Thailand under attack for refusing to import experimental vaccines

By Bronwen Evans

Thailand has been one of the most successful countries in the world in managing the spread and lethality of the Covid-19 virus. For most of the second half of the year there were no reported cases of community spread and in total, by the end of November 2020 only about 4000 infections had been reported and 60 deaths. Life had pretty much returned to normal apart from continued mask wearing and temperature checks in public spaces. However, the economy was badly damaged – GDP fell by 6.1% in 2020.

Thailand has been trying to strictly control its borders by only allowing nationals and those with long term residency or work permits to enter. Even these people must test negative for Covid to enter the country and undergo a two week quarantine. Despite these efforts it was inevitable that that Thailand would be susceptible to further outbreaks due to its porous borders with countries such as Myanmar, Cambodia, Vietnam, and Laos. Prior to the outbreak there were about four million migrant workers from these countries working in Thailand and although earlier in the year many went back home, after a few months many were crossing back across the border into Thailand illegally to get work. In December some signs of community transmission began to emerge – firstly in some border areas in the north and west of the country and then a major outbreak was detected in Samut Sakhon just south of the Bangkok capital. This province is a centre for the seafood industry and has many processing factories staffed by migrant workers, especially from Myanmar where the virus had become widespread by the end of the year. Localised cases of the virus began popping up in provinces around Thailand and to contain the spread, some provincial borders were closed. Thailand’s government encouraged people to work from home and placed restrictions on entertainment and nightlife but avoided a nationwide lockdown. Indeed, there was never a full lockdown in Thailand even during the first outbreak in March and April but then more businesses were ordered to close such as hair salons, restaurants and hotels.

In general Thailand has pursued its own path for managing the virus – in addition to no mandated lockdowns, it has not implemented mass testing and the health system has developed its own treatment protocols including steroids, plasma, hydroxychloroquine, the anti-viral drugs Favipiravir and Ritonavir, as well as the antibiotic Azithromycin. Thailand also developed its own test finger prick blood tests and it plans to produce its own Favipiravir under license. In July Thailand was ranked first among the countries with the highest COVID-19 recovery index, according to a report issued by the Global COVID-19 Index (GCI). The recovery rate improved further in the most recent outbreak with only 22 deaths among 20,000 confirmed cases, or a death rate of around 0.001, with a total death rate of 82 which is a little over one per million in the total population of around 70 million.

However, the Thai government is now being attacked for its vaccination policy. It plans to import and has an agreement to produce AstraZenaca vaccines. It is also importing some Sinovac vaccines. To date, the government has purchased 26 million doses from AstraZeneca and 2 million doses from China’s Sinovac. Recently, the government reserved an additional 35 million doses from AstraZeneca. It plans to vaccinate around 50% of the population by year-end.

It has come under strong attack from an opposition party which has criticised its reliance on AstraZeneca, suggesting this is due to corruption, and from the tourism industry, and expat groups for being too slow to vaccinate the population and again for its reliance on AstraZenaca. Expat groups, tourism operators and private health providers want to be able to import other vaccines but the government has so far prohibited this. Moreover, there is no policy at the moment for vaccinating anyone but Thai nationals. Thai health officials have also rejected the idea of a vaccine passport saying that there is no evidence that the vaccines prevent transmission.

The loudest voices of criticism are coming from the tourism industry which has been devastated, especially in former tourist meccas like Phuket, which was heavily reliant on foreign tourists. Prior to the Covid-19 outbreak there were around 40 million international tourists coming to Thailand and tourism accounted for around 25% of GDP. Now those numbers are virtually zero. Expats are also loudly complaining as they want access to vaccines and for those around them to have “herd immunity” and are getting support from English language media such as the Bangkok Post.

There is also growing public criticism of the vaccination particularly from the business community, as countries which are part of the Covax agreement are now preparing to roll out their inoculation drives. However Thailand’s Public Health Ministry says the Covax programme’s requirements are too limiting to put down billions of baht in deposits to join. It says under the programme, the kingdom cannot fully choose the vaccine it would get, when it would get the vaccine and the cost might be higher than acquiring from direct negotiations with the producers, authorities said. According to Supakit Sirilak, chief of the Department of Medical Sciences who is also deputy chairman of a committee acquiring vaccines for Thais:

“We are being asked to pay about 4 billion baht for the product when we don’t know for sure what we will get and when we are going to get it. We might get a very expensive vaccine that is not easy to transport or a vaccine of a quality that we are not satisfied with. We have no way to choose what is best for us,” he said, adding the minimum price for a vaccine under Covax is US$10.50 (310 baht) per dose. According to Public Health Minister Anutin Charnvirakul, Thailand stands to get a dose of the Covid-19 vaccine from AstraZeneca for US$5 or about 150 baht. Watcharapong Kuwijitsuwan, secretary to the Public Health Minister, said if Thailand decided to join but later refused to sign contracts with the firms providing the vaccine as allocated by Covax, it would have to lose its deposit.

Dr Supakit Sirilak said Thailand initially responded to the Covax invitation with interest, as it is one way to acquire Covid-19 vaccines for Thais. However, many details mentioned by the agreement left the ministry uneasy, especially given possible legal concerns in the event of any dispute.

Another very important reason is that by law, the Thai government is not allowed to spend money on vaccines which have not been proven to be effective.

Although the government has not completely ruled out the option of private organisations importing vaccines, as of last week, Health Minister Mr Anutin said local administration organisations and the private sector are not allowed to buy any Covid-19 vaccines by themselves for the time being.

He said producers were testing their vaccines in human trials and agreed to sell them to governments for emergency use only. “Vaccines would be used to prevent severe symptoms that may cause death, though whether they can prevent infections has yet to be confirmed,” Mr Anutin said.

One reason for Thailand’s independent stance, is that up to now management of the crisis has largely been left to the medical professionals rather than the politicians. Dr Supakit says it took Thailand more than 50 years to develop the healthcare system whose strengths shone out in the global fight against COVID-19.

In 2001, the WHO appointed Thailand as the WHO Collaborating Centre for Research and Training in Field Epidemiology, in recognition of the Kingdom’s strengths and abilities in the medical field. Thailand ranked an impressive 6th in the 2019 Global Health Security Index and topped the rankings in Asia. It scored second highest for its health system, third on disease prevention and fifth on rapid response.
In July Thailand was ranked as the best country in the world for recovering from Covid.

As yet, there does not seem to be an outcry however from the general population – although Thailand too has been caught up in the fears about the virus most Thai people don’t seem to be in a big rush to be vaccinated. They are pragmatic, tend to trust the health professionals and are happy to wait and see what the side effects of the vaccines are.

However it remains to be seen if the government can resist growing pressures particularly from the business community as economic forecasts for 2021 are being revised down due to the latest outbreak. Meanwhile opposition groups have introduced a no confidence vote in the government focusing on its failure to control the borders and the slow vaccine rollout.

Additional references:

https://www.bangkokpost.com/thailand/general/2068211/chula-to-develop-cheap-covid-19-diagnostics

https://www.nature.com/articles/s41467-021-21240-1