Thailand is involving private health care companies in its COVID-19 vaccination drive after facing criticism for delays. But the decision risks creating major inequalities in vaccine pricing and accessibility.
By Umair Jamal
Thailand’s government has decided to allow private companies to import and sell COVID-19 vaccines, reversing a previous decision to restrict distribution to public hospitals.
The country has ordered 63 million COVID-19 shots, including 26 million doses of the AstraZeneca vaccine which will be produced by a local company, Siam Bioscience. This also includes another 2 million doses from China’s Sinovac and 35 million imported shots from AstraZeneca.
In March, health experts in Thailand said that private companies should be allowed to import 15-20 million doses in addition to those ordered by the government in order to meet the country’s needs.
The move could accelerate vaccinations but unregulated private sector competition is likely to drive up prices and could make the vaccine inaccessible for millions across the country.
Government remains indecisive about private sector vaccination
Prime Minister Prayut Chan-ocha and his government have created confusion as to the role of private firms in the vaccine rollout. In January, Prayut said that his government would permit only public hospitals to distribute imported COVID-19 vaccines. He said that private hospitals can import the drugs but wouldn’t be allowed to use them in the first phase of the inoculation drive.
The government plans to vaccinate roughly 19 million people in the “first phase”, though it hasn’t given a timeline for this, and says half of its adult population will be vaccinated by the end of the year.
On February 8, the government then seemed to walk back its decision and said that only the government can import vaccines in the initial phase. The decision left many companies disappointed as they planned to immediately begin importing vaccines from China, Russia and elsewhere in preparation for later distribution. Boon Vanasin, chairman of Thonburi Healthcare Group, told Reuters that the decision represented a move to monopolize vaccines.
In a separate statement, Dr. Paisarn Dunkum, secretary-general of the Thai Food and Drug Administration (FDA) said that private companies are welcome to import vaccines but they need to register beforehand.
The lack of clarity on the issue has left many wondering if the government realizes the urgency of the situation.
Government faces criticism on private sector vaccinations
Some observers worry that commercial interests may create vaccine inequality between the rich and poor and leave millions without access to the vaccine. Already, Thailand’s major private chain hospitals such as the Bangkok Dusit Medical Services, Bangkok Chain Hospital and Chularat Hospital are eying vaccine profits. Thonburi Healthcare Group has already received orders for vaccines from the tourism and manufacturing sectors and plans to charge around US$65 per jab (2,000 THB).
Aat Pisanwanich, an academic based at the Thai Chamber of Commerce University, believes that private companies are likely to worsen vaccine accessibility due to “the economic hardship Thais are experiencing.”
“The government itself cannot create accessibility to vaccines either, because the vaccination does not cover enough people soon enough,” he said.
Echoing Aat’s view, Kiat Ruxrungtham, director of the Centre of Excellence in Vaccine Research and Development at Chulalongkorn University, said that once private entities become part of Thailand’s vaccine distribution, pricing differences will create massive inequality.
“If the private hospitals set a high price for a particular vaccine, it might create an impression that what they sell is superior to what the government provides for free,” he said.
Besides the issue of pricing, there are fears that marginalized ethnic minorities in Thailand, which have received little government aid throughout the pandemic, may be left further behind.
“Instead of prioritizing the most vulnerable populations first, the rollout is leaving behind marginalized communities like migrant workers and stateless people,” said Matcha Phorn-in, a human-rights activist in Chiang Mai.
In another controversial move, the government has decided to allow municipalities to import vaccine for their residents. This could leave poorer regions behind and political leaders may exploit the situation for electoral gains, undermining transparency. Elections for mayoral positions and other local posts are scheduled for later this year.
“It’s clear that local administrators are using this opportunity to boost their popularity ahead of the next elections,” said Pita Limcharoenrut, leader of the opposition Move Forward Party.
The dynamic could create controversy between richer and poorer municipalities, as areas with fewer resources may be unable to procure enough doses or lack the public health systems needed to manage a vaccination campaign.
Private support for vaccine rollout can be effective if initiated properly
To address public concern, the government will have to issue clear regulations for private sector vaccine distribution. The government needs to determine many of the details for private vaccine programs, including pricing, distribution plans, accessibility and other technical issues.
Thailand’s government has been criticized for its slow vaccine rollout and this pressure is likely to grow. But it doesn’t mean that the government should enlist the help of private companies without putting in place proper monitoring and accountability mechanisms.