SINGAPORE (NYTIMES) - As the United States and Europe ramped up their Covid-19 vaccination programmes, the Asia-Pacific region, once lauded for its pandemic response, struggled to get them off the ground.
Now, many of those laggards are speeding ahead, lifting hopes of a return to normality in nations resigned to repeated lockdowns and onerous restrictions.
The turnabout is as much a testament to the region's success in securing supplies and working out the kinks in their programmes as it is to vaccine hesitancy and political opposition in the US.
South Korea, Japan and Malaysia have even pulled ahead of the US in the number of vaccine doses administered per 100 people - a pace that seemed unthinkable in the spring. Several have surpassed the US in fully vaccinating their populations or are on track to do so, limiting the perniciousness of the Delta variant of the coronavirus.
In South Korea, the authorities said vaccines had helped keep most people out of the hospital. About 0.6 per cent of fully vaccinated people who contracted Covid-19 had severe illness and about 0.1 per cent died, according to data collected by the Korea Disease Control and Prevention Agency from May to August.
In Japan, serious cases have fallen by half over the last month, to a little over 1,000 a day. Hospitalisations have plummeted from a high of just over 230,000 in late August to around 31,000 on Tuesday.
"It's almost like the tortoise and the hare," said Dr Jerome Kim, director general of the International Vaccine Institute, a non-profit organisation based in Seoul and focused on vaccine research for the developing world. "Asia was always going to use vaccines when they became available."
Risks remain for the region. Most of the countries do not manufacture their own vaccines and could face supply problems if their governments approve boosters.
In South-east Asia, the roll-out has been slow and uneven, dragging down economic prospects there. The Asian Development Bank recently lowered its 2021 growth outlook for developing Asia to 7.1 per cent from 7.3 per cent, in part over vaccination issues.
But for much of the region, the shift has been striking, success that is rooted in its different worldviews and governance structures.
In a contrast with the US, vaccines were never a polarising issue in Asia-Pacific.
Although each country has had to contend with its own anti-vaccine movements, they have been relatively small. They have never benefited from an ecosystem - sympathetic media, advocacy groups and politicians - that has allowed misinformation to influence the populace.
Overall, most Asians have trusted their governments to do the right thing, and they were willing to put the needs of the community over their individual freedoms.
Dr Reuben Ng, an assistant professor at the National University of Singapore's Lee Kuan Yew School of Public Policy who has studied vaccine hesitancy globally for the past decade, said that pre-Covid-19, the discussion around immunisation had always been mixed in Asia because of some scepticism about the safety.
But Dr Ng and his team, who have been analysing media reports, have found that the region now holds mostly positive views on vaccines.
There is widespread belief in Asia that vaccines are the only way out of the pandemic. This month, when a vaccination centre in Tokyo offered 200 walk-in shots for young people, hopefuls queued from the early morning hours, and the line extended for blocks.
In South Korea, when the authorities opened vaccinations to people in their 50s, roughly 10 million simultaneously logged on to a government website to sign up for shots. The system, which was designed to process up to 300,000 requests at a time, temporarily crashed.
People in poorer nations whose lives were upended by extended lockdowns felt they had no choice but to get vaccinated. Indonesia and the Philippines are home to thousands of daily-wage workers who cannot rely on unemployment benefits to survive.
Mr Arisman, 35, a motorcycle taxi driver in Jakarta, Indonesia, said he got his second shot of the Chinese-made Sinovac vaccine in July because his job involved contact with many people.
"If I get sick, I don't get money," said Mr Arisman, who like many Indonesians goes by one name. "If I don't work, I don't get money."
The lack of social safety nets in many Asian countries motivated many governments to roll out the vaccines quickly, said Dr Tikki Pangestu, a co-chair of the Asia-Pacific Immunisation Coalition, a group that assesses Covid-19 vaccine preparedness. "At the end of the day, if they don't do it, they're going to end up with social unrest, which is the last thing they want," he added.
When the US and European nations were rushing to vaccinate their people late last year, many Asian countries felt they had the luxury of time. They had kept the coronavirus under control by masking, testing and keeping their borders shut. Many nations wanted to wait until the clinical trials were completed before they placed orders.
Then came the Delta variant. Despite keeping their countries largely sealed off, the virus found its way in. And when it did, it spread quickly. In the summer, South Korea battled its worst wave of infections, hospitals in Indonesia ran out of oxygen and beds, and healthcare workers in Thailand had to turn away patients.
With cases surging, countries quickly shifted their vaccination approach.
Sydney announced a lockdown in June after an unvaccinated limousine driver caught the Delta variant from an American aircrew member. Then, Prime Minister Scott Morrison, who had previously said vaccination "was not a race" called in July on Australians to "go for gold" in the country's inoculation drive.
He moved to overcome a supply shortage, compounded by the slow regulatory approval.
In August, Australia bought one million Pfizer doses from Poland; this month, Mr Morrison announced a purchase of one million Moderna shots from Europe.
When the Delta outbreak emerged, fewer than 25 per cent of Australians over age 16 had received a single shot. In the state of New South Wales, which includes Sydney, 86 per cent of the adult population has now received a first dose, and 62 per cent of adults are fully vaccinated. The country expects to fully inoculate 80 per cent of its population over 16 by early November.
"There was great community leadership - there were people from across the political divide who came out to support vaccination," said Dr Greg Dore, an infectious disease expert at the University of New South Wales. "It really helped us turn around a level of hesitancy that was there."
Many governments have used incentives to encourage inoculations.
In South Korea, the authorities eased restrictions in August on private gatherings for fully vaccinated people, allowing them to meet in larger groups while maintaining stricter curbs for others. Singapore, which has fully vaccinated 82 per cent of its population, previously announced similar measures.
Researchers there have also analysed the pockets of people who refuse to be inoculated and are trying to persuade them.
Dr Ng from the National University of Singapore and his team recently found out that a group of seniors who lived alone were worried about possible adverse effects from the vaccine, fearing they could die in solitude. The volunteers promised they would visit after the vaccinations, a strategy that worked.
"This targeted approach does make a difference, because at the end of the day, the mass communications campaign can only take you so far," Dr Ng said.
Once countries were able to order vaccines, many had to scramble to set up the infrastructures needed to immunise the masses and quell public anger over the initially slow roll-outs.
Ms Miharu Kuzuhara, 26, a graphic illustrator in Tokyo, got her Pfizer shots in July and August but was frustrated that she had to wait that long.
"We were losing to our other Asian neighbours, like Taiwan and South Korea," Ms Kuzuhara said. "I had this feeling of disappointment, like Japan is really the worst."
The Japanese government dispatched the country's military to run vaccination centres in Tokyo and Osaka and authorised companies to give shots to their employees. Local governments offered payments to doctors and nurses to administer the shots during their days off.
The share of people inoculated against Covid-19 in Japan, at 69.6 per cent, recently overtook that of the US. In some rural areas, vaccination rates are already close to 100 per cent.
"Normally, people are hesitant, they're not very enthusiastic about vaccines," said Dr Takashi Nakano, a professor of infectious diseases at Kawasaki Medical School. But "there was strong political commitment, a real feeling in the nation that because this is an infectious disease, we need to take steps to prevent it".