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In Thailand, Health Security May Be Under Threat

By Ezra Chan
on May 1, 2023

Thailand is regarded as a leader in health security for both Asia and the developing world at large. The Southeast Asian country sits on the permanent steering group of the Global Health Security Agenda (GHSA) and was selected as its Chair in 2021. The Global Health Security Index (GHSI) 2021 report ranked Thailand as 1st in Asia and 5th overall in their analysis of a country’s ability to mitigate and respond to outbreaks, making it the only country in the top 15 to not have a high income economy (according to the World Bank, Thailand has had an upper middle-income economy since 2011). Arguably, global health security indices were criticized after their track record proved imperfect during the Covid-19 pandemic. However, the 2021 report tried to address some of these criticisms and shortcomings and thus continues to support the notion that Thailand is an important potential role model for strengthening health security in (relatively) resource limited settings. Thailand’s achievements in health security are, however, overshadowed by the challenges it has faced in governance and political instability in recent years.

Throughout the Covid-19 pandemic, countries around the world have been plagued with concerns over existing health security and how health systems can be strengthened. Developing countries have faced vaccine supply shortages, inadequate testing capacities, and limited vaccine rollout, leading to high infection rates,  hospitalizations and crippling economies. During the first year of the pandemic, Thailand maintained very low rates of infection, sparking curiosity in many health experts as to why they remained largely unscathed. Despite an increase in cases through 2021, their healthcare infrastructure and public health interventions continue to lead Southeast Asia in health security.

Thailand’s high GHSI ranking is significantly attributed to their successes in two categorical measures: detection (1st overall) and response (2nd overall), but also in most of the other GHSI categories the country does well (including with respect to the health system).

The GHSI reported Thailand maintained a highly effective emergency preparedness, response planning and risk communication capability, surpassing many other better-resourced countries in this regard. Thailand also reportedly sustains a durable and efficient laboratory system, including top-ranking diagnostic capacity and the ability to scale up laboratory specimen transportation during emergencies. Their capacity and investment in real-time surveillance and reporting contributes to their exceptional health security, along with widespread coverage and public access to basic healthcare services.

One of the notable features of the Thai health system is the Universal Coverage Scheme (UCS) that was introduced in 2001. This healthcare reform dramatically increased healthcare access and affordability in the country, making Thailand a gold standard in health systems for emerging markets. The UCS covers about 76% of the population and is funded by general taxation – the Social Security Scheme and Civil Servant Benefit Scheme cover the rest of the population. While the UCS is not infallible, it provides strong evidence that universal healthcare coverage is possible in middle-income settings.

The successes of the Thai health system provide strong health security for the country as well as the region by limiting cross-border disease dispersion. It is particularly impressive given that Southeast Asia’s year-round tropical climate makes the area vulnerable to emerging disease threats, which continues to threaten Thai health security.

To improve international cooperation in health security, Thailand entered into a bilateral effort with the United States, a fellow member of the GHSA permanent steering group. On July 10, 2022, the U.S. Department of State released the United States-Thailand Communiqué on Strategic Alliance and Partnership, co-signed by U.S. Secretary of State Anthony Blinken and Deputy Prime Minister and Foreign Minister Don Pramudwinai of the Kingdom of Thailand. The communique outlines multiple areas of strategic cooperation including commitments to furthering regional and global health security, in part through the sharing of information. Thailand’s location in Southeast Asia, a region with a substantial proportion of the world’s communicable disease burden, makes the country a valuable source of biosurveillance data.

Health security under threat?

Efforts in this area are likely to be impeded, however, if conflicts between the military-backed government and the citizenry continue. Among others, this would likely stall timely disease threat data communication and analysis. But there’s plenty more to the story, as a  quick political recap   of the past few years in Thailand shows.

Thailand has undergone contentious regime turnover, with the most recent military coup in 2014 which left the country under the control of a military junta. The political regime has since transitioned in 2019 to a semi-elected but heavily military-dominated government. While Thailand’s health system remains strong for now, the lack of civil liberties and political rights illustrate a vastly different side to the nation’s development, and pose a future risk for health security. Military and police forces brutally responded to the growing dissent that was highlighted by large, anti-government protests seen in 2021. The strictly enforced public health measures that have added to the country’s strong health security during the Covid-19 pandemic have also been criticized for their role in enforcing militant rule and censorship over the Thai population. The Thai government reportedly “ordered factories…to be temporarily sealed off during the pandemic, locking tens of thousands of migrant workers inside with limited access to essential supplies and health care” during the Covid-19 pandemic. As such, it is unclear how the Thai government’s commitment to equal healthcare access might change in future public health crises.

More confrontations between the military-backed monarchy and the people would likely result in a (further) weakening of democracy in Thailand. According to researchers at the Center for Strategic and International Studies, public health policies during the Covid-19 pandemic have “exacerbated underlying feelings of discontent with Prime Minister Prayuth Chan-ocha, the military-dominated government, and the monarchy”, while also creating odd new alliances (between many ‘Red shirts’ and ‘Yellow shirts’). Although the strong Thai health system seems to be part of the “social contract” in the country, it remains to be seen what would happen to it if political tensions and violent responses increase. The Thai healthcare system might be more vulnerable than appears at first sight. If so, the health and security of the country would likely devolve with it.

In short, maintaining strong biosurveillance, healthcare access, as well as ensuring civil rights is critical for Thailand to support its position as a leader of health security and development.

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