Cambodia has achieved an impressive rate of vaccination against COVID-19. In mid-November, 79% of the population had been fully vaccinated with two doses, putting the country among Asia’s leaders. Only Singapore has done better with a full vaccination rate of 82.7%. South Korea, Malaysia and Japan are behind on 77.2%, 76.6% and 75.2% respectively.
What is hidden by Cambodia’s impressive performance?
For political, diplomatic and financial reasons, almost all of the vaccines used to date in Cambodia are Chinese (Sinovac and Sinopharm). If there is a country where vaccine diplomacy has been given free rein, it is the kingdom of Cambodia, which Prime Minister Hun Sen has sought to position in China’s orbit. This is shown by the maritime and airport facilities granted to Peking by Phnom Penh at a time when regional tensions over the South China Sea are continuing to grow.
Cambodia, in fact, is the only poor country which has received more vaccines than it needs thanks to Chinese largesse. Hun Sen has even been able to offer hundreds of thousands of Sinovac and Sinopharm vaccine doses to neighbouring Vietnam, Laos and Myanmar.
It’s in Cambodia’s political interests to promote Chinese vaccines. Hun Sen seeks to force the population to use them, avoiding individual liberties and personal choices and showing scorn for the precautions used in more developed countries where public opinion counts.
Hun Sen has made vaccination obligatory for everyone. Civil servants, and public and private-sector employees who are not vaccinated by a certain date will be fired. Children and adolescents between 12 and 18 also had to be vaccinated. Then the age threshold was lowered to six, with the threat of these young children otherwise being thrown out of school. That was done as a warning for the parents, who are not allowed to have an opinion on the risks imposed on their children.
This obligation for under-12s to be vaccinated was issued without the agreement of the World Health Organization (WHO). With the aim of satisfying China, which sees Cambodia as a testing zone for its vaccines, Hun Sen has decided to go beyond the developed countries which are still at the stage of clinical trials for child vaccination. In fact, in Europe and North America, there is still discussion over whether young children should be vaccinated and, if so, the dosage that should be used. Hun Sen prefers to decide himself unencumbered by scientific or prudential considerations. His goal is simply to reach the highest vaccination rate as quickly as possible.
The problem is in the almost exclusive dependence on Chinese vaccines, which reflects a wider political decision. Chinese vaccines do not seem to offer optimal efficacity, according to the most credible international comparative studies. They are not recommended in Europe or North America.
Compared with other countries which have a vaccination rate near that of Cambodia, but which use vaccines produced in the US and Europe, there are differences in mortality rates which can indicate differences in the effectiveness of vaccines.
If the number of deaths due to COVID-19 over a recent period of months is broken down between the vaccinated and the unvaccinated, in Cambodia, with Chinese vaccines, 33% of the deceased are vaccinated. In countries such as France or the UK, using American or European vaccines, the vaccinated represent less than 10% of deaths.
Knowing full well that Chinese vaccines are relatively less effective and fearing their possible dangers, Hun Sen himself chose to have the Anglo-Swedish vaccine AstraZeneca.
The world is now discussing the question of a third “booster” dose to reinforce and prolong the immunity given by the first two doses. Whatever the initial doses used, a growing number of scientists are now recommending a “messenger RNA” vaccine for the third dose, which means either Pfizer or Moderna. Both are produced by US firms.
To respond to this new demand, Cambodia will have to relinquish its quasi-exclusive dependence on Chinese vaccines. Hun Sen recently asked the Australian prime minister to fulfil a promise to supply millions of doses of Pfizer as quickly as possible.
On Nov. 8 it was announced that Australia will deliver 3 million doses of a Western vaccine to Cambodia, of which 1 million will arrive before the end of the year. By then, Cambodia will have received 2 million extra Chinese doses for free, while 100% of the target population of 10 million adults have already been vaccinated, as have 98% of children and adolescents between 12 and 18.
In contrast with many other poor countries, Cambodia is inundated with vaccines thanks to its good relations with China. But record vaccination rates do not necessarily mean that the pandemic will quickly be brought to an end, given the many other factors at play.
Cambodia has lost a lot of time due to ignorance, political obstinacy and the corruption of its leaders.
Even at the height of the pandemic, the country kept its borders open. Air links with China have always been maintained, notably with the city of Wuhan, the epicentre of the pandemic. On Feb. 18, 2020, Hun Sen declared that COVID-19 would only come to Cambodia on “31 February,” his way of saying “never.” He forbade masks from being worn in his presence. At the same time, his minister of health Mam Bunheng “reassured” the public by stating that COVID-19 could not take root in a hot country like Cambodia because “the coronavirus can’t survive at a temperature higher than 30C.”
COVID-19 exploded in Cambodia on Feb. 20, 2021 when a group of Chinese visitors who were supposed to be in quarantine bribed the Cambodian civil servants who were watching them and were able to move freely around the country.
Hun Sen is now trying to make up for lost time and put his failings right as he embraces vaccines with such zeal to the detriment of individual liberties and the most elementary precautions.
A further example of Hun Sen’s idiosyncratic methods: to hide the recent increase in infections, the dictator suddenly decided, by himself, to end antigen or rapid tests under the pretext that they are not reliable enough. He must know that in other countries where there are scientific advisors to help political leaders take complex decisions, these antigen tests are used in parallel with molecular (PCR) tests (which are longer, more complex and more costly to carry out) in order to measure contaminations in the fastest and most reliable way.
Cambodia’s case shows clearly that a dictator tends to decide everything by themself. This is true even in areas where specific knowledge and experience which the dictator does not have are required. This leads to the danger of politics interfering with public health.
The views and opinions expressed in this article are those of the author.
Sam Rainsy, Cambodia’s finance minister from 1993 to 1994, is the co-founder and acting leader of the opposition Cambodia National Rescue Party (CNRP).