Regional health security architecture in ASEAN countries: Lessons from regional CDC models and Japan's strategic partnership for ACPHEED development

The COVID-19 pandemic exposed critical gaps in regional health security mechanisms, prompting ASEAN to establish the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), with functions distributed across Indonesia, Thailand, and Vietnam. This policy analysis examines strategic development approaches for ACPHEED through comprehensive benchmarking of the European Centre for Disease Prevention and Control (ECDC), Africa Centres for Disease Control and Prevention (Africa CDC), and Gulf CDC, supported by consultations in Indonesia (2024) and Sweden (2025) involving ASEAN member states and international partners. A comparative analysis reveals distinct organizational models: the ECDC operates within European Union (EU) institutional frameworks emphasizing functional specialization; the Africa CDC employs decentralized Regional Coordination Centers; and the Gulf CDC implements hybrid governance <i>via</i> Permanent Communication Networks. Each model offers valuable lessons for ACPHEED's development, particularly concerning governance structures that balance regional coordination with national sovereignty. ACPHEED faces unique challenges due to ASEAN's consensus-based, nonlegislative institutional nature and its tri-country operational structure. Critical success factors include phased surveillance emphasizing a defined scope and capacity building; inclusive governance mechanisms ensuring equitable member-state ownership; and operational frameworks applying subsidiarity principles to complement existing ASEAN mechanisms. Sustainable financing remains paramount given ASEAN's limited budgetary authority. Japan's strategic partnership should capitalize on its technical expertise in laboratory systems, digital surveillance, and disaster preparedness through comprehensive institutional support. ACPHEED's success depends on sustained political commitment, realistic financial arrangements, and effective integration into global health security architectures. This analysis provides a strategic roadmap for ACPHEED's preparatory phase so that it can serve as a regional health security leader while addressing ASEAN-specific institutional constraints.