Thailand has money to fight the Covid-19 pandemic. Yet people are falling like leaves. It’s clear. Cash handouts cannot save lives. Highly effective vaccines can. Rapid mass vaccinations for everyone in the country can. Repeat, everyone.
But can these effective Covid-19 solutions happen fast enough to save lives and rescue the national economy?
Amid rising public frustrations with state failure to contain the pandemic, the government must quickly fine-tune its Covid-19 policy. People are dying. The economy is crumbling. Policy procrastination is killing the country.
We cannot wait. Money is not the problem. The question is how to use it effectively.
Last year, the government issued a decree to secure a loan of one trillion baht to cope with the pandemic. This year, it has secured another loan of 500 billion baht. About 94 billion baht has been allocated for public health measures. With the money left from the 40-billion baht central budget this year together with the central budget next year, the government has at least 134 billion baht for public health measures to contain the coronavirus and return the country to normal.
More than 9,000 people have lost their lives during the pandemic — many from lack of access to vaccinations, rapid tests, and unnecessarily delayed hospitalisation. Almost two years into the pandemic, only 8% of the population have received the required two doses of vaccination. Officially, one million people have been infected. In reality, the figures may be much higher.
The economy is also collapsing. Stuck in the pandemic, the country loses more than 150 billion baht a month alone from tourism.
Not that we don’t know how to fight the pandemic. Experiences in Great Britain, Singapore, Israel, and other countries have shown that three things must be achieved before they can reopen the countries.
Firstly, the majority of the population must receive highly effective vaccines. It is 70% in Great Britain and 80% in Singapore and Israel. Secondly, the spread of the virus must be effectively contained until the ratio between confirmed deaths and confirmed cases (7-day moving average) rate drops to 0.1-0.2%. And thirdly, the number of ICU patients (7-day moving average) should be below 9 per one million people.
In Thailand, as of August 20, less than 10% have received full vaccination. The ratio between confirmed deaths and confirmed cases (7-day moving average) is 1.16%. The number of ICU patients per million (7-day moving average) is 17.5. And about 25% of people tested are infected.
The government has declared it would open the country this October. That won’t happen. Thailand is far from being ready.
But we have the resources. To turn things around, the government must invest in five crucial public health measures. They are:
- Highly Effective vaccines
First and foremost, Thailand must acquire highly effective vaccines immediately for mass vaccinations. The vaccines must be distributed quickly, widely, and transparently.
As of August 20, 2021, 25.8 million doses of vaccines have been administered, yet the pandemic situation remains critical. One of the main reasons is the use of Sinovac. Due to its low efficacy rate, even if half of the population receive Sinovac, it still cannot stop the spread of the coronavirus.
To acquire highly effective vaccines such as Pfizer ( about 2,600 baht for two doses) and Moderna (about 3,300 for two doses) for 50 million people to be fully vaccinated costs about 130-165 billion baht. Still, it is worth the investment.
Giving people highly effective vaccines prevents a massive number of Covid deaths. The investment in highly effective vaccines will be covered in a few months when the country can welcome tourists again.
Even when the tourism industry still cannot return to the pre-pandemic situation, life will return to normal — or nearly — enabling the domestic economy and the export industry to pick up.
In addition, the government must buy more antiviral drugs such as Favipiravir and Remdesivir so the patients can use them promptly and sufficiently. The red tape is now the hindrance preventing the doctors from giving these medicines to the patients in time. This bureaucratic rigidity must be dismantled.
In Singapore, the government has gained public confidence and trust by providing a sufficient amount of highly effective medicines. Apart from being proactive in acquiring the best vaccines and medicines available, the government is closely monitoring the development of new drugs and collaborating with other countries in research and development to ensure that Singapore will promptly receive more effective drugs when the research is successful.
2. Mass rapid testing
Mass rapid tests are crucial to stop the spread of the virus because it expedites isolation and hospitalisation. The government must then invest in mass rapid testing to reduce Covid deaths and economic damages.
In Singapore, it conducts about 12,039 RT-PCR tests per one million people a day. In Thailand, it is about 933 tests per million a day.
In addition, Singapore encourages home use of rapid antigen tests. Although it is not as accurate as of the RT-PCR test, the rapid antigen test kits (ATKs) are very useful. Apart from ATKs, the government also gives Singaporean households free oximeters. Local authorities also regularly inspect the sewage system of dormitories, hostels, and condominiums to detect the virus. The rationale is simple: The earlier the virus detection, the earlier to stop it from spreading.
In Thailand, tracing the transmitters is difficult amid ever-rising infection. This makes mass rapid antigen testing all the more crucial. In July this year, about 350,000 people had Covid. Judging from the mass rapid tests in communities, about 19% are infected. In Bangkok, the infected comprise 43% of all the infected nationwide. The mass rapid tests in crowded communities also show that about 29% of people are infected.
Without mass rapid testing, the infections will likely rise again after the lockdown. This is because the lockdown can reduce Covid deaths and infections only temporarily. The death rates will decline during the first 60 days and the infections will reduce in 20 days[1]. But the effect of the lockdowns will decline over time because of public fatigue. Besides, the lockdown is very costly economically. According to SCB Economic Intelligence Centre, the lockdown costs 770 billion baht damages in private consumption or about 4.8% of gross domestic product.
Rapid detection of the coronavirus infection will save the country a lot of resources. Prompt isolation in early Covid stages save lives and the cost of hospitalisation for critical patients. Financially, mass testing for one million people and prompt isolation can save the country about 5.1 billion baht.
For mass rapid testing, the government should :
- Increase the tests and testing venues. The tests should be available every day. There should be an online reservation system for onsite tests, especially for workers camps, congested communities, markets, airports, ports, nursing homes. The testing should be offered every day until the infection positive test rate is below 5% which indicates successful virus containment.
- Improve Covid surveillance by distributing free rapid antigen test kits (ATKs) and oximeters to every household. Priority targets should include people in congested communities and workers in the informal sector who face high risks of Covid infection such as taxi drivers, moto-taxi drivers, food deliverers, cleaners, garbage collectors, and street vendors.
According to the Bangkok Metropolitan Administration, there are nearly 600,000 people or 146,462 households in 638 congested communities in Bangkok. Home use rapid antigen tests, thermometers and oximeters for each household costs about 1,000 baht. Spending 146.5 million baht in healthcare kits for the urban poor will save hospitalisation costs about 3.2 billion baht.
- Distribute ATKs to business operations especially SMEs which cannot work remotely. For example, food processing, public transportation, construction, restaurants, hotels, salons, spas, fitness centres, nursing homes and nurseries. Testing every two weeks will prevent business shutdown after the lockdowns.
There should be an online system for the businesses to apply for free ATKs, report test results, and coordinate with health professionals and the isolation and hospitalisation systems.
The government should also provide online training for the business representatives on the proper use of ATKs before giving them the kits.
This mass rapid testing should begin immediately for all businesses during the lockdown and afterwards until the infection rate in each province falls below 5% for two consecutive weeks.
This investment in mass rapid testing is highly worthwhile economically. There are 11.9 million workers in the manufacturing, construction, transport, warehouse, hotels, and food industries. Half of them are in SMEs. They produce about 5.8 trillion baht or 37% of the GDP in 2020. A set of ATK costs about 120 baht, costing 2,856 million baht to test the workers twice a month. This is a worthwhile investment to ensure that the country can maintain production worth 0.5 trillion baht a month. Apart from saving lives, the rapid tests also save hospitalisation costs for about 66 billion baht.
- Distribute ATKs to places of mass gathering such as schools so they can continue their activities. For the businesses, they should be required to conduct rapid antigen testing before their gatherings at their own expense.
- Exempt tax for ATKs to make them affordable. At present, the antigen test kit costs 250-400 baht inclusive of VAT.
3. Isolation and medication
Speed is the key. Isolation and medication must happen immediately after the infections. This measure is particularly crucial for residents in crowded communities and the homeless. Early community isolation and timely medication can prevent the patients from spreading the virus and sliding into critical conditions.
State agencies need to integrate health services for Covid patients so they can get help without delay. People with serious symptoms should get Covid tests and medication at once.
The government must provide support for home isolation and proper venues for community isolation, especially for the urban poor. The costs for providing this support are much less than the medical costs for critical patients.
Since July 2021, the number of infected people with mild symptoms has significantly increased. Prompt isolation and medication will stop the spread of the virus and reduce the number of critical Covid-19 patients. According to the Department of Medical Services, receiving Favipiravir in the first four days since the symptoms show can prevent critical conditions and deaths. All infected people then must receive effective medications at once.
The medical cost for mild patients in a community isolation centre costs about 30,000 baht. Without prompt medical care, the symptoms will quickly worsen. The medical costs for moderate and severe Covid-19 patients are about 190,000-360,000 baht. The government then should invest in community isolation centres for effective virus control.
4. Better protection for frontline personnel
Apart from work overload, doctors and health personnel face high risks of infections. They need to get better vaccines, more pay, and better protection. Their families also need better protection, particularly the elderly and those with illnesses.
At present, doctors get extra 1,500 baht per eight-hour shift. Nurses and other health personnel get extra 1,000 baht. They often work longer hours amid high infection risks so they deserve better pay. The government should consider giving them year-end bonuses as a token of appreciation for their sacrifice.
5. Increase volunteers and staff
In urgent need right now is more volunteers and staff to help people in home and community isolation. The government should recruit volunteers and staff with proper remunerations. They should receive training on Covid-19 care and online case reports for further supervision from health professionals. The volunteers and staff should already have full vaccination or are former Covid-19 patients if they have to work in community isolation centres.
At the same time, state agencies should work closely with the various volunteer groups which are now helping Covid-19 patients as well as giving them funds so they can expand their services. The collaboration will lead to a more effective system to help people.
Highly Effective vaccines, mass rapid testing, isolation and treatment, protection for frontline health personnel, and more volunteers and staff to aid for home and community isolation. These five public health measures are highly worthwhile investments economically. More importantly, they are also necessary to save lives and rescue the economy.
Thailand has the money. The question is whether or not the government has the will and the vision to successfully steer Thailand out of the pandemic.
By Dr.Saowaruj Rattanakhamfu, Research Director for Innovation Policy for Sustainable Development
[1] Goldstein et al. (2021) (accessed from https://voxeu.org/article/declining-effectiveness-lockdowns)