Cambodia’s vaccination drive a race against time

As the first tranche of 324,000 British-Swedish developed Oxford-AstraZeneca vaccines arrived at Phnom Penh’s International Airport on March 2 – and with one of the first doses already administered to Cambodia’s prime minister – there is certain cause for Covid-19 optimism in Cambodia. 

The vaccines were provided by the World Health Organization-backed COVAX scheme, an internationally-funded project that will eventually supply vaccines to 20% of the world’s population in more than 100 developing countries. Cambodia is one of the world’s first countries to receive inoculations from the scheme.

COVAX is expected to deliver 6.4 million doses to Cambodia in total, enough for 3.2 million people, or 20% of the population. The first tranche of the AstraZeneca vaccines was produced by the Serum Institute of India.

Cambodia has also received 600,000 doses of the Chinese-made Sinopharm vaccine in early February, while Beijing said on March 1 that another 400,000 doses will arrive next month. 

For all the enthusiasm over vaccinations, however, there’s mounting concern as Cambodia is now in the grip of its worst wave of the pandemic. As of March 3, more than 374 cases have been linked to the so-called “February 20 community transmission” incident, which started in Phnom Penh and has now spread nationwide.

This represents more than one-third of the combined infection numbers recorded since the beginning of the pandemic.

Localized shutdowns have been ordered in several major cities, while a system of track-and-tracing has worked to locate where infected patients had recently visited, allowing people who also visited those places to be tested. 

Cambodia’s trade preference stripped

The arrival of new vaccines potentially designates a shift in Cambodia’s international standing, which was slightly restored in 2020 after years of negative publicity over the ruling party’s stranglehold of political power since 2017 that has effectively turned the country into a one-party state. 

This caused the European Union to punitively partially strip Cambodia of its trade preferences last year while the United States has perennially warned that the country could become a beachhead for Chinese power in Southeast Asia. 

Last October, a former senior Singaporean diplomat sparked a heated debate after suggesting Cambodia could be expelled from the regional bloc because of its closeness to China. 

Hun Many, a son of the prime minister and president of the Union of Youth Federations of Cambodia, intimated in a speech on March 3 that Cambodia may have received the first delivery of COVAX vaccines in the Asia-Pacific because of its humanitarian efforts last year. 

In February 2020, Cambodia received international applause for accepting the Covid-infected Westerdam passenger vessel into its ports, after the cruise ship was turned away by other Asian states. The WHO branded Cambodia “A Small Country with a Big Heart” for the gesture, and Prime Minister Hun Sen earned praise from the US and EU governments. 

In many ways, this incident typified the government’s handling of the pandemic. On the one hand, Cambodia may now be reaping the rewards for good deeds it performed last year. On the other, analysts reckon that the latest outbreak of Covid-19 infections shows Cambodia’s pandemic luck is finally running out.

‘Luck, not success’

Sophal Ear, associate professor of diplomacy and world affairs at Occidental College at Los Angeles, typifies the country’s handling of the pandemic as “a reflection of luck, not of success in doing anything.”

“You can see that it only takes one event for things to change dramatically overnight. Poor oversight of quarantine centers where Chinese tourists can sneak out is exactly how we got here,” he added, referring to the theory that the “February 20 community transmission” began after Chinese visitors bribed security guards to allow them to leave a quarantine center early. 

Indeed, Cambodia has had many fortunate escapes. It was one of the last Southeast Asian countries to suspend flights to and from China. In February 2020, Hun Sen said canceling travel would “kill” the country’s economy and “destroy ties with China.”   

A much greater concern is the state of the country’s underfunded and under-equipped healthcare services, which, up until now, hasn’t had to contend with a major infection outbreak. 

WHO officials have been quoted in local media as saying that the country’s hospitals could be “overwhelmed” in the event of a “worst-case scenario” outbreak. 

On February 24, only days after the latest outbreak, the Health Ministry said Phnom Penh’s hospitals were running out of capacity to treat Covid-19 patients, forcing many to be transferred to clinics in neighboring Kandal and Kampong Speu provinces.

At the time, the country had only 150 active cases. It had about 400 as of March 3. 

As a percentage of GDP, government spending on healthcare has actually fallen over the past decade, from 7.5% in 2011 to 5.9% in 2017, according to United Nations Development Program figures.  

In 2017, there were only 0.7 hospital beds per 1,000 people in Cambodia, compared with 2.2 per 1,000 people in Thailand. 

Public support

Nonetheless, there appears to be much public support for the government’s handling of the pandemic, as well as a surge of nationalist feelings among intellectuals. 

In the ISEAS-Yusof Ishak Institute’s latest State of Southeast Asia survey, which questions opinion-formers in the region, some 26.9% of Cambodians strongly approved of their government’s handling of the pandemic, the fourth-highest rate in the region. 

When asked “which ASEAN country has provided the best leadership to ASEAN on Covid-19?”, 53.8% of Cambodian respondents said Cambodia, the third highest national group to vote for their own country’s efforts.

This is all the more illustrative since when all national respondents were polled only 1.6% said Cambodia had the best leadership, lower than even Laos, Malaysia and Thailand. 

Cambodia’s long-ruling Prime Minister Hun Sen, who marked 36 years in power in January, has received many of the accolades.

“Obtaining this [AstraZeneca] vaccine is yet another achievement that comes from the efforts of the head of the government, Samdech Prime Minister Hun Sen,” said Health Ministry spokeswoman Or Vandine on March 2, using one of Hun Sen’s many honorifics. 

“And the vaccines will be used soon but first we are waiting for the prime minister’s recommendation after he gets the first jab at Calmette Hospital on March 4,” she added. 

It remains unclear why the prime minister, and not the Health Ministry, is taking the lead in determining the roll-out of the newly-arrived vaccines. Yet Hun Sen and leading ruling party grandees, including Defense Minister Tea Banh, have played a driving role in negotiating vaccine donations from abroad – which has come with benefits.

Within an hour of the announcement that Cambodia would receive the AstraZeneca vaccine on February 28, Hun Sen asserted that he and his wife would be the first people to receive the inoculation. 

PM changes tune

“I would like to inform [you] that, if nothing changes, I will receive the vaccine at 8:30am on March 4 at Calmette Hospital during which there will be a press conference,” he wrote on Facebook, referring to a state-run hospital in the capital. 

Back in early February, when China announced it would donate a first set of 600,000 doses to Cambodia, Hun Sen also vowed to be the first to receive the vaccine when it arrived. 

Others had secretly received inoculations beforehand, including the defense minister and his family, as Asia Times reported, and Hun Sen subsequently pulled out after being informed that the Sinopharm vaccine wasn’t suitable for people above the age of 59. Hun Sen is 68. 

Instead, his eldest son and military chief Hun Manet became the first person to receive the jab as the country’s vaccination campaign started on February 10. 

Hun Sen’s early enthusiasm for being at the front of the line for the Sinopharm vaccine was, he said, to show his compatriots that the Chinese-made inoculation was safe, a concern considering the significant questions over its efficacy both domestically and internationally.

It might also have been for geopolitical reasons. Back in December, Hun Sen said Cambodia would only accept vaccines certified by the WHO, which excluded jabs produced in China, now Cambodia’s closest ally. 

At the time, analysts perceived that as a sleight of Beijing, which may have then explained Hun Sen’s early enthusiasm for being the first to receive the Chinese-made vaccine – although he later backed away from the vow. 

Less clear, however, was the reason for his rush, only one hour after the Health Ministry announced the arrival of the AstraZeneca vaccines, to state he would be the first in the queue for the Western-made jab. 

Vaccine diplomacy

The government’s vaccination campaign so far has prioritized senior politicians and officials before members of the public. 

The Defense Ministry sequestered half of the first tranche of 600,000 vaccines donated by China, leaving the Health Ministry, tasked with inoculating civilians, with only 300,000. 

At the beginning of the vaccination program on February 10, priority groups included front-line medical workers, soldiers and government officials. Hun Sen also added tax collectors to the list of priority cases, as well as waste-collection workers.

In mid-February, Hun Sen announced that elite athletes would also be considered for the priority category, including more than 600 who are expected to participate in the upcoming Summer Olympic Games in Japan and the 2021 Southeast Asian Games in Vietnam in November. 

It remains to be seen whether Cambodia follows other regional states, like Laos, and prioritizes migrant workers, whose remittances are essential for poor households, and employees in the decimated tourism sector. 

A statement by the Defense Ministry on March 1 estimated that 60,405 soldiers had received the first dose of the Sinopharm vaccine and another 5,376 had received their second dose since the vaccination campaign began on February 10. By March 3, the numbers were up to 84,758 soldiers for first-round doses and 6,153 second-round shots. 

Stepping up the pace

Since the Defense Ministry sequestered half of the 600,000 vaccines China provided as part of its first tranche of donations, that means only less than a third of the vaccines the ministry now has have been used. Although the pace of vaccination appears to be rising quickly. 

Between February 10 and March 1, the Health Ministry only administered 24,331 first-round doses, and 913 people have received their second jab, it said in a statement. By March 3, however, the number had risen to 40,910 first-round doses and 1,533 second-time shots.   

The first phase, between February 10-23, was conducted for priority groups in the capital. The second phase then saw vaccinations expanded to the nine provinces bordering Thailand, Laos and Vietnam. The third phase, which started last week, expanded it to other provinces.

According to the Health Ministry’s latest data, of the 48,943 civilians who have volunteered to be vaccinated, some 8,033 (16%) haven’t been allowed to do so. The ministry disallows vaccinations for pregnant women, cancer patients, those with certain allergies and ailments, as well as over 59s.