Source: ISPSW

Dr Christina Lin


In the competition between East and West over global governance models, it seems Asian countries may be emerging as the winners when it comes to health governance. Asian countries overall have fared better in managing the Covid-19 pandemic, with lower mortality rate which are attributed to Asian culture, climate, demographics, prior experience with SARS and MERS coronaviruses, and use of antimalarial drug hydroxychloroquine. Given the more successful mitigation models compared to their western counterparts, Asian countries appear likely to continue heeding their own judgement and guidelines for pandemic management rather than deferring to Western models.


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In the competition between East and West over global governance models, it seems Asian countries may be emerging as the winners when it comes to health governance. On the issue of pandemic management, currently East Asian and South Asian countries enjoy comparative lower mortality rate for Covid-19 than western countries.1

Taiwan, now touted as the gold standard for pandemic management, has a population of 23.7 million people but only seven deaths. Vietnam has registered zero death with a population of 95.5 million, while South Korea (population: 51 million) has lost 300 and Japan (population: 126 million) has lost 1001. In contrast, the US (population: 328 million) has lost 154,000 while the UK (population: 66 million) has lost 45,961. Italy (population 60 million) has lost 35,121, Spain (population: 47 million) has lost 28,443 while France (population: 67 million) has lost 30,238 and Germany (population: 83 million) has lost 9,217.

In order to control for population variance across countries, as measured by case-fatality-rate (CFR) per 100,000 people, Asian countries still rank lower in the CFR vis-à-vis Western countries.

According to Johns Hopkins University, European countries have the highest CFR rate in double digits with UK at 15.2% followed by Belgium (14.6%), Italy (14.2%), France (13.7%), Spain (10.1%), and Germany and US at 4.4% and 3.4% respectively.

In Asia, CFR is at single digits with China is at 5.3% followed by Japan (3%), India (2.2%), South Korea (2.1%), Malaysia (1.4%), Taiwan (1.5%) and Singapore (0.1%).4

There have been debates over the reason for this discrepancy, ranging from Asian culture of wearing masks,
climate contrasts, genetic differences, younger demographic, and previous experience with the SARS coronavirus and MERS coronavirus epidemics that enabled faster responses to the new threat.5

Another possible reason is the widespread use of the anti-malarial drug Hydroxychloroquine (HCQ), which has somehow become a political football in the West.6

HCQ is an anti-viral drug sold under the brand name Plaquenil as well as a generic medicine. It has been around for 60 years, and is often used to treat malaria, lupus, rheumatoid arthritis, and other autoimmune diseases. In 2005, US National Institute of Health (NIH) reported in its journal Virology that chloroquine, a more toxic form of hydroxychloroquine, was effective in preventing the spread of Covid-19’s predecessor SARS.7

Covid-19 is the novel SARS Coronavirus 2 (SARS-CoV-2), which is genetically closely related to the SARS Coronavirus (SARS-CoV)
from 2002. Authored by Martin J Vincent, Eric Bergeron, Suzanne Benjannet, Bobbie R Erickson, Pierre E Rollin, Thomas G Ksiazek, Nabil G Seidah, and Stuart T Nichol, the study concluded that “Favorable inhibition of virus spread was observed when the cells were either treated with chloroquine prior to or after SARS CoV infection”, and this appears to be supported by health experts in Asian countries.

For example India and Indonesia stand by the antimalarials, with Indian Council for Medical Research (ICMR) arguing they found no evidence the drug caused harm as a prophylaxis and encouraging HCQ as a preventive treatment for its medical workers.8

Indonesian doctors also use the drug to treat all Covid-19 patients and has ramped up its production, granting licenses to local manufacturers to produce millions of doses.9

In South Korea, Korean Centers for Disease Control and Prevention also used HCQ in combination with an antiHIV drug to effectively treat Covid-19, as well as in Taiwan for treating mild cases.10

Likewise, Malaysia found the antimalarial effective in treating early stages of Covid-19 infections.11

Malaysian Health Director-General Dr. Noor Hisham Abdullah said the off-label use of HCQ managed to delay Covid-19 progression that could have led to low fatality rates in the country. He divides Covid-19 infections into four stages: the first is testing positive without symptoms; the second stage shows mild symptoms; the third is pneumonia but does not need oxygen; the fourth stage is pneumonia needing oxygen; and the fifth stage is needing ventilator support.12

In Malaysia, 88% of its Covid-19 cases are in the first two early stages, and Dr. Abdullah observed the impact of HCQ is mainly on Categories 1 and 2 which prevented deterioration into Categories 4 and 5. It is important to point out that HCQ is not a cure, nor is it an effective treatment for severe case of Covid19.

Rather, many Asian countries use it to treat early and mild cases of the virus to prevent it from becoming worse, which according to a recent Henry Ford Hospitals group study of 2,500 patients, show promise it could reduce mortality by about half compared to those not given the drug.13

The Association of American
Physicians and Surgeons (AAPS) seems to share views on the drug’s benefits as well.14

In light of Asian countries’ lower mortality rate and comparative success in Covid-19 management, perhaps this time Western countries could take some lessons learned from their model of health governance.

It may also benefit a seemingly politicised WHO to learn from Taiwan which has emerged as a successful model for managing Covid-19, yet continues to be banned from WHO membership. Given this, in conjunction with WHO’s at times contradictory guidance on Covid-19, it appears Asian countries will likely continue to exercise their own judgement when it comes to guidelines for mitigating the pandemic.15

Remarks: Opinions expressed in this contribution are those of the author.

Martin Fritz, “Why does coronavirus kill fewer people in East Asia?”, Deutsche Welle, June 12, 2020,; Asad Hasham, “The curious
case of South Asia’s ‘low’ coronavirus deaths”, Aljazeera, May 18, 2020,; Simon
Denyer and Joel Achenbach, “Researchers ponder why covid-19 appears deadlier in the U.S. and Europe than in Asia”,
Washington Post, May 28, 2020,
2 “Taiwan: a role model for pandemic management”, Healthcare in Europe, April 3, 2020,; “Taiwan’s early success makes it a role model
for Covid-19 pandemic management”, July 6, 2020,
3 “Mortality analysis”, The Johns Hopkins University Coronavirus Resource Centre, updated July 30, 2020,
5 Ralph Jennings, “Not just coronavirus: Asians have worn face masks for decades”, Voice of America, March 11, 2020,
7 Martin Vincent et al, “Chloroquine is a potent inhibitor of SARS coronavirus infection and spread”, Virology Journal, U.S.
National Institute of Health, August 22, 2005,;
8 Amanda Hodge, “Coronavirus: India and Indonesia stand by antimalarials”, The Australian, May 29, 2020,; Vijay Jarayaj, “This Indian slum contained a possible CVOID-19 disaster with hydroxychloroquine”, Life Site, July 22, 2020,;
9 Kate Lamb, Tom Allard, “Exclusive: Indonesia, major advocate of hydroxychloroquine, told by WHO to stop using it”,
Reuters, May 26, 2020,
10 Elizabeth Shim, “South Korea experts recommend anti-HIV, anti-malaria drugs for Covid-19”, UPl, March 12, 2020,; Christina Lin, “Hydroxychloroquine used by South Korea while U.S. is divided”, Times of Israel, April 27, 2020,;
Formosa TV English News, “Tsai touts plans to donate Taiwanese hydroxychloroquine and masks abroad”, April 9, 2020,
11 Kanmani Batumalai, “Malaysia finds hydroxychloroquine can slow Covid-19 progress”, Code Blue, June 9, 2020,
12 “Antimalarial drug helped stop Covid-19 patients from worsening: DG”, Code Blue, April 7, 2020,
13 M S Seshadri, T. Jacob John, “Experts explain: The case for using hydroxychloroquine (HCQ) to treat Covid-19”, The Indian
Express, July 15, 2020,
; “Treatment with Hydroxychloroquine Cut Death Rate Significantly in Covid-19 Patients”, Henry Ford
Health Systems Study Shows”, Henry Ford Health System, July 2, 2020,
14 “Hydroxychloroquine has about 90 percent chance of helping Covid-19 patients”, Association of American Physicians and
Surgeons, (AAPS), April 27, 2020,
15 Bayram Altug, “WHO criticized for ‘contradictory’ Covid-19 statements”, Anadolu Agency, July 7, 2020,

Related: Act early with early Covid-19 treatment: Dr Vladimir Zelenko

COVID-19 outpatients – early risk-stratified treatment with zinc plus low dose hydroxychloroquine and azithromycin: a retrospective case series study

The story behind hydroxychloroquine and the Zelenko Protocol: safe pre-hospital treatments for Covid

‘Only a one in 17 billion chance hydroxychloroquine doesn’t work’: medical professor

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