Exploring layers of vulnerability during COVID-19: qualitative research with communities in Indonesia, Nepal, and Vietnam

What does it mean to be vulnerable in a pandemic? COVID-19 and its complex ramifications have challenged policymakers and researchers worldwide to redefine and reassess vulnerability. This paper presents experiences of being vulnerable during the pandemic among communities in Indonesia, Nepal and Vietnam. From November 2020 to April 2021, we conducted qualitative research with communities in 13 locations including Jakarta, Bandung and Sumba in Indonesia; Morang & Sunsari, Kathmandu, Bhaktapur, Sindulpalchowk, Lower Mustang and Kapilvastu in Nepal; and Hanoi, Ho Chi Minh City, Nam Dinh and Dak Lak in Vietnam. We held discussions with key informants from local communities and healthcare systems to explore local ideas of vulnerability. Based on these discussions and findings from our media monitoring at all study locations, community members at high risk of adverse impacts from the pandemic were identified. Participants were purposively sampled to represent a range of age groups, occupations and levels of exposure to COVID-19 in the community and enrolled in semi-structured in-depth interviews about their experiences with the pandemic and public health responses. We analyzed and framed the results using Luna’s metaphor of “vulnerability layers”. In total we held discussions with 16 key informants from local communities and healthcare systems and collected 93 in-depth interviews with community participants. Using the “vulnerability layers” metaphor, we describe how stimulus conditions, namely stringent public health responses to COVID-19, may aggravate vulnerabilities a person already experiences or create new vulnerability experiences (for example, stigmatized status). A vulnerable experience can be exacerbated by the layering of multiple vulnerabilities or their cascade effects; on the other hand, it can be mediated by personal or collective protective factors. Our findings also demonstrate the role of context, including local disease control approaches and sociocultural attitudes and norms, in both the activation of and protection against vulnerability. Vulnerability assessments should take into account potential stimulus conditions (including public health responses) and local complexities rather than relying on groupings of impacted people. An understanding of the local context is also essential to improve the uptake and effectiveness of public health measures.

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Journal
BMC Medical Ethics
Published
2026-03-02
DOI
https://doi.org/10.1186/s12910-026-01400-y
Primary Topic
COVID-19 and Mental Health
Type
article
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article

Exploring layers of vulnerability during COVID-19: qualitative research with communities in Indonesia, Nepal, and Vietnam

Le Thi Hoang Lan, Le Nguyen Truc Nhu, Ninh Thi Thanh Van, Nguyen Hoang Yen et al.
BMC Medical Ethics
COVID-19 and Mental Health
article

Exploring layers of vulnerability during COVID-19: qualitative research with communities in Indonesia, Nepal, and Vietnam

Le Thi Hoang Lan, Le Nguyen Truc Nhu, Ninh Thi Thanh Van, Nguyen Hoang Yen, Huong Dang Thao, Huynh Le Anh Huy, Donovan L. Joseph, Phong Thanh Nguyen, Lam Anh Nguyet, Nan Hong, Ngoc Thao Nguyen, Livia Nathania Kurniawan, Dung Tien Viet Vu, Abhilasha Karkey, Nguyen Thi Han Ny, Thi Ha Uyen Tran, Nam Vinh Nguyen, Ralalicia Limato, Soraya Weldina Ragil Dien, Thao Tran, Amit Gautum, Dinesh Deokota, Dewi Friska, Aria Kekalih, Văn Vĩnh Châu Nguyễn, Nguyen Than Ha Quyen, Day Jeremy, Mary Chambers, Phung Le Kim Yen, Phu Huong Lan Nguyen, Pratibha Thapa, Aakriti Pandey, Thanh‐Truong Nguyen, Nguyễn Thanh Thùy Nhiên, Huynh Ngan Ha, Jennifer Ilo Van Nuil, Le Kim Thanh, Ida Ayu Sutrisni, Bùi Thị Hồng Ngọc, Mỹ Ngọc Nghiêm, Summita Udas, Bích Thủy Dương, Fisher Jaom, Kestelyn Evelyne, Lawson Katrina, Nguyen Le Thao My, van Doorn H. Rogier, Tinh Hien Tran, Tran Kim Van Anh, Le Van Tan, Trần Thị Bích Ngọc, Ho Thi Bich Hai, Hung Vu Bao, Thi Thanh Tam Tran, Nguyễn Thanh Ngọc, Mutia Rahardjani, Mai Thị Phước Loan, Nguyễn Thị Ngọc Diệp, Rabi Shakya, Geskus Ronald, Nguyen Thanh Truong, Tran Thanh, Trịnh Sơn Tùng, Vidaillac Celine Pascale, Thi Thu Thao Ho, Samita Rijal, Minh Phuong Phan, Ho Quang Chanh, Pham Ngoc Thanh, Nguyen Thanh Tam, Ngoc Thien Vuong Huynh, Thi Thuy Dung Le, Kesteman Thomas, Trong Vuong Vo, Dong Thi Hoai Tam, Ong Phuc Thinh, Tan Tai Ngo, Nguyen Duc Manh, Diana Timori, Ngoc Phuong Thao Pham, Nguyen Huy Man Dinh, Nguyen Thuy Thuong Thuong, Van Hiep - Pham Van Thinh Nguyen, Ngo Thi Hoa, Claus Bogh, Rabaa Maia, Nguyen Phuong Thao Tran, Yacoub Sophie, Tran Minh Hien, Phung Tran Huy Nhat, Thị Thu Trang Bùi, Thi Thuy Hong Pham, Pawan Sharma, Nguyen Thi Kim Ngoc, Fahmi Ramadhan, Thwaites Louise, Nhung Doan Phuong, Thành Luân Nguyễn, Vu Thi Ty Hang, Niharika Kharel, Le Thanh Hoang Nhat, Lam Uyen Thai, Thwaites Guy, Nguyen Xuan Truong, Nguyen Minh Nguyet, Trung Trieu Huynh, Thị Tuyết Trinh Huỳnh, Choisy Marc, Thi Bich Ty Dinh, Thị Thanh Thương Nguyễn, Vu Thi Ngoc Bich, Thuong Nguyen Thi Huyen, Huynh Xuan Yen, Lam Minh Yen, Nguyen Thi Kim Tuyen, Anup Rajbhandari, Le Dinh Van Khoa, Manish Duwal, Yen Thi Hong Nguyen, Nguyen Van Vinh Chau, Phung Khanh Lam, Raph L. Hamers, Tran Dong Thai Han, Nguyễn Thị Thu Hà, Du Hong Duc, Nguyễn Thị Quỳnh Trang, Phung Le Kim Yen, Kim Nhung Huynh, Sonia Lewycka, Dong Huu Khanh Trinh, Nguyen Thi Phuong Dung, Leigh Jones, Huynh Trung Trieu, Trần Thị Hằng, Manh Hung Le, Ho Van Hien, Rahman Motiur
article en

Abstract

What does it mean to be vulnerable in a pandemic? COVID-19 and its complex ramifications have challenged policymakers and researchers worldwide to redefine and reassess vulnerability. This paper presents experiences of being vulnerable during the pandemic among communities in Indonesia, Nepal and Vietnam. From November 2020 to April 2021, we conducted qualitative research with communities in 13 locations including Jakarta, Bandung and Sumba in Indonesia; Morang & Sunsari, Kathmandu, Bhaktapur, Sindulpalchowk, Lower Mustang and Kapilvastu in Nepal; and Hanoi, Ho Chi Minh City, Nam Dinh and Dak Lak in Vietnam. We held discussions with key informants from local communities and healthcare systems to explore local ideas of vulnerability. Based on these discussions and findings from our media monitoring at all study locations, community members at high risk of adverse impacts from the pandemic were identified. Participants were purposively sampled to represent a range of age groups, occupations and levels of exposure to COVID-19 in the community and enrolled in semi-structured in-depth interviews about their experiences with the pandemic and public health responses. We analyzed and framed the results using Luna’s metaphor of “vulnerability layers”. In total we held discussions with 16 key informants from local communities and healthcare systems and collected 93 in-depth interviews with community participants. Using the “vulnerability layers” metaphor, we describe how stimulus conditions, namely stringent public health responses to COVID-19, may aggravate vulnerabilities a person already experiences or create new vulnerability experiences (for example, stigmatized status). A vulnerable experience can be exacerbated by the layering of multiple vulnerabilities or their cascade effects; on the other hand, it can be mediated by personal or collective protective factors. Our findings also demonstrate the role of context, including local disease control approaches and sociocultural attitudes and norms, in both the activation of and protection against vulnerability. Vulnerability assessments should take into account potential stimulus conditions (including public health responses) and local complexities rather than relying on groupings of impacted people. An understanding of the local context is also essential to improve the uptake and effectiveness of public health measures.

BMC Medical Ethics
Angkor Hospital for Children (KH), University of Indonesia (ID), University of Oxford (GB), Oxford University Clinical Research Unit (VN), Hospital for Tropical Diseases (VN), Oxford University Clinical Research Unit Indonesia, Kathmandu University (NP)
Good health and well-being
Openalex Percentile: Top 41%
COVID-19 and Mental Health
DOIOpen Access PDFOpenAlex
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