Indonesia has reported more daily Covid-19 infections than India and Brazil as the Delta strain sweeps across south-east Asia, placing intense pressure on health systems. Most countries in the region are experiencing their worst outbreaks since the pandemic began, fuelled by the emergence of more aggressive variants and a lack of vaccines. In Malaysia, shipping containers have been sent to hospitals because their morgues are so overwhelmed. In Thailand, field hospitals are being built at the capital’s two airports. In Myanmar, social media has been inundated with desperate pleas for oxygen. In Indonesia, the worst hit, volunteer undertakers visit homes, collecting the bodies of people who were unable to access treatment. On Saturday, Indonesia reported 51,952 cases and 1,092 deaths, higher than India and Brazil for a third day running. More than 72,400 people have died, according to official records. Only the UK – which has a far higher rate of testing – recorded more new infections on Saturday, 54,674. Health experts believe Indonesia’s figures are a severe underestimate. “The centre [of the pandemic] in Asia is already in Indonesia right now, but if we have more testing capacity we are already the epicentre of the world,” said Dr Dicky Budiman, an Indonesian epidemiologist at Australia’s Griffith University. “We miss many cases and we don’t identify maybe 80% of these cases in the community … In Indonesia the testing is passive, it’s not active. The one who comes to the healthcare facility is the one who gets tested if they show symptoms, or if they also identity as the contact,” he said. Indonesia has one of the world’s weakest testing systems, performing 55.89 tests for every 1,000 people since the start of the pandemic, according to Our World in Data. This is a lower testing rate than in India, with 318.86 swabs per 1,000 people. The UK, which has one of the highest rates, has conducted 3,311.03 tests per 1,000 people. While Europe is hoping mass inoculation campaigns will help mitigate the worst of the new, more aggressive variants, south-east Asia’s vaccination rates remain extremely low. In Myanmar, less than 4% of the population has received one vaccine dose. The country’s vaccination campaign has collapsed, as has the wider health system, following the military coup in February. The independent news site the Irrawaddy reported on Saturday that four major cemeteries in Myanmar’s main city Yangon had experienced one of their busiest weeks ever. On Thursday alone, the cemeteries buried more than 700 people. Elsewhere, Vietnam, where millions are again under lockdown, has fully vaccinated fewer than 1% of its citizens. Thailand and the Philippines have fully vaccinated fewer than 5%. The International Federation of Red Cross and Red Crescent Societies has warned of a “widening global vaccine divide”, and urged wealthier countries to speed up their delivery of vaccines. Not only have far fewer people across south-east Asia received doses, but there are also concerns that Chinese-made Sinovac, which is being relied upon by many governments, is less efficacious than other jabs. Indonesia and Thailand, which have both vaccinated their health workers with Sinovac, have said they will offer a booster dose from a different vaccine to improve protection. So far this month, 180 Indonesian healthcare workers have died, according to the civil society group LaporCovid-19, which is tracking the pandemic. It’s not clear how many had been vaccinated. Dr Anan Jongkaewwattana, of the National Centre for Engineering and Biotechnology in Thailand, who has researched the impact of Sinovac, welcomed the decision to give additional jabs. A preliminary study run jointly by the centre and Thammasat University found that antibody levels among 500 Thai medics vaccinated with two doses of Sinovac fell 50% within 40 days. The researchers have not yet looked specifically at neutralising antibodies, the key parameter for protection against the virus, or at new variants. However, their findings do, like other studies, suggest the vaccine’s impact weakens over time, said Anan. “It is a warning sign that vaccines made from the inactivated viruses might not be able to maintain the immune response long enough,” Anan said. The region’s slow vaccine rollout is further exacerbated by production delays in Thailand. The royal-owned company Siam Bioscience is a regional hub for the AstraZeneca vaccine, and is contracted to supply doses to neighbouring countries. It has already postponed deliveries, and Thailand is considering imposing limits on vaccine exports, to prioritise its own population. Thailand, which had recorded fewer than 30,000 cumulative cases at the start of April, has seen its caseload rise to more than 400,000. The World Health Organization warned on Friday that the number of Covid patients who are seriously ill was at an all-time high, and that Thai hospitals would continue to face “a very high burden” over the coming days and weeks. The Thai government has been criticised both over its chaotic and sluggish vaccination campaign, and for failing to introduce firmer restrictions earlier in the year. In Malaysia, fatalities have more than tripled since early in May, reaching 6,866 deaths. Lockdown measures introduced on 1 June have caused economic misery for many. Over recent weeks, people have hung white flags from their windows to signal that they are unable to cope economically, and are in need of assistance. Much of the manufacturing sector, however, has been allowed to continue operating. Cases have continued to rise, with health experts blaming inconsistencies and loopholes in the restrictions. Last week, record daily infections were recorded for three days running. Dr Khor Swee Kheng, an independent health policies specialist, said the Malaysian government should urgently boost healthcare capacity in and around Kuala Lumpur, where hospitals are most stretched. “A generous and comprehensive welfare protection to support nutrition, mental health and ability to stay at home for all Malaysians,” was also needed, he said. Dicky said Indonesia, and other nations, could not rely on vaccinations and instead needed to focus on strengthening surveillance. “We have to have a response based on public health – the early detection, the testing and tracing.” Greater collaboration between south-east Asian countries was also needed, he said, adding that the region has a highly mobile population. “That’s why we need to collaborate with testing and tracing together otherwise we cannot control this in the region.”