State capacity and COVID-19 testing

COVID-19 raises issues of inequality within societies and forefronts the need for more inclusive innovation. It also lays bare a country’s ability to effectively mitigate the fallout of a pandemic through widespread mobilisation of different segments of society. It is about the extent to which the state can effectively marshal innovation, particularly, around testing.

Some countries have tested widely, like Germany and South Korea. As a result, they seem to have a better handle on the spread of the virus. While, other states, including the UK initially restricted testing to only the most ill. 

Underlying national testing strategies is the associated cost. The cost-benefit analysis of each test looks bleak on a population-level basis, with some countries reporting only a small percent of those tested were found to have the virus. However, even proponents of the so-called ‘herd immunity’ strategy are now coming around to the idea that widespread testing is essential.

The question then becomes: how can testing be done on a reliable, affordable and inclusive basis? If the cost calculation is too great, then only those who can afford to will be tested. This is dangerous for the whole of society, but particularly those in the most precarious economic situations.

Viet Nam’s fast, affordable test kits

Viet Nam has made headlines for responding to the outbreak efficiently, with limited resources. The country has focused on containing the virus through extensive communication (through direct text messages to citizens and enlisting war-time propaganda artists to adorn big cities with pandemic posters), the mobilisation of the army and compulsory, state-operated, centralized quarantine centres. It has organised informants both on the ground and through online social networks. It also has a public database of all people infected with the virus and discloses the whereabouts of patients. 

Perhaps most importantly, Viet Nam was one of the first countries to develop affordable test kits and export them to Europe. By early March, three different teams produced test kits that cost less than $25 and provided results within 90 minutes. 

The speed of innovation-to-production was thanks to:

1. Innovation on top of existing approaches. The Viet Nam Academy of Science and Technology, as well as the Institute of Military Medicine (IMM), used the RT-LAMP technique (reportedly already developed by the WHO and the American CDC). Meanwhile, the University of Technology, Hanoi, decided to go with the RT-LAMP technique. This kit is the first in the world to be based on RT-LAMP.

2. The Vietnamese Government acting early to bring together relevant groups and resources, to instigate widespread efforts. At the end of January, Viet Nam’s Ministry of Science and Technology organised a meeting on COVID-19 with virologists around the country. Here, the IMM was commissioned to develop a test kit, for which they used patient lab samples from the National Institute of Hygiene and Epidemiology.

3. The state quickly formulating a shared mission around COVID-19, uniting different ministries, research organisations and civil society. As a result, a greater share of the population was able to get tested. The Government also mobilised civil society by encouraging people to follow instructions and take precautionary measures, thus giving them a shared mission of identifying potential cases.

4. The private sector and universities collaborating. IMM’s kit was commercialised by a company called Viet A, at an expected production rate of 10,000 kits/day. So far, the IMM Viet A test kit has been sold and exported to Malaysia, Iran, Finland and Ukraine – with 20 other countries placing orders.

What can we learn from Viet Nam’s response

Viet Nam’s ability to mobilise a widespread response to the COVID-19 crisis offers helpful insights into the broader issue of the pandemic and state capacity.

Actors, all relying on public funding of different forms, very quickly developed affordable, and accurate, test kits. In addition to funding, it seems that the Vietnamese Government crucially instigated research into responses through its convening of virologists across the country in January 2020. Equally, hospitals were effective in sending in samples for research.

This shows that the state is the ultimate convener and mobiliser. By coordinating across researchers, hospitals and civil society, the state-as-mobilizer can set the environment for innovation.

By acting early and decisively to put COVID-19 testing on the research agenda, states, like Viet Nam, can pave the way for the crucial innovations that can ultimately prove their capacity to protect citizens.

*For her research, Dr Robyn Klingler-Vidra worked with colleagues Ba Linh Tran and Ida Uusikyla in Viet Nam. Read further details in a paper published by the Global Policy journal or this article published by The Conversation.