Nisha Pillai: Welcome to ADB Insight. I'm Nisha Pillai. Almost two years into the global pandemic, vaccination remains one of the most critical issues facing countries in the Asia Pacific. While countries like the People's Republic of China have vaccinated more than 80% of their populations, the wave of COVID-19 variants, like Delta and Omicron, has seen some countries reintroduce curfews and lockdowns, slowing the return to normality. And the emerging science, suggesting the need for booster shots, has created further demand for vaccines.

So, as we approach yet another year of living with COVID, it's clear much more needs to be done. To explore this further, I'm joined now by Dr. Jerome Kim, the Director-General of the International Vaccine Institute based in South Korea. Dr. Kim, welcome. Thank you for joining us.

So how is Asia faring in terms of uptake and distribution of COVID vaccines?

Jerome Kim: Thank you, Nisha, for the opportunity to speak with you today. Vaccination has been, on the whole, very good. But of course, there are very few low-income countries in Asia. And so, typically you have vaccination rates over 50% to 85 to 90%, and significant numbers of people are already receiving booster vaccinations. 

Nisha Pillai: And what about the Pacific region?  

Jerome Kim: Yes, so the Pacific has actually benefited from the availability of vaccines through countries in the region. And so, they've actually done fairly well. The thing about the Pacific is that these are island nations by and large—and coming from Hawaii—I know what it's like to be on an island. They're able to actually limit the number of people who get there. So, very strict quarantines and isolation have relatively spared them from the ill effects of COVID. A significant number of the island nations, and Fiji comes to mind, have very positive attitudes towards vaccination. And in part this is due to, you know, previous experiences, very negative experiences with infectious diseases around the time that the islands were discovered. So, some countries have incorporated that into the messaging around why it's so important to be vaccinated. Other countries have been less successful.  

Nisha Pillai: Is it a given that more variants are likely and if so, how should countries prepare themselves if more variants were to emerge?  

Jerome Kim: You know, we're in the midst of an Omicron outbreak and it's starting to taper off in some areas. All it needs to do is find under-vaccinated populations, and Omicron or whatever variant develops out of Omicron, or out of one of the Delta-like viruses that is still in circulation, could very easily spread again through populations. Remember that the under-vaccinated or the unvaccinated are going to be the source of future outbreaks.  

Nisha Pillai: What do you see as the main obstacles to getting more people vaccinated in the Asia Pacific region? Is it access, is it distribution or is it vaccine hesitancy? 

Jerome Kim: Yes—it's hard to say “yes” to all of those things—but in fact, it is all those things. In general, equity has been easing, you know, the concerns around the maldistribution of vaccines has been easing because the world is making two billion doses of vaccine a month. That's a huge amount of vaccine. That's way more vaccines than we do for any other disease in a whole year. So, the equity issue is easing. Now with boosters, that equity issue will potentially surface again. But it's, as you point out, primarily an access issue—can we get the vaccines that are now presently in significant supply to the people who need them as quickly as possible? We're going from vaccinating just children in many countries to vaccinating everybody. So, you're going from vaccinating 130 million people in the world—the children who are born every year—to vaccinating eight billion people in the world. And healthcare systems, particularly under-resourced healthcare systems, are not necessarily set up for that. The nurses, doctors, staff in these healthcare facilities and hospitals are already overworked. And how are you going to do that? Do you have a mass campaign around the country? Do you have mass vaccination days? Do you set up vaccination centers and ask people who are making a dollar a day to give up a day of work so they can walk to a vaccination center, so the family doesn't have anything to eat. These are issues that are deeply rooted in other development issues. As you point out, then there are people who resist vaccination. And the anti-vaccination movement, the vaccine hesitancy movement, has had a full year to gear up. And some of the misinformation that's out there is mind boggling, and it really makes it difficult for countries to articulate a clear message around the vaccines. But we need to do this. We need to know what the negative messages are. We need to present positive messages in a way that governments aren't used to doing. You know, governments are used to saying, “this is the way it is.” But they're now going to have to be able to develop far more nuanced and reactive methods, and actually methods that engage people and help to overcome some of the misinformation that's out there. I know some colleagues who are actually looking into the best way to message to a generation that, you know, would rather see something for 10 seconds on an iPhone or a smartphone than, you know, sit down and watch CNN or the BBC or read a newspaper.  

Nisha Pillai: Do you think COVID is here to stay? Will it become endemic like the flu, something we get a shot for every year?  

Jerome Kim: Yes, so I don't think that we'll ever be COVID-free. I think that the virus is circulating. It's developed the capacity to infect people who were previously infected and there are situations, there are settings in which we know that viruses will evolve, you know, outbreak settings in general, but also in under-vaccinated populations. And we need to vaccinate as many people as possible, fully. And that's now the standard priming doses and then a booster dose.  

Nisha Pillai: And how much hope should we put on the antiviral drugs that are slowly coming on stream that people could take at home? 

Jerome Kim: Yes, that's a great question. And you know, I think we've made a lot of progress. Unfortunately, Omicron has taken out a significant number of the monoclonal antibodies that prevent progression to severe disease, hospitalization, and death. Remdesivir continues to work, Paxlovid, the Pfizer antiviral, continues to work. Molnupiravir, which is the Merck antiviral, also should theoretically continue to work. So again, the antivirals look pretty good. The issue here is, of course, the same ones that we have for vaccines—access and equity. Are we able to get enough Paxlovid or Remdesivir to countries around the world where significant numbers of people might theoretically be at risk? In many of those countries we don't have diagnostics, so we don't actually know when a person is infected, and the last thing we want to do is start using these drugs empirically—that is, without knowing that a person has COVID-19 but has symptoms similar or compatible, like a cough, a sore throat, all of those (symptoms), a fever. Those things are common to influenza, as well as other viral illnesses that are not COVID. So, we have to make sure that when we give these medications that it's being given for COVID-19 infection, to prevent severe disease from developing. 

Nisha Pillai: And finally, can I ask you if you were a policymaker right now, Dr. Kim, what would be the actions that you would be prioritizing?  

Jerome Kim: I think 2022 should be rightly considered the year of vaccination, making sure that everyone is fully vaccinated, and that means the primary series plus the booster doses. The second thing is that this is the year where we're going to really have to think about stepping back and understanding how and which controls can be released, and what needs to remain in place in order to prevent outbreaks from occurring—that is, preventing other people from getting sick— allowing economies to once more open up. And then finally, preserving those freedoms that people have, not only to go out and do things, but also, you know, the pandemic has put a significant number of restrictions on people around what they can do under observation. And so, I think we're going to need to really come to grips with those three big issues in 2022. 

Nisha Pillai: Jerome Kim, thank you so much for your time and our very interesting interview.  

Jerome Kim: Thanks a lot, Nisha. It was great to speak to you. 

Nisha Pillai: And indeed, thank you to everyone joining us for this episode of ADB Insight. I'm Nisha Pillai and I hope to see you again very soon. Goodbye for now.