CASE STUDY: Decisiveness Amid Uncertainty: Reflections on Vietnam’s War on COVID-19

Introduction

 Vietnam has a population of over 96 million people across 58 provinces and 5 municipalities under the command of the central government’s 18 ministries.[i] Early in the year 2020, as in countries the world over, policy makers within various agencies of the Government of Vietnam received word that a novel pneumonia-like illness had been identified in China. Given Vietnam’s 1,065 km land border with China, the country’s agencies went on high alert.[ii] On January 23, 2020, the first cases of the novel coronavirus, dubbed COVID-19, were identified in Vietnam. As the virus began to spread, Vietnamese policy makers implemented a wide range of effective measures to limit the social and economic impacts of the virus. The outcome of their swift decisions enabled Vietnam to become a global leader in COVID-19 containment, with one of the lowest infection rates of any country.[iii] Many of these measures were similar to countries around the world and included border closures, contact tracing, mask wearing mandates and movement restrictions.[iv] Vietnam’s response also had a number of unique characteristics due to its own specific socio-political factors. For example, it has a one-party centralised socialist government. It also had effective direction of the Communist Party and Governement, with the strong leadership of Deputy Prime Minister Vu Duc Dam, the Head of the National Steering Committee for COVID-19 epidemic prevention and control, a decisive leader with the confidence of the people.[v] It was also able to respond with a relatively low financial cost.[vi] Furthermore, the country has a long history of resilience in the face of crises, with a demonstrated ability to mobilise the citizenry to overcome war and countless natural disasters.

There were, however, many elements of success in Vietnam’s policy response to COVID-19 that can be applied more broadly. Learning about and analysing the decisions made can prepare decision makers to respond more effectively to future national emergencies. This case study highlights three main areas of success in Vietnam’s response to the COVID-19 crisis:

1. The Government of Vietnam’s crisis preparedness and quick response at an early stage of the pandemic;
2. The Government of Vietnam’s effective use of communication; and
3. The empowerment of local governments to respond locally.

 The case study follows the developments around the spread of COVID-19 in Vietnam chronologically. Part I looks at the month of January 2020, when the virus spread was at an early stage. Parts II and III focus on the period of March and April 2020, when the first wave of the virus was in full force. The epilogue will highlight key responses to the crisis in general, including the second wave of COVID-19 infections in Vietnam, which began around July 2020. The case study is intended to be used for ­­­­teaching and learning in leadership or policy maker training, as a whole, or in individual parts, corresponding to the main areas of success of Vietnam in responding to the COVID-19 pandemic mentioned in this case study.

A nation ready for crisis

When news of the outbreak of a pneumonia-like virus in Wuhan, China first reached Vietnam in early January 2020, the potential threat was difficult to ignore. Vietnam has a developing healthcare system, close proximity to China, and a large population. Nonetheless, Vietnam also had past experience with emergencies and viruses like the Severe acute respiratory syndrome (SARS) outbreak in 2003.

January 1 2020

Mr Nguyen Van Nam, Director General of the General Department of Preventative Medicine at the Ministry of Health, received an email from the Minister of Health forwarding an email from the World Health Organisation (WHO) alerting Vietnam to an outbreak of a pneumonia-like virus in Wuhan, China. Reports suggested that it resembled SARS. The Minister had requested a meeting the next day to discuss this new virus and what early measures Vietnam could put in place. Mr Nam had come across some brief reports from Chinese and international counterparts just the day prior and had already been closely monitoring information coming out of China. [i]

 Mr Nam was a young official in the Ministry back in 2003 when SARS spread in Vietnam and killed five doctors and nurses. Vietnam had successfully controlled the SARS outbreak in six weeks and worked closely with international experts. The success of containing SARS without more deaths was in part because of Vietnam’s transparent collaboration with the international community, decisive action of the government and the sacrificial efforts of

the doctors and nurses who isolated themselves at the hospital despite the great risk to their lives.[ii] Mr Nam recalled that SARS was most infectious when patients were the sickest and thus in hospital, explaining how Vietnam’s outbreak was limited mainly to hospital staff. What if this virus was more infectious, would Vietnam be able to stamp it out as quickly? [iii]

 Over the past two decades Vietnam had also developed its public health infrastructure to contain the spread of infectious diseases. This included greater coordination between Ministries and better resources for the Ministry of Health to work with the provincial and district-level authorities to help engage all citizens in the efforts to combat disease. With experiences from combating SARS fresh in his mind, Mr Nam went through whatever reports he could find from the WHO, ASEAN and Chinese counterparts, to find out more about the symptoms, fatalities and infection rate of the new virus. He also reached out to regional Vietnamese infectious disease agencies to see if there were reports of patients with similar symptoms.[iv]

At the meeting the next day, different officials and experts presented their opinions and research about what was known about the new virus. It was clear that, at the very least, the border needed to be tightened to prevent the virus entering Vietnam. Even though Vietnam had yet to report a case and there was no evidence of human-to-human transmission, it was impossible to assume that the virus had not already entered Vietnam given its border with China.  The Minister agreed to immediately present the information they had provided to the Prime Minister and relay the need to strengthen the border. The Minister also wanted to make immediate plans for Vietnam’s response to prevent the virus from spreading. He called for a larger meeting on January 7 with international health experts and the Ministry of Health officials to decide on Vietnam’s next steps.

At the end of the brief meeting, Mr Nam walked hurriedly out of the Minister’s office to get right to work. He had been asked to coordinate the Ministry of Health’s scenario planning of the virus spread in Vietnam as well as government responses to each of these scenarios to be presented at the January 7 meeting.

While Mr Nam had a difficult task ahead of him to prepare for the upcoming meeting, he was not alone. In addition to his Ministry of Health counterparts, he had at his disposal the Vietnam Public Health Emergency Operations Centre (PHEOC)[1]. Set up in 2017, the PHEOC’s main goal was to share information promptly and proactively as well as coordinate resources to prevent infectious diseases and major public health emergencies. It has four regional offices located at four of Vietnam’s main public health institutes: National Institute of Hygiene an Epidemiology, Pasteur Institute at Ho Chi Minh city, Tay Nguyen Institute of Hygiene and Epidemiology, and Nha Trang Pasteur Institute.[v]

 The Ministry of Health had also been anticipating a rise in infectious diseases globally with Ebola and MERS-CoV, and in December 2019, set up the Rapid Response Team under PHEOC. As a result, a quick and nimble mechanism had recently been set up to support the Central, Provincial and District levels of government with a team of epidemiologists, infectious disease specialists, logistics specialists, and laboratory workers designed to move quickly to any potential outbreak area to diagnose, test, contain and communicate about suspected diseases. However, these teams had never been used before and if this virus were to spread fast it might be too much for them. Another aspect that the scenario planning had to consider was ensuring that all localities could be reached to educate them about any potential viruses. During past disasters, like floods and storms, rural areas had suffered waiting for help from the provincial and central government authorities. To build more local capacity to respond to various disasters, including public health emergencies the government adopted the ‘four on-the-spot’ motto in 2006.[vi] It replicates a structure of emergency preparedness from the local authority level down to the household. At each level, leadership, human resources, materials and logistics plans are in place to be activated just before, during and after a disaster. Who makes the decisions, what resources do communities and households have available to save lives, and how are these resources distributed? These are the questions that the ‘four on-the-spot’ motto address. In the case of viruses, Mr Nam’s predecessor had already introduced the motto to the Ministry of Health for controlling influenza, bird flu, cholera and other infectious diseases. But the application of such disaster preparedness plans still faced numerous infrastructure and funding challenges, especially in rural areas. Any effort to control the virus would require an extraordinary amount of coordination from the central government all the way down to each household. [vii]

January 7 2020

The planning meeting was convened with representatives from the Ministry of Health, the PHEOC, the Institute of Hygiene and Epidemiology, Central Hospital for Tropical Diseases, and experts from the WHO, the Centers for Disease Control and Prevention (CDC), and the Food and Agriculture Organization United Nations (FAO).[viii]

 A few risk factors were clear from the meeting:[ix]

• With the upcoming Tet Lunar Holiday, there would be many returning Vietnamese from China and abroad traveling within the country. Infectious diseases are known to spread in Vietnam during this time.
• Not much was known about the ‘pneumonia-like virus’ including how infectious it was, how to treat it and how verifiable the information coming out of China was. [x]
• If the disease was not prevented from spreading, and it proved to be as deadly as SARS or MERS-CoV, it could easily overwhelm the health system and result in a major public health crisis.

 In addition, Vietnam’s past experiences with infectious diseases like SARS and Influenza A taught Vietnam the need to focus on prevention rather than management of the spread of the disease.

In response to these risk factors, international health experts from the WHO recommended the need to remain vigilant and monitor the disease closely by alerting hospitals and clinics to activate their infectious disease protocols to look out for anybody with respiratory symptoms. They did not recommend closing the border with China, restricting international travel, or instituting large scale public health measures like restricted movement or the closures of schools. Not much was known about the virus at this point and Vietnam had yet to report a case. Everyone in the room was mindful of the need to proactively prevent an epidemic without causing major disruption to people’s lives and the economy. In fact, the scenarios and responses that Mr Nam and his team had planned out were designed to ensure the gradual introduction of public health measures so as not to cause social and economic disruption.

 Mr Nam and other officials from the Ministry of Health determined three clear scenarios from best to worst case:

1) No virus cases in Vietnam;

2) Cases in Vietnam that could be traced to overseas arrivals;

3) Widespread community transmission in Vietnam.[xi]

 In each of these scenarios he was certain there was a need to do more than leave it to hospitals to look out for patients with symptoms. However, it would be challenging to convince the public to be vigilant when Vietnam had no reported cases and so little was known about the virus. He had to also convince the Minister of Health and all the people in the room now that there was no time to delay in reaching out to the public and to begin proactively educating them on virus transmission.[xii] Implementing comprehensive measures above and beyond WHO advice and convincing the WHO about the relevance of those measures, was necessary, even at this early stage.

Discussion Questions:

• What solutions would you have advised the Government for each of the above three scenarios?
• There were no reported cases in early January 2020. What additional information would the Deputy Prime Minister need in order to decide the kinds of measures Vietnam should put in place at this early stage (above and beyond WHO advice)? To assist you, think of examples in the following categories: public health information, economic/financial information, demographic information, immigration information, among others.
• Why is it important to have multiple scenarios when planning in an emergency/crisis situation?

Resolution

Decision 156 from the Ministry of Health issued on January 20, 2020, before the first reported case of the virus, was a comprehensive decision preparing the country for three different scenarios of virus transmission (outlined above in Part I). Focusing on direction and inspection, communication, monitoring and prevention, treatment, logistics and international cooperation, the pivotal decision (Decision 156) would set the tone for Vietnam’s strong and proactive response. By January 30, 2020 when Vietnam had five cases and no deaths, the National Steering Committee was set up. Comprising all relevant Ministries as well as departments and even the press and telecommunication companies, it was a multisectoral response. The Steering Committee was tasked with advising the Prime Minister and coordinating between all departments to ensure every measure was implemented.[i] In all of their early decisions, Vietnam decision makers had taken note of actions taking place in China, where the virus first originated. In China, there was construction of field hospitals and a strict lockdown in Wuhan. The Chinese government had an extraordinary meeting during the lunar new year. All of these signs indicated that the virus was a serious concern in China and Vietnam could not hesitate. [ii]

Part II

Effective Communication and Stopping Disinformation

Between January 2020 and March 2020, around 600,000 articles, posts and videos related to the pandemic were shared on social media. [i] This included many types of fake and misleading information. The types of misinformation can be categorised as 1. those related to suspected COVID-19 cases; 2. private information about the lives of patients; 3. false offers for virus testing; and 4. false information about how to prevent and tre at the virus.[ii] Each of these threatened to weaken trust in government institutions and solidarity amongst the public in combating the virus if not handled effectively. A whole-of-government effort at the central and local levels, together with the cooperation of international and private media companies, was necessary.[iii] Such cooperation enabled official Ministry of Health messaging to reach over 50 million users a day on social media platforms.[iv]

With quick and decisive action, Vietnam was able to introduce many successful policy measures in the early days of the virus spread. This continued through later stages of the pandemic. In terms of communication policy, this included timely, transparent and accurate messaging regarding the virus and its spread.[v] To do this, government agencies at all levels used a wide range of digital and traditional tools to reach the broadest cross-section of the population possible. These measures included spreading public health messages and updates through social media platforms, house visits by networks of volunteers, the enlistment of popular entertainment figures to produce educational songs and poems, and translated in all local languages, and even the once controversial, but highly effective, loudspeaker systems scattered throughout each commune to repeatedly spread educational messages related to proper hand washing, social distancing and mask wearing. [vi][vii]

 Public messaging evoked a sense of collective action against the ‘enemy’ virus, with one well-distributed poster stating, ‘staying at home is patriotic’ (ở nhà là yêu nước).[viii] The Prime Minister himself broadcast catchy slogans such as, ‘Fighting against the pandemic is like fighting against the enemy’ (chống dịch như chống giặc). The success of such policies early in the pandemic led to the announcement of Deputy Prime Minister Vu Duc Dam on February 25^th 2020, that all 16 COVID-19 patients identified in Vietnam had been cured. The Deputy Prime Minister declared that Vietnam had ‘won’ the first battle of its fight against the virus but needed to remain vigilant.

Patient 17

On March 6, 2020, health authorities discovered COVID-19 patient number 17.[ix] She was a young woman who had returned from England on flight VN0054 on March 2. She was the first reported infection in Hanoi and Vietnam was in high alert again. People in close contact with the patient were quarantined and the area where she lived was secured and sanitized. In all, over 200 passengers and crew on her flight, her relatives, as well as all medical staff who came into contact with her were isolated and quarantined. The systems to mitigate spread of COVID-19 were all effectively put in place and government agencies had a unified, quick and strict response.[x] However, the atmosphere amongst the general population was of anxiety, confusion and disappointment. Being so close to containing the virus, how could it be that it was still able to spread? Formal and informal news networks, as well as many social media users, were busily crafting theories and explanations. Some of these stories were grounded in truth. Others had elements of truth but filled in gaps of information with falsehoods. And many were complete distortions of the truth.

 Some people on social media criticized patient 17 for being wealthy and traveling to COVID-19 hotspots while making false declarations on health forms. Rumors of her ‘luxurious’ trips spread like wildfire online.[xi] The spreading of false information also had practical consequences. In Lao Cai province, a famous tourist destination in the northern mountainous region of Vietnam, 300 kilometers from Hanoi, four social media accounts published misinformation that nine South Korean tourists on the same flight as patient 17 had entered Vietnam then visited the town of Sa Pa. The rumour quickly spread throughout the population, and on all the social media platforms. In a state of panic and fear, local people rushed to purchase essential goods, leading to depleted supplies and exorbitant prices.

The problem of COVID-19 disinformation for decision makers

The above situation created major challenges for decision makers to overcome in their fight against COVID-19. Firstly, the spread of confusion and fear amongst the population through disinformation, or ‘fake news’, can lead to insecurity and reduced confidence in government decision makers to lead the crisis response. Secondly, the hoarding of essential food and goods can lead to a supply shortage at the local level. This threatens to undermine the promise of local leaders that there is adequate food supplies. It can also lead to faster spread of the virus if people are concentrated in shops and waiting in lines. Beyond this, there were various other factors that complicated the response of decision makers. These include:

1. Tourists cancelling holidays to Lao Cai province due to false fears of COVID-19. This led to negative economic impacts as a direct result of the ‘fake news’;
2. Growing suspicion of foreigners, which led to some hotels refusing entry to Koreans for fear of catching the virus. This led to a potential strain in diplomatic relations between Vietnam and South Korea;

A growing sense of disappointment and fear in the general population. This threatened to undermine the unity and trust, which are essential in the fight against COVID-19.

Responding successfully to the crisis

In the night of March 6, 2020, soon after patient 17 was announced, Mr Quoc, Director of the Department of Information and Communications of Lao Cai province, received news from his staff of the fast-spreading disinformation regarding patient 17 and nine South Korean tourists. He first verified the information with the Department of Immigration (Ministry of Public Security) by phone. Following this he quickly prepared a preliminary plan to respond to the situation and submitted it to the Chairman of the Lao Cai Provincial People’s Committee. The Chairman agreed with Mr Quoc’s proposal and assigned the provincial Department of Information and Communications to urgently coordinate with relevant government agencies to handle the issue and report back by 16.00 on March 7.

In the morning of March 7, the Director of the Department of Information and Communications of Lao Cai province convened an urgent meeting with the purpose of handling the spread of false information about the nine Korean tourists as well as developing a plan to respond to fake news in the prevention of COVID-19 in general.[i] The capacity of local Vietnam decision makers to engage in rapid, multi-sectoral decision making is a key strength in the country’s response to the COVID-19 crisis.[ii] The following representatives were present at the meeting:[1]

• Mrs An, Representative of People’s Committee of Lao Cai province
• Chief of the Office of the Department of Information and Communications of Lao Cai province
• Heads of different divisions and units of Department of Information and Communication of Lao Cai province: Lao Cai Information Technology and Communication Center; Division of Post and Telecommunication – Information Technology; Inspection Division
• Representative of Public security team of Lao Cai city
• Representative of the Subcommittee on COVID Prevention Information 19
• Leader of the People’s Committee of Sa Pa district
• Representatives of radio, television and press agencies of Lao Cai province
• Leaders of relevant departments: Department of Health, Department of Tourism, Department of Foreign Affairs, Department of Market Management of Lao Cai Province

 Below is a reenactment of some of the options and challenges that were discussed at the meeting.

 Mr Quoc: Fellow colleagues, we are faced today with the challenging task of responding to the misinformation spreading rapidly in our province. Our response should be swift, yet thorough. What is the best course of action to take?

 Mrs An: It will send a clear signal to the instigators of ‘fake news’ if we take a hardline approach that focuses on detection and criminal punishment. This will deter others from creating and spreading further disinformation.

 Mr Thang: I agree with Mrs An. We need to take quick action against the people behind the four social media accounts that initially started the rumors about the Korean tourists. Where possible, those who shared the news should also be punished. We need to make this response public so that people think twice about sharing such false news.

 Mrs Minh: These people spreading the news are not the real problem here. It is the media companies that allow this to be shared in the first place. We need to go to the source to stop the spread. If we are too tough, the population could become even more fearful at a time when fear and mistrust are the enemy to fighting the pandemic.

 Mr Thang: It’s true. Many of those sharing these stories on social media are trẻ trâu (buffalo children/millennials). Sanctions that are too strong will negatively impact their future.

 Mr Quoc: There is also the challenge of identifying the correct perpetrators. On social media many people are anonymous. If we stop one post here, they could just create another account and post on another social media website under a different name and IP. Remember, we have over 60 million social media users in Vietnam!

Resolution

At the end of the meeting, the delegates submitted to the Chairman of the Provincial People’s Committee an urgent dispatch with a multi-strategy plan. Below are a few key points:

1. The Department of Information and Communication, together with verification from the Ministry of Public Security, would issue a clear and concise written notice on the situation of the nine Korean tourists travel to Sa Pa (see Annex 2).
2. The Department of Information and Communications would work closely with the press, through online, radio and television to inform the public about the actual situation of patient 17. This would be done with clear language and would be translated into the local ethnic languages.
3. Informing the public would use all forms of communication possible. This included social media, text messages, traveling loudspeakers and traditional broadcasts. The aim was to control the message with accurate information and reach the largest possible number of people.
4. The Department of Public Security, in collaboration with Department of Information and Communication of Lao Cai province (Information Technology and Communication Center; Division of Post and Telecommunication – Information Technology; Inspection Division), would use technology to identify the perpetrators of fake news, determine the reasons and motives for posting fake news, explaining so that the people who posted fake information are aware of their mistakes and then get them to remove posts, publish corrections and understand their mistakes, public apology and commit not to repeat it.
5. Lao Cai City Public Security Team eventually fined four people who spread fake news (10 million VND [435 USD] each) and widely publicized this information on the mass media.

A Decentralised Response to the Crisis

Control activities at main entrance of Bach Mai hospital, locked down as a major Covid-19 outbreak area

The preparedness and decisive actions of Provincial and District governments throughout Vietnam in response to the spread of COVID-19 were a critical part of its success.[i] This did not happen by accident. Historically in Vietnam, close attention to the capacity development of local governments has been a priority as it has gradually gone through decentralization reform over the last 40 years.[ii] The efforts to contain COVID-19 provided an opportunity to test the strength of these systems through an all-of-government response, where every decision maker needed to make significant choices under a great deal of pressure and uncertainty.

The response of local authorities to the pandemic required different approaches in urban and rural areas.[iii] However, all provincial and district government officials were faced with the challenging task of applying Central Government laws and policies related to the spread of COVID-19 to the local context and fast-changing realities in their jurisdictions.[iv] A locality with high density housing, for example, would have different risks and priorities than another which was a mountainous tourist destination. Yet some aspects of the response to the virus were universal. Local governments played an important role in early action on school closures, supporting social and economic relief initiatives, contact tracing and providing essential health services, among others.[v] Below is a fictionalised story, based on factual events that occurred around March 2020 and April 2020. Its purpose is to highlight the challenge of decision-making amidst uncertainty and facilitate reflection on the relationship between levels of government in responding to a crisis situation.

Local Government Decision Making in a time of Crisis: A Story for Reflection

As mentioned in Part I above, the speed with which Vietnam policy makers responded to the threat of the pandemic was clearly one of the strengths of the response. This was true at all levels of government, from the Central to the Provincial to the District and the Commune. This agility, however, also brought with it challenges for provincial, district and commune officials to correctly interpret the directives and apply them to the realities of their own jurisdictions. One such decision maker was Phan Văn Duc,[1] the Chairman of the People’s Committee of Province X.[2] Province X has a population around half a million people and its economy is largely dependent on agriculture. It only has three main hospitals with the capacity to treat seriously ill patients, and a largely rural population spread across the province, with many of its young people working in larger cities in other provinces. Each district has varying capacities to deal with the virus. For example, in urban districts with higher population, the risk of transmission is high but there is hospital, while some rural districts have a lower transmission risk but no nearby hospital.[vi] Mr Duc was faced with a challenging decision: how to apply the Central Government directives if they can be interpreted in multiple ways, especially with each district having different needs?

The Provincial Government’s authority to take action in Province X, as the crisis threat of COVID-19 grew, came from The Law on Prevention and Control of Infectious Diseases 2007[i]. This empowers the provincial level decision makers to choose to enact public health directives in accordance with national law. They were also given another decision-making instrument by the Prime Minister on April 3, 2020; Directive No. 16 / CT-TTg On Urgent Measures for COVID-19 Epidemic Prevention and Control.[ii] This Directive requires all people in the province to socially distance, wear masks and stay home for 15 days. It also requires restaurants, karaoke and cafes to shut. Directive 16 was initially applied all around Vietnam in the quick response to stop the spread of the disease. However, while he faithfully obeyed and understood the need to act quickly, Mr Duc was not completely comfortable with the application of Directive 16 in his province because it had no recorded COVID-19 cases. Closing businesses and initiating a lockdown would be difficult for the businesses and people. It was also not completely clear to him if Directive 16 meant that people could leave their homes for reasons such as visiting the doctor, or if it was to be a strictly policed with fines given when people left the house for any reason. At the same time, he was worried that young people from other provinces returning home would spread the disease and it could easily overwhelm the few hospitals. Because there was an urgent need to act fast, Directive 16 had to be implemented immediately and there was no time to clarify the information from the Central Government.

Swift Action in Uncertainty – April 3-15 2020

In normal circumstances, Mr Duc might have sent a official communique (công văn) to the Central Government to seek clarification about the need to apply Directive 16, given no cases in his province, and the strictness of the home lockdowns. However, he knew from the case of SARS that the immediate threat of a pandemic meant that action had to be taken now to limit the impacts on people and the economy in the long term. There was no time to lose by seeking clarifications. Therefore, rightly or wrongly, he implemented the Directive in very strict terms. First, he ensured that police issued fines for people who left their homes during the two-week lockdown. Second, he set up fencing around roads to block the movement of people in major areas. Third, he stopped all people from traveling from one locality to another.

Some of these decisions, it turned out, were inconsistent with the intentions of Directive 16. This was clarified on April 3 through Prime Minister Document No. 2601/VPCP-KGVX, which provided further guidance on implementation of Directive 16. People were indeed allowed to travel if necessary and to leave their homes for essential supplies such as food and medicine. Mr Duc’s actions also had unintended consequences. As people thought that they would not be able to buy food for two weeks, they overbought which created unnecessary panic in some places and price increases due to speculation. People were also separated from their families, which caused problems for family members dependent on each other. However, these decisions also managed to ensure his province had no cases. When faced with the challenge of how to rapidly implement Directive 16 in a crisis situation, Mr Duc decided that it was safer to interpret the Directive quickly in a strict sense so that it would better fit the Central Government’s wishes. He knew that the Central Government had excellent scientific and economic advisors and experience with previous infectious diseases. He believed that applying the Decision would protect his people from the virus. Still, if he had waited for the clarification from the Central Government, he may have interpreted the Directive better and chosen a different course of action.

Clarity through Communication – April 15-24 2020

After this initial two-week lockdown, the Central Government looked to the local leadership of the Provincial Government for the next of the crisis management. The National Steering Committee consulted all 63 provinces in Vietnam for their opinions on the crisis response based on their local realities. These consultations included valuable inputs from the district level government officials who also had a good relationship with commune leaders and a clear understanding of the situation in their localities. This flow of communication enabled information to be shared across local governments with an all-of-government effort. Even though policies were mostly designed by the Central Government, its implementation is conducted by local leaders, the decision makers at the provincial and district levels were therefore crucial to its success.

A number of provincial officials concurred with the need to continue social distancing and to take a province-by-province approach based on the unique needs in each place. The Central Government agreed that the Chairman of the Provincial People’s Committee would decide what form of social distancing measures should be used throughout a province. However, to ensure that implementation of measures would not be overly diverse and chaotic, causing confusion, the Central Government classified provinces according to three risk-categories: high, medium and low. Until April 22, high risk provinces strictly adhered to Decision 16, while those at medium risk could look at the opening up of some key economic activities while adhering to Decision 16.  Those with low risk could go back to Directive 15, which allowed gatherings of up to 20 people in a room.[i]

The Prime Minister then made Directive 19 / CT-TTg on April 24 2020, which clarified how to implement measures to prevent and control the COVID-19 epidemic given the evolving situation as a follow-up to Directive 16. It still mandated social distancing and mask wearing but allowed groups of five people to gather and restaurants to remain open with safe distancing measures.^[ii] This permitted a less strict and more flexible response to COVID-19 management at the provincial level in places with no cases and allowed each provincial government to decide when and where to apply the previous Directive 16, if there were COVID-19 cases within a 28-day period. Crucially, it allowed the local authorities to have more proactive decision-making authority.[iii]

No Easy Solutions – After April 24 2020

 With more clarity about implementing the Directives, Mr Duc and the People’s Committee were then faced with another challenge. There was one suspected case in his province of a student who returned from Ho Chi Minh, who was previously infected but tested negative on returning, but was now testing positive again. Should the People’s Committee of Province X implement the strict Directive 16 or the more lenient Directive 19? If he chose the Directive 16 option, local economies could suffer and problems could arise with people staying home. However, it might also be safer given the sudden threat of this case.  If he chose Directive 19, people could still carry on with daily life under different conditions, but there was higher risk of the disease spreading out of control in the more densely populated areas of the province. Mr Duc could not predict the future, but he could weigh these issues, in light of Central Government laws and policies, and make a decision to the best of his ability.

Epilogue: Combatting the second-wave in Vietnam

Throughout February and March 2020, as the virus spread in the community, Vietnam gradually introduced a range of measures including nationwide social distancing on April 1, to slow down the rise in cases. By June 1, the country opened up internally with the resumption of domestic flights. On July 25, after 99 days with no community transmission, Patient 416 emerged, a 57-year-old man from Da Nang. This marked the start of Phase 3 and Danang went into lockdown. Within just a few days almost 50 cases were reported including in Hanoi and Ho Chi Minh. As domestic travel had resumed an estimated 80,000 people had travelled to the coastal town during that time and had to be evacuated without further spreading the virus. By July 28, the whole city of Da Nang was placed in lockdown and Vietnam was put into high alert again. The new outbreak virus strain was more contagious, with eight deaths linked to it. [i]

Various theories emerged as to the resurgence. First, people smugglers from China had brought the virus in through the illegal trafficking of migrants. Secondly, Vietnam’s borders had been closed since the end of March, except for repatriation flights, and so returning Vietnamese could have been a source.[ii] A third theory, was that the virus was never fully eliminated and was spreading in the community without detection until Patient 416. As the country had no reported cases for a few months, people could have grown complacent, relaxing social distancing and mask wearing guidelines.

Regardless, the government responded swiftly, but this time with targeted lockdowns to ensure the least economic disruption possible. The Central Government sent its most experienced team to Da Nang to assist with controlling the virus spread. In addition to the successful application of the traditional methods of contact tracing, disinfecting and quarantining, the country carried out widespread testing. Almost the entire population of Da Nang was tested. Hanoi tested about 50,000 people who returned from Danang, and districts where cases were reported were put into local lockdown. By September 11, 2020, Da Nang had not reported any cases for 14 days and restrictions were eased. All new cases throughout the country could be traced to Da Nang, meaning there was no wide-spread community transmission. The success of stamping out the second wave within six to eight weeks built on Vietnam’s decisive, comprehensive and rapid approach since it first learned of the virus. To date, a year after the virus came to global attention, Vietnam has only reported just over 1500 cases with 35 deaths as of January 2021, while the global toll stands at over 90 million infections and close to 2 million deaths.[iii]

[i] Ibid.

[ii] Hugh Bohane, “On the ground in Vietnam’s new COVID epicenter of Danang,” Nikkei (Danang) 2020, https://asia.nikkei.com/Spotlight/Coronavirus/On-the-ground-in-Vietnam-s-new-COVID-epicenter-of-Danang.

[iii] Malhotra, “The key to Viet Nam’s successful COVID-19 response: A UN Resident Coordinator Blog.”; “Covid-19 Dashboard.”

[i] “28 tỉnh, thành phố tiếp tục thực hiện Chỉ thị 16/CT-TTg.”; “28 tỉnh, thành phố tiếp tục thực hiện Chỉ thị 16/CT-TTg.”

[ii] Prime Minister Directive No. 19 / CT-TTg, 24 April 2020, http://ubmttqvn.quangnam.gov.vn/Default.aspx?tabid=127&ni=472.

[iii] Ibid.

[i] Government of Vietnam, Law on the Infectious Disease Prevention and Control 2007, http://www.chinhphu.vn/portal/page/portal/chinhphu/hethongvanban?class_id=1&;_page=1&mode=detail&document_id=51257.

[ii] Prime Minister Directive No. 16 / CT-TTg 31/3/2020, https://thuvienphapluat.vn/van-ban/EN/The-thao-Y-te/Directive-16-CT-TTg-2020-implementation-of-urgent-measures-for-prevention-and-control-of-Covid-19/438660/tieng-anh.aspx.

[1] This is a factual scenario. However, all names and locations have been changed and are provided here for educational purposes only.

[i] Dat Huynh, Mehmet Serkan Tosun, and Serdar Yilmaz, “All‐of‐government response to the COVID‐19 pandemic: The case of Vietnam,” Public Administration and Development 40, no. 4 (2020), https://doi.org/10.1002/pad.1893.

[ii] Melissa Dell, Nathan Lane, and Pablo Querubin, “State Capacity, Local Governance, and Economic Development in Vietnam,” National Bureau of Economic Research  (2015).

[iii] Xuan Tran, B., H. Thi Nguyen, H. Quang Pham, H. Thi Le, G. Thu Vu, C. A. Latkin, C. S. H. Ho, and R. C. M. Ho. “Capacity of Local Authority and Community on Epidemic Response in Vietnam: Implication for Covid-19 Preparedness.” Saf Sci 130 (Oct 2020).

[iv] Le Quy Phuong, “Author interview with Chairman, People’s Committee of Tay Loc Ward, Hue City,” 14 October 2020.

[v] Huynh, Tosun, and Yilmaz, “All‐of‐government response to the COVID‐19 pandemic: The case of Vietnam.”

[vi] Phuong, interview.

[1] This meeting actually took place in Lao Cai on March 6^th 2020 and the general outcomes and attendees have been documented elsewhere. Here, the dialogue and characters are fictional and representative in order to achieve the educational objectives of this case study. Where possible, the information presented is factually accurate based on interviews with representatives of the respective agencies.

[i] Mr. Tang Van Hanh, “Author interview of Deputy Director of the Department of Information and Communications, Lao Cai Province,” 2020.

[ii] B. Xuan Tran et al., “Capacity of local authority and community on epidemic response in Vietnam: Implication for COVID-19 preparedness,” Saf Sci 130 (Oct 2020), https://doi.org/10.1016/j.ssci.2020.104867, https://www.ncbi.nlm.nih.gov/pubmed/32834512.

[i] Hong Kong Nguyen and Tung Manh Ho, “Vietnam’s COVID-19 Strategy: Mobilizing Public Compliance Via Accurate and Credible Communications,” Yusof Ishak Institute: ISEAS Perspective, no. 69 (25 June 2020).

[ii] Ibid.

[iii] Năm, Thứ. “Tin Giả Và Trách Nhiệm Của Báo Chí.” Tuyên giáo (Hà Nội), 30 July 2020. http://tuyengiao.vn/cung-suy-ngam/tin-gia-va-trach-nhiem-cua-bao-chi-128965.

[iv] Ibid.

[v] La, Viet-Phuong, Thanh-Hang Pham, Manh-Toan Ho, Minh-Hoang Nguyen, Khanh-Linh P. Nguyen, Thu-Trang Vuong, Hong-Kong T. Nguyen, et al. “Policy Response, Social Media and Science Journalism for the Sustainability of the Public Health System Amid the Covid-19 Outbreak: The Vietnam Lessons.” Sustainability 12, no. 7 (2020). https://doi.org/10.3390/su12072931.

[vi] Ibid.

[vii] Nguyen Xuan Son, “Author interview with Director of Thua Thien Hue Communication and Information Department,” 24 October 2020.

[viii] Ibid.

[ix] “Xuất Hiện Bệnh Nhân Thứ 17 Nhưng Đừng Quá Hoang Mang “. CÔNG AN NHÂN DÂN (Hà Nội), 7 March 2020 2020. http://cand.com.vn/Xa-hoi/Xuat-hien-benh-nhan-thu-17-nhung-dung-qua-hoang-mang-584673/.

[x] La, Viet-Phuong, Thanh-Hang Pham, Manh-Toan Ho, Minh-Hoang Nguyen, Khanh-Linh P. Nguyen, Thu-Trang Vuong, Hong-Kong T. Nguyen, et al. “Policy Response, Social Media and Science Journalism for the Sustainability of the Public Health System Amid the Covid-19 Outbreak: The Vietnam Lessons.” Sustainability 12, no. 7 (2020). https://doi.org/10.3390/su12072931.

[xi] Ibid.

[i] Ms. Bui Minh Thu, “Author interview with expert from the Department of Communication at the Vietnam Ministry of Health,” 2020.

[ii] “28 tỉnh, thành phố tiếp tục thực hiện Chỉ thị 16/CT-TTg,” Chinhphu.vn, 16 April 2020, http://baochinhphu.vn/Tin-noi-bat/28-tinh-thanh-pho-tiep-tuc-thuc-hien-Chi-thi-16CTTTg/393227.vgp.

[1] On 21 August 2017, the Ministry of Health issued Decision No. 3796 / QD-BYT to establish the Vietnam Public Health Emergency Operations Centre (PHEOC) (under the General Department of Preventative Medicine).

[i] International Society for Infectious Diseases, “Undiagnosed pneumonia – China,” news release, 12 December 2019, https://promedmail.org/promed-post/?id=6864153%20#COVID19.

[ii] Kevin Fong, “Sars: The people who risked their lives to stop the virus,” BBC News (London), 16 August 2013 2013, https://www.bbc.com/news/magazine-23710697.

[iii] Fong, “Sars: The people who risked their lives to stop the virus.”

[iv] Nguyen Duc Thanh, “Author interview with the Deputy Chief of Staff, Ministry of Health, Government of Vietnam,” 29 October 2020.

[v] Ministry of Health Decision No. 3796 / QD-BYT, 24 September 2014.

[vi] The Joint Advocacy Network Initiative, Four On-The-Spot Motto in Disaster Management: Key contents and actual application, Care International Vietnam (Hanoi, 2010), https://www.preventionweb.net/files/13235_13235FouronthespotMotto1.pdf.

[vii] Initiative, Four On-The-Spot Motto in Disaster Management: Key contents and actual application.

[viii] Thanh, interview.

[ix] Ibid.

[x] “Mr Mai Tien Dung: Vietnam’s anti-epidemic does not rely on international recommendations,” VN Express (Hanoi), 1 January 2021, https://vnexpress.net/ong-mai-tien-dung-viet-nam-chong-dich-khong-dua-vao-khuyen-cao-quoc-te-4214860.html.

[xi] Ministry of Health Decision No. 156 / QD-BYT, January 20, 2020.

[xii] Ibid.

[i] “Vietnam’s Socio Economic Situation,” Data and Statistics, General Statistics Office of Vietnam, Government of Vietnam, 2020, accessed December 5, 2020, https://www.gso.gov.vn/en/data-and-statistics/2020/09/infographic-socio-economic-situation-2019/.

[ii] Tomoya Onishi and Yuchi Nitta, “Coronavirus fears haunt Vietnam and Myanmar border towns,” Nikkei (Hanoi), January 29, 2020 2020, https://asia.nikkei.com/Spotlight/Coronavirus/Coronavirus-fears-haunt-Vietnam-and-Myanmar-border-towns.

[iii] Kamal Malhotra, “The key to Viet Nam’s successful COVID-19 response: A UN Resident Coordinator Blog,” UN News (Geneva), 29 August 2020 2020, Health, https://news.un.org/en/story/2020/08/1070852.; “Covid-19 Dashboard,” Johns Hopkins University Coronavirus Resource Center, 2020, accessed December 5, 2020, https://coronavirus.jhu.edu/map.html.

[iv] Dinh, L., P. Dinh, P. D. M. Nguyen, D. H. N. Nguyen, and T. Hoang. “Vietnam’s Response to Covid-19: Prompt and Proactive Actions.” J Travel Med 27, no. 3 (May 18 2020). https://doi.org/10.1093/jtm/taaa047. https://www.ncbi.nlm.nih.gov/pubmed/32297929.

[v] Ha, B. T. T., Quang Ngoc, T. Mirzoev, N. T. Tai, P. Q. Thai, and P. C. Dinh. “Combating the Covid-19 Epidemic: Experiences from Vietnam.” Int J Environ Res Public Health 17, no. 9 (Apr 30 2020). https://doi.org/10.3390/ijerph17093125; uynh, T. L. D. “The Covid-19 Containment in Vietnam: What Are We Doing?”. J Glob Health 10, no. 1 (Jun 2020): 010338. https://doi.org/10.7189/jogh.10.010338. https://www.ncbi.nlm.nih.gov/pubmed/32373318.

[vi] John Reed, “Vietnam’s coronavirus offensive wins praise for low-cost model,” Financial Times, March 24 2020 2020.