Governor Weerasak Wijitsaengsri of Samut Sakhon recently announced the expediting of the process in which COVID-19 patients in the province could be transferred to community facilities to await hospital treatment. In the past, the governor explained, a number of official regulations had made such a transfer a lengthy process. Now, however, these regulations were to be amended.
“If a regulation will cause people to die because there is no place for the sick to be isolated, then we must overcome those regulations,” he declared on his Facebook page. “Let’s make it clear: what’s more important, regulations or deaths?”
Governor Weerasak knows from personal experience how dangerous the coronavirus can be. Only a few months ago, he had fought it off after spending more than forty days on a ventilator. The fact that he now acts with urgency to ensure that as many others are protected from that same disease is highly worthy of praise.
Unfortunately, the bureaucratic system in Thailand as a whole does not operate with quite the same speed.
It is worth noting that while this is a piece on the Thai bureaucracy, it is not a critique of individual bureaucrats. Bureaucrats who act with integrity and do their best to serve the nation are to be commended and respected.
But the bureaucratic system — how it operates, its culture and the various regulations that define it — is widely recognized to be inefficient and badly in need of reform. Indeed, the current COVID crisis has starkly shown this to be the case.
In some instances, bureaucratic delays simply cost money or some inconvenience. Calling 1668 to request a hospital bed, for example, was not toll-free; given the length of time it may take to connect and speak on that number, phone bills can quickly add up. Only recently has the Ministry of Digital Economy and Society requested that COVID-related numbers become toll-exempt.
And in other cases, the consequences are even more serious.
Take another example from earlier in the year, during the second wave. The Rural Doctor Society, in an appeal to the government in January, explained that a cabinet meeting on December 29th had approved urgently buying ventilators and improving inpatient halls to ensure better ventilation. Yet two weeks later, these purchases were still facing a long and bureaucratic procurement process that, they said, threatened to cause a delay of one to three months if not expedited.
Testing was also hampered by regulation, particularly when it was required that hospitals accept everyone who tests positive into their care, leading overwhelmed hospitals to eventually reject people from testing. The government moved slowly on permitting self-testing using rapid antigen tests. When this was permitted, symptomatic patients with results from rapid antigen testing were, until recently, unable to access treatment, because rules required results from difficult-to-obtain PCR tests. (Thankfully, this was recently updated to permit entry into the home isolation system.)
Perhaps on one level it isn’t difficult to understand why the bureaucratic system moves slowly. Regulations create a risk-averse culture where officials, fearful of the consequences, would prefer to move cautiously to ensure that they cannot be found to have broken any rules. Yet the result is a system that does not move speedily enough during a fast-moving pandemic, when lives are at stake.
Critically, it may have hampered Thailand’s long-running struggle to procure vaccines. Dr. Somchai Jitsuchon, who sits on the board of the National Vaccines Institute, recently described how last year efforts to order vaccines had run up against barriers in Thailand’s procurement law. The government, in turn, had not responded quickly to requests to amend the procurement law in parliament. In addition, the bureaucratic process delayed the government’s request to increase its order from 26 million to 61 million doses, with the letter only finally sent in May.
To fix this situation, the Thailand Development Research Institute has recently proposed that the government form what the media has called a “dream team” of diplomats, businessmen and medical experts to lead Thailand’s vaccine purchase efforts. (Full disclosure: I am a TDRI researcher.) The rationale behind this is to allow this team to work full-time on vaccine procurement without being bound by bureaucratic regulations.
Thailand cannot afford to wait. The government cannot hide behind regulations as a defense against moving with insufficient speed. Rules, after all, can be amended. In fact, the government usefully has a majority in parliament which it can use towards this end. What is required is a mindset that is willing to cut through bureaucratic barriers in order to protect what must be prioritized: lives. If regulations must be amended in order to speed up the nation’s efforts to fight the coronavirus, so be it.
We often discuss the concept of a “regulatory guillotine”: increasing efficiency and reducing costs by getting rid of unnecessary regulations. This cannot remain a buzzword. Speed is of the essence. Rules must be changed to keep up with the ever-changing circumstances of this crisis. It’s now more urgent than ever to cut through the web of rules that are slowing down Thailand’s COVID-19 response.