Vaccination-saturated Bangkok starts sharing

In early August, Bangkok had one of the highest vaccination rates in the world. It seems it was only for this that the rest of the country started to get its fair share of vaccines. How much have other regions caught up in vaccination rates?

By The Isaan Record

Earlier this month, the Thai government was optimistic about the country’s recovery from the Covid-19 crisis. Its “Sandbox” strategy to bring tourists back to Thailand seemed to be paying off. The spokesperson for the Centre for Covid-19 Situation Administration enthused that Thailand was “halfway to herd immunity.” Bangkok administrators put out extra efforts to get shots to the few residents still unvaccinated and started to look to expand the categories for those who’d become eligible next for the vaccine, such as the city’s medically vulnerable youth aged 12 to 18. 

Bangkok officials had reason to be optimistic – but only for Bangkok and Greater Bangkok. As of June 8, 243% Bangkok had received 243% of its share of vaccines to population and Greater Bangkok as a whole received 47% of all doses while making up only 20% of the population. At the same time, Isaan was receiving only 63% of its share of doses. 

Bangkok must be the most highly vaccinated capital in the world, with an astonishing 97.5% of its eligible residents having received their first dose by Sept. 20, 2021. 

This “capital-first” policy was not seen in capitals of other countries and quite often the imbalance was reversed. In England in mid-September, for instance, the first-dose vaccination rate in London of 67% was the country’s lowest. In France, the province containing Paris has the third lowest first-dose vaccination rate out of 13 provinces. More importantly, there is only a 10% range between the highest and lowest first-and second-dose vaccination rates. 

More equal distribution of vaccinations, but still a lot to catch up

The way the vaccination has been rolled out in Thailand mirrors the existing inequality between the metropole and the periphery. In early July, Bangkok and Greater Bangkok had 303% and 227%, respectively, of their share of doses in proportion to population, while Isaan received only 50% of its share, and the North, 59%, the Lower South 62% and the Central region 62%. Bangkok was getting six times more than Isaan, and Great Bangkok got 4.5 times more than Isaan. 

By early August, the gap lessened slightly. Bangkok got 2.9 times more than its share in proportion to population and Greater Bangkok got 2.1 times its share. Other areas benefited slightly in kind: Isaan got 51% of its share, the North, 59%, Lower South, 77%, and the Central Region, 69%.

Phuket was something of an exception, getting 738% of its share of doses to population in early July, and 436% in August.

The only reason Bangkok allowed vaccination distribution to extend more widely to the rest of the country is that it was already vaccination-saturated. About 91% of Bangkok residents had received a first dose on Sept. 1. Three weeks later, it was up to 97.5%. There were simply not that many more to vaccinate. As a result, the gap of inequality between Bangkok and most of the rest of the country narrowed.

Regional inequality in distribution of vaccinations in target groups continues 

A look at regional vaccination distribution in target groups shows some of the dynamics of how this inequality is expressed. Up to Sept. 8, Bangkok received almost four times more than Isaan, when calculated according to proportion of population. For medical personnel, Bangkok took three times more than Isaan. But for public health volunteers, Isaan got more than six times more than Bangkok. 

For these two groups, it may simply mean that there are a lot more medical personnel in Bangkok per population than Isaan and a lot more public health volunteers per population in the Northeast. In these cases, it might merely reflect a pre-existing inequality in medical personnel (which would be an issue in itself) and public health volunteers in these two areas.

There ought to be more equal numbers per population for target groups like senior citizens, people with pre-existing conditions, and “general population.” The number of doses that went to Isaan’s senior citizens and those with pre-existing conditions increased dramatically, and the gap between Bangkok and Isaan lessened.  

The problem comes with the “general population” that was allowed to get the vaccination. Some 21.28 million doses went into the arms of people whose bodies could better handle infection and had lower risk of serious illness and death. By putting those vaccinations into the arms of people whose turn had not yet come, those same 21 million doses did not go into the arms of people at greater risk. 

But there is also a strong regional inequality at play here. More than 10 million, or 48% of those vaccinations were given in Greater Bangkok. It was 234% of the area’s share in proportion to population. Bangkok itself got more than three times its share while the “general population” of Isaan and the North did not even receive half of their share of doses. received only 46 The mistargeted are the ones that of people who , depriving the vast majority of which Greater.

Opening vaccinations to the general population was the fatal step

Just like other countries, the Thai government established a list of priority groups. It initially set the number of medical personnel at 712,000 people or 1.4% of target groups, Public Health Volunteers at one million (3.8%), Frontline Officials at 1.9 million (1.2%), the Elderly at 12.5 million (25%), people with conditions at 5.4 million (11%), and the general population at 28 million (57%). It would take, for instance, two million doses for the one million public health volunteers, 200% of doses, to be fully vaccinated (two doses).  

Medical professionals have received 332% of its share, by number. Public health volunteers and frontline officials have received about half their doses. But as of Sept. 8, the two top priority groups – senior citizens and those with pre-existing conditions – have received less than 30% and 40% of the doses needed to be fully vaccinated, respectively. 

Another way of stating it is to show what percent of each group has had enough doses to be fully vaccinated (total percent of doses divided by 2) which indicates actual rather than stated priority to each:

  • 1.7 full vaccinations – Medical Professionals
  • 0.6 full vaccinations – Public Health Volunteers
  • 0.5 full vaccinations – Frontline Officials
  • 0.4 full vaccinations – People with pre-existing conditions
  • 0.4 full vaccinations – General population (18-59)
  • 0.3 full vaccinations – The Elderly

Why did the two most needy groups receive proportionately the lowest number of doses? What was so hard that it apparently made it impossible for the Thai government, like so many other governments around the world, to announce the eligibility of these two groups and give them vaccinations first?

The reason seems to be that the government added a new criterion: using vaccinations as a way to fix outbreaks (rather than social distancing, etc.). Bangkok was experiencing an outbreak, so it almost immediately abandoned its initial plan. Soon, a trickle grew into a flood, and then anyone and everyone in Bangkok was getting vaccines.  

Conclusion

It’s not surprising that the distribution of vaccines has been carried out according to a “Bangkok-first” policy, just like anything else in Thailand: the good schools, high-tech transportation systems, the opportunities, etc., etc., etc. – and vaccinations – for Bangkok first.

Such a self-centered approach can only be maintained by shunning any expression of common compassion and adopting an attitude of contempt toward others. Perhaps the rest of the story of France’s vaccinations reveals a clue. While vaccinations have been spread in an equal manner in “France proper” and no province has lower than a 71% vaccination rate, the colonial-like states, populated with lesser kinds of French, stand in stark contrast. Only 55% in La Réunion have received a first dose of the vaccine, Martinique, 32%, and Guyane only 25%

Another instance might be Turkey, at least in one respect. Vaccination rates in the largest city, Istanbul, was 59% in early July, and only 67% in the capital, Ankara. The highest rate of 79% is in Muğla Province, on the Aegean Sea, perhaps Turkey’s “Sandbox.” The lowest rate is eastern province Siirt which has a vaccination rate of 27%. It is probably no coincidence that a majority of the population in the province is Kurdish. Often under martial law, always distrusted for their political ambitions, and rarely recipient of development funds, people in Turkey’s Kurdish provinces are more a subject population.

Perhaps not so different from Isaan, the North, and the Deep South.

It’s not easy to explain why Thailand’s distribution of vaccines is so unequal. But it is easy to say what the consequences might be: putting the most vulnerable at greater risk of hospitalization and death.

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Note: Figures in this article are calculated by putting together Nonthaburi, Pathum Thani (Health Zone 4), Nakhon Pathom, Samut Sakhon (Health Zone 5), Samut Prakan (Health Zone 6), Krungthep Mahanakhon (Health Zone 13) to create Greater Bangkok. Figures for the Upper South are drawn from Zone 11 and Lower South, Health Zone 12;  Health Zones 3, 4, 5, 6 for the Central Region; Health Zones 1, 2 for the North; and Health Zones 7, 8, 9, 10 for Isaan. Source: Extrapolated from figures in the Department of Disease Control’s daily report, July 8, August 1, 9, and 20, 2021. Reports can be accessed on the Ministry of Public Health’s website

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