Testing Capacity: State Capacity and COVID-19 Testing

Robyn Klingler-Vidra, Ba Linh Tran and Ida Uusikyla use emerging research from Viet Nam to argue that states are the 'ultimate convener and mobilizers' during pandemic responses.

One of the key questions emerging from the COVID-19 pandemic is: which governments are best able to respond? Is a Chinese-style lockdown the most effective in protecting local (and by extension, global) citizens? Is it the techno-state that is more effective as it relies on extensive data collection and transparency on the whereabouts of those with the illness, as in Israel, Korea and Viet Nam? Or is the liberal government’s embrace of social trust, as in Sweden, ultimately the best approach?

For many of us, the question of whether authoritarian regimes or democracies are best equipped in responding to the pandemic will feel like a familiar conundrum. An important issue within the debate is that of safeguarding freedoms, such as civil liberties, during responses to crises also feels familiar. So even if the health and economic outcome is a positive one, as Amartya Sen would assert, if one’s rights are usurped in the process the value of the model needs to be questioned.

COVID-19 also raises issues of inequality within societies, and brings the need for more inclusive innovation to the fore, rather than support of innovation that does not account for distributive effects.

Increasingly, one of the arenas underpinning state capacity vis-à-vis the COVID pandemic is testing, as this is essential to ascertaining who in society is infected. By knowing where cases of the illness are, the spread of the pandemic can be more surgically contained and resources more efficiently distributed. Some countries have tested widely, like Germany and South Korea, and seem to, as a result, have a better handle on the spread of the virus. Other states, including the UK until recently, have instead restricted testing to only the most ill, particularly those in hospital. 

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

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

It is in this context that we turn to one emerging economy, that has a large land border with China, the original epicentre of the outbreak: Viet Nam. The country has made headlines for responding to the outbreak efficiently, with limited resources, committed leadership and an entrepreneurial-spirited society.

However, Viet Nam has not (yet) taken up mass testing.  Instead it has focused on containing the virus through the mobilization of the army and compulsory, state-operated, centralized quarantine centres, as well as the organization of mass surveillance, physically on the ground and through social networks. The state has been particularly efficient in using social media and mobile phones (SMS updates from the Ministry of Health) to keep citizens informed. They also have a public database of all people infected with the virus (Viet Nam’s mass testing figures are growing, but have, to date, not been on the same scale as that of, say, South Korea). 

Viet Nam was one of the first countries to develop affordable test kits and export them to Europe. The country now has three affordable kits available. How did they do it? Are there lessons that policymakers in advanced and emerging economies alike can learn from Viet Nam’s fast, and low-cost development of test kits?

Viet Nam’s fast, affordable COVID-19 test kits 

Viet Nam’s kits have been developed at lightning speed and low cost. The tests’ efficacy has been validated by external government bodies (though their efficacy has not been publicly verified by the WHO; media reports do say that the RT-PCR kits by VAST and IMM met the standards of the WHO). The tests themselves are built upon approaches taken by other kits (for example, by the CDC in the US). Here’s a summary of Viet Nam’s three COVID-19 test kits: 

As astute readers will have noticed, each of the three teams are located within publicly-funded bodies. Does this support the notion that it is the government who leads? Let’s take a closer look. 

How did they do it, and so quickly?

1. Innovating on top of existing approaches

VAST and IMM developed their own test kits based on the real-time RT-PCR technique, which is recommended by the WHO. In fact, it appears that their kits were based on ones already developed by the WHO and the American CDC, and IMM even said that ‘because we are behind, our researchers were able to take advantage of [what had been developed] and optimise it.’ IMM began by contacting Charité, at the Universitätsmedizin Berlin, to ask for information on the new virus. They were provided with Professor Christian Drosten’s procedure for testing the virus. The UOT Hanoi, on the other hand, decided to go with the RT-LAMP technique. This kit is the first in the world to be based on RT-LAMP.

2. The state as convenor and mobilizer

The Vietnamese government acted early to bring together relevant groups and resources, to instigate widespread efforts. Furthermore, it showcased the strength of the government as a mobilizer of the army, society and academia. At the end of January, Viet Nam’s Ministry of Science and Technology organised a meeting on COVID 19 with virologists around the country; it was in this meeting that IMM was commissioned with developing a test kit within two weeks. IMM pulled it off and one key factor in their success was the NIHE managed to isolate and grow COVID-19 from patient samples in labs. The ‘test subject’ (RNA of COVID-19) used to develop their kit was provided by the National Institute of Hygiene and Epidemiology (NIHE).

3. Shared mission 

The shared mission of Vietnamese society in responding to COVID-19, combined with the mobilizing capacity of the state, fueled a quick response. The state quickly formulated a shared mission around COVID-19, uniting different ministries, research organizations and civil society. Within a matter of weeks the research teams had produced reliable test kits; the UOT kit by early February and the VAST and IMM kits in the first week of March. Through this quick development of kits, at an affordable price, a greater share of the population in Viet Nam - and elsewhere - are able to be tested. Beyond kits, the government has mobilized civil society by encouraging society to respond to the crisis by “following the instructions” and taking precautionary measures. Government and civil society have shared the mission of identifying potential cases.

4. Collaboration across private sector and universities

The kit by UOT was not a top-down initiative but rather more of a grassroots project by two lecturers, Dr. Hoa Le and Dr. Ha Nguyen. They started developing a kit in early January when they heard about a new lung disease in China. (It is not known if their research used RNA from NIHE, but it seems their research was wholly based on their own synthesis of the virus’ DNA, based on information released by China). IMM’s kit was developed by the military institute, but then commercialised by a company called Viet A, at an expected production rate of 10,000 kits/day. So far, via 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 development of COVID-19 test kits? 

COVID-19 has resulted in an unprecedented test of state capacity globally, particularly, countries’ ability to protect the well-being of their citizens. One of the key determinants of a country’s ability to effectively mitigate the fallout of the pandemic is through widespread mobilization of different segments of society to respond to the crisis. It is about the extent to which the state can effectively marshal innovation, and in this case, around testing. For these reasons, the case of Viet Nam’s development of affordable test kits offers helpful insights into the broader issue of COVID and state capacity. 

Three different teams - all relying on public funding, of different forms - very quickly developed affordable, and accurate, test kits. More than the government’s funding, it seems that the Vietnamese state crucially instigated research into responses through its convening of virologists across the country in January. The NIHE, for its part, was very quick in working to isolate COVID-19 from patient samples so the virus could be studied and grown by researchers across the countries. Equally, hospitals were effective in sending samples to the NIHE for research. Collectively, it can be speculated that the government was active in coordinating (1) sources of research materials (from hospitals), basic science (via NIHE), and applied science (IMM and VAST).  

If other states are to learn from this, we suggest this takeaway: the state is the ultimate convener and mobilizer. By coordinating across researchers, hospitals, and communicating with civil society, the state-as-mobilizer can set the environment for innovating. This is a point that Kai-fu Lee made in his book, AI Superpowers; the ultimate value of Made in China 2025’s push for artificial intelligence was in instigating widespread innovation around AI across the country, not in the government’s direct activities. In the case of COVID, by acting early and decisively to put COVID 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.

Robyn Klingler-Vidra is Senior Lecturer in Political Economy in the Department of International Development at King's College London, where she research focuses on innovation and venture capital policy in East Asia. She is the author of The Venture Capital State: The Silicon Valley Model in East Asia and led a 2019 Innovate UK-funded study: Global Review of Diversity and Inclusion in Business Innovation.

Ida Uusikyla works as Innovation Consultant at UNDP Viet Nam Accelerator Lab focusing on strategic, inclusive and governance innovation. She holds a Master’s degree from the London School of Economics and Political Science in Development Management and Bachelor’s degree from University of Helsinki in Political Science.

Ba-Linh Tran is a Vietnamese researcher and consultant in higher education management. His clients include both Vietnamese universities and foreign universities in Vietnam, which he has consulted on a range of issues, including strategy making, research training and student recruitment. He also has experience working in lifelong learning and ESL/EFL. Ba-Linh holds a PhD in Education from the University of Bath in the UK; his thesis focuses on the role of non-strategists (e.g. deans, lecturers, students) in realising a university's strategies.

Image: Christina Morillo via Pexels.