Letter to Bangkok: Thailand’s inequality puts millions at risk

It seemed that Thailand had avoided the brunt of te Covid-19 epidemic and was praised by international bodies. The government crowed its success and laid out schemes to bring tourists back to safe Thailand. Then the virus caught up with the country in April. The government chose a strategy that favored Bangkok and tourist destinations and deprived millions in the provinces from vaccination. 

By The Isaan Record

Canada takes equality to the extremes and holds a remarkable egalitarian and collective sense. Seeing the lack of available vaccines, the Canadian government decided that it would be best to give the most people to get at least some protection against Covid-19 by giving just one dose of a two-dose vaccination. 

Unlike leaders of other countries, democratic or otherwise, it was only last week that Canadian prime minister, Justin Trudeau, got his second dose. Canada made sure as many as wanted it got at least one dose first, starting with those at highest risk. As a result, 69.4% of Canadians have been vaccinated, the highest rate of any major country in the world. And Canada’s prime minister just takes his place in the line, just like any other citizen. 

It has become commonplace to say that the Covid-19 crisis has exacerbated existing inequalities in various societies over the last year and a half. 

But the Thai government deserves special recognition for its vaccination rollout. Aside from championing (and buying up) a vaccine that few trust, the government has openly carried out a “Bangkok first” policy that mirrors Thailand’s perversely hyper-centralized nature. There are always reasons given, spokespersons are brought forward to explain. Somehow the end result is always the same: Bangkok gets first dibs. Bangkok represents 11 percent of the country’s  population but has taken 34 percent of the first doses of vaccines. Proportionally, for every six vaccines Bangkok took for itself, it generously gave one to Isaan.

A good start…

Actually, Thailand had started out pretty good in handling the epidemic. The government took quarantining seriously, traced new cases, and took strict measures when necessary. With transmission cases low, it dreamt of portraying Thailand as a Covid sanctuary for foreign tourists. 

After ducking the first and second waves, the government came up with the “Sandbox” concept to lure tourists to COVID-free destinations in the South. While the world suffered, Thailand would be that shining light, the safe haven for surf and sun for foreign guests. Thailand would come roaring back!

All seemed good. There was no rush. By early April, the upper echelons of the government had predictably taken care of itself first, AstraZeneca was the vaccination of choice. The rest could experiment with Sinovax. People in the healthcare sector would come first with 42%. At third were governmental frontline workers at 11%. As a last thought, seven percent were aged and five those who were health compromised.

The beginning of vaccine rollout aberrations. Source: Ministry of Higher Education, Science, Research and Innovation, April 7, 2021

While those old and compromised were largely overlooked, another group got the vaccine first: those in “risk areas,” making up 35% of those vaccinated.

Who were at risk? Or rather, where were they? Of course they were in the Bangkok area. It had the most cases, so it was naturally argued that it should be Bangkok (and those in the Bangkok “monthon”) where the focus of efforts should be concentrated. Those in “risk areas” came to be defined, at various times, as workers in hot spots, as those in areas where it was hoped tourism could be revived, and who knows who else. 

But what is the larger point of vaccines? Are vaccinations intended to control the spread of the virus in hot spots? Or are vaccinations intended to move a society, over the course of months and months, towards something approaching herd immunity?

It was in April that health officials in other parts of the world were warning that vaccinations were not aimed at stopping outbreaks. As everyone’s heard around the world again and again, outbreaks or clusters are best controlled not by vaccinations, but by tracing, isolating, temporary shutdowns, masks, and social distancing.

The third wave crashes into Thailand

Even as the numbers of cases started to increase in early April, the government continued its tourist “sandbox” planning. By May, the misplaced priorities were clear. Only a little over two percent of the population overall had received any vaccination at all. 

The imbalance was already apparent. Isaan as a region had the lowest vaccination rates: Kalasin was the lowest at 0.42 percent, Sisaket (0.57), Roi Et (0.62). But other provinces like Phayao (0.63) and Kamphaeng Phet (0.64) were also overlooked.

The hogging of vaccines begins in earnest. Source: Ministry of Higher Education, Science, Research and Innovation, May 13, 2021.

At the same time, many areas were getting way more than their fair share. For touristic reasons, Phuket had raced to the front of the line with 24.41 percent of residents given their first dose. Ranong (8 percent) and Tak (7 percent) were exceptionally high, while smaller sandbox destinations like Surat Thani (3.42), Phang Nga (2.78), Chonburi (2.63) getting a good start. But it was Bangkok (6.1 percent) and its environs that took the lion’s share: Samut Prakan (25.04), Nonthaburi (3.82), and Samut Songkhram (2.82), representing almost 40 percent of overall vaccinations.

But even in Bangkok, inequalities were apparent. Government big-wigs themselves were caught violating Covid-19 restrictions left and right in their nightclubs, generating new clusters. Quarantining at home is easy enough for the rich, but the poor in Bangkok’s slums in one-room dwellings found it difficult to isolate themselves. Rich people started buying vaccination registration cards from the poor or even travelled abroad to get the jab. All kinds of people seemed to be getting the vaccine: movie stars, employees of big companies, members of the media.

Priorities shift decisively to Bangkok

By June, Thailand’s hopes for a grand reopening were dashed. It was in the full throes of the epidemic, compounded by the arrival of the Delta variant of the virus. The die was cast: Bangkok first (save the sandboxes).

Gross inequality in vaccinations. 
Source: Ministry of Higher Education, Science, Research and Innovation, June 16, 2021

Pretty soon all sorts of people were posting that they got the vaccine. No longer just movie stars, it was anyone who had the right connections. It was incredible: in a little over three weeks, the rate of Bangkok first doses went from 19.5 to 39 percent, and second doses more than doubled to 11.5 percent. In “Bangkok Monthon,” first doses grew from 15.5 to 28.7 percent, and second doses from 4.7 to 8.9 percent.

Thailand and Canada faced a similar situation: dim prospect of getting enough vaccinations. The Canadian government made the calculation to play it safe and spread the vaccine around as much as possible. Thailand could have done the same with its 12 million vaccinations. It would have gained some recognition domestically and internationally by spreading the doses singly. They would have been enough to cover 64 percent of 712,000 healthcare professionals, 12.5 million elders, and the 5.4 million with compromised health. Or, with two doses, it could have made a good start with these groups.

Source: Ministry of Higher Education, Science, Research and Innovation, June 16, 2021

Instead, the government has taken a very different approach. Vaccinating seniors and those with compromised systems do not seem a priority at all. Only 6.8 of the former and 8.4 percent of the latter groups have received one dose, compared to 102 percent of healt providers and 27 present of frontline officials who have. And inexplicably 7.6 percent of privileged members of the general public have gobbled up 2.8 million doses. 

How can there be equality when Bangkok always takes first?

The government has fully embraced a “Bangkok first” approach. Looking at the national picture of the vaccination rollout in Thailand doesn’t get at the gross inequality at play. 

Certainly, the virus has become a fearful possibility. With the crashing vaccination registration websites, the unsure availability of vaccinations, and a government that got around to ordering vaccines way late in the game, it’s no wonder people don’t do whatever they can to get their hands on a dose. It’s become a free-for-all.

State and state-supported officials come first, te elderly come last. Source: Ministry of Higher Education, Science, Research and Innovation, June 16, 2021

The problem is that for every dose taken by someone who can’t waited their turn in line, someone elderly or is health compromised is deprived, even theoretically. 

Just as serious of a problem is that the vaccination gorging of Monthon Bangkok (and sandbox destinations) is simply the latest – and in this case potentially fatal – consequence of a centuries-old “development” strategy that privileges the metropole and its inhabitants over the periphery. Monthon Bangkok makes up 21 percent of the country’s population yet consumed nearly half of the first doses of the vaccine. It has gotten 235 percent of its share, to population, while Isaan has gotten 48 percent of its. Another way to say it is that the monton of Bangkok has gotten 4.9 times more its share than Isaan has. When compared with just Bangkok, it has gotten six and a half times more its share of first doses than Isaan.

1 Nonthaburi, Pathum Thani (Health Zone 4), Nakhon Pathom, Samut Sakhon (Health Zone 5), Samut Prakan (Health Zone 6), Krungthep Mahanakhon (Health Zone 13)  2Zone 11  3Health Zone 12  4Health Zones 3, 4, 5, 6  5Health Zones 1, 2  6Health Zones 7, 8, 9, 10   
Source: Extrapolated from figures in the Department of Disease Control’s daily report, July 8, 2021

Other regions have fared just as badly. The North has gotten just 58 percent of its share of first doses, the Central Region 65 percent, and the lower South 63 percent. Conversely, the upper South has received 154 percent of its share of first doses, and 229 percent of its second.

The one concession Bangkok has made is to its still-lagging tourist scheme in the South. Phuket has gotten 1.8 times more than Bangkok of its share of the first and five times more of the second. More grotesquely, for the sake of the nation, Phuket has received 12 times more than Isaan of its share of first doses and 21 times its second. 

Thailand doesn’t have vaccination hesitancy; it has vaccination scarcity. Under suc terms, it hardly seems fitting to post proudly that you’ve gotten the vaccination when so many otters would jump at the chance to get one but dont have the “right connections.”

A recent book on Bangkok mentions that Bangkokians feel all Thais are equal. Is it true? Bangkok takes up the majority of government expenditures. It has the best schools, the best transportation, the best of…well, everything. The existing system is certainly not equal and that should be the concern of every Thai. In this matter of life and death, full consideration of the equitable distribution of vaccines is to be taken. 

Healthcare is a right and not a privilege. For persons who do not have health concerns to insist on a vaccine is saying that for some reason, you feel you are more privileged, that you have more right to a vaccine than other Thais.

For a trickle of tourists, for the needs of Bangkok businesses, and to address the fears of those in the capital, the government has declared that other lives mean less. Its only audience is Bangkokians, the center of the known universe. It is on their approval that the current government rules. There is no reason for it to care what people outside the capital experience. 

Up to May 16, 2.8 million first doses were given to people in risk areas and another 540,000 members of the general public, ahead of te elderly and vulnerable. Shouldn’t the government be required to give an account of why these people received first doses and thereby deprive those more needy?

Source: Ministry of Higher Education, Science, Research and Innovation, June 16, 2021

Recently, doctors have been talking about putting themselves at the top of the vaccine registry to get a booster of the vaccine, just in case. The Bangkok Post reported that one million vaccinations were to be donated to Thailand by Japan and added in a subtitle: “Focus will be on Bangkok for 1 million donated AZ jabs.”

No. Just stop it.

It is high time to treat all Thai citizens (and foreigners living here) equally and to give with all due haste to those at the most risk: the aged and the vulnerable throughout the entire country and not just in Bangkok. It’s time for the government to reset its priorities.

Bangkokians: Lockdown where you are and keep yourself and others safe. It is not a good time to travel around the country. Wait until the Covid-19 crisis passes. Don’t come and visit. Instead, send us some of those damn vaccines!

Read in Thai version here