Is speed critical for Thailand’s vaccination drive?

It has now been a little over a year since the first case of COVID-19 was discovered in Thailand, making it the first country outside of China to come into contact with this novel disease. One year later, with a second wave of cases still yet to reach its trough, the borders having been closed for months and the economy more than a little battered, more than a few Thais are wondering when all of this will finally be over. 

The solution, of course, is the vaccine: that elixir of hope that promises to restore normalcy to a world utterly tired of extraordinary times, disoriented by a year of head-spinning tragedy. But even with the light visible at the end of this dark tunnel, it appears this train is not moving towards it at anything close to full speed. 

Why so? This was a key topic that Progressive Movement leader Thanathorn Juangroongrueangkit took up in a presentation on Facebook Live, The Royally Bestowed Vaccine: Who Wins, Who Loses? Unsurprisingly given its name — the title is a reference to the AstraZeneca vaccines that will be produced locally in Thailand by Siam Bioscience, a pharmaceutical company owned by the Crown Property Bureau — this was a controversial speech as Thanathorn questioned all aspects of the government’s management of Thailand’s vaccine procurement and distribution. 

Thanathorn wanted to know why the government was putting all its eggs in the AstraZeneca basket, aside from another small batch of Sinovac vaccines that will be arriving first. (Thailand has been attempting to diversify its orders. Dr. Nakorn Premsri, the Director of the National Vaccine Institute, recently said at the FCCT that negotiations are ongoing with companies such as Pfizer, Johnson & Johnson and Sinopharm.)

He also asked why Thailand was relying on the “financially unsuccessful” Siam Bioscience and whether or not it was meant to generate popularity for the government. This has been furiously debated elsewhere: the permanent secretary of the Ministry of Health, for one, quickly retorted that AstraZeneca had selected Siam Bioscience due to its production capabilities, and that sales will be made on a “no profit, no loss” model. 

Given that ample attention has been given to other aspects of the speech, and that there is insufficient information to scrutinize either the claims or the rebuttals, what I do want to look at is another key concern which Thanathorn honed in on: that the vaccination drive is too slow and lagging behind other countries. 

Thanathorn noted that even as several countries have already purchased enough doses to cover their entire population and begun vaccination campaigns, Thailand still has signed only enough doses to cover 21.5% of the population (excluding an order for 35m more doses that the cabinet has approved) and only plans to vaccinate half the population this year.)

He then cited a number of examples of neighboring countries that has secured more coronavirus doses than Thailand — Malaysia, for example, has already bought enough for 71% of the population, with a goal of inoculating 83% by the end of this year. Several countries, on the other hand, have already begun vaccinating their populations. Israel is the world leader with over a quarter of the population already vaccinated, while the United Kingdom and the United States have already vaccinated 6.45% and 4.36% of their people, respectively. 

Intuitively, it makes sense: to end the pandemic, we need to vaccinate as many people as is needed to establish herd immunity, as quickly as possible. On this metric, Thailand is failing, with a relatively unambitious year-end goal, so few doses already secured, and a vaccination timeline that is slow at best.  But here’s a question that should be raised: is speed the best way to judge the success of Thailand’s vaccination campaign? 

In many places around the world, there is really no choice but to roll out the vaccines as soon as possible. At the time of writing, the United States has a seven-day average of 200,000 cases per day and a total of just a little under 400,000 deaths due to the coronavirus. Hospitals in states such as California are now overwhelmed. Choosing not to inoculate as much of the population as soon as possible, in this case, is a conscious choice to perpetuate tragedy. No wonder, then, that the authorities in America and Europe are granting regulatory approval to vaccines as quickly as they can. 

But a number of countries that have zero, or have largely controlled, local infections, are moving much more slowly. 

The reasons for this are diverse. Some are concerned about the potential side-effects of the coronavirus vaccine. As Park Neung-hoo, South Korea’s health minister told the Financial Times in December, “We are coping with Covid-19 relatively well, so we don’t have to begin vaccination in a hurry when the risks have not been verified yet.” This may indeed be one of the concerns that is driving Thailand’s decision-making. In the wake of several elderly Norwegians dying after taking Pfizer’s vaccine, Prime Minister Prayut Chan-o-cha wrote that he refuses to let Thais be a “lab rat.”

Another issue is that lingering fears about the new vaccines can botch a rollout without proper trust-building. Even in Indonesia, which is currently recording thousands of cases a day, a pollster found that only 37% of Indonesians are currently willing to be vaccinated. Japan, also fighting a surge in cases, has one of the lowest levels of vaccine confidence in the world, according to the Asahi Shimbun.

Others are even slowing their rollouts out of humanitarian courtesy towards virus hotspots. New Zealand’s Deputy Prime Minister Grant Roberson recently said that “we’ve got a situation in the UK and the US where they are really struggling at the moment with tragic levels of deaths. That’s where the vaccine is rolling out first.” 

One example of a country that has also moved slowly and cautiously in its inoculation drive is Vietnam, which may be ASEAN’s most successful country in containing the pandemic. So far, Vietnam has only ordered enough doses for 15 million people out of a population of 95 million, and is still in talks with Pfizer, along with Chinese and Russian companies for other orders. 

All of these are difficult concerns to balance. Without a rapid vaccination drive that creates herd immunity, the global situation will only take longer to resolve, and continuing border controls will likely ruin more livelihoods in a tourism-oriented country like Thailand. And caution can only go so far: there is no way to be completely certain about the long-term effects of any of the vaccines. It is still evident, however, that there are more moving parts to this equation than simply speed and the number of doses ordered. 

As I am not a public health expert and lay no claim to any medical expertise, it is hardly for me to say which strategy is correct. Is Thanathorn right that speed is of essence? Or is the government moving along at an appropriate pace? That is for the public health authorities to decide. 

What is clear is that the government must do a better job of communicating its vaccine strategy to the public so that people understand its intentions and can debate it with a clear understanding of what it is thinking. 

For one, if it is taking a cautious approach, it should be clear about it. At the FCCT, Dr. Nakorn Premsri explained that Thailand has decided to be cautious with its vaccination program so that the “safety profile” of each vaccine can be understood once our own inoculation campaign starts. Emphasizing that coverage rather than speed is key, he said: “this is not a one hundred meter race,” he said. “It’s a marathon.” 

If that is the government’s strategy, it needs to be communicated more effectively to the Thai people. Otherwise, given that most will assume that speed is of critical importance, the takeaway that some people take from Thailand’s cautious approach will be that of indifference and incompetence. That was why Thanathorn’s take quickly resonated with many netizens, and unless the government is able to halt the decline in trust, Thais’ confidence in the government’s public health response will erode.

Such skepticism towards government competence can only hinder the vaccination campaign moving forward. 


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