Thailand's COVID-19 national vaccination programme hit by supply shortage, uncertain delivery schedule
As COVID-19 rages in Southeast Asia, regional governments are racing to roll out their national vaccination programmes. In the second part of a series, CNA looks at how Thailand has been hamstrung by an uncertain vaccine delivery schedule.
BANGKOK: When Thailand rolled out its COVID-19 vaccination programme on Feb 28, it was launched with a professional sheen.
Anutin Charnvirakul, the health minister, took the first jab with a smile in front of cameras. He flashed the victory sign as the Chinese-produced vaccine from Sinovac was injected into his arm. The historic moment was broadcast live on television and applauded by Prime Minister Gen Prayut Chan-o-cha, who was standing close by.
“The vaccination today made me confident that everybody is provided with care, which has a good standard and efficiency,” Gen Prayut said. “It shows our readiness to vaccinate the public. So, please rest assured.”
A few weeks later, the situation took a sharp turn. A big cluster at Bangkok’s high-end nightclubs triggered waves of outbreaks that have since plunged Thailand into a crisis. Daily case numbers have surged above 10,000 as the highly-contagious Delta variant spread nationwide.
As the death toll continues to climb, the government has come under fire for its management of the pandemic. The national vaccination programme - which is supposed to immunise 50 million people against COVID-19 by the year end - has been hit by uncertainty, delays and confusion.
It has struggled with securing sufficient vaccines and an uncertain delivery schedule, among other issues.
“The first misstep,” said social critic and writer Sarinee Achavanuntakul, “is the appalling lack of a risk management mindset.”
Ms Sarinee believes that it was a dangerous decision early this year to bank on two vaccine producers - AstraZeneca and Sinovac - for herd immunity. She has also questioned why Thailand has not joined COVAX - a global initiative for equitable access to COVID-19 vaccines.
“Many things can go wrong,” she said.
"Thailand is not facing anything that other countries haven’t seen before. Why haven’t we learnt all the lessons? Why haven’t we taken appropriate precautions?
"I think that’s the question a lot of people are asking, not to mention one very big problem right now, which is a total lack of transparency and honesty," she added, referring to how there have been differing accounts between AstraZeneca's vaccine delivery commitment to Thailand and what the government had told the people.
Thailand has reported more than 512,000 infections and 4,000 deaths since the pandemic hit it last year. On Monday (Jul 26), there were 167,057 patients in hospitals and 4,289 of them were in critical conditions.
In Bangkok - a major hotbed of transmission - medical resources are under severe strain. Hospital wards are getting full and ventilators are scarce. Many residents have not been able to access public healthcare or COVID-19 tests. Some of them died at home while waiting for help from rescue groups, according to reports.
Based on data from the Medical Sciences Department, 46 per cent of infections in Bangkok were caused by the Alpha strand of the coronavirus and 54 per cent came from the Delta variant, which is more contagious and aggressive.
As infections soar, the demand for COVID-19 vaccines has also grown. Still, many Thais have struggled to access them through the national vaccination programme.
A number of people who have successfully registered for the inoculation since last month saw their appointments postponed indefinitely amid reports of vaccine shortage.
One of them is Bangkok-based freelancer Onamon Chaipramote, who needs to visit the hospital regularly for her prescription. Her first vaccination appointment last month was a disappointment when she was informed upon arrival that the vaccine had run out. The second one on Jul 9 has been postponed for an unspecified period.
“It’s hopeless. They don’t inform us clearly when the vaccine will be available. Every day, the system would tell me to wait for my new allocation,” she told CNA.
With no immunity against COVID-19, Ms Onamon has to bring a change of clothes every time she visits the hospital. She sprays herself with disinfectant before going home to reduce the risk of transmission.
“My family is very worried,” she said. “They fear I’d infect them. As they’re already old, they think it’d surely kill them.”
Last Wednesday (Jul 21), director of the National Vaccine Institute Nakorn Premsri made a public apology to the people of Thailand for failing to provide sufficient COVID-19 vaccines, citing time-consuming bureaucracy that has adversely affected the procurement process.
“I apologise to the people of Thailand as the National Vaccine Institute - despite its best possible efforts - only managed to procure an insufficient amount of vaccines for the situation that is beyond our expectation," he said in a live broadcast from the public health ministry.
"The COVID-19 pandemic is new to our experience. The mutation of the virus was not anticipated.”
The National Vaccine Institute plays a key role in liaising with vaccine producers to procure the shots. According to its director, the institute will continue to source more vaccines for this year and the next as well as reach out to producers of second-generation COVID-19 vaccines to address variants of concern.
“The goal is to have them delivered from the first quarter of 2022,” Mr Nakorn said. “All these have to be expedited as we cannot wait any longer.”
The government signed a deal with Pfizer last Tuesday to secure 20 million doses of its vaccine, which are expected to arrive in Thailand in the fourth quarter of this year.
Meanwhile, the National Vaccine Institute has also reached out to Gavi, a co-leader of COVAX, to express Thailand’s interest in joining the initiative as it hopes to procure more vaccines for next year.
Since Thailand rolled out its vaccination programme in February, 12,307,788 people have received their first dose of the COVID-19 vaccine and 3,652,990 people have been given two, the Centre for COVID-19 Situation Administration reported on Monday.
ISSUES WITH VACCINE DELIVERY SCHEDULE
Since April, the government has declared that it would have 100 million doses of COVID-19 vaccines to cover at least 70 per cent of the population by the end of this year.
Most of them would come from AstraZeneca through Thailand-based manufacturer Siam Bioscience, which is owned by a subsidiary of the Crown Property Bureau. The rest would come from other vaccine producers such as Pfizer-BioNTech and Sinovac.
The news was delivered by Gen Prayut on Apr 23, when the daily case numbers went over 2,000 for the first time.
In a televised address to the nation, he announced that the government had successfully procured 61 million doses from the company and that the first 6 million doses would be delivered in June. He also said Thailand would then receive 10 million doses from AstraZeneca in each of the following months.
Leaked correspondence between AstraZeneca and the Thai health minister revealed the company’s vaccine commitment is different from what Gen Prayut had claimed.
In the letter dated Jun 25, AstraZeneca's vice president of global corporate affairs Sjoerd Hubben said: "Based on our best ability to forecast monthly supplies while the supply chain is still very new, we believe that in an average month with uninterrupted manufacturing Thailand MOPH (Ministry of Public Health) will receive approximately 5 to 6 million doses, depending on the drug substance yield."
The information was confirmed by AstraZeneca Thailand in an open letter to the people of Thailand on Jul 24. Written by its managing director James Teague, the letter said AstraZeneca’s projections showed that “in months with uninterrupted manufacturing”, it can supply 5 to 6 million doses in Thailand.
According to the letters, Thailand may only receive 35 million to 42 million doses from AstraZeneca this year, instead of 61 million doses it wished to get.
Commenting on this, Ms Sarinee said: “So, now we have to ask: when the government told us in April ‘Don’t worry. We’re going to get 61 million doses - 10 million doses per month.’, how could they do this?”.
According to Opas Karnkawinwong, director-general of the Disease Control Department, the advance market commitment between Thailand and the biopharmaceutical firm was created before Siam Bioscience started manufacturing the vaccine.
As a result, he said, the contract does not specify how many doses have to be delivered per month. Instead, a bilateral discussion prior to each delivery would determine the amount.
On Apr 24, the Disease Control Department sent a letter to AstraZeneca to request 6 million doses of its vaccine in June, 10 million doses monthly between July and November and 5 million doses in December.
“However, the delivery depends on the production capacity,” Mr Opas clarified in a press conference on Jul 18. “So, it doesn’t mean we’ll get 100 per cent of the requested amounts.”
By the end of this month, AstraZeneca Thailand said it will have delivered 11.3 million doses to the country. The company has supplied Thailand with 9 million doses so far, according to Mr Teague, with 2.3 million doses to be delivered to the Public Health Ministry this week.
“WE CELEBRATED OUR VICTORY TOO LOUDLY”: HEALTH OFFICIAL
Since Jul 17, Thailand’s daily new infections have remained above 10,000.The situation is a far cry from how things were last year, with months of zero transmission locally.
The country was then praised by WHO for its “comprehensive approach” to contain the pandemic. Data from the health ministry showed a blueprint for Thailand’s COVID-19 vaccine access was approved in April 2020 by the National Vaccine Institute.
Yet, it was not until Nov 27 that the first vaccine deal was signed. The contract was between the Thai health ministry and AstraZeneca. The delivery - which would be locally supplied by Siam Bioscience - was expected to start from mid-2021.
Before the AstraZeneca vaccines were delivered from its Thai manufacturing facility, Thailand was hit by waves of outbreaks and rushed to procure millions of doses of vaccine from Sinovac to control the transmission. Medical professionals and frontline workers were the first group to receive the vaccine.
However, data from the health ministry revealed more than 600 medical workers fully vaccinated with the Sinovac vaccine were infected by COVID-19 between April and July.
The incidents raised public concern about the choice of vaccines by the government. Some have criticised the government's continued procurement from the Chinese biopharmaceutical firm and demanded different types of vaccines to fight the Delta variant.
“There are better ones that should be used as options and they should be given out freely too. People shouldn’t have to pay for that,” said Chitapanya Kattiyangkorn, whose parents are admitted for COVID-19 treatments after waiting for hospital beds for almost two weeks.
His mother was infected after her vaccination appointment was postponed last month while his father - who suffers from paralysis and diabetes - tested positive after receiving his first dose of the AstraZeneca vaccine.
“His condition isn’t so good,” Mr Chitapanya said. “He’s in the ICU at the moment, on a ventilator.”
READ: People jabbed with Sinovac COVID-19 vaccine to get AstraZeneca as second dose, says Thailand health ministry
On Jul 12, Thailand approved cross-vaccination to increase public immunity against the coronavirus variants, with Sinovac being the first dose and AstraZeneca the second.
It also decided to give medical personnel and frontline health workers a third shot of COVID-19 vaccine from AstraZeneca or Pfizer to boost their immunity.
Looking at Thailand’s management of COVID-19 vaccines, Bussabong Wisetpholchai from the Society and Health Institute, which is under the Public Health Ministry, pointed to poor planning and complacency as a result of a long period of zero domestic transmission last year.
“At that time, we lived with the number zero. We nourished it. We celebrated our victory too loudly. Did we celebrate the victory with arrogance, so much so that we didn’t imagine what could happen?” she said.
Ms Bussabong - a professional registered nurse - currently volunteers to help COVID-19 patients in home isolation. She told CNA the number of such patients is high and medical equipment required for monitoring the symptoms is insufficient.
Despite having only received her first dose of the AstraZeneca vaccine, Ms Bussabong continues to work on the frontline along with hundreds of other health volunteers to provide as much assistance as possible to COVID-19 patients who cannot access public healthcare.
“The situation is unbearable. Who would be able to stand reports of the elderly dying at home,” she said.
“Humans should not face anything like this. We’re all humans and after all, we have a duty to save other humans’ lives.”