epidemic in 2003 and human cases of avian influenza between 2004 and 2010. As a result, Vietnam had both the experience and infrastructure to take appropriate action. Vietnam makes many key containment decisions in a matter of days, which may take weeks for governments in other countries to make. Although Vietnam is a highly centralized country, a number of key decisions were made at the local level, which also contributed to the swift response.

Country Overview
Since the 1980s, Vietnam, a country of nearly 100 million people, has undergone a significant economic transformation. The adoption of economic reforms known as the Doi Moi policies in the mid-1980s turned a centrally planned economy into a socialist-oriented market economy, setting Vietnam on a path to its current middle-income status.
Vietnam has invested heavily in its health care system, with public health expenditures per capita increasing an average rate of 9 percent per year between 2000 and 2016.3 These investments have paid off with rapidly improving health indicators. For example, infant mortality and maternal mortality decreased by more than half between 1990 and 2018.4
Vietnam has a history of successfully managing pandemics: it was the second country after China to face SARS and, after 63 cases and five deaths, it was the first country declared SARS-free by the World Health Organization (WHO).5 Many interventions pioneered by Vietnam during the SARS epidemic are being used to respond to COVID-19. Similarly, its experience with epidemic preparedness and response measures may have led to greater willingness among people in the country to comply with a central public health response.
In the wake of the SARS epidemic, Vietnam increased investments in its public health infrastructure, developing a national public health emergency operations center and a national public health surveillance system.6 The national center and four regional centers run exercises and trainings to prepare key stakeholders in government for outbreaks, and they have managed preparedness and response efforts for measles, Ebola, Middle East respiratory syndrome (MERS), and Zika. Throughout the COVID-19 pandemic, the government has continued to incorporate new lessons and regularly conducts intra-action and after-action reviews.7
Vietnam has long maintained robust systems to collect and aggregate public data, and in 2009 it shifted to a nearly real-time, web-based system. Since 2016, hospitals are required to report notifiable diseases within 24 hours to a central database, ensuring that the Ministry of Health can track epidemiological developments across the country.8 In collaboration with the US Centers for Disease Control and Prevention (CDC), Vietnam implemented an innovative “event-based” surveillance program in 2018. Event-based surveillance empowers members of the public, including teachers, pharmacists, religious leaders, and even traditional medicine healers, to report public health events. The goal is to identify clusters of people who have similar symptoms that might suggest an outbreak is emerging.9
Outbreak Timeline

Emerging COVID-19 success story: South Korea learned the lessons of MERS

This is a guest post by June-Ho Kim (i), Julia Ah-Reum An (i), SeungJu Jackie Oh (i), Juhwan Oh (ii), Jong-Koo Lee (ii) as part of the Exemplars in Global Health platform (see institutional affiliations1).

South Korea’s response to COVID-19 has been impressive. Building on its experience handling Middle East respiratory syndrome (MERS), South Korea was able to flatten the epidemic curve quickly without closing businesses, issuing stay-at-home orders, or implementing many of the stricter measures adopted by other high-income countries until late 2020. It achieved this success by developing clear guidelines for the public, conducting comprehensive testing and contact tracing, and supporting people in quarantine to make compliance easier. The country successfully managed outbreaks in March and August and gradually gained control of a larger, more dispersed outbreak in December 2020. Overall, South Korea has shown success across three phases of the epidemic preparedness and response framework: detection, containment, and treatment.
  • Detect: South Korea built innovative, high-capacity screening facilities and worked closely with the private sector to ensure an adequate supply of tests from the onset of the pandemic. The country maintains approximately 600 screening and testing centers and 150 diagnostic laboratories, with capacity reaching 110,000 tests as of November 2020.
  • Contain: South Korea isolated infected patients, increased compliance by supporting those in quarantine, and traced contacts with unusual thoroughness. Hundreds of epidemiological intelligence officers were deployed for these tracing efforts and empowered to use a wide variety of data sources, including credit card transactions and closed-circuit television footage.
  • Treat: The health system surged to meet demand, especially in Daegu, the site of a large cluster of infections in March 2020. An additional 2,400 health workers were recruited in Daegu alone. Across the country, the government restructured the hospital system, built temporary hospitals to increase capacity, and addressed shortages of personal protective equipment (PPE) through centralized government purchasing.
South Korea’s strong enabling environment positioned the government to act quickly and effectively. After its flawed response to a MERS outbreak in 2015, the government made 48 reforms to boost public health emergency preparedness and response. In addition, a well-functioning national health insurance system, ample human resources and infrastructure, and constructive relationships between key institutions—such as the president’s office, the Ministries of Health, Education, and Foreign Affairs, and the Korean Centers for Disease Control and Prevention, which was renamed the Korea Disease Control and Prevention Agency (KDCA), during the pandemic—enabled an extraordinarily decisive response to the pandemic.
Country Overview
Since the 1960s, South Korea’s economy has grown at a remarkable pace, and it is currently the 12th largest in the world.2 Health outcomes have improved alongside economic progress. South Korea put social health insurance in place in the 1970s, achieved universal health care coverage in 1989, and transitioned to a single-payer system in 2004.3
South Korea’s health system is centered on hospital-based care. The number of hospital beds per capita, 12.3 beds per 1,000 population, is two times higher than the average in Organisation of Economic Cooperation and Development (OECD) countries.4 The country excels not only in hospital capacity but also in interactions with doctors, with an OECD-leading 16.6 consultations annually per capita.5 Although some critics suggest that South Korea’s health system is overly dependent on secondary or tertiary facilities instead of primary facilities, this extra capacity enabled hospitals to respond quickly to COVID-19 without sacrificing care for non-COVID-19 patients.6
Despite its robust health system, South Korea struggled to respond appropriately to the 2015 outbreak of MERS, which resulted in nearly 17,000 suspected cases and 38 deaths. During the six months of that outbreak, Koreans lived in fear, and the government lost an estimated US$2.6 billion in tourism revenue while spending almost US$1 billion on diagnosis, treatment, and other parts of its response.7
After MERS, the country made a total of 48 reforms to improve pandemic preparedness and response, including more infection control staff and isolation units, expanded outbreak simulations and PPE training, and community-based collaboration between medical centers and local governments.8 When COVID-19 struck, the painful memory of MERS inspired an early and aggressive government response—and a willingness among people to wear masks, cooperate with contract tracers, and otherwise listen to public health officials. For example, wearing a mask in public spaces, already common because of air pollution, became a social norm early in the pandemic.9 A poll showed that more people adhered to public prevention protocols during the COVID-19 outbreak than during the MERS outbreak.10


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