The National Vaccine Security Act 2018, a law passed by the National Legislative Assembly, appears to have been the template for the government’s incoherent vaccine programme and was brought into focus this week when the Director of the National Vaccine Institute, an agency established under its provisions, highlighted the country’s unwieldy bureaucratic process for the procurement of vaccines. Dr Nakorn Premsri was offering an apology for the delays in delivering vaccine doses in sufficient quantities for the national vaccination programme. 

The head of the institute responsible for Thailand’s vaccination campaign has come out this week to suggest that the cumbersome system for vaccine procurement, as mandated by law, is partly responsible for the failure of the government to supply enough vaccines to secure the country against the devastation of the Delta variant of COVID-19. It comes as one of Thailand’s leading doctors and an advisor to the Centre for Covid-19 Situation Administration (CCSA) has obliquely criticised the government for failing to order American mRNA vaccines such as the Pfizer jab in November last year pointing out that it considered the outbreak under control at that time.

Nakorn Premsri, the Director of the National Vaccine Institute this week outlined the complex and laborious process for vaccine procurement in a speech at the Ministry of Public Health as he apologised for the perceived torpor in Thailand’s vaccination programme as the government’s target to administer 100 million doses by the end of 2021 looks in doubt as the limited capacity of the AstraZeneca deal between the government and the UK Swedish firm was clarified last week causing uproar and a perceived split between the minster and his junior minister from different political parties within the coalition government. The system, outlined by Dr Nakorn, can be traced back to the 2018 National Vaccine Act which may have over complicated and overregulated the response to the crisis.

Another top doctor and respiratory disease specialist on Thursday called on the government to immediately suspend any further orders for the Chinese made Sinovac vaccine.

He told the media that the effectiveness of the vaccine reduces over time and no further doses should be imported until the Chinese firm produces a vaccine that is effective against all emerging COVID-19 strains.

He acknowledged that the jab has some efficacy in preventing serious illness and disease.

Dr Manoon Leechawengwongs is the Head of Intensive Care at Vichaiyut Hospital.

Sinovac is shown in a Thai study to be effective at protecting against serious illness or death

On the other hand, a recent analysis from within the Thai public health system showed that Sinovac was over 90% effective in preventing serious illness, hospitalisation or death after a sample of medics vaccinated with the jab was compared to a sample who had not been vaccinated.

Blame game over bungled national vaccination drive as top doctors call for Sinovac’s withdrawal

As Thailand currently grapples with its worst COVID-19 emergency, a blame game has opened up at the highest levels of the government over the bungled vaccination campaign with a rising chorus of calls from top Thai doctors to withdraw the Sinovac vaccine from the immunisation programme.

The only problem is that the Chinese made vaccine is still the mainstay of the programme even after last week’s order by the Department of Disease Control to mix the vaccine jabs with the AstraZeneca vaccine in personal double doses, a controversial move aimed at improving efficacy against the Delta variant.

Barely concealed split with the Ministry of Public Health last week between the senior and junior minister from different coalition parties 

The failures associated with the vaccine programme, including uproar this week over the terms of the contract with AstraZeneca which led to barely concealed conflict within the Ministry of Public Health between the Bhumjaithai Party senior minister Anutin Charnvirakul and the Democrat Party junior minister, Satit Pitutacha, has led to the Director of the National Vaccine Institute, Dr Nakorn Premsri, issuing an apology to the public.

The apology echoes points made by several figures speaking out in recent days in favour of the Minister of Public Health, Mr Anutin, who some sources say was, at one stage, being vehemently urged by supporters to tender his resignation over the affair as they felt he was being made a scapegoat for the government’s failure.

Minister Anutin was confronted with AstraZeneca contract terms which appeared to contradict the government’s assurances relating to dose deliveries

The minister was confronted last week with the public revelations that the contract ratified with AstraZeneca as late as May this year provided for only 3 million doses per month and that in talks with the firm, a figure or 5 to 6 million was agreed verbally despite public pronouncements on the subject which tended to indicate that 61 million doses of the vaccine manufactured here in Thailand would be delivered for use in the vaccine drive before the end of the year.

Crisis over AstraZeneca vaccine doses threatens to undermine the government as virus surge grows

The furore and controversy from last week’s revelations have raised tensions within the government and has led vocal Bhumjaithai Party party MPs and supporters to come out in defence of the party leader and deputy prime minister over the affair.

National Vaccine Institute boss apologised but appeared to blame the government’s unwieldy approach to vaccine procurement for the delays

In a speech at the Ministry of Public Health, this week, Dr Nakorn recalled that 61 million doses of the AstraZeneca vaccine were ordered in November 2020 after talks with the UK Swedish firm took place in August and September 2020.

He said that such talks followed a Ministry of Public Health order issued under the National Vaccine Security Act 2018, a well-timed law passed for the purpose of sourcing vaccines in the case of an emergency.

The official explained that all orders or decisions to do with vaccine procurement had to go before a committee within the Ministry of Public Health chaired by the secretary of the department.

He disclosed that this committee was composed of selected experts and representatives from relevant government agencies.

The 2018 National Vaccine Act calls for up to 10 such committees as part of the wider implementation of vaccine policy.

No one person, agency or body can make the decision or take responsibility suggested the top official

Dr Nakorn told his audience that even though the National Vaccine Institute had been working with the Department of Disease Control to source vaccines, the final decision was made by the vaccine procurement committee within the Ministry of Public Health which also has, working with it, an associated number of panels.

He explained that this is because of the many matters to be considered concerning such decisions including the budget and legal contract.

He stated that because of this, no one person, agency or body could take responsibility for ordering a particular vaccine because of the wide range of inputs required and the need for experts.

Admission of failure as crisis overwhelms plans: ‘NVI has tried to do all it can, it cannot procure enough vaccines to respond to the unexpected situation’

He said that even when an agreement is made, it then had to be handed over to the Attorney General’s Office where it was further reviewed before being finalised with the contractor or supplier concerned.

‘This has led to a public feeling that the vaccine procurement may not meet the target. It’s all about those impediments and constraints. I apologise to the public. Even though the NVI has tried to do all it can, it cannot procure enough vaccines to respond to the unexpected situation,’ he told his audience at the ministry.

Overcomplicated law passed in 2018 by the junta government’s legislature part of the problem

Indeed it could be argued that the 2018 law which became effective on the 18th November 2018 and promulgated on the 21st November 2018, instead of helping to make the country’s response to the current virus crisis effective and timely, may have crippled it with an overcomplicated regulatory scheme especially while dealing with an emergency.

For instance, it established a committee which is chaired by the Prime Minister while separate to this, the management committee of the National Vaccine Institute was to be chaired by a qualified expert.

The 2018 law also seems to prod the government towards local control of the vaccine process including the development, production and distribution of vaccines.

The complex nature of the mechanisms established by the bill coupled with the existing structures within the Ministry of Public Health and other control points within the government, appear to have contributed to what is undeniably a less than coherent or satisfactory outcome. 

The law has all the hallmarks of well-intended reform efforts of the former junta government aimed at making the process of government more accountable, consensus-based and less prone to the whims of individual leaders, executives or ministers.

Emerging variants have scuppered the government’s calculations and judgements at this point

Dr Nakorn also blamed the emerging variants of the virus which have severely challenged the efficacy of the Sinovac vaccine, the country’s first vaccine ordered and delivered.

‘The Covid-19 pandemic is something we have never experienced before. The mutations of the virus are also unforeseeable and are spreading even faster, further disrupting vaccine procurement efforts.’

Director ordered on July 14th by Minister Anutin to begin drafting an order to limit the export of AstraZeneca vaccines produced in Thailand

The defence by the National Vaccine Institute Director came after it was reported that he had been tasked by the Minister of Public Health, Anutin Charnvirakul, to speedily implement a regulation seeking to restrict exports from Thailand of the AstraZeneca product to make more vaccines available for domestic use.

Such an order has the potential to damage Thailand’s diplomatic relations with Southeast Asian countries who are also depending on supplies from the Thai plant and the relationship between AstraZeneca and the government.

It may also be something that is explicitly covered by the contract, copies of which have been obtained by opposition parties but with large portions redacted.

It is understood that, despite this, such a course of action was agreed on July 14th last before the furore blew up over the nature of the government’s contract with the UK Swedish pharmaceutical company and the limited commitments made in it.

Decision on such a course taken in principle with Department of Disease Control boss sent to negotiate

The decision however was one only taken, reportedly, in principle.

At the meeting, the Director of the Department of Disease Control, Dr Opas Karnkawinpong, was tasked with opening talks with the firm which is operating in partnership with the Thai firm Siam Bioscience in Pathum Thani to see if more doses can be arranged.

Dr Opas revealed the total number of doses supplied by AstraZeneca from February 24th to July 16th was only 5.3 million, far short of the numbers indicated by the government at the outset of the arrangement.

Pfizer contract signed formally and publicly

The ministry official along with the Minister of Public Health Anutin presided this week over a contract signing ceremony for 20 million doses of the Pfizer mRNA vaccine that are scheduled for delivery in the last three months of the year.

Anutin signs up Pfizer for 20 million doses but warns that Covid-19 may be with us for some time into the future

In mid-June, it was announced that this contract had been agreed and signed between Pfizer in New York and Dr Opas on behalf of the Department of Disease Control but no price terms were specified at that point.

Later in July, 1.5 million Pfizer doses are to be delivered separately as part of a programme by the US government to support countries and allies worldwide with their vaccination efforts.

These will be used, it is understood, as booster shots for public health workers.

Top CCSA doctor and advisor to the PM supports the Pfizer vaccine and also calls for a halt to Sinovac deals

Pfizer is the preferred choice of Dr Prasit Watanapa of Bangkok’s prestigious Siriraj Hospital, at this time, because it is an mRNA vaccine that has been shown to be more effective at countering the Delta variant of the virus although its potency, too, has been shown to weaken against the variant in recent Israeli studies.

Dr Prasit, who is a top advisor to the Prime Minister and the Centre for Covid-19 Situation Administration (CCSA), has also come out to urge the government to halt further orders of the Chinese product.

The cabinet, on June 10th, approved the purchase of 10.9 million doses of Sinovac with a price tag of ฿6.1 billion, a move which has caused consternation among opposition MPs and activists who have even threatened to sue the government over the decision, at this time, claiming it is unconstitutional.

Sinovac ฿6.1 billion deal defended by health officials

Nevertheless, the decision was defended by the Department of Disease Control because of its wide availability.

Its supporters point to a Chiang Rai study among public health workers where it was found to be 82.8% effective at preventing infections.

Dr Prasit was at pains, however, to point out that he was not suggesting that the Sinovac vaccine was one of low quality compared to others.

‘One should not say that Sinovac vaccines are low quality because each type of vaccine can be used effectively in certain circumstances. But Sinovac vaccines may not be the only solution during the current situation where the Delta variant is rampant,’ he explained.

Pfizer mRNA doses should have been ordered by the government in November last year says Dr Prasit 

He called on the government to order more mRNA or Pfizer vaccines and said that this should have been done in November last year.

‘Pfizer vaccines are better. From now on, the government should avoid placing orders for Sinovac vaccines because they have efficacy problems. It should look at vaccines of high quality such as AZ and J&J, mRNA vaccines and protein subunit vaccines such as Novavax,’ he explained. ‘The government should have ordered Pfizer vaccines last year. Thailand was able to control the outbreak back then so it did not order them. Now the government has ordered them, but it has to wait because we were too slow.’

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