Thailand

Last week, Thanat Khoman, the longtime politician and former foreign minister of Thailand, died of natural causes in Bangkok. He was 102, and one of the last surviving leaders who played a central role in the Indochina Wars of the 1950s, 1960s, and 1970s. Thanat was foreign minister between 1959 and 1971, when the spread of communism through Indochina---communist forces had nearly encircled Luang Prabang during the First Indochina War, and communist forces obviously were making gains in Laos and South Vietnam during Thanat’s tenure---terrified the conservative Thai military regime. Thailand supposedly prided itself on neutrality and working with all nations, a foundation of Thai diplomacy for centuries, yet it already had been moving closer toward a security partnership with the United States even before Thanat’s tenure as foreign minister. In March 1962, Thanat and U.S. Secretary of State Dean Rusk signed a bilateral communiqué in which Washington promised to come to Thailand’s aid if it faced aggression by neighboring nations. The communiqué built upon an already-close U.S.-Thai relationship that had been forged in the 19th century, with the bilateral Treaty of Amity and Commerce in 1833. The communiqué solidified Thailand’s role as a crucial U.S. ally. During the Vietnam War years that followed the communiqué, the United States would dramatically build up Thailand’s armed forces, and Thai troops would become deeply involved in the wars in Laos and South Vietnam. (For an excellent, English-language account of Thai soldiers in the Vietnam War, see Richard Ruth’s In Buddha’s Company: Thai Soldiers in the Vietnam War). In addition to their contributions in Vietnam, Thai troops helped a conservative Laotian general defeat a neutralist/leftist force in Laos in civil conflict in Vientiane in 1960. In later years, Thai troops repeatedly reinforced Hmong irregulars in Laos when the army of Hmong and other hill tribes, led by Vang Pao, faced disaster in Laos’ highlands. Overall, the United States lavished security and economic assistance on Thailand between the mid-1950s and the mid-1970s, rapidly modernizing the kingdom’s physical infrastructure. Washington gained as well. The U.S. Air Force based much of its Indochina campaigns in Thailand, and bases in Udon Thani and Ubon Ratchathani swelled into virtual mini-Americas in the midst of the drought-ridden, baking-hot Thai Northeast. (I am in the final stages of editing my next book, which will examine the secret war in Laos during the Vietnam War, and how the Laos war turned the CIA into a military organization. Many of the key actors involved in the U.S. effort in Laos were based at the CIA’s station on the Udon Thani facility.) At the time of the Thanat-Rusk communiqué, the U.S-Thailand alliance was built on real mutual needs. Although, in retrospect, the communist threat to Thailand was limited---the actual Communist Party of Thailand never gained significant traction in the kingdom, for one---it seemed reasonable to believe that Thailand might be threatened by the political upheaval in Southeast Asia. And Thai leaders needed U.S. protection, U.S. diplomatic support despite the Thai generals’ abuses, and massive U.S. economic and security aid. The United States needed a stable and friendly Thailand for its bases, its leadership among non-communist countries in Asia, its example of economic development via free market economics, and its ability to make the defense of South Vietnam seem, at least superficially, like a multinational endeavor. Later in his career, Thanat became less supportive of the U.S.-Thailand relationship he had helped forge. He played a significant role in the founding of ASEAN, which he saw as an organization that could help Asians solve their own problems. He later advocated closer Thai relations with China, as the Vietnam War wound down in the 1970s, in part to reduce Bangkok’s dependence on Washington. By the 1980s, a time when he was still deeply involved in Thai politics, Thanat had become publicly critical of Thailand’s dependence on the United States for its security. But the reality is that, today, even before the May 2014 coup in Thailand, the bilateral relationship is significantly diminished---a far cry from what it was in Thanat’s day. The hard truth is that the United States needs much less from Thailand than it did, putting the Thais in a weaker position in the relationship, and making it easier for U.S. governments to criticize Thai leaders for rights abuses. The United States no longer relies on Thailand as a security partner the way it once did; there is no major war in Southeast Asia, and the United States has built close partnerships with Vietnam and Singapore, partnerships that are taking the place of many aspects of the U.S.-Thai security relationship. The alliance is frayed and weaker, and probably never will recover its vitality.

The U.S.-ASEAN summit earlier this week, held at Sunnylands estate in California, was overshadowed by the death of Supreme Court justice Antonin Scalia, and the political debate over his possible replacement. Many Southeast Asian leaders, who had looked forward to the summit as a sign of the Obama administration’s interest in the region, as well as a kind of blessing for hardline rulers like Cambodia’s Hun Sen and Thailand’s Prayuth Chan-ocha, were probably disappointed by how little attention the summit got from the U.S. media and from many U.S. politicians and opinion leaders. Still, the summit offered several glimpses into the current and future challenges facing U.S.-ASEAN relations. For one, as several media outlets have noted, the joint statement released after the summit, while noting a need for “mutual respect for the sovereignty, territorial integrity, equality and political independence of all nations ... and a shared commitment to peaceful resolution of disputes” in the South China Sea, did not mention China or China’s role in creating an environment ripe for armed conflict in the Sea. (Less than a week after the summit, Fox and other news outlets reported that China has placed surface-to-air missiles on an island in the disputed Paracels chain in the South China Sea). The lack of any mention of China in the joint statement, despite the fact that before the summit U.S. officials clearly intended any joint statement to reference China’s actions in the Sea, testifies to the continuing divisions within ASEAN over how to handle China’s growing power in the region. This fissure between countries, like Vietnam, that are terrified of China’s rising power, and those, like Cambodia and Thailand, that are much less concerned, has repeatedly divided ASEAN in the past five years. These divisions are undermining the organization’s famed consensus. On several occasions now, ASEAN leaders or defense ministers have been unable to agree upon a joint statement summarizing ASEAN’s position toward China’s actions in the South China Sea. Second, selling more Southeast Asian nations on joining the Trans-Pacific Partnership (TPP) will not be easy. Four Southeast Asian nations---Singapore, Brunei, Malaysia, and Vietnam---already have committed to joining the TPP. Vietnam in particular stands to make major economic gains from joining, and the recent Party Congress, which essentially ended Vietnamese Prime Minister Nguyen Tan Dung’s political career, will not change Hanoi’s commitment to the TPP. But though President Obama used the Sunnylands summit to press other ASEAN members to join the TPP, public and elite opinion in several Southeast Asian countries is largely against TPP accession. In particular, in Thailand, where a potential U.S.-Thailand free trade agreement was scotched by public protests and a lack of popular support a decade ago, there is now little will in the Thai government or among Thai opinion leaders to join the TPP. In Indonesia, public support for joining TPP is also tepid, despite President Joko Widodo’s pledge that the country will sign up. The fact that the U.S. Congress, which gave President Obama fast track authority, now appears to have put discussions about ratifying TPP on ice until after the November elections, cannot be helping President Obama persuade ASEAN members to sign up for the deal. Third, the White House clearly understands the importance of symbolism in ASEAN. Many previous U.S. administrations, going back at least two decades, have disdained ASEAN as a talk shop that rarely produces tangible outcomes, and have bristled at the organization’s seeming love of symbolism---showy photos of leaders clasping hands, working groups that deliver lengthy and jargon-filled plans for future integration, hundreds of ASEAN-related meetings of top officials every year. But ASEAN moves slowly and cautiously, even more so now than the organization did in the 2000s, when it was led by dynamic former Thai foreign minister Surin Pitsuwan. Regional powers that invest in ASEAN, accepting its symbolic gestures as part of doing business, are often rewarded with opportunities to improve bilateral ties with individual ASEAN nations. The Obama White House clearly has understood this bargain---join in the symbolism, and (sometimes) reap the reward of closer bilateral relations with ASEAN members and a better image among Southeast Asian publics. From signing ASEAN’s Treaty of Amity and Cooperation in 2009, to this week’s Sunnylands summit, the White House has embraced ASEAN’s symbolism-before-substance style with fervor.

Read Part 1 here and Part 2 here.  Part 3 Southeast Asia’s decade of democratic regression, which I examined in the previous blog post, reflects a worrying global retrenchment. Freedom House’s annual Freedom in the World report, which measures the spread or retrenchment of freedom globally, has reported ten straight years of declining global political freedom. In Freedom House’s 2016 edition of Freedom in the World, more than seventy countries registered declines in political freedom as compared to the prior year. The implications of this democratic regression are broad and significant. On a human level, the regression of democracy means that, compared to a decade ago, more of the world’s people are living today under governments that restrict economic, social, and political rights. People living under authoritarian rule are more likely to have shorter and less healthy lives, as shown by indicators of human development; over time, democracies have proven more effective in fostering key aspects of development including life expectancy and reduced child mortality. The global democratic regression may lead to more interstate conflict. In addition, political retrenchment may foster extremism, creating favorable conditions for groups inspired by the self-proclaimed Islamic State or for other types of extremists, such as Buddhist nationalist extremist groups in Myanmar or hardline royalist groups in Thailand. Already, outside Southeast Asia groups linked to the Islamic State have made headway in states where political freedom has regressed, or never fully emerged, and where people feel they cannot create political change by working within the system. In Egypt, for example, where a military government has thrown leaders of the Muslim Brotherhood in jail, and also crushed more liberal political groups, Islamists have increasingly turned to violence, attacking police, military, and government targets in the Sinai and other parts of the country. In Libya, where the collapse of the Qaddafi dictatorship led to a chaotic political environment, the Islamic State has established a large foothold, and have reportedly started heading south to recruit fighters from sub-Saharan African states. Overall, notes Edward Delman of The Atlantic in a study of the Islamic State’s international recruiting, “the countries that send the largest numbers of foreign fighters to Syria and Iraq, either in absolute terms or on a per-capita basis, tend to be either politically repressive (Saudi Arabia, 2,500 fighters), politically unstable (Tunisia, 6,000 fighters), discriminatory toward a Muslim minority (Russia, 2,400 fighters), or a combination of the above.” Notably, Southeast Asian nations are not on the list of countries that send the most foreign fighters to Syria and Iraq. Yet Southeast Asian nations that do not embrace political reform could face a greater threat from Islamic State-linked extremists. To combat the spread of Islamic State-influenced groups in Southeast Asia, the region’s leaders need, most importantly, to reverse Southeast Asia’s democratic regression. The region’s leaders should not overreact to the actual threat of terrorist attacks, but rather should more effectively address the root causes of popular alienation from normal politics. After all, even if 1,500 or even 2,500 Southeast Asians have traveled to Islamic State-controlled territory and returned to the region, this figure is a miniscule fraction of the total population in Southeast Asia. And as Delman notes, countries in the Middle East and Europe have contributed a far higher number of fighters to the Islamic State than Southeast Asian nations. Yet if Southeast Asian nations respond to the militant threat by subverting the rule of law, and promulgating legislation that gives the security forces excessive powers, they risk further alienating populations and actually pushing more people into joining extremist groups. Instead, Southeast Asia’s leaders should battle militants within legal frameworks. In Indonesia, the Jokowi government had not, before this month, sought legislation that would allow security forces to detain suspects for extended periods of time without charge, as is possible in some other countries in the region. Potential changes to counterterrorism laws in Indonesia currently being debated still would not give security forces the sweeping powers they enjoy in other Southeast Asian nations. Still, Indonesia is going to probably get tougher. The country is about to potentially pass preventative detention laws that could allow the authorities to hold terrorism suspects for up to six months, a significant shift that could undermine the rule of law in the archipelago. Adhering to the rule of law bolsters popular support for antimilitancy efforts and does not run the risk that regional governments can use detention for broad roundups of political opponents. Jokowi’s government also has sent a signal that it will not tolerate extrajudicial killings by the police and other security forces. Although Indonesia’s security forces hardly enjoy a clean reputation, Jokowi has suggested that an independent, nonpartisan investigating body will analyze suspected rights abuses by the security forces, such as in places like Papua. Other governments in Southeast Asia should copy this approach, relying on legal, humane strategies to investigate and arrest militants, and fostering more effective oversight of security forces. In addition, countries in Southeast Asia need to strengthen institutions that can resolve political conflicts, so that they do not have to rely on undemocratic, archaic institutions to resolve disputes. In Thailand and Myanmar, political conflicts too often are resolved by the military; in Cambodia and Malaysia disputes are often resolved in backroom negotiations involving a small handful of business and political elites. These weak institutions foster cycles of political conflict, and make it easier for militants to claim that democracy is failing to create peace and security.

Ariella Rotenberg is a research associate in U.S. Foreign Policy at the Council on Foreign Relations. As of January 9, 2016, Thailand has implemented refractive error eye screening in first-grade classrooms nationwide. Additionally, any student that is identified with vision impairment through the refractive error screening, is guaranteed to be seen at the local hospital by an ophthalmologist and provided with glasses to correct for their impaired vision. Under this policy, it is estimated that 260,000 Thai children will be able to access spectacles that they need but may not have otherwise received. With the exceptions of South Korea and Iran, Thailand stands way ahead of the pack among Asian countries in having universal eye screening for children. Last September, the World Health Organization (WHO) hosted a meeting focused on promoting universal eye health across the Western Pacific region specifically because the region lags in providing universal vision care. Thailand’s new nationally-approved program for testing and treating children with vision impairment exemplifies the shift in the global health agenda from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). As Yanzhong Huang explained in his Expert Brief, the new agenda entails a widening of the scope of global health initiatives to include issues such as non-communicable diseases (NCDs) and social determinants of health. Vision impairment fits neither into the category of infectious disease nor in the category of non-communicable disease, at least not in the way is it typically defined. It is, however, encapsulated in the broad mandate of the third SDG, namely, “ensure health lives and promote well-being for all at all ages.”  It is the very fact that vision impairment fails to fit neatly into either category, perhaps, that it has remained so underfunded and under-addressed, despite the fact that one third of the blind children in Thailand between the ages of one and fourteen became blind from untreated refractive error—nearsightedness, farsightedness, and astigmatism. These conditions, if uncorrected, can cause learning disabilities, may result in behavioral problems from an inability to focus, and even cause blindness. Thailand’s government demonstrated the success of evidence-based health policy making with its eye screening intervention. The eye screening program was piloted by Thailand’s semi-autonomous Health Intervention and Technology Assessment Program (HITAP) in order to decide whether or not the government should include this health service in their universal health coverage (UHC) package. In order to decide about new health services, the Ministry of Public Health deploys HITAP to assess pilot interventions based on cost-effectiveness and impact. A cross-sectional study of the refractive eye screening was conducted in seventeen schools spread out over four provinces. The results of the study showed that the detection rate for primary school children of visual impairment was relatively high: 52 percent for mild visual impairment and 74 percent for moderate visual impairment. The study also revealed significant willingness on the part of teachers to perform the screening and that parents trusted teachers to conduct the screening given the limited number of health professionals available. Furthermore, the study found the cost of the screening conducted by teachers to be relatively low–low enough to be funded by current revenue raised for the UHC services. The universal treatment of refractive error in Thailand addresses not only a health risk, but also works to counteract detrimental social determinants of health. The third SDG has been interpreted to address not only medical conditions, but also the underlying social and economic factors that allow many easily-treated conditions to go untreated in underserved populations. Access to something as simple as an eye screening, ophthalmologists, or eye glasses is commonplace in developed countries where routine clinic visits are typical, but not in developing countries where a large majority of the population does not have access to reasonable quality eye care services. In Thailand specifically, awareness of refractive errors is associated with higher income and urban residence. Furthermore, according to a World Health Organization (WHO) report, uncorrected refractive error in a child who needs glasses and later becomes blind due to lack of treatment “can hinder education, personality development, and career opportunities, in addition to causing an economic burden on society.” Incorporating early detection and treatment of refractive error in Thailand not only addresses the immediate health concern of vision impairment and possibly vision loss, but it helps in that respect to equalize opportunities for successful education, development, and career opportunities. Two weeks ago, I had the chance to travel to the eastern Thailand province of Samutprakan—one of the pilot provinces for the eye screening intervention. The photo for this post features three young girls at Samutprakan elementary school, one of whom was fitted for glasses as part of the pilot program. The site visit reminded me that UHC and other health-related SDG targets are not just words on paper, but they drive forward actions across the world that have the potential to significantly improve access and health outcomes. The health problems the eye screening program seeks to address, the negative social determinants of health it intends to counteract, and the fact that it is cost-effective, impactful, and funded sustainably, offer clues on how health-related SDGs can be effectively pursued at the country level.  

Rachel Brown, Lincoln Davidson, Ariella Rotenberg, Gabriel Walker, and Pei-Yu Wei look at five stories from Asia this week. 1. Developer of collapsed building arrested in Taiwan. After launching an investigation to determine the reasons behind the collapse of a seventeen-story building during a 6.4-magnitude earthquake in the city of Tainan last Saturday, Taiwanese authorities have arrested developer Lin Ming-Hui. The earthquake struck around 4 a.m. local time at the start of the Chinese New Year holiday, compounding the tragedy for some. One-hundred victims have been reported killed in the earthquake thus far, and reportedly nineteen people are still missing eight days after rescue efforts began. All but two of the victims were from the Weiguan Jinlong apartment complex. As it was one of the few buildings to suffer serious damage in the earthquake, questions arose about the complex’s structural soundness. Probes have revealed multiple illegal activities that may have contributed to the building’s collapse, including the fact that there were 50 percent fewer steel stirrups to reinforce concrete beams than required in the design blueprint. Prosecutors took Lin and two other men, identified as architects who designed the complex, into custody on Tuesday, and are seeking to charge the three men with professional negligent homicide. The three are yet to be officially charged, though they are being held incommunicado. Tainan’s Public Works Bureau is currently inspecting remaining buildings linked to Lin. 2. India says “no” to free Internet. The Telecom Regulatory Authority of India (TRAI) this week prohibited Internet service providers from offering select content to users for free, a ruling seen as a slap in the face to Facebook. For the last several months, the company has been pushing Free Basics, which offers free access to its social network and basic online services like news, health, and career information. Through Free Basics, Facebook, rather than consumers, would pay for the cost to transmit that data over wireless networks. Facebook has argued that offering basic online services for free will help bring more people online, improving the lives of millions; critics contend that Facebook is creating an uneven playing field by only letting certain services into Free Basics. However, there’s no evidence that “zero-rating,” as the practice is called, actually has the effect of giving some services an unfair advantage. 3. Indonesian court convicts seven men for Islamic State ties. This week, an Indonesian court convicted and sentenced seven men who were training, recruiting, and distributing propaganda for the Islamic State (IS). This is the first time that Indonesia has sent anyone to jail for ties with IS. The country has been on high alert since an attack in Jakarta last month that claimed eight lives, for which IS claimed responsibility. Four of the men were sentenced to three or four years in prison for violating Indonesia’s anti-terrorism laws  by participating in training camps for IS fighters. The court sentenced two others to similar-length terms for acting as recruiters for the terrorist organization. The seventh man convicted will serve a five-year term for cofounding an IS website that promoted the group’s ideology and that the Indonesian government shut down in 2014. In the past two months, antiterrorism police in Indonesia have arrested nearly fifty people who are suspected of having ties with those who planned and carried out the attack in Jakarta in January. 4. Ex-leaders put pressure on Thai junta. Former Thai prime ministers and siblings Yingluck and Thaksin Shinawatra recently returned to the public view in a move that has stirred concerns among ruling Thai military leaders. In rare media interviews this week, Yingluck expressed hope that support would remain strong for Puea Thai, her family’s political party. When elections will next be held is uncertain, as a member of the Thai junta recently expressed frustration when asked if the government still planned to conduct elections in 2017. Yingluck is prohibited from taking part in politics for the next five years, but is still popular in northeast Thailand. Meanwhile, Yingluck’s brother, Thaksin, sent out books and calendars commemorating his time in office and conveyed a message for the Lunar New Year to supporters in Thailand encouraging them to mobilize. He lives abroad to avoid a two-year jail sentence on corruption charges. In mid-January a corruption trial began regarding a rice subsidy scheme during Yingluck’s administration. She could face up to ten years in prison and thus her recent efforts to raise her public profile may be an attempt to defend her image and ensure a fair trial. While the scheme proved popular with Thailand’s large agricultural population, the subsidy ultimately cost the Thai government billions of dollars and led to Yingluck’s removal in 2014. Ironically, the current junta instituted a somewhat similar scheme in January to support rubber-tree farmers in southern Thailand. 5. Slowing Chinese oil production boosts market and saps SOEs. China’s top three petroleum-producing state-owned enterprises (SOEs), Sinopec, PetroChina, and CNOOC, have reported a significant drop in crude oil production over the past year. If the trend continues, China’s overall oil output could fall by up to 200,000 barrels a day through 2016. The decline in production should be a boon for the global oil market, which has been struggling with a persistent surplus and a broadly damaging low price since mid-2014. However, the production slowdown will be harder for the SOEs to handle: because they have a political imperative to maintain stability and avoid layoffs, the companies are limited by how much they can slash unprofitable production. The Chinese government even set a $40-a-barrel price floor for oil last month in order to shield the companies from massive losses. The financial challenges facing China’s oil producers brings to light the difficult path ahead for reforming the country’s SOEs, which have been a recurrent sticking point for the country’s broader economic reform plan. Bonus: Indian police try a spicy solution to crowd control. In India, a country with the world’s largest protests and hottest chili peppers, police have found a creative way to bring the two together. In a new approach to controlling protesters, cops in Haryana are now equipped to use marble- and chili-loaded slingshots to disperse unruly crowds. The method is seen as a safer alternative to using rubber bullets, which were linked to at least two deaths in past protests. Police typically also use methods like batons and tear gas, and have implemented pepper-spraying drones in recent years. Some critics worry that the slingshots could cause serious injuries to civilian protesters, and may not be a safer alternative to conventional approaches.

Several years ago an Indonesian girl named Widya posted a message on my blog. She asked where she could obtain the drug Sorafenib for her father, who was terminally ill with liver cancer. Her family had already spent a significant sum on her father’s healthcare and could not afford further treatment. I forwarded the message to a pharmaceutical executive in Jakarta, who responded that Sorafenib was available in Indonesia but a month’s dosage would cost around $4,500 (the average monthly salary in Jakarta is about $1,180). “I hope the patient has health insurance coverage, otherwise the family will have to pay out of pocket,” he said. Widya’s plight highlights one of the most important reasons to implement universal health coverage (UHC): to reduce out of pocket spending and ensure everyone access to quality healthcare without incurring crippling financial hardship. Drug expenditure typically places the largest burden on the people who can least afford healthcare. A considerable share—up to 68 percent—of out of pocket health costs in resource-limited countries is for medication. The rapid increase of the burden of non-communicable diseases (NCDs) has posed further challenges to accessing healthcare in in low- and middle-income countries, where the high price of promising anti-NCD medication can deter people from seeking care or impoverish families and health systems. Not surprisingly, the UHC target included in goal three of the UN Sustainable Development Goals (SDGs) emphasizes “access to safe, effective, quality, and affordable essential medicines and vaccines for all.” Inclusion of off-label drugs in the UHC benefit package, as shown in the use of bevacizumab in Thailand, serves as an example of how to offer high-cost NCD treatment in a safe and effective way. As a result of rapid population aging, thousands of elderly persons in Thailand suffer from age-related visual impairment, especially macular degeneration (AMD) and diabetic macular edema (DME). Absent timely and effective treatment, these eye diseases often result in blindness. Injection of ranibizumab (Lucentis)—an FDA-approved anti-vascular endothelial growth factor (anti-VEGF) manufactured by Genentech—has shown to stop, even reverse vision loss in most patients with AMD and DME. With a price tag of $1,733 per dose, however, Lucentis is hardly affordable to people with limited or no health insurance coverage. Since 2005, another drug manufactured by the same company, bevacizumab (Avastin) has been applied by eye doctors as a highly effective but far cheaper alternative to Lucentis. A study published in the British Journal of Ophthalmology in May 2007 found that while Lucentis is about fifty times more expensive than Avastin, the former needed to be two and a half times more effective to justify the additional cost. Unlike Lucentis, Avastin is FDA-approved only for treatment of colon and other cancers, but not for macular degeneration, which means that Avastin can only be prescribed as an off-label (“unlicensed”) treatment for AMD or DME. Off-label drug use potentially can improve affordable access to innovative medicines largely because of its flexibility. While a pharmaceutical company is prohibited from advertising a drug for any unapproved purposes, physicians are free to use it for any purposes that in their professional judgement are considered safe and effective. This practice can be adopted by almost any country in the world: in the United States, for example, off-label use of drugs is very common in cancer treatment. Older, generic medications (which tend to be less expensive) are most commonly prescribed for off-label use when they have found new uses not formally approved. They are cheaper also because the developer has not yet invested considerable resources seeking its official approval. In 2011, at the request of the subcommittee of the National List of Essential Medicines (NLEM), the Thai Ministry of Public Health’s Health Intervention and Technology Assessment Program (HITAP) conducted a systematic study of the clinical efficacy and effectiveness of both Avastin and Lucentis for the treatment of AMD and DME. The study found that the efficiency of Avastin was not significantly different from Lucentis, although the safety of Avastin for treating macular disease is inconclusive. Based on the study, the sub-committee negotiated with the pharmaceutical company, which offered to halve the price of Lucentis. Finding the reduced price would still not fundamentally solve the affordability problem, the sub-committee listed Avastin in the NLEM for AMD and DME, making Thailand the first country to officially endorse Avastin for macular treatment. Since November 2012, all Thai patients eligible for treatment of AMD and DME have been able to get Avastin nearly free. NLEM constitutes the minimum reimbursement list for all major health insurance schemes, including Civil Servant Medical Benefit Scheme, Social Security Scheme and Universal Coverage Scheme (UCS). Under UCS, which covers everyone regardless of socio-economic status and is used by three quarters of the country’s population, a patient pays only thirty baht ($0.8) to the hospital he or she was referred to receive eye injections of Avastin. For fear that the wide use of Avastin may negatively affect the marketing of Lucentis, the pharmaceutical company opposed the government’s endorsement of Avastin’s off-label use. In April 2012, Novartis (the other developer of Lucentis) actually challenged the use of Avastin as an alternative to the licensed Lucentis in England and Wales. This concern did not affect the use of Avastin for off-label treatment in Thailand because the original market for Lucentis was kept intact in that country: wealthy people still pay out of pocket for Lucentis and government employees are still able to receive Lucentis for free under the Civil Servant Medical Benefit Scheme. Those two customer segments have remained loyal to Lucentis due to the belief that it is safer and more effective than Avastin. Furthermore, in making the decision of including Avastin in the NLEM, the sub-committee engaged multiple stakeholders including ophthalmologists, academicians, Thai FDA and the pharmaceutical industry. According to Dr. Paisan Ruamviboonsuk, President of the Royal College of Ophthalmologists of Thailand, the government’s alliance with ophthalmologists increased its leverage vis-à-vis pharmaceutical firms in the off-label use of Avastin. The story of Avastin is dramatically different in China, where at least 10 percent of patients with eye diseases suffer from AMD. Until September 2010, Avastin had been used as an off-label treatment for AMD in more than thirty hospitals where more than one thousand patients had reportedly received the injections. But the hospitals could only use the drug “secretly” because no regulation exists on off-label drug use of medications. Until the end of the month, when Avastin was officially launched in mainland China, the drug had been considered legally “fake.”  Any drug not marketed via legal channels is categorically considered counterfeit by Chinese law. Unfortunately, right before the Chinese hospitals could use the drug legally, adverse reactions were reported among sixty-one patients receiving the injection of Avastin at the Shanghai No. 1 People’s Hospital. The local regulatory body rushed to announce that it was caused by a “fake” version of Avastin, even though it was very likely caused by contamination in repackaging of the drug. By punishing those who marketed and used the drug, the government sent a signal that off-label use of drugs in China was a crime. Unlike their Thai counterparts, the Chinese Medical Doctor Association, which represents two million medical practitioners nationwide, played no active part in the decision making process. As a result, few Chinese hospitals have continued the off-label use of the drug ever since, and a large number of the AMD patients have lost access to affordable and effective treatment. That said, off-label drug use is certainly not the only means to access high-cost drugs. Access can be increased significantly if off-label use is combined with multiple interventions implemented by different stakeholders, such as compulsory licensing, negotiating prices with pharmaceutical firms and engaging in pooled procurement, expanding patient assistance programs and voluntarily lowering drug price by pharmaceutical firms. No matter what measures are adopted, the decision-making should be an evidence-based process participated in by multiple stakeholders and supported by health technology assessment (HTA), which takes into account human rights, cost-effectiveness, safety, and intellectual property rights.

Read Part 1 here.  Part 2 After Jakarta’s initial successes against militants such as those from Jemaah Islamiah, a new generation of Islamists began to emerge in Southeast Asia in the late 2000s and early 2010s. Some had been students in schools set up, in the 1990s and 2000s, by earlier generations of radicals, while others had taken part in plots and attacks in the 1990s and 2000s and had survived the region-wide crackdown on Jemaah Islamiah and other militants. As Indonesian militancy expert Sidney Jones notes, many of these survivors lacked the discipline and organizing principles that had been characteristic of Jemaah Islamiah in the late 1990s and 2000s. Jones notes that the Indonesian authorities were saved in January 2016 primarily by the militants “incompetence,” but if radical groups continue to grow and train in Syria, they may eventually perfect more deadly bombing and shooting plots in Southeast Asia. The rise of the self-proclaimed Islamic State has provided new inspiration for the younger radicals and, for some willing to travel to Syria and Iraq, a new place for young Southeast Asian militants to train and meet fellow militants from around the world. In some ways, for Southeast Asian radicals the Islamic State’s wars in Syria and Iraq were a kind of modern version of the Afghanistan of the 1980s, a place for foreigners to come, learn how to fight, and mingle with other radicals. However, it was far easier for Southeast Asians to make the journey to Islamic State territory than it had been to join the mujahedeen in Afghanistan during the 1980s. Social media, for one, made it far easier for young Southeast Asians to learn about life in Islamic State territory and plan trips to Islamic State-controlled regions than it had been for radicals who wanted to fight in Afghanistan in the 1980s. In addition, the Islamic State’s theatrical brutality, tailored to social media, seemed designed to inspire radicals in other countries to adopt more brutal tactics. Some Islamic State leaders apparently see the value in recruiting and training Southeast Asians. After all, Indonesia has the largest Muslim population in the world, and Indonesia and Malaysia are two of the most prominent moderate Muslim-majority states in the world, countries with close relations with the United States, France, China, and other countries either involved in the battle against Islamic State or targeted for attacks by Islamic State leaders. In the past four years, the Islamic State has not only created a brigade of its fighters for Indonesians and Malaysians, who speak a common language, but also released video messages, shared on social media, targeted at Southeast Asian recruits and including efforts to Southeast Asian women to travel to Islamic State territory and potentially marry fighters. Jones’s Institute for Policy Analysis of Conflict estimates that as many as forty percent of Indonesians who have traveled to join the Islamic State are women and children. At the same time as the Islamic State is spreading its message into the region, Southeast Asian states are struggling with other factors that could spark radicalism. These factors include: The expansion of social media and Internet access, and the growing use of apps like WhatsApp and Zello that are harder for the authorities to track; the growth in foreign-funded religious schools in Southeast Asia; and, incompetent Southeast Asian prison systems, which tend to group Islamists together and often brutalize them; and, some Southeast Asian leaders’ response to the growth of the Islamic State, a response that has too often morphed into outright Islamophobia. In Myanmar, Thailand, Malaysia, Cambodia, and other countries in the region, a lack of political freedom has been probably the biggest driver of militancy. Once touted as a democratic beacon for other developing regions, since the late 2000s, much of Southeast Asia has witnessed a democratic retrenchment. In its report on global freedom in 2009, Freedom House ranked the Philippines, Thailand, Singapore, Malaysia, and Timor-Leste as “partly free” nations, and ranked Indonesia as “free.” Twenty years earlier, only the Philippines ranked as “partly free” in the region; the rest of these countries were graded “not free,” while Timor-Leste did not even exist as an independent nation. In Thailand, for instance, throughout the 1990s and much of the 2000s, Thailand appeared to have left its era of military interventions behind; Thai army commanders insisted the era of coups had passed and that the armed forces would become a normal military, run by elected civilian ministers. Thailand passed a progressive constitution in 1997, and in the 1990s and 2000s the country held multiple free elections. Malaysia, meanwhile, seemed poised to develop a competitive two-party system in the 2000s and early 2010s. In Cambodia, unexpected gains by the opposition coalition in 2014 national elections led to a brief period of compromise between opposition politicians and longtime prime minister Hun Sen. Today, few people are touting democracy in Southeast Asia as an example of political freedoms. Since the 2000s, Thailand has suffered more than a decade of political turmoil capped by a military coup in May 2014, the second coup in the kingdom in less than a decade. The country is still ruled by a junta, and even if elections are held in 2017, Thailand’s new constitution, written under junta rule, will dramatically restrict democratic freedoms and undermine democratic institutions. In 2015 Hun Sen’s government ended the rapprochement with the opposition. The Cambodian government pursued criminal charges against opposition leader Sam Rainsy, forcing him into exile, and Cambodian police did nothing as a mob of people, potentially organized by the ruling party, attacked opposition lawmakers just outside the parliament building. In Malaysia, the story is similar. After the 2013 general election, which the ruling coalition narrowly won, relying on gerrymandering and alleged vote fraud, the government jailed opposition leader Anwar Ibrahim, and used a new law to crack down on other opposition politicians and civil society activists. In Myanmar, since the end of junta rule in 2010-11, Muslims have been the targets of brutal violence. Gangs and paramilitary organizations, apparently tolerated by the state, have launched waves of attacks on Muslim communities in western Myanmar and other parts of the country; over 130,000 Muslim Rohingya, an ethnic minority, fled their homes, and often wound up in camps for the internally displaced that seemed more like internment camps than centers designed to aid refugees. In southern Thailand, meanwhile, increasingly autocratic rule has added to popular alienation from the Thai state and made it easier for militant cells to recruit, according to a study of recruiting by Don Pathan, an expert on the southern Thai conflict who writes for The Nation newspaper. The government of former Prime Minister Yingluck Shinawatra, the last popularly elected leader before the May 2014 coup, had attempted to launch peace negotiations with the southern militants. But after the coup the Thai army essentially jettisoned the talks. In late 2015 and early 2016, several representatives of the southern insurgents held informal meetings with army negotiators in an attempt to restart the talks, but these informal meetings have yet to produce any tangible results. In Malaysia, the government’s increasing repressiveness and desire to burnish its Islamic credentials have combined to fuel radicalism. Malaysia’s government has not only passed legislation that could suppress opposition voices, but also used its powers to entrench economic and political preferences for ethnic Malays, disempowering ethnic Indians and ethnic Chinese. Malaysian leaders also have used speeches to increasingly try to portray Malaysia a state for Malay Muslims, and tarred opposition leaders by portraying them as stooges of non-Muslim ethnic minorities. As a result, although Malaysian Prime Minister Najib tun Razak has been vocal, on the international stage, about the need for moderate Muslim voices to combat militancy, his government has allowed Malay Muslim nationalist voices to dominate the governing coalition and to wield extensive power over public discourse. At the same time, the government’s crackdown on public protests, nonprofits’ operations, and independent media have limited the means by which Malaysians, including Islamists, could participate peacefully in public discourse. Religion has become central to Malaysians’ identities, as economic and social policies entrench the linkage of faith and identity. “More and more Malays identify themselves first and foremost as Muslims. In a poll carried out [in 2015], Merdeka Center found that 60 per cent of Malays consider themselves as Muslims first, 27 per cent as Malaysians first, and only a peculiarly low 6 per cent saw themselves as Malays first,” writes Penang Institute analyst Kok-Hin Ooi in an analysis for New Mandala. Of course, the extremism that has bloomed in Southeast Asia from failed democratization does not only entail Islamism. Southeast Asia’s failed democratization has sparked many forms of extremist groups, all of which pay little heed to legal, constitutional means of resolving political conflicts. In Thailand, the stalled democratization has fostered a rise in militant Buddhist organizations, some of which have pushed to make Buddhism the state religion. It also has sparked the growth of hardline, conservative, royalist street demonstrations. These royalist street demonstrators, some of whom also belong to militant Buddhist groups, paralyzed Bangkok with protests in late 2013 and early 2014, disrupted planned parliamentary elections, and ultimately set the stage for the May 2014 coup. (During the 2013 and 2014 protests, many of these royalist groups openly called for an end to the franchise for poor Thais and/or a restoration of the absolute monarchy.) In Myanmar, incomplete democratization, and the vacuum of political power left by the end of authoritarian rule, has also allowed radical Buddhist nationalist groups to gain power. Some of the new Buddhist nationalist groups have alleged links to hardline, anti-Muslim political parties; others allegedly are linked to the gangs and paramilitaries that have terrorized the Rohingya and other Myanmar Muslims. These empowered extremist groups are not necessarily fueled primarily by economic grievances. The three provinces of southern Thailand are not the poorest in the country, and are far from the poorest areas of Southeast Asia. In fact, the southernmost provinces are far richer than some areas of Thailand’s rural, drought-hit northeast. The extremist royalist groups that helped topple the Yingluck government and pave the way for the coup were led by middle class and upper class Thais, including some of the richest people in the kingdom. In Malaysia, meanwhile, the most hardline Malay Muslim groups, and the militant Islamist cells that have been uncovered, do not usually attract the poorest in Malaysian society, but rather middle-class and lower-middle class Malays, especially those who apparently fear that urbanization and more open politics might mean a dilution of state privileges for Malays. Indonesia, by contrast, has not regressed politically over the past decade, and its continued democratic transition has blunted the appeal of radicalism. Along with the Philippines, it is the only Southeast Asian nation to be consistently ranked among the freest nations in the developing world by Freedom House. In his first two years in office, President Joko Widodo has helped further entrench democratic culture and institutions, even if he has been less aggressive in pushing on long-term political and economic reforms than some of his supporters had hoped. (In particular, Jokowi has tended to fall back into statist, economic nationalist policy prescriptions.) Still, as President Jokowi has maintained the system of regional and local elections, installed prominent anticorruption activists at the center of his cabinet, and transformed the style and image of the presidency from that of a remote, almost monarchical figure to that of a public servant listening to public concerns. Meanwhile, by the middle of the 2010s, Indonesia’s massive decentralization of legislative authority and government budgets had greatly empowered local politicians and local populaces. Decentralization allowed for a degree of differentiation in how localities handled issues like the selling of alcohol, the regulation of gambling, and other issues that Islamic parties and Islamist militant groups tended to emphasize. (Occasionally, these local laws catered to devout Christians, such as in predominantly Christian areas of Papua, rather than to Muslims.) And decentralization and democratic consolidation have greatly helped Indonesia’s battle against a new generation of militants. Decentralization, for one, helps reduce the appeal of Islamic parties and militant groups on the national level. Devout voters can obtain many of their demands through local legislation, reducing the appeal of national Islamic parties---or of militant groups who pledge to force change through violence. Freedom of expression means that Indonesians can openly advocate for the imposition of harsher Islamic laws or other goals of militant groups; the state does not stifle their voices. Confidence in Indonesia’s political system, and the impact of Indonesian presidents’ public speeches against militants, has clearly had an impact on the Indonesian population. In a poll released in November 2015 by the Pew Research Center, nearly 80 percent of Indonesians had an unfavorable view of the Islamic State, a much higher unfavorable figure than in Malaysia, Turkey, and Pakistan, among other countries. In Malaysia, for instance, only about sixty percent of the population in the same poll, had an unfavorable view of the Islamic State. It helps that the largest Indonesian religious organizations have added their weight to the countermilitancy campaign. Nahdlatul Ulama, an Indonesian religious movement with some 50 million members, has developed a sophisticated public campaign promoting a tolerant version of Islam. The campaign also emphasizes to Indonesians how alien the Islamic State’s form of Islam is to Indonesia’s Islamic traditions. These national campaigns have helped the Indonesian security forces, who rely on tips from the populace. Although militants were able to strike in Jakarta in January, in December 2015 Indonesian security forces made a string of arrests in five cities of people allegedly linked to Islamic State and planning a larger attack. To be sure, Indonesia has not eradicated militant groups. Terrorist attacks are always a possibility in Indonesia, even if the government has shifted public opinion against Islamists and destroyed many militant cells. The archipelago’s porous borders, notoriously corrupt immigration checkpoints, and open society all allow militant groups to come and go with impunity. Yet Indonesia’s open society has helped inoculate the country against the possibility that militant groups inspired by the Islamic State will gain large numbers of followers.

Read Part 2 here and Part 3 here.  Part 1 On January 14, militants struck in one of Jakarta’s busiest shopping and office districts. At around 11 am, one attacker blew up a suicide bomb at a Starbucks. Then, a group of attackers grabbed foreigners from the area, started firing wildly into the street, and drove a motorcycle toward a nearby police station and attacked that. The surviving militants then engaged in a running gun and bomb battle with Indonesian police, leaving a total of eight people dead, including five of the attackers. After the attacks, it quickly emerged that the purported ringleader, an Indonesian man named Bahrun Naim, had been living in the Islamic State’s “capital,” Raqqa, where he had reportedly organized the Jakarta violence. Although the brazenness of the attack shocked some Indonesians, the fact that militants inspired by ISIS committed violence in Jakarta was not particularly surprising. Since the previous autumn, Indonesian police and intelligence had been receiving reports of ISIS-linked militant cells organizing on Java and other islands; a month before the attack, Indonesian police had made a string of arrests, across the archipelago, of militants allegedly linked to the Islamic State. One of Indonesia’s leading specialists on militant groups, Sidney Jones of the Institute for Policy Analysis of Conflict, had warned that ISIS has “transformed the terrorism threat [in Indonesia] after years of mostly foiled [terrorism] plots” in the archipelago. And the Indonesian government had estimated that hundreds Indonesians had traveled to Islamic State-held territory in Syria and Iraq and then returned home. So many Indonesians and Malaysians had traveled to Islamic State territory that IS had started a brigade of fighters just for visiting Indonesians and Malaysians. Indonesia was not alone in facing the threat of militants linked to or inspired by the Islamic State. Some Southeast Asian intelligence organizations place the total number of Southeast Asians who have made the trip to ISIS territory as between 1,200 and 1,800. Even in Singapore, a city-state with an extremely effective intelligence service, radicals inspired in part by the Islamic State have returned to the island, according to public speeches by Singapore’s prime minister. In addition, several veteran militant groups in Southeast Asia whose existence predated the rise of the Islamic State, such as those fighting in the southern Philippines, have publicly pledged their allegiance to IS in 2014 and 2015. Whether these pledges are designed to bring more notoriety to the veteran groups, or actually constitute real linkages with IS, remains unclear, but their impact is to strengthen Islamic State’s image as a group with real global appeal. Yet of all the Southeast Asian nations facing rising militancy---the Philippines, Singapore, Malaysia, Thailand, Cambodia, Myanmar, Brunei, and Indonesia---Indonesia is actually the best equipped to combat the challenge of radicalism. The Indonesian government confronted an earlier rise of militancy, in the late 1990s and early 2000s, a time when many Indonesian militants were inspired by al-Qaeda; Indonesian security forces effectively penetrated the earlier militants’ cells and broke up many terrorism plots, without comprising Indonesia’s democratic transition. To be sure, as Jones notes, that earlier decade of militant activities left some radical networks in place, networks that IS sympathizers now may try to activate in the archipelago. The Islamic State’s powerful social media messaging may help militants regroup in Indonesia. But these militants will have a difficult time seriously threatening Indonesia’s social fabric, or upsetting the political gains Indonesia has made since the end of the Suharto dictatorship. Indeed, while much of Southeast Asia backslides into authoritarian or semi-authoritarian politics, highlighted most notably by Thailand’s harsh military rule, Indonesia’s political system has continued to mature, becoming a consolidated and essentially federal democracy. This maturation, and the maturation of Indonesia’s religious establishment, has created many ways to co-opt radicals through the political process, undermining the appeal of militant groups to the broader public---and making it easier for police to identify and arrest the small number of extremists planning violent attacks. I will examine why democratic regression facilitates militancy in other Southeast Asian nations in my next post.

Over the past three weeks, several events have dramatically highlighted the growing appeal of the Islamic State based in Southeast Asia. First, on January 14, a group of militants reportedly run by an Indonesian man who had traveled to Syria carried out an attack in a busy neighborhood in Jakarta, leading to at least seven deaths. Several weeks before the attack, the Indonesian police had made a string of arrests of other Indonesian cells linked to the Islamic State. Then, last week, Singaporean authorities made a major announcement. The city-state announced that it was using its Internal Security Act, which allows for detention without charge, to hold 27 Bangladeshis who it claimed had become radicalized, and were considering launching terrorist attacks. It was the Singaporean authorities’ broadest use of the Internal Security Act in three decades. According to several news reports, the Singapore police claimed that some of the Bangladeshis were planning to return to Bangladesh to carry out terrorist attacks. Most of the Bangladeshi laborers were quickly deported from Singapore. Do these events add up to a serious threat from the Islamic State to Southeast Asia , either by Islamic State recruiting and funding of Southeast Asian militant cells or simply by Islamic State inspiration for Southeast Asians? As I mentioned in a previous post, IS created a brigade in Syria for visiting Southeast Asians, including Indonesian fighters. IS also may be providing a small amount of seed money to some militant groups in Southeast Asia, and the Islamic State clearly hopes to spread its ideology more widely. Its propaganda arm has produced videos, shared online, in Indonesian/Malay and targeted at Indonesian and Malay youths. Indonesian, Malaysian, Philippine, and Thai authorities believe between 600 and 1,200 Southeast Asians have traveled to Syria and Iraq in recent years to fight with the Islamic State and then have returned to Southeast Asia. In addition, several existing militant groups in Southeast Asia have taken public oaths of loyalty to the Islamic State in the past two years, probably both because they share beliefs with the Islamic State and because the loyalty oaths bring them greater media attention. What’s more, as Zachary Abuza of the National War College has noted, the growing influence of Islamic State in Southeast Asia may be leading to a kind of competition among Southeast Asian militant groups to see who can carry out the most brutal attacks, following in Islamic State’s use of extremely brutal, well-publicized tactics. Such brutal tactics, Abuza notes, are easily spread through social media. But overall, the level of threat to Southeast Asian nations varies widely. It is true that Indonesians have traveled to Syria to fight, and even taken part in their own brigade, but Indonesia also is one of the most open societies in the region, with a government and a religious establishment that has a record of effectiveness at combating militancy. Indonesia’s biggest religious organizations have launched campaigns to combat the influence of IS and other groups. Indonesia’s decentralized, free politics filter Islamists through the political process. In the Philippines, the Aquino government is close to completing a landmark peace agreement that could end much of the fighting that has plagued Mindanao for decades. Although there are holdouts unwilling to accept the deal, the completion of the peace process, combined with a flow of investment and aid to Mindanao, could dramatically undercut any public support for militants in the southern Philippines. In contrast, Thailand, Malaysia, and Myanmar have political environments that could be conducive to growing militancy. All three are either outright authoritarian regimes or are currently somewhere between democracy and autocracy; the lack of political freedom means there are few legitimate avenues for Islamists to engage in politics. In Thailand, harsh army rule in the three southern provinces has added to southerners’ anger, made it harder to gain cooperation with army units hunting for militant cells, and potentially has fostered radicalization of young men and women. In Myanmar, there has been little violent reaction so far from Muslim populations that have been terrorized for four years now, particularly in Arakan State; many Muslims are so battered that they are focusing all their energy on survival. Still, it is not hard to imagine that years of attacks on Myanmar Muslims might eventually lead to the emergence of militant Myanmar Muslim groups, perhaps with inspiration or even training from Islamic State. And in Malaysia, the environment is perhaps even more favorable for militants inspired by the Islamic State. Since the 2013 Malaysian general election, the Malaysian government has “been competing...to show the Malay heartland” its Islamic credentials, according to Murray Hunter, a business consultant with thirty years of experience in Southeast Asia. Hunter notes that the ruling coalition also has been publicly burnishing its Islamic credentials in an attempt to tar the opposition as dominated by ethnic Chinese. Such strategies are fostering religious and ethnic divisions in Malaysia. “This is a perfect environment for Islamic State dogma…to breed,” Hunter notes.

It’s that time again---time for resolutions that last a couple weeks into the new year and bold predictions that (surely) will turn out right this year. Right? 1. Najib tun Razak will be Malaysia’s Prime Minister at the End of 2016 For most of 2015, many Malaysian politicians, observers, and activists wrote Najib off, sure that the in-fighting within the governing coalition, the scandals around the 1MDB state fund, and the torrent of criticism of Najib by former prime minister Mahathir would ultimately force Najib out of office. They were wrong. In fact, after surviving UMNO’s December general meeting unscathed, Najib passed legislation that will entrench his power. Just before the end of parliament’s sessions for the year, Najib presided over the passage of new legislation that will potentially give the government unprecedented powers to detain critics on national security-related charges. Expect Najib to still be in control in Malaysia as this year ends as well. 2. Thailand’s Elections will be Pushed Back Farther The Thai junta, which took power in a coup in May 2014, has pushed back the date for elections and a handover of power several times, after a draft new charter collapsed. Prime Minister and junta chief Prayuth Chan-ocha has now promised elections in 2017, but Prayuth also shows signs that he is consolidating his rule. This past year, the military has been busy purging members of its ranks not aligned with Prayuth’s army faction, and launching an even more intensive crackdown on dissent than it did in the months after May 2014. With the Thai king still alive but apparently quite ill, expect Prayuth and the other generals to push elections off even farther, possibly into 2018 or beyond. 3. Jokowi Will Have a Better Year 2015 was a difficult year for Indonesian President Joko Widodo. Struggling to make the transition in his first full year on the job from city mayor to leader of one of the most powerful nations in the world, at times he seemed to zigzag on foreign and economic policies from day to day. His personalized style of decision-making, in which he relied on few close advisors and often made decisions by his gut, proved unworkable in governing such a large and diverse country. Saddled with ministers and other officials who had proven themselves at PDI-P loyalists but did not embody Jokowi’s brand of clean politics, the president also found his reputation as a different type of politician tarnished. It got worse. In the fall, haze enveloped parts of Indonesia and spread throughout the region; Jokowi went home after one day of a planned multi-day trip to the United States to help lead the fight against the haze. By leaving so soon, he may have alienated some of the major corporate leaders he had planned to meet and woo later in the trip on the U.S. West Coast. Given his troubled 2015, 2016 could hardly go worse for Jokowi. And, in all likelihood, the Indonesian president will have a better year. He already has shed himself of several ministers and advisors who had damaged his reputation for fighting graft, and his public image also has benefited from the recent scandal surrounding the speaker of the lower house of parliament, who allegedly tried to extort money from Freeport McMoran. The fact that Jokowi’s energy minister actually reported the allegations against the speaker to the parliamentary ethics committee is, to many Indonesians, a sign that Jokowi’s administration is taking graft seriously. In addition, Jokowi has slowly and steadily begun to push back against economic nationalists within his administration and in parliament. Although the president is unlikely to deliver the massive regulatory reforms he promised in late 2015, the president has set an ambitious economic reform agenda. If he can even push through half of the reforms he has promised for 2016, both local and foreign investors will cheer, and the Indonesian economy will benefit. 4. Laos will not be an Effective Asean Chair In 2015, the Association of Southeast Asian nations was chaired by Malaysia, a country with a wealth of skilled and English-speaking diplomats and officials, and the capacity to capably hold hundreds of meetings annually. Although the Malaysian government was distracted by the 1MDB scandal and in-fighting within UMNO, it still managed an effective chairmanship. Laos will have serious trouble doing the same. Of all the members of Asean, Laos is by far the least prepared to chair the organization; its diplomatic and bureaucratic corps is small, and it has no leaders who could take charge at an Asean meeting and help bridge gaps on divisive issues. Laos is the most authoritarian nation in Southeast Asia, and Laotian leaders already have shown that they are uncomfortable with the nongovernmental aspects of Southeast Asian integration, declining to let Asean civil society groups hold a meeting next year in Laos. 5. China Will Show Southeast Asia both the Stick and the Carrot As I noted in CFR.org’s roundup on Chinese policy in 2016, Beijing this year probably will continue its dual approach to Southeast Asia. Expect China to continue upgrading atolls in the South China Sea and preparing them for use as military bases, while also using ever-tougher tactics to threaten Vietnamese and Philippine ships traveling in disputed waters---tactics like openly displaying guns pointed at Vietnamese and Philippine vessels. But in dealing with mainland Southeast Asian nations like Thailand, Myanmar, and Laos, which chairs Asean in 2016, China will turn on the charm. In particular, Chinese officials and leaders will be eager to win over the new Myanmar government led by the National League for Democracy. Read Part 2 here. 

Last week, in a move that was shocking despite the cooling U.S.-Thailand relationship, the Thai government announced that the U.S. ambassador in Bangkok, Glyn Davies, was being investigated on suspicion of having insulted King Bhumibhol Adulyadej. Ambassador Davies had spoken to the Foreign Correspondents Club of Thailand in late November. During his talk, according to the New York Times, Davies criticized the “long prison sentences handed to some of those found guilty of criticizing [the] king” under Thailand’s lèse majesté laws, generally considered the harshest in the world. (This past weekend, Human Rights Watch warned that one prominent critic of the junta had disappeared after being questioned on lèse majesté charges.) Ambassador Davies enjoys diplomatic immunity, so even if he is found guilty of lèse majesté, he will not be tried and punished under Thai law. However, Thai authorities have hinted that the investigation will continue and that Davies could be subject to some kind of reprimand from the government. Still, it remains unclear what such a reprimand would entail. Does the investigation of the United States’ ambassador suggest that U.S.-Thai relations are deteriorating even more rapidly than some Thailand observers fear? Certainly, the bilateral relationship is at one of its lowest ebbs in years, with the Obama administration having taken a relatively tough stance against the military junta since the May 2014 coup---a stance that clearly rankles Prime Minister Prayuth Chan-ocha and many other senior Thai military leaders. For example, even though the junta has cracked down hard on public protests in Bangkok, it has allowed a group of conservative, royalist demonstrators to gather in front of the U.S. embassy, holding profane signs and launching profane chants against the United States and the U.S. ambassador. The fact that these royalists are allowed to protest, in the heart of Bangkok, suggests that at least some members of the junta are extremely angry with the White House’s cooler approach toward Thailand. But the investigation into Ambassador Davies also highlights another significant problem in Thailand today---even the royalist, authoritarian government is increasingly losing control of how the lèse majesté law is applied. To be sure, the Prayuth government appears to be using the law to stifle some forms of dissent, according to numerous human rights groups. But it is not always clear that the government wants all the lèse majesté cases to go forward. Although the law supposedly protects the king and other top members of the monarchy (even though the king himself has publicly questioned whether he should be above criticism), anyone can file a lèse majesté claim against anyone whom they believe has somehow damaged the Thai monarchy under the law’s vague clauses. In recent years, many private Thai citizens have launched lèse majesté claims against other Thais, and against some foreigners. In fact, the number of lèse majesté cases has jumped over the past decade. Since the May 2014 coup, Thailand’s military courts, which have taken over most of the judicial proceedings and which apparently want to appear as protective as the monarchy as possible, have been issuing the harshest sentences for lèse majesté in modern Thai history. In the Davies case, it appears that the case was initiated by a private citizen, a known arch-royalist. Since Prayuth’s government’s legitimacy is based in significant part on its vow to protect the monarchy and---though this part is left unsaid---oversee a peaceful and orderly transition to the next king, it can hardly ignore lèse majesté claims. The government cannot ignore lèse majesté allegations even if those claims appear pointless or potentially detrimental to Thailand’s strategic interests. In other words, an arch-royalist government led by a military man cannot even dictate how the lèse majesté law is utilized, a sign of Thailand’s increasingly out of control politics.

Human trafficking has long been a serious problem in Thailand. For decades, Thailand has been a source country for trafficked people, a transit country, and a destination for trafficked men and women, who come mostly from poorer neighboring states. (By some estimates, at least two million people from Myanmar alone are working in Thailand illegally, and many of these Myanmar citizens were trafficked to Thailand.) Men and women are trafficking to the kingdom to work in Thailand’s construction, sex, seafood, and domestic service industries, among other sectors of the economy. The scope of the trafficking problem is hardly unknown: The Thai government first began high-level discussions of trafficking nearly three decades ago, in 1990, according to a study of regional anti-trafficking efforts by the United Nations Economic and Social Commission for Asia and the Pacific. In 1997, the government passed a new anti-trafficking law, and since then it has regularly passed anti-trafficking legislation. For decades, however, the Thai government’s and Thai civil society focused mainly on human trafficking related to sex work. The country was commended by international organizations for some aspects of its approach, including public campaigns to inform sex workers about HIV/AIDS and providing free condoms and other types of contraception to some sex workers. (To be sure, the government’s still did little to improve the basic rights of many sex workers---particularly for those outside Bangkok nightlife areas and those living in Thailand illegally.) At the same time, the Thai government, Thai civil society, and many international rights organizations paid less attention to the role trafficking played in other Thai industries---namely seafood canning, fishing, and construction. Demand for foreign labor remains high in these industries in the kingdom. As fewer and fewer Thai nationals want to work in the dangerous and low-paying fishing and seafood industries, Thailand’s fishing and seafood companies have faced a regular shortfall of labor. The United Nations estimates that Thai fishing companies need to employ an extra 50,000 migrant workers every year to fill vacant jobs. Only in the past five years has the focus of anti-trafficking efforts in the kingdom truly broadened to include serious efforts to expose and combat modern-day slavery in the seafood and fishing industries, several of which are dominated by some of Thailand’s largest, most influential companies. The Thai Union Group, for instance, is the world’s biggest processor of canned tuna. The focus has shifted to trafficking in these industries in large part because of the efforts of foreign media outlets, like the Guardian, the Associated Press, and Reuters, and efforts by international rights groups like the Environmental Justice Foundation. (One of the most comprehensive Guardian stories on modern-day slavery in Thailand can be found here.) The Thai government has demonstrated a mixed, somewhat confused response to these revelations of widespread trafficking in the seafood and fishing industries. There are some signs of increased enforcement of Thai labor laws. Thailand has filed charges in the last year against at least one hundred people allegedly involved in trafficking. The junta also has sent several senior officials from the Foreign Ministry around the world to convince important trading partners that the regime is serious about combating trafficking. Yet the Thai government also may be stonewalling investigations that could implicate senior army and police officials in trafficking organizations. Reporting by Reuters and other outlets has suggested that navy officers and other military officials are directly involved in the smuggling of Rohingya and other migrants for the seafood and fishing industries. In part, the junta has tried to intimidate reporters from tracking links between trafficking and the armed forces. The Thai navy filed defamation charges against Phuket Wan, a news site based on the resort island, for essentially republishing a lengthy Reuters report that implicated the navy in the trafficking of Rohingya. (The Phuket Wan pair was acquitted in September.) Indeed, perceptions of Thailand’s failure to take effective action against trafficking in these industries were a major reason why the country was downgraded to the lowest tier in the U.S. State Department’s 2014 Trafficking in Persons report. The clearest evidence that the Thai government is not fully committed to the fight against trafficking emerged last week. As the New York Times reported, one of Thailand’s most senior anti-trafficking investigators, Police Major General Paween Pongsirin, has fled the country and asked for asylum in Australia, after quitting the police last month. The Major General apparently fears that, if he remains in Thailand, senior officials implicated in some of the over one hundred cases he has pursued might try to have him killed. The Thai government now is reportedly considering pursuing a defamation case against Major General Paween. Not exactly a sign of strong intent to follow up on Paween’s charges.

Rachel Brown, Lincoln Davidson, Ariella Rotenberg, and Gabriel Walker look at the top stories in Asia this week. 1. Human trafficking investigator flees Thailand. Maj. Gen. Paween Pongsirin, a senior Thai police officer leading an investigation on human trafficking in Thailand, has fled the country to seek asylum in Australia. After more than thirty graves, which are believed to contain the remains of trafficked Rohingyas, were discovered near the Malaysian border this summer, Paween had been tasked with investigating the site and the trafficking network responsible. His investigation resulted in more than 150 arrest warrants and other charges against individuals in Bangladesh, Myanmar, and Thailand, including a senior lieutenant general in the Thai Army. Paween reported that the inquiry had been shut down prematurely, and that he now feared retribution from traffickers and corrupt authorities implicated for the crimes. The Thai government is considering whether to bring a defamation case against Paween, as it did recently against two journalists for reporting the Thai navy’s involvement in human trafficking. In a report published earlier this year, the U.S. Department of State found that the Thai government “does not fully comply with the minimum standards for the elimination of trafficking, and is not making significant efforts to do so.” 2. China merges state-owned enterprises.  Multiple mergers among Chinese state-owned enterprises (SOEs) were announced this week. On Tuesday it was revealed that the China Metallurgical Group will be incorporated into China Minmetals, although the timing to complete the merger is unknown. The State Council has also reportedly approved the merger of two shipping companies, China Shipping Group Co. and China Ocean Shipping Co., which will result in the fourth-largest shipping line in the world. Such mergers are hoped to reduce competition between firms and improve economies of scale. Metals and shipping SOEs were recently identified as among those with the worst financial-risk ratings, so it is not shocking that firms in these sectors would be targeted for early restructuring. Not all recent mergers have improved competitiveness, however. In June, two state-owned train makers, the CSR Corp. and CNR Corp., merged but thus far the year-on-year revenue for the new combined company has fallen. The mergers come in the wake of overall SOE reforms presented by the Chinese government in September that seek to promote private investment, establish investment mechanisms for state capital, and potentially restructure certain SOEs to create national champions. SOEs in the telecom and air transport sectors are now also allegedly being considered for mergers. 3. Anonymous hacks Abe’s site to retaliate for whaling. The hacking group Anonymous took credit for temporarily disabling Japanese Prime Minister Shinzo Abe’s personal website yesterday, claiming the act was a retaliation for Japan’s decision to resume scientific whaling activities last week. Although an investigation as to whether Anonymous was indeed responsible for the cyberattack is still ongoing, Anonymous has hacked the government sites of other whaling countries before, like Iceland, and a Twitter account representing the group threatened to continue if Japan did not discontinue the program. Despite a 2014 International Court of Justice ruling that deemed one of Japan’s “scientific” whaling programs illegal, last week’s program, which sent a fleet to Antarctica’s Southern Ocean to kill 333 minke whales, is new. One scientist called the whaling campaign the same old story with a different name—like putting “lipstick on a pig.” In total, thirty-three countries, including the United States, have protested against Japan’s new whaling program, and Australia has considered taking legal action to put an end to it. 4. Afghan president visits Pakistan. On Wednesday, leaders from Pakistan and Afghanistan announced plans to resume peace talks between the two governments, although the Taliban has not yet agreed to the talks. The announcement was made at the annual Heart of Asia conference where Pakistani Prime Minister Nawaz Sharif and Afghan President Ashraf Ghani met. Ghani’s visit to Pakistan coincided with a two-day Taliban siege of the Kandahar airport, which left more than fifty people dead and signaled a growing Taliban resurgence. Ghani risked political criticism by engaging with Pakistan, an unpopular nation among many Afghans, to attempt to restart the peace talks. Tensions persist between the two countries over a variety of issues including whether Pakistan harbors terrorists and Pakistan’s desire to repatriate approximately two million Afghan refugees currently in the country. Rahmatullah Nabil, the head of the Afghan intelligence service, the National Directorate of Security, resigned this week amidst disagreements surrounding Ghani’s policy toward Pakistan. In July, Pakistan hosted an initial round of peace talks between the Taliban and the Afghan government, but the second round was postponed after the announcement of Taliban leader Mullah Omar’s death. 5. Myanmar opens stock exchange. After two decades of delays, Myanmar finally launched its first stock exchange, the Yangon Stock Exchange, on Wednesday. Prior to this, Myanmar was the largest economy in Asia without a stock exchange. The move is an important step towards liberalization for a country that has languished in recent decades due to mismanagement by a military junta; officials hope the exchange will help spur investment and boost the economy. Progress will come slowly, however. Although six companies have already been approved to list on the market, they will not start trading until next spring, and foreign firms are still barred. Bonus: The Islamic State produces a new propaganda song, this time in Chinese. This week, the Islamic State, also known as ISIS, released a war chant in Mandarin calling for Chinese Muslim men to take up arms. Al-Hayat Media Center, the ISIS-run media group, released the four-minute acapella chant known in Islam as a “nasheed” that advocates death in service of Islam. By using Mandarin for the song might indicate that ISIS is aiming to attract a broader base of Chinese Muslims, whereas previous propaganda has been aimed at China’s Muslim Uighur minority in the Uyghur language. The spokeswoman for the Chinese foreign ministry said in response to the video that “in the face of terrorism, no country can stand alone.”

Ashlyn Anderson, Rachel Brown, Lincoln Davidson, Ariella Rotenberg, Ayumi Teraoka, and Gabriel Walker look at the top stories in Asia this week. 1. Antigovernment protests erupt in Seoul. This week, tens of thousands of people filled City Hall plaza in downtown Seoul to protest President Park Geun-hye, demanding her resignation. The protestors wore plastic raincoats to guard against the cannons of water and liquid tear gas fired at them by the police. The grievances against President Park include the replacement of history textbooks in the country with a specific government-issued one. Student protestors argue that the government textbook would whitewash the legacy of Ms. Park’s father, former President Park Chung-hee. Unionized workers also protested against changing labor laws that they believe favor the chaebols, powerful family-run Korean conglomerates, making it easier for them to fire workers. The exact number of gathered protestors was somewhere between 68,000, according to the government, and 130,000, according to the protest organizers; no matter which is the more accurate number, it is unquestionably the largest protest under Ms. Park’s government. 2. Thailand deports two Chinese refugees. Two Chinese dissidents, Jiang Yefei and Dong Guangping, were deported from Thailand after being arrested on October 28, 2015, for lacking valid visas. Canada had already accepted both men as refugees and they possessed “protection letters” from the United Nations. The Office of the United Nations High Commissioner for Refugees said that the exact rationale for the deportations remained unknown and that many officials from international organizations had tried to prevent it. Jiang Yefei had lived in Thailand since 2008 after being detained in China earlier that year for critiquing the government’s handling of the Sichuan earthquake. Dong Guangping was detained in China between May 2014 and February 2015 following his involvement in a commemoration of the 1989 Tiananmen Square crackdown. Both men are believed to be at risk of torture in China. The deportations from Thailand to China fit into a recent pattern of behavior between the two nations: In July, the Thai government, which has not signed the 1951 Refugee Convention, deported over one hundred Uighurs back to China. Thailand’s relations with China improved after the Thai military coup in May 2014, which weakened ties with Western nations and led the government to begin seeking out new partners. 3. Tourism in Japan booms thanks to Chinese visitors. The Japanese government will raise its annual target for the number of foreign visitors to Japan to thirty million, as the current target of twenty million by 2020 is likely to be attained this year, five years ahead of schedule. This is largely due to a weaker yen brought about by “Abenomics,” Prime Minister Abe’s economic policies, as well as his policies to encourage tourism such as the relaxation of visa requirements and welcoming low-cost airline carriers. This year, 16.3 million foreign tourists have already visited Japan, beating last year’s record of 13.4 million over the entire year. The number of visitors to Japan was on a constant increase until 2008, before the trend took a hit from the financial crisis in 2009 and the Tohoku earthquake and tsunami in 2011. Abe reversed this trend again when he came back to the office in 2012, as he saw tourism as a central component to his overall economic program. The dramatic uptick in the number of Chinese visitors has played an important role in this about-face: between January and October of this year, 4,283,700 Chinese tourists visited Japan, and accounted for nearly half of the 1 trillion yen (8.1 billion USD) that foreign visitors spent in the country. 4. India sells off 10 percent more of Coal India. This Wednesday, the Indian government approved a 10 percent sell-off of Coal India, the state-owned mining company that is the biggest coal-producing enterprise in the world. The move, which should provide the government with around $3.2 billion, was part of Prime Minister Narendra Modi’s broader push to privatize state-owned enterprises, and followed up a similar sale last fiscal year that netted $3.6 billion. Although some say that the Coal India divestment will play a part in easing pressure on government finances, Modi may not be able to reach his budget deficit target by the end of this fiscal year by selling other state assets. And while the company’s stock has fallen about 13 percent this year, it may be in a position to benefit as the country attempts to double its coal production by 2020. 5. Come buy from me, Argentina. China and Argentina announced this week that China would provide funding for $15 billion nuclear power plant projects in Argentina. The two plants, one of which will utilize the Chinese-designed Hualong One reactor, will roughly double Argentina’s nuclear power output. The loans, coupled with a nuclear plant project in the UK that China announced last month it would be funding as well, demonstrate the country’s commitment to flaunting its wealth abroad, even as the economy slows back home. And as Chinese investment in Africa declines, the nuclear projects may signal further interest among the Chinese leadership in partnerships with Latin America, which already accounts for 13 percent of Chinese outward foreign direct investment. Bonus: Mobile app enables a collective approach to clearing garbage in Delhi. Following the launch of Indian Prime Minister Narendra Modi’s “Swachh Bharat” campaign to clean up India, a new app was introduced in New Delhi that allows citizens to snap photos of trash piles and send them to the Public Works Department along with corresponding GPS coordinates. All three municipal corporations involved in garbage collection have pledged support for the initiative. The launch of the app comes just in time for a focused cleanliness drive in Delhi from November 22 to 30. The app is also an example of how the Indian government’s “Digital India” mission can be effective in empowering citizens to come up with solutions to societal issues.

As Thailand’s political situation continues to deteriorate, with civilian politicians beginning to push back against army rule, and the deadline for a new constitution and free election delayed again, Thai Prime Minister and junta leader Prayuth Chan-ocha seems increasingly frustrated with the debate, compromise, and public scrutiny common in a constitution-drafting process, and a democratic society. The prime minister has become known for his outbursts at the press and other critics, but in recent weeks his speeches have become more vitriolic. Last Wednesday, in the middle of a long speech, Prayuth publicly warned: “I must make it clear. If there is no peace and order [in Thailand], I must stay on” as prime minister. Prayuth has not defined exactly what constitutes a lack of peace and order in the kingdom. It is not the first time the junta leader, already the longest-serving Thai coup leader in decades, has threatened that he could hold the prime minister’s job for an extended period of time; the junta had originally promised that Prayuth would just be a caretaker, until 2015 or 2016 at the latest. Yet Prayuth’s warnings about his hold on power, such as this one, have become increasingly ominous. By now, more than a year into junta rule, the military has taken over or co-opted most institutions in Thai society. Many press outlets are cowed, with some of the most critical reporters having quit or engaged in self-censorship. Thailand’s once independent bureaucracy has mostly toed the junta’s line. And it appears that even the royal palace is not immune from the junta’s power. A series of recent lèse majesté arrests, believed to be of figures close to Thailand’s Crown Prince, suggest the military may also be sending signals that it will weaken the power of the Prince and his associates. Still, Thailand’s civilian politicians have not all accepted long-term junta rule as a fact. Pressure from both Democrat Party and Puea Thai leaders helped force the first constitution-drafting committee to rule out some of the most antidemocratic clauses in their proposed charter, and ultimately to vote down the charter itself. Former Puea Thai politicians and Puea Thai supporters have vowed to begin holding public rallies, wearing red, the symbolic color of Puea Thai and of former Prime Minister Thaksin Shinawatra. Ultimately, a growing group of former Puea Thai politicians and supporters who want to make their voices heard may clash with the increasingly repressive junta rule. The effects of Thailand’s political instability are widely felt. Last month, Thailand’s exports fell for the ninth month in a row, as slowing growth in major Thai partners like China and the political chaos in Thailand combined to undermine export growth. The country continues dropping on surveys of press and Internet freedom, even though the junta has vague plans to position Thailand as some kind of regional IT hub. In the most recent Freedom House report Freedom on the Net, released last month, Thailand was ranked as “Not Free," falling behind countries like Zimbabwe and Venezuela in the ranking of Internet freedom. (The junta has proposed further constraining Internet freedoms by creating a single gateway for all content coming into Thailand, though whether it will follow through on that plan remains uncertain.)