In sickness and in health

In many ways, the call for the regional revival of the South Asian Association for Regional Cooperation (SAARC) to respond to the COVID-19 pandemic in early 2020 was designed to fail. After all, the geopolitical red tape that followed the creation of the COVID-19 Emergency Fund played to a predictable pattern of gridlocked regionalism, with India and Pakistan at loggerheads about how the funding was to be disbursed. Plagued by chronic trust deficit, weak institutionalisation and stasis, Southasia once again finds itself between a rock and a hard place. This failure raises fundamental questions about how Southasia chooses to engage with questions of benefit sharing, trade-offs and the allocation of risks and burdens within the neighbourhood. But the current moment also marks an inflection point. While the regional project has never appeared more dysfunctional, its raison d’être has never been stronger. And interesting new examples of cross-border collaboration in the fields of public health and disease control offer potential pathways for Southasia to repurpose its regional project in imaginative ways.

Admittedly, a regional project that is already in crisis mode is ill-equipped to deal with the challenge of better regional cooperation. It is perhaps telling that SAARC tends to make news for cancelled summits, with heads of states having met only 18 times since 1985. This has resulted in a crippling policy vacuum that is there as much by default as by design. The top-down formal model that characterises SAARC has held it back from fulfilling its regional mandate. The caricatured image of the region as the least integrated in the world is not without basis. As per a 2018 study by the World Bank, intra-regional trade in Southasia remains at an abysmal 5 percent of the region’s total trade. It has also not helped that the bulk of the trade is heavily skewed in India’s favour. For instance, according to data released by Nepal’s Department of Customs in early 2020, Nepal’s trade deficit with India constitutes 60 percent of its overall deficit. Economist Mustafizur Rahman draws attention to the growing concern within Bangladesh about its rising trade deficit with India, which stood at USD 7.35 billion in 2019, with imports from India amounting to USD 8.60 billion, whereas its exports remain at a modest USD 1.25 billion.

The region could also be facing its worst economic performance in four decades, with growth set to substantially decline from the projected 6.3 percent to anywhere within the range of 1.8 to 2.8 percent this year, as per the World Bank’s South Asia Economic Focus released in April. The ripple effects are already being felt across the region. By the first quarter of 2020, Sri Lanka’s unemployment rate had registered a 10-year high to stand at 5.7 percent. But what is even more disturbing is the steep spike in youth unemployment across the region. With nearly half of Southasia’s 1.8 billion-strong population aged below 24, this concern is a very real one. The estimated youth unemployment rate in Afghanistan is already above 17 percent. A recent report by the Asian Development Bank and International Labour Organisation estimated that India might see over 6 million job losses among youth within six months of the continued spread of COVID-19, followed by Pakistan with 2.3 million. Women will also be disproportionately impacted. A recent study commissioned by UN Women and the United Nations Development Fund estimated that, by 2030, for every 100 men aged 25-34 living in extreme poverty, there would be 129 poor women in Southasia.

Border regions as engines of recovery

Can COVID-19 be a catalyst to undertake a fundamental reappraisal of Southasia’s regional project? What this moment truly represents is a critical cue to leverage the location of border regions. This can not only help fill the policy vacuum at the heart of SAARC but also enhance overall state capacity within Southasia to deal with the grave challenges that the pandemic presents.

Subregional initiatives such as the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) are intrinsically well-positioned to play this role, since they are premised on geographically proximate border regions being important sites of cooperation. For instance, consider how BIMSTEC has managed to maintain a brisk institutional calendar in contrast to SAARC, having held the 20th Session of the BIMSTEC Senior Officials’ Meeting in Colombo in March 2020. As BIMSTEC prepares to hold its fifth summit in January 2021, Nepal has a valuable opportunity as the host state to use its agenda-setting role to build a focus on human security. BIMSTEC’s institutional journey so far offers a measure of optimism in this regard given its cross-cutting array of focus areas such as poverty alleviation, public health, agriculture and transport connectivity. Strengthening the convening capacity of border regions on these key social and developmental sectors can send the right signals to build habits of cooperation especially when trust levels are low. Sectoral regional dialogues on cross-border trade, transport and health steered by border regions can do more to instill trust among India’s neighbours than if these were to be steered by country capitals.

There are other imaginative methods being used to reconnect regions economically by reviving inland waterways in the region. In 2019, India and Bangladesh added new ports of call for inland waterways trade that include landlocked Nepal and Bhutan. This is a move with the potential to open up economic opportunities for marginalised communities across hinterland Southasia. Inland waterways have historically played a major role as connectors in the region. Another step in the right direction for galvanising regional trade is Pakistan’s decision in July 2020 to reopen transit trade from Afghanistan to India via the India-Pakistan border at Wagah.

Border agencies within Southasia will have a critical role in convening and coordinating key components of what the post-pandemic region will look like. The first order of business needs to be formulating standardised guidelines for the safe handling of cargo, supply and logistics chains. Different border agencies need to share regulatory responsibilities to ensure faster clearance on the ground. There are interesting takeaways from the regional guidelines approved by the Southern African Development Community (SADC) in June 2020 for the facilitation of trade and transport and inter-agency protocols to be followed at points of entry. These include joint customs and quarantine inspections or one agency undertaking exit and entry screening of drivers and workers on behalf of other agencies. To avoid possible gridlocks and delays, coordination across several key sectors such as customs, health, logistics and security agencies need to also be agreed upon. The months-long logjam at the India-Bangladesh land ports of Petrapole and Benapole in 2020 underlines the costs that the absence of regional protocols can result in. Differences between the two sides on the movement of consignments resulted in a prolonged standoff and heightened tensions at a border crossing that accounts for 70 percent of their bilateral trade.

Gridlocks such as these are resulting in a gradual awareness that regional coordination can be valuable and complementary to national-level initiatives. The SAARC meet for health ministers and officials convened by Pakistan in April 2020 is a step in the right direction but requires sustained coordination among health agencies to bear fruit. Cross-border e-health cooperation tools, including web conferencing systems for sharing clinical knowledge and expertise among healthcare professionals, will be vital for capacity building at the regional level. In this regard, Sri Lanka’s proposal to set up a single depository for information can plug gaps in communication, coordination and cooperation. Similarly, Afghanistan’s recommendation for a telemedicine framework to provide access to healthcare in less accessible locations is the need of the hour. Several information sharing platforms are also being put in place at the regional level, such as the SAARC COVID-19 Electronic Information Exchange Platform (COINEX), particularly for health professionals, as well as a SAARC WhatsApp group, besides online training modules for improving regional coordination.

There currently exists no formal coordination and collaboration at the regional level on implementation of health-related Sustainable Development Goals (SDGs) despite important national initiatives taken by several Southasian countries. In this regard, there are important takeaways for SAARC from the 33-member Economic Commission for Latin America and the Caribbean (ECLAC) that has developed a framework aimed at helping member countries to implement and integrate SDGs into their respective national action plans. Given the looming economic crisis, what will be indispensable are regular exchanges between Central Bank heads from the region to share country-experiences and measures to strengthen financial stability. Incidentally, an ideal institutional platform already exists in the region in the form of SAARCFINANCE, a network of central bank governors and finance secretaries that was set up in 1998 as a way to promote better cooperation, including harmonisation of banking practice.

Southasian disease-surveillance networks

The pandemic has also revealed shortcomings in benchmarking tools such as the Global Health Security Index and underlined the need for moving towards more localised metrics in assessing disease preparedness. A Regional Health Security Index could be an invaluable policy tool to collectively assess the capacities of healthcare systems. Similarly, an effective regional disease-surveillance network can go a long way in addressing capacity gaps and burdens. Southasia has been conspicuously absent from several multi-disciplinary and multi-sectoral disease research networks that have made considerable headway in capacity building in several parts of the world. What is urgently needed is to identify cross-border sites for subregional cooperation in epidemiological data collection across the region. This will result not only in more accurate disease burden estimates, but also help plug implementation gaps and shortcomings of top-down, national approaches.

There are interesting takeaways from cross-border disease-surveillance networks around the world. The Mekong Basin Disease Surveillance (MBDS) Cooperation commenced in 2001, for instance, has built cultures of trust and transparency with a strong focus on border health and capacity building within the region. Steered by health ministers from member countries, the MBDS has 25 designated cross-border sites with a strong focus on local cross-border coordination. Another successful example of cross-border cooperation that has looked past geopolitical tensions is the Middle East Consortium on Infectious Disease Surveillance (MECIDS). Established in 2003, initially to share data on foodborne disease outbreaks, it brings together public health experts and officials from the Palestinian Authority, Israel and Jordan. Similarly, the East African Integrated Disease-Surveillance Network (EAIDSNet) established a web-based portal that links human and animal health disease surveillance.

Many such initiatives have rich takeaways for Southasia to collectively invest in joint collaboration in screening, testing and more effective risk identification measures. For instance, the Connecting Organisations for Regional Disease Surveillance (CORDS) comprises six regional networks spread across 28 countries in Asia, Africa, the Middle East and Europe to combat outbreaks more effectively. Notably, Southasia is not part of this important network. Similarly, the Asia Partnership on Emerging Infectious Diseases Research (APEIR) initiated in 2006, is a platform for researchers, practitioners and senior government officials from Cambodia, China, Laos, Indonesia, Thailand and Vietnam. The APEIR is an interesting instance of a bottom-up network made up of more than 30 research institutes, universities and department ministries with an initial focus on avian flu research and subsequently broadened to cover all emerging infectious diseases research.

To its credit, SAARC was among the earliest regional organisations to convene a summit to underline the imperative for a regional response. As it mulls ways to navigate the post-pandemic landscape, it would be both timely and useful to convene a post-pandemic review summit. What capacities were built? What worked and what did not? For instance, the Emergency Capacity Building (ECB) Project, a collaborative initiative between Bangladesh, Bolivia, Indonesia, Niger and the Horn of Africa, includes joint agency simulations training and disaster engagement response protocols. The ECB Project has institutionalised joint evaluations and has developed standardised protocols for measuring impact. These can be valuable accountability-enhancing tools during emergencies that allow for institutional learning and adaptation to produce inclusive development outcomes.

A post-pandemic review could also be an excellent occasion for Southasia to remember that the idea of collective action to combat a health emergency in the region is not a new one. The regional experience of dealing with the Severe Acute Respiratory Syndrome (SARS) in 2003 is an interesting case in point. At the onset of the outbreak, SAARC leaders convened an emergency meeting of the SAARC Health Ministers in Male. The Male Declaration that was signed at the summit outlined the nuts and bolts of a regional strategy such as screening procedures at ports of entry, contact tracing guidelines and quarantine facilities for patients. This regional template of a collective problem-solving model is an apt reminder that this is neither the first epidemic and nor is it likely to be the last.

The pandemic has shown how vulnerable the Southasian publics are to health emergencies and the subsequent economic havoc. Today, the new anthem of ‘we are all in it together’ may impart a heady dose of optimism. But clearly, it will take more than rhetoric to get there. The allegorical warning that Edgar Allan Poe sounded in ‘The Masque of the Red Death’ may be closer to the bone than we may care to acknowledge. Set against the grim backdrop of the black plague, it warns of the futility of trying to keep social worlds apart. The cost of this political abdication? No one escapes.

In the midst of battling a pandemic, Southasia has been given a rare moment to deliver on the promise of a shared regional sentiment. The question is, can this ephemeral moment be converted into an enduring one?

(This article was first published in Himal Southasian.)