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COVID-19: The path ahead for Southeast Asia’s pharmacy network

As the ASEAN economies loosen their coronavirus lockdowns, what is the outlook for COVID-19’s containment and the continued impact on the region’s pharmacy networks? mClinica Pharmacy Solutions can help pharmacists navigate the new post-coronavirus realities and support their migration to more online value add in the patient relationship through the use of apps such as SwipeRx.

While the number of confirmed ASEAN COVID-19 cases continues to climb by 10,000-15,000 new cases per week (see chart below), several Southeast Asian countries have now managed to stabilize or even reduce the growth in the number of new infections. Regardless of how well they have contained the pandemic, all the ASEAN countries are starting to ease the stringent lockdowns put in place to curb the spread of the disease. 

Southeast Asia’s COVID-19 nightmare began with the first record cases in Thailand in January. Since then, the pandemic has followed four distinct phases: 

Phase 1: Blissfully unaware. For several weeks the severity of the outbreak went largely undetected. With the notable exception of Vietnam, most ASEAN’s governments responded slowly.

Phase 2: Rapid response. Testing was ramped up, and the number of confirmed cases took off in March across almost all of Southeast Asia. In response, governments imposed lockdowns across the region in March and April, which helped curb the spread of the disease. During this phase, Malaysia, the Philippines, and Thailand looked to be coming to grips with the outbreak. In Singapore, however, COVID-19 took hold in the city-state’s packed migrant worker dormitories, causing the number of cases to explode. 

Phase 3: Consolidation. In the month of May, lockdowns were extended, and early gains consolidated in Thailand, Vietnam, and Singapore. The archipelagos of the Philippines and Indonesia became the new epicenters of the pandemic in Asia. 

Phase 4: Loosening lockdown. Vietnam started to ease its public health restrictions in April; in May/June, all the other major ASEAN countries joined in—tentatively at first, then with increased boldness.   

Covid-19 cumulative and weekly news cases in ASEAN

Note: cases for weeks ending on date indicated

Source: Intercedent Asia (WHO data) 

Vietnam’s pandemic response has been exemplary and initial suspicions that Hanoi was underreporting have been disproved by the evidence of hospital wards. Having a land border with China, the original epicenter of the global pandemic, Vietnam “overreacted” from the outset, putting in place stringent measures far sooner than its neighbors. Hanoi quickly sealed off outbreaks in the north of the country and imposed border and travel restrictions. Later, Vietnam imposed among the most stringent of regional lockdowns. 

The way forward

Having exhausted government coffers and slashed interest rates, the emerging ASEAN economies are now running out of levers to support their flagging economies. Many have decided it is time to lift the lockdown—ready or not. One reason for optimism has been the mercifully low death toll attributed to the coronavirus. Hardest hit so far: the Philippines (1,103 deaths as of June 17) and Indonesia, which has recorded 2,231 COVID-19 deaths, the region’s highest by far. Vietnam, Cambodia, and Laos have yet to report a single fatality; Brunei and Myanmar have had only three and six deaths, respectively. Singapore’s excellent healthcare system has managed to restrict the death toll to 26 from a caseload of 41,000. Malaysia recorded 121 deaths as of June 17, meaning only 1.4% of its recorded coronavirus cases have died (versus 5.5% in the USA). 

Southeast Asia Emerging from Lockdowns

Source: Intercedent, Oxford Univ Blavatnik School of Government (data)

Countries of most concern: Indonesia and the Philippines

President Duterte downgraded the quarantine classifications of various cities and regions on June 15 despite stubbornly high numbers of new in COVID-19 cases. Manila, also kept its lower quarantine status despite an uptick in cases. It seems that the administration is unwilling to bear the economic costs of resuming a strict lockdown on Greater Manila, and its 25 million residents. The new epicenter of the country’s epidemic, the country’s second city of Cebu, was the only area to backtrack into the most restrictive quarantine category. The Philippines has now moved towards a more flexible and bottom-up approach to quarantine decisions, in which local governments petition for and receive protocol reclassifications. Decision making in Indonesia is localized to a great extent already.

“In the next 3-5 years, a new generation of 'millennium pharmacies' will emerge. Sales will shift from serviced to self-service, from drugs to more cosmetics, vitamins, skin-care products and, unique in Indonesia, herbal remedies.”

Apt, Septian Johanka, S.Farm, Apotek Segar Karawang, Indonesia

"The lifting of lockdown will boost the sales of every pharmacy, particularly in over-the-counter agents such as vitamins and items such as face masks and gloves. Hopefully, the pandemic will improve the adherence of many patients to their prescribed regimens, particularly those who have comorbidities such as diabetes and heart diseases."

Mark Clyde Daona, St. Joseph Drugstore, Philippines

At over 66,000 cases, Indonesia now has the highest number of recorded COVID-19 cases in 

Southeast Asia, a number that wildly underestimates the real total due to a lack of testing. As of mid-June, Indonesia had conducted 350,000 tests, a relatively small number compared to its population of 270m (2020). By comparison, Singapore has completed 570,000 tests for a resident population of 5.7m. Bizarrely, Indonesia has reported more than 2,200 deaths but has not registered a single patient as being in a “serious” or “critical” condition.

In both the Philippines and Indonesia, there will be growing tensions between ministries tasked with rolling out back-to-business protocols and local governments trying to address health realities on the ground. As the pandemic evolves, local governments will face an expanding array of informational and logistical obstacles to managing the virus

Implications for pharmacy networks

In the countries with rising or stable cases (see table below), there will be a continuing challenge for drugstore owners in finding ways of providing quality pharmaceutical care without compromising the safety of both patients and drugstore personnel. Some consumers may want to buy their medicines and other necessities in bulk to reduce their exposure from continually going out, which will oblige pharmacies to ensure the availability of all fast-moving items. COVID-19 has accelerated the shift to online marketing. Patients enjoy price transparency (where there are licensed online pharmacies) and can access unlimited information on illnesses, symptoms, and drugs without stepping foot in the pharmacy.

Covid-situation-infographic

“The pandemic has prompted pharmacies to introduce more convenient ways to interact and gain access to patients, even when they are unable to leave their homes. Delivery services that minimize person-to-person contact, online pharmacist-patient communication and the adoption of contactless payment are here to stay.”

Shaun Wee, Healthlane Family Pharmacy, Malaysia

Pharmacy professionals have played a central role in educating patients about COVID-19 and the protocols on how to prevent infection, reducing mental stress as they retain patient trust. In the near term, pharmacy professionals will continue to ensure that they have safety measures in place to receive patients in their pharmacies (e.g. taking temperature, sanitizer, staff in PPE, etc.). Longer term, because of the precautions being observed by the community during the pandemic, purchasing habits may change as customers try to be less physically present in pharmacies. Alternative channels such as telemedicine consultation with pharmacists and “call for pick-up” ordering. The rise of these alternatives in providing quality pharmaceutical care will challenge pharmacists to take on more complex duties and responsibilities. As they re-invent aspects of their business, pharmacy professionals can access the collective pharmacy wisdom on SwipeRx, benchmarking best practices and getting the latest news updates. 

Swiperx-face-shield-img

SwipeRx Indonesia is providing free face shields and masks to some pharmacies.

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