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8 Jun, 2020

How Thailand Contained Covid-19: Why a Public Health System with Popular Support Matters

Bangkok – One of ASEAN’s preeminent political scientists has heaped praise on the Thai healthcare system for the clean-up campaign that averted a potential Covid-19 disaster, but also obliquely hinted whether the kingdom can also clean up its fractious and divided political system, too.

In an analysis published on June 7, Prof Walden Bello, Co-chair of the Bangkok-based NGO Focus on the Global South, said that it was not authoritarian decrees from above but a strategy of persuasion built on a tradition of cooperation between public health authorities and civil society that made the difference.

A Filipino national, Prof Bello co-founded Focus on the Global South in 1995, under the aegis of Chulalonkorn University, Thailand’s pre-eminent educational institution. In 1998, he was the principal author of “A Siamese Tragedy: Development and Disintegration in Modern Thailand (London: Zed, 1998), a book on political economy, the Thai edition of which was used as a text in some of the country’s leading universities. In 2003, he was conferred the prestigious Right Livelihood Award (the “Alternative Nobel Prize”).

Although he now lives in the Philippines, he was stuck in Bangkok when the lockdowns were imposed. He wrote his analysis on the basis of his observations during that period.

Prof Bello writes that when the novel coronavirus began its swift spread from China in mid-January, people in Thailand feared the worst, especially as the country was enjoying record visitor arrivals from China. However, that did not happen.

Today, “Thailand’s record is nothing to sneeze at: 3083 infections and 57 deaths, with a 96 per cent recovery rate. This becomes starkly evident when one compares the explosive rates of infections in the US, Europe, and Brazil.” While Taiwan and Vietnam have a better record, Thailand is well ahead of Japan and South Korea, which are often written about as success stories, Prof Bello says.

He notes how “a measure of disorganization” and “fumbles on the part of the political leadership” in the early stages of dealing with the looming crisis dissipated as the public health authorities soon stabilized the situation.

Prof Bello writes, “As in most other countries, public health authorities very early on discarded mass testing saying they did not have the resources to conduct this. In its place, they put into effect an aggressive strategy of contact tracing, quarantining those testing positive and hospitalizing those with serious symptoms, and requiring international travelers arriving from “dangerous communicable disease areas” to self-isolate or, in some cases, be confined to government quarantine centers.

“While the government did adopt an Emergency Decree, the battle against the pandemic was led by public health authorities deploying a strategy of persuading people to use face masks and hand sanitizers, observe social distancing, and stay at home. As noted above, much of this work was carried out at the grassroots level by hundreds of thousands of village health volunteers.

“Polite visual and audio reminders were ubiquitous in both public places and supermarkets. On television, Covid 19-related advice was pervasive, and one of the most watched spots was the daily 11 am update of the Center for COVID-19 Situation Administration (CCSA) led by a medical doctor who laid out the numbers, offered assessments of the national and international situation, and used the opportunity to boost popular morale.”

He notes that the moves also proved to be politically advantageous for the Thai government.

“The current regime is a polarizing one, so whatever were their intentions, it proved a smart decision for its military leaders to yield center stage to public health authorities with a thoroughly professional image. This was in contrast to the United States, where President Donald Trump consistently contradicted his medical experts, or the Philippines, where President Rodrigo Duterte has used police coercion and threats of shooting people instead of persuasion to achieve citizens’ compliance.

“Indeed, in the view of some observers, the public health authorities’ response did not need the Emergency Decree, the main objective of which was, in their view, twofold: to unify a fractious ruling coalition and to contain the public criticism of the disorganization that marked the political leadership’s confused response to the crisis in the beginning.”

Prof Bello goes on to list a number of other reasons “for the extremely high degree of compliance to public health advisories”. These include the high personal hygiene habits of Thai people and past successful public health campaigns, such as the population control and anti-AIDS campaigns of the 1980s and 1990s, the Magic Eyes Bangkok clean-up campaign and the universal health care campaign initiated by former Prime Minister Thaksin Shinawatra, who was ousted in a military coup in 2006.

However, he warns, “all this may give the impression of a conformist society marked by a high degree of consensus. That is not the case.”

In fact, Prof Bello says, Thailand is a turbulent society rent by social conflict. Massive street protests marked the period from around 2004 to 2014, as populists and conservatives struggled for political control of the country. Today, a military-dominated pro-royalist government rules, but conflict is not far from the surface. This history of social conflict makes the high degree of consensus in the area of public health even more remarkable. Indeed, public health is one of the few non-politicized areas of social life, and public health authorities enjoy a degree of trust and confidence that other state authorities — and certainly high profile political leaders — do not have.”

Prof Bello adds, “Coercive measures have not been absent during the lockdown period, with some people arrested, indicted, or threatened with arrest under laws and directives that included the government’s Emergency Decree to deal with Covid 19. According to a recent Amnesty International report, three activists have been indicted for their staging peaceful protests, while several organizations marking the sixth anniversary of the May 2014 coup against the Yingluck Shinawatra were reportedly harassed. The report also mentions the arrest and indictment of an artist who posted on Facebook that were no health checks at Bangkok’s Suvarnabhumi Airport upon his arrival in March. It is unlikely that these events made a contribution to the successful campaign against the pandemic. Indeed, with the widespread publicity they elicited, it is more likely that they detracted from the public health authorities’ effort to build national unity against Covid 19.”

He concludes by flagging what he calls the Thai “Recipe”. This “recipe” was not one of authoritarian politicians dictating from above and whipping people in line with coercive measures. Rather, he says, “what really made the difference was voluntary compliance of citizens and the voluntary service of hundreds of thousands of grassroots public health activists that built on a history of successful public health campaigns and institutions that were founded on cooperation between the public health authorities and civil society.

“The lesson of Thailand for the world is that a good public health system with popular legitimacy really makes a difference in times of crisis.”

Click here to read the full analysis by Prof Bello.