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Purpose: This paper analyzed the healthcare systems of the Philippines and Vietnam prior to the coronavirus disease 2019 (COVID-19) and their strategies on mass testing, contact tracing, quarantine procedures and information dissemination about the pandemic. Design/methodology/approach: Steinmo's (2008) historical institutionalism approach was used in this paper. Secondary data gathering, document analysis and comparative process tracing were employed. Findings: The findings revealed that Vietnam's implementation of its Law on Prevention and Control of Infectious Diseases in 2007, its relatively low-cost healthcare system, its efficient mass testing and contact tracing strategies and its science-based decisions are contributory to its success in handling the pandemic. Meanwhile, the Philippines failure to enact its Pandemic and All-Hazards Preparedness Act in 2013, its costly and dominantly private healthcare system, its heavy focus on strict, long lockdowns and its militarist methods to control the spread of the pandemic were found to be insufficient. Research limitations/implications: Detailed study on the delivery of healthcare services in marginal areas, healthcare spending for COVID-19 positive individuals and information dissemination strategies about the pandemic were not explored. Practical implications: Health institutions can redesign their governance mechanisms by ensuring a cost-effective healthcare system and maximizing resource utilization to ensure efficient management of future pandemics. Moreover, national governments should not compromise their country's healthcare system over the economy during a pandemic. Originality/value: This paper analyzed the countries' history of healthcare governance and its influence in handling COVID-19 compared to previous studies which only focused on the countries' strategies during the pandemic. [ABSTRACT FROM AUTHOR]