Beyond commerce: Why DEFA matters for ASEAN health collaboration

The conclusion of negotiations on the ASEAN Digital Economy Framework Agreement (DEFA) marks a significant milestone in Southeast Asia’s digital transformation journey.  

Much of the discussion surrounding DEFA has focused on trade, e-commerce, digital payments, and ASEAN’s ambition to become a leading digital economy. 

Less discussed is that DEFA's most transformative opportunities may be enabling a more connected regional health ecosystem. 

ASEAN is home to 682.7 million people, representing 8.4 per cent of the world’s population, and has emerged as the world’s fifth-largest economy with a combined gross domestic product (GDP) of US$3.9 trillion (S$5 trillion).  

The region also has a highly mobile population, and has been advancing its digital trade efforts and payment systems. 

Regional health data exchange lagging 

Comparable progress in regional health data exchange, however, has been more limited. 

The Covid-19 pandemic demonstrated the value of digital platforms in responding to shared health threats. Yet growing mobility is creating demands that existing arrangements were not originally designed to address. 

Consider a patient who receives treatment in one ASEAN country and continues to receive care in another.  

In many cases, essential clinical information does not travel with the patient. Diagnostic tests are repeated, treatment histories become fragmented, and healthcare resources are used less efficiently. 

This challenge is becoming increasingly relevant as medical tourism expands across Southeast Asia. The ASEAN medical and wellness tourism market, valued at more than US$66 billion in 2024, is projected to exceed US$218 billion by 2034.  

One of the sector’s persistent challenges has been ensuring continuity of care after patients return home.  

As medical travel becomes more common, secure access to relevant health information is becoming a practical requirement for patient safety and service quality. 

During Covid-19, digital vaccination certificates became interoperable through internationally agreed standards and trust frameworks.  

More recently, the European Union launched the European Health Data Space (EHDS), creating a framework to support secure use of health data across member states for patient care, research and policymaking. 

The emergence of DEFA raises an important possibility: Could ASEAN move in a similar direction? The answer depends less on technology and more on governance. 

Building the foundations for cross-border health data sharing 

ASEAN operates through consensus-based cooperation.  

Member states differ considerably in institutional capacity, digital maturity, and regulatory readiness. Health systems also vary substantially. These disparities make regional health integration more complex than digital commerce integration.   

The latest World Health Statistics Report highlights an important reminder. Progress toward Universal Health Coverage has slowed, while major gaps remain in health information systems, mortality reporting, and surveillance capacity.  

At the same time, ASEAN is entering a period of rapid digital transformation. With around 500 million internet users, governments in ASEAN are investing in digital public infrastructure (DPI), including digital identity systems, payment platforms, and trusted data exchange mechanisms.  

The next frontier may be DPI for health. 

Across ASEAN, governments are accelerating digital health transformation through electronic health records, health information exchanges, telemedicine platforms and other digital health services.  

However, most initiatives remain national in scope. The rapid growth of medical tourism, labour mobility, and cross-border travel increasingly highlights the need for trusted mechanisms that support continuity of care beyond national borders. 

This is where DEFA becomes particularly relevant. One of the agreement’s forward-looking provisions supports cross-border data initiatives.  

The opportunity is especially relevant in a situation where healthcare, travel, and digital services are becoming increasingly interconnected.  

Trusted health data exchange could support continuity of care, strengthen public health surveillance, and improve preparedness for future health emergencies. 

Importantly, ASEAN’s own Migration Outlook has already recommended the development of digitised systems for collecting, processing and sharing information to support cross-border governance and crisis response.  

DEFA may provide the broader regional framework needed to advance such aspirations. 

Yet interoperability is not simply a technical matter.  

Health data is among the most sensitive forms of personal information. Questions of privacy, consent, cybersecurity, accountability and governance remain central to any future discussion on regional health information exchange. 

ASEAN’s regulatory landscape also remains diverse.  

Several member states have enacted personal data protection laws, while others continue to strengthen their legal frameworks. As ASEAN advances cross-border data initiatives, the challenge is not necessarily to harmonise regulations but to establish trust and compatibility across different legal systems.  

An important step in this direction is the ASEAN Model Contractual Clauses (MCCs) for Cross-Border Data Flows, which provides a voluntary legal mechanism to facilitate trusted transfers of personal data between organizations operating under different national legal regimes.  

However, implementation remains at an early stage, and their practical contribution to cross-border health data sharing will depend on stronger governance for privacy, consent, security, and accountability. 

Turning DEFA into a health opportunity 

This is why capacity building must become a central pillar of ASEAN’s digital health agenda. Policymakers need a deeper understanding of data governance and cross-border regulation. 

Regulators require stronger expertise in privacy protection and cybersecurity. Health professionals need digital competencies, while institutions must develop the capacity to manage increasingly complex digital ecosystems. 

ASEAN’s health bodies, together with the ASEAN Secretariat, have an opportunity to ensure that health becomes part of the broader DEFA’s implementation agenda. Digital integration should not remain solely in the domain of economic and digital ministries. 

Development partners also have an important role to play. ASEAN has long benefited from collaboration with dialogue partners and international organisations. Future cooperation should focus not only on technology deployment but also on governance, workforce development, regulatory strengthening, and institutional readiness. 

Ultimately, DEFA may become more than a digital economy agreement. Its legacy could extend beyond trade if ASEAN succeeds in translating digital integration into stronger regional health cooperation. 

Therefore, the future of healthcare in Southeast Asia will depend on ASEAN’s ability to transform digital connectivity into institutional connectivity, enabling countries with different levels of digital maturity and health system capacity to work together.  

If that can be achieved, DEFA may help create a more connected, resilient and people-centered health ecosystem for the millions of people who live, work, study, and travel across the region every year. 

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The author is a lecturer at Universitas Gadjah Mada, Indonesia, and Board Member of Asia eHealth Information Network.  The views expressed are the personal views of the author.