The WHO South-East Asia region is home to almost 2 billion people—nearly 26% of the global population—and shares a disproportionate burden of disease and mortality. The region has struggled against the enduring impact of colonialism, recurrent invasions, famines, floods, and constant cross-border and internal hostilities. An estimated 8.5 million lives lost each year are attributed to non-communicable diseases. Communicable diseases also claim 40% of 14 million annual deaths that occur in the region. With a large and dense population, vulnerability to natural disasters, and unregulated development, the South-East Asia region is at high risk for new and emerging infectious diseases. The region also has the highest estimated number of deaths due to climate change—2.4 million people die each year from breathing polluted air.
Over the past few decades, countries in the region have also made substantial health advancements. In addition to decline in maternal and under-5 child mortality from malaria, the region has been free of maternal and neonatal tetanus since 2016. India has been free of polio since 2014. By 2016, Thailand achieved the elimination of mother-to-child transmission of HIV. Sri Lanka and Maldives achieved zero incidence of lymphatic filariasis and were declared free of malaria. Sri Lanka has led by example in malaria elimination even in the wake of political and economic crises.
These advancements have been deeply impacted by the COVID-19 pandemic. As we enter the third year of the pandemic, the South-East Asia region registered close to 57 million confirmed COVID-19 infections and more than half a million deaths (the actual numbers might be considerably higher). There is no estimate of indirect effects from the pandemic in terms of physical, economic, social, and psychological cost. The disruption of care and services is reversing decades of progress in health care and child development.
The road to recovery seems longer than expected, with some nations actively managing to return to normal whereas others struggle to control the infection. Nations in the South-East Asia region can help each other by sharing experiences on measures that have worked at a local level, especially in resilient communities that have used their social and cultural resources to survive the pandemic. Shared data can also be leveraged to understand the social, economic, political, and cultural drivers of the pandemic. Regional cooperation is crucial to mitigate the broad effects of COVID-19 and foster quicker recovery with built-in resilience. To prevent future pandemics, we need to address the socioeconomic determinants of health, such as the conditions in which we live, work, eat, drink, learn, and play. This adjustment will require a strong political will and a collective notion of health development, guided by robust scientific evidence. We need all stakeholders, both global organisations and local communities, to recognise the importance of health in policies and investments, engage in difficult conversations, build on existing knowledge, and select priorities on the basis of regional needs.
COVID-19 has given us an opportunity to make amends and build better, fairer, and stronger health systems. Science has shown the ability to develop rapid and effective tools to counter emerging infectious threats, but only with concerted efforts and adequate investment. India has shown how its potential in vaccine production and development can contribute to equitable access to these tools regionally and internationally. We need inclusive and effective policies to deliver equitable and better social, economic, and health responses. Public trust in science needs to be strengthened through better communication from policy makers and health-care workers.
For that reason, and to help meet health and clinical challenges in the region and facilitate positive changes, The Lancet Group launches a new open-access journal, The Lancet Regional Health – Southeast Asia, as part of The Lancet’s global initiative to advocate for health-care quality and access in all six WHO regions. In this inaugural issue, we publish high-quality research that adds crucial evidence and raises awareness around priority issues in the region. Two systematic reviews by Downey and colleagues, and Gadsden and colleagues synthesise evidence on the widespread disruption of the provision of essential services for infectious and non-communicable diseases and their impact during COVID-19 in the South-East Asia region. These articles provide key evidence to inform future policy on protecting services and pandemic preparedness. Raut and Huy highlight the stark reality of the impact of COVID-19 on service provision in terms of child health, education, and development and call for urgent action from all sectors of society to prevent long-term effects of the pandemic.
The Lancet Regional Health – Southeast Asia gives a voice to researchers, clinicians, policy makers, and other relevant stakeholders by publishing science-based evidence on health issues pertaining to the region and creating an open forum for constructive discussions that can help to advance research and health care. We are advocating for universal, high-quality, and accessible health care, and are committed to building a better, fairer, and healthier future for the nearly 2 billion people in this region.