The World and Thailand in Perspective after Two Years of COVID-19
At the time of writing, people in many countries worldwide are roaming streets freely without masks on their faces after the number of COVID-19 cases in 184 countries has reached 613 million, after 12.6 billion administered doses of vaccines, and 6,517,051 deaths1 (compared to about 70-85 million deaths in World War II). In Thailand, the official daily report now shows only 1,321 new cases and 14 deaths. As things overall are easing, it seems Thailand will soon announce the COVID-19 pandemic as endemic in October, delaying its original plan to do so since July. This article invites you to look in retrospect at this emerging infectious disease through two lenses: one to look at the big picture of COVID-19 worldwide through a comparison across various dimensions and the other one to examine how Thailand responded to COVID-19 from day one, 31 January 2020, when the first case was reported in the country to its turning point, and to identify the lessons learned.
4 Performance Indexes of COVID-19 Responses Worldwide
The Lowy Institute studied global COVID-19 responses using data from 116 countries over 43 weeks in 2021 and gave the performance score of 0 to 100, with 0 representing the lowest effectiveness and 100 representing the highest effectiveness. Its findings can be summarised as follows:
1. Regions: The Lowy Institute ranked regions’ performance of COVID-19 responses in the order
of highest to lowest as Asia-Pacific, the Middle East and Africa, Europe, and Americas. However, details of countries in the same region can vary. For instance, Taiwan, a small country, and countries with no land border like Australia and New Zealand were successful in their pandemic responses, while India, Indonesia, and the Philippines took a long time to turn the crisis back to normal. In terms of vaccine accessibility, Africa had the lowest vaccination rate. By country, only 4 in 100 people in Haiti and 14 in 100 people in South Sudan were vaccinated against COVID-19.
2. Political systems, defined as a set of rules that grants authorities political powers and allows
them to exercise those powers, are the common tools used by all countries, regardless of their types of regimes, to contain the spread of COVID-19. Governments around the world implemented various stringent measures and restrictions, such as social distancing, mandatory mask wearing, home isolation, lockdowns, and border closures. Although each government’s varying degrees of restrictions reflected the nature of each political system, it was found that different political systems did not significantly affect how well countries handled the pandemic. On one hand, authoritarian countries were able to slow the spread effectively during the initial outbreak of the virus, presumably because their leaders have more control over the social aspect of citizens’ lives, the media, and bureaucracy without the need to also weigh up transparency and checks and balances on their scale. On the other hand, most democratic countries, with the mechanism of accountability and individuals’ freedom to advocate for their rights, began their pandemic responses with more difficulties, but over time were able to achieve satisfactory outcomes, at least until the newer variants emerged. Hybrid regimes, such as Bolivia and Ukraine, did not cope very well with the pandemic, with only 30% and 36% of population respectively having been vaccinated against COVID-19. Cuba, a communist country, had the highest vaccination rate per capita of 95.1% or 3.67 doses per head.
3. Population size: At the onset of the pandemic, a population size did not largely affect the
performance of a country’s response to COVID-19, but after one month, countries with a population of fewer than 10 million were found to have handled the pandemic better than those with a larger population. However, the longer the spread of the virus continued, the smaller the gap became. Borders between nations were another important consideration. There was evidence that leaving borders open contributed to a rise in infections in a nation.
4. Economic development: Advanced economies with greater fiscal powers and resources may
have been assumed to perform better than poorer countries or developing countries, but surprisingly, the data showed the opposite. During the initial stage of the pandemic, developed countries could access and distribute vaccines to greater population faster, as shown in high vaccination rates, such as 63.3 million administered doses or 2.46 doses per person on average in Australia, 2.52 doses per person in Singapore, and 2.67 doses in the UAE. But over the longer period, many developing countries proved to have handled the pandemic better. Many developed nations experienced surges in new cases with the second wave of infections.
Thailand’s COVID-19 Vaccine Procurement and Distribution
Thailand was recognised as one of the countries that handled COVID-19 well, with 56,954,724 vaccinated people or 76.5% of the population, 4.66 million (0.02%) infections, and 32,447 (0.07%) deaths. It is therefore worth magnifying the country’s vaccine procurement and distribution timeline to evaluate government’s performance and effectiveness in responses to COVID-19.
Thailand was recognised as one of the countries that handled COVID-19 well, with 56,954,724 vaccinated people or 76.5% of the population, 4.66 million (0.02%) infections and 32,447 (0.07%) deaths.
Internationally, 91-year-old British national Margaret Keenan was the first person in the world to have received COVID-19 vaccination on 8 December 2020. In Southeast Asia, Thailand is the only country that did not join COVAX (COVID-19 Vaccine Global Access Facility), a WHO-sponsored coronavirus vaccine program which provided poor countries with free vaccines. The Thai Government did not see the scheme worth investing in as Thailand, categorised as a middle-income country, would not be eligible for free vaccines and would have to contribute to vaccine procurement. The Government’s goal was to use AstraZenecaas the main vaccine during the first several months of its vaccine rollout. However, due to the shortage of AstraZeneca supply, the Government turned to inactivated virus vaccine Sinovac despite its high price and ample global data suggesting its lower efficacy than mRNA vaccines.
On 28 February 2021, Professor Yong Poovorawan, MD, administered the first-ever COVID-19 jabs in Thailand, doses of Sinovac, in a “Vaccine Inauguration Ceremony”, joined by Deputy Prime Minister and Public Health Minister Anutin Charnvirakul and other ministers aged lower than 60. On the same day, Thailand received its first shipment of 117,000 doses of AstraZeneca. Between March and April 2021, Thailand’s vaccination rate inched towards the hundred thousand mark. When faced with criticism over inadequate supplies of vaccines, Deputy Prime Minister and Public Health Minister Anutin Charnvirakul in a press interview said that he would negotiate with Pfizer again, “[I] would beg them to speed up the vaccine delivery as soon as possible”. With the backdrop of vaccine uncertainty, the number of infections spiked before reaching a peak in July 2021, during which new cases increased from 400,000 to 500,000 within only eight days. As of 26 July 2021, Thailand had 512,678 accumulated cases. The first shipment of 1.5 million Pfizer doses donated to Thailand by the U.S. arrived in the country on 30 July 2021, after which an online photograph of a Thai medical frontline worker holding a sign thanking U.S. President Joe Biden for the donation sparked dramatic public debates. As of November, the vaccination rate had not yet reached 70% of the population, and the 1 million-dose target set by the Government had not yet been achieved. The problems in Thailand’s vaccine procurement demonstrated poor risk management without a backup strategy.
Thailand’s turning point was when the vaccination rate started to climb satisfactorily in November 2021, when the country had over 30 million doses of COVID-19 vaccines in reserve, comprising 13 million AstraZeneca doses, 10 million Pfizer doses, two million Sinopharm doses, and two million Moderna doses, some of which included a donation from the U.S., procurement by the private sector, and a donation of 1.5 million Sinovac doses from the Chinese Government. In December, AstraZeneca, despite its delayed shipments being forecast to occur in 2022, finally delivered the entire committed 61 million doses to Thailand.
Thailand’s turning point was when the vaccination rate started to climb satisfactorily in November 2021, when the country had over 30 million doses of COVID-19 vaccines.
So far, Thailand has administered over 143 million doses of COVID-19 vaccines or 2.05 jabs per person. However, what makes the country’s “fully vaccinated” status unusual is the “vaccine cocktail mix” where different vaccines are administered in various combinations. This combination strategy is found to have caused some troubles for people travelling overseas as some countries require travellers to have received certain approved vaccines. To enter Japan, for instance, a traveller must have received at least three doses of COVID-19 vaccines, excluding inactivated virus vaccines like Sinovac or Sinopharm. According to The Researcher’s Covid Tracker, Thais received AstraZeneca the most at 48 million doses, followed by Pfizer at 37 million doses. However, since March 2022 onwards, Pfizer has been the most administered vaccine in Thailand.
It is worth looking at two main issues involving Thailand’s vaccine management. First is unfair vaccine distribution or the so-called “VIP vaccines” at all levels of society – individual connections, private organisations, government agencies, both at local and national levels. Some provinces received a larger quantity of vaccines and much more quickly than the others, stirring public doubts over vaccine manipulation to gain political advancement or solicit votes in upcoming elections.
Second is the lack of unity in executing the vaccine rollout plan. The coalition parties all wanted to have a role in distributing vaccines, creating various channels of vaccine registration, including the Mor Prompt (Doctor is Ready) application, the Social Security system (S. 33), the Thai Ruam Jai platform (by then Bangkok Governor Asawin Kwanmuang), and on-site/walk-in registration, without effective collaboration across the different channels.
Besides the vaccine distribution issue, Thailand at some point faced shortages of medical masks and gloves, prompting the public to question the efficiency of the cabinet-approved budget of 225 million baht on 3 March 2020 for the Ministry of Interior to buy materials to make 50 million masks for the general members of the public, with hashtags like #หน้ากากหาย? (#lostmasks?) and #โรงพยาบาลขาดหน้ากากหนักมาก(#hospitalsdonthaveenoughmasks)
From Controlling the Public with “Fear” rather than “Providing Knowledge” to a Sudden “Self-Care” Practice
Significant contradictions were conveyed in the Thai government’s communications with the public. On one hand, the public health minister played down the coronavirus saying it was “just a flu”. On the other hand, the Government and the public created an evil image of those infected with the virus, causing these people to be rejected and feared by the rest of society. In one example, “little ghosts”, returning Thai migrant workers from South Korea, were condemned for bringing the virus into Thailand. In another example, people opposed the building of field hospitals near their communities. The public health minister rebuked COVID-19 infected medical staff, saying “[We] need to punish [these people]. We are not happy about the medical staff who do not watch out for themselves” and proposed the Internal Security Act B.E. 2551 to be invoked to prevent COVID-19 clusters emerging from political protests.
Significant contradictions were conveyed in the Thai government’s communications with the public. On one hand, the public health minister played down the coronavirus saying it was “just a flu”. On the other hand, the Government and the public created an evil image of those infected with the virus, causing these people to be rejected and feared by the rest of society.
Besides controlling the spread of COVID-19 by fear, the Government based their pandemic responses on its distrust of people. One of the most astounding examples was when some doctors alleged people intentionally contracted the virus for an insurance payout.
The Ministry of Public Health took a long while to allow the public to use self-rapid antigen tests, which might also reflect its distrust of people. The Ministry’s directive to allow sales of rapid antigen tests at local and online distributors came into effect on 29 September 2021, lagging Europe and the U.S. for some time. Singapore by then had already distributed free self-test kits to its citizens. Australia, however, allowed the use of self-test kits at around the same time as Thailand.
Currently, the Omicron variant makes up of 90% of total infections in Thailand. People who contracted this variant have milder symptoms than the Delta variant. The Government has, therefore, removed COVID-19 from the Universal Coverage for Emergency Patients (UCEP) scheme and switched to individual patient’s eligibility for health coverage. It has also advised people with mild symptoms to isolate at home or at a community isolation facility. Home isolation, i.e., living with the virus, is a universally accepted approach adopted by many countries. In Thailand, the situation has mostly affected low-income earners, those at the lower end of the economic spectrum, and the vulnerable. These groups of people are most at risk as they cannot help themselves when falling ill, cannot take sick leave for an extended period, and have no proper place to self-isolate due to limited space at home. A huge number of the lower middle-class and those who live from hand to mouth opted for a COVID-19 insurance policy that pays a lump sum benefit when they test positive. This type of insurance was so popular that some insurers struggled to meet their payment obligations and eventually went out of business.
Making quality medication accessible, cheap, and equitable for everyone is the key to effective and dependable self-care and home isolation. The big question now is whether Favipiravir, the main antiviral medication used by Thailand’s Ministry of Public Health, is actually effective. Research overseas found that COVID-19 patients with mild to moderate symptoms who were given Favipiravir did not show different outcomes than those who were given a placebo. This casts doubts over whether the medicine could reduce the coronavirus, or, in fact, it totally lacks efficacy. People also ask a similar question about herbal medicine green chiretta, which was at some point in high demand for COVID-19 treatment. Molnupiravir and Paxlovid, approved and used as standard COVID-19 treatments by many countries, are still expensive and hard to find in Thailand. Next door in Cambodia, both Molnupiravir and Paxlovid are available at local pharmacies at an affordable price.
Making quality medication accessible, cheap, and equitable for everyone is the key to effective and dependable self-care and home isolation.
This policy of using COVID-19 oral medication should be based on credible research, and relevant information should be communicated to the public to allow them to make informed decisions. People should not be left puzzled with contradictory information and no choices but “helping themselves”, resonating with the motto, “God helps those who help themselves”, that many people are using to get by in this COVID-19 era.
Government Competencies, Leaders’ Responsiveness, and Citizens’ Compliance with Restrictions
Three major factors contributing to the effectiveness of government responses to COVID-19 over the past two years are:
1. Government Competencies and Public Health System Capabilities
Thailand’s responses to COVID-19 supported by medical professionals paint a clear picture of the Thai government’s attitude, power relationship, and operations that are centralised by the Centre for COVID-19 Situation Administration (CCSA), chaired by the prime minister. The CCSA is overseen by the National Security Council (NSC) chief in his ex officio capability as the CCSA director, whose role is to propose important restrictions, such as imposing and lifting lockdown, cancelling the test and go program, and extending the Emergency Decree. Village health volunteers and public health volunteers have also played a crucial role in stopping the spread of COVID-19, and their effort should be recognised. It is noteworthy that the Thai Government approved a central budget to increase the remuneration for both types of volunteers from 500 baht to 1,000 baht per month for six months from October 2021 until March 2022 under the frontline worker special payout scheme with a budget of 3.15 billion baht.
2. Leaders’ Responsiveness
Although there is no direct correlation between leaders’ responsiveness and types of regimes, common experiences from handling the COVID-19 pandemic show that whether a leader takes the severity of the disease seriously, acts quickly and communicates adequately with the public leads to how effective or ineffective a response to COVID-19 is, particularly in procuring and distributing vaccines and imposing restrictions.
3. Citizens’ Compliance with Restrictions
In a pandemic, governments step in to take control of how people live their everyday lives and how society operates. Success in responding to the pandemic depends in part on how willingly people in society comply with government restrictions and recommendations, e.g. wearing masks, washing hands, adhering to social distancing rules, and curfews, and more so on how each individual fulfills his/her responsibility as a sensible citizen and builds support networks without having to wait for government directives.
The people of Thailand deserve high praise for their cooperation with the government and the development of their collective support networks.
This article is part of the Comparative Assessment of the Pandemic Responses in Australia and Thailand, supported by the Australia-ASEAN Council under Australia-ASEAN Council COVID-19 Special Grants Round, the Australian Department of Foreign Affairs and Trade.
 From Our World in Data and JHU CSSE COVID-19 Data
 สหรัฐฯ ได้บริจาควัคซีนโควิด-19-19 ของไฟเซอร์จำนวน 1,503,450 โดสให้กับประเทศไทย
 Golan Y et al. Favipiravir in patients with early mild-to-moderate COVID-19: a randomized controlled trial. Clinical Infectious Diseases. 6 September 2022.”