Vaccine drive in Bangkok’s Khlong Toei shows Thailand can address pandemic inequity—if it chooses to

Khlong Toei. Photo: Андрей Бобровский, CC BY 3.0, via Wikimedia Commons

A new push to vaccinate residents of a dense, low income Bangkok neighborhood shows what might be possible if Thailand adopts a more equitable pandemic response. 

Editorial

Though Thailand’s success in containing COVID-19 has garnered praise around the world, the government’s handling of the pandemic has prompted intense criticism inside the country. 

Thailand has recorded around 75,000 infections since the start of the pandemic with just over 300 deaths, or around 4.3 deaths per million people. Thailand saw less than 7,000 total cases during all of 2020, and by the second half of the year, the country had largely returned to “normal” life.

Since the new year however, Thailand has been hit by its second and third waves of infections. New cases peaked at over 800 per day in late January, slowed to fewer than 100 for much of March and then spiked again to over 2,000 per day in late April.

Many Thais say the government response has been misguided and wrongheaded in a number of ways—from failing to offer adequate economic relief, to abusing new emergency powers intended to help manage the pandemic. The economic toll of the pandemic in Thailand has led to a spike in mental health issues, including suicides. Migrant workers face intense racism and are excluded from government support programs entirely, leaving them with few options. As pro-democracy protests grew in mid-2020, civil society groups condemned the government’s use of COVID-19 restrictions to target protestors.

In recent months, a main point of public outrage in Thailand has been the government’s vaccination program: the apparent lack of planning, the slow rollout and the role of a biotech company tied to the monarchy.

Siam Bioscience, a previously unheard of firm owned by the Crown Property Bureau, was given an exclusive contract to produce AstraZeneca’s COVID-19 vaccine. There was little-to-no transparency around the deal, which also involves Siam Cement Group, another company with ties to the monarchy.

Thailand has so far vaccinated only around 1% of its population of 66 million. According to Reuters, it will take Thailand eight months to vaccinate just 10% of its population if the rollout continues at the current rate.

But in early May, Thailand began a plan to vaccinate 70% of residents in a dense area of Bangkok in just two weeks, after over 300 people in the district tested positive during the current wave of infections. 

COVID-19 Case Investigation in Thailand flickr photo by CDC Global Health shared under a Creative Commons (BY) license

Thailand’s third wave shows fast spread among Bangkok’s priveleged

Thailand’s third wave of infections began with a series of clusters tied to bars and nightclubs in Bangkok—upper class venues frequented by the city’s “high-so” crowd, including at least one hostess bar allegedly visited by senior government officials.

Though infections quickly spread beyond this crowd, the initial outbreak stands in stark contrast to Thailand’s second wave, which began in a popular shrimp market and rapidly spread through foreign migrant worker communities.

The differences in the public and government responses from one wave to the next have prompted debate. Though much of the difference was a shift in tone and the way the outbreaks were reported in the media, there were also clear changes in approach: outbreaks among migrants prompted racist backlash; outbreaks among Bangkok bargoers prompted little more than a public slap on the wrist. Migrant workers were barricaded into their residences; people exposed to Bangkok’s nightlife clusters were allowed to travel for the Songkran new year holiday.

As a recent piece in the Bangkok Post put it, “The phrase ‘the rich getting the infection and leaving the poor to pick up the pieces’ is catching on, which does not bode well for the government. It is now being held to account for dropping its guard and allowing the virus to spread at the expense of poor people already living hand to mouth and feeling the economic squeeze from COVID-19 tightening further.”

Khlong Toei market. Photo: Kounosu, CC BY-SA 3.0, via Wikimedia Commons

Khlong Toei vaccine push stands out in government response

As for the Khlong Toei cluster, the neighborhood is sometimes referred to as a slum, with between 80,000 and 100,000 residents living in close proximity. On April 28, the government reported an initial outbreak of 65 new cases in the area after a large testing site opened at a local temple, Wat Saphan.

Cases quickly outpaced the available hospital beds and residents were forced to isolate at home. According to one report, at least six people died in the first days of the outbreak before medical help could get to them.

Wat Saphan was opened up as a space to house patients while they wait to be transferred to a hospital. Phra Phisanthammanusit, the temple’s abbot, told Prachatai he hopes the plan will help reduce the stress and conflict in the community around social distancing and infections.

“Have you been to the community? The room is [30-40 square meters], with five people living together. Think if one person gets sick, where will the other four live? And what if there is a bedridden grandma? Where will she be moved to?”

The Khlong Toei outbreak itself shows the severe impact the third wave is having on lower income, marginalized communities with few options to protect themselves. But the government’s decision to launch a vaccination drive in the area appears to prioritize this group. With vaccine doses still scarce in Thailand, the government has realized it needs to target populations that are most at risk for spreading the virus.

As Yiamyut Sutthichaya writes for Prachatai, “Living conditions at Khlong Toei, where extended families live in a single room, cramped, wall-to-wall houses make it difficult to properly abide by social distancing and quarantine protocols. On top of that, their precarious financial situation forces them to keep working, mostly in the service and heavy manual labour sectors, in order to put food on the table.”

The localized vaccination drive may not signal a wholesale shift in government strategy—to prioritizing the most marginalized at-risk communities—as Khlong Toei is just one neighborhood and is well known. But it does illustrate the potential for similar efforts elsewhere, to tailor responses to local needs and to reallocate resources towards the people most affected by the current wave. Without such an effort, Thailand’s inequality will only continue to worsen as the pandemic stretches into a second year.

As Phra Phisanthammanusit put it, “Damn it, we almost survived.”

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