Thailand’s history of dealing with serious disease offers both hope and fear on how it will handle the Covid-19 pandemic.
The 1918 Flu Pandemic
The flu virus, dubbed the Spanish Flu, arrived in Thailand, then called Siam, with Thai soldiers who had fought in Europe in World War I. Most of the 19 Thai deaths in that war were from the disease believed to have begun in a US army camp. In the next two years the flu infected 2.3 million Thais, some 36% of the population. More than 80,000 Thais died, including the heir presumptive to the throne, Prince Chakrabongse Bhuvanath. Like Covid-19, the 1918 flu attacked the lungs, often leading to pneumonia.
Thai troops returning from World War I
As terrible as the death rate in Siam was, it was lower than in the rest of the world, which suffered at least 40 million deaths. The Spanish flu pandemic in Siam sparked the establishment of the Department of Public Health in November 1918. The department later became the Ministry of Public Health that is dealing with the current pandemic.
A century ago, of course, medical science had far fewer weapons to attack disease than it does today. It was not until the 1930s that researchers discovered the pandemic had been caused by a virus.
Recent Pandemic Disease Threats
In the last three decades, Thailand and the rest of the world have dealt with other pandemic threats: HIV/AIDS, first reported in Thailand in 1984, Severe Acute Respiratory Syndrome (SARS) in 2003, Avian influenza A(H5N1) in 2004-2007, and the Middle East respiratory syndrome coronavirus (MERS-CoV) in 2016.
While there have been many advances in disease detection, control and treatment, the most important tools are still those used in 1918 – keeping people apart to lower transmission rates and providing clear, consistent and truthful information to the public.
The actions recommended so far against Covid-19 by the Ministry of Public Health appear to be reasonable. This is no surprise. I worked closely with the Ministry during my 19 years at the Kenan Institute Asia. The Institute, with funding from USAID and private donors, helped Thailand with diagnostic tests for AIDS, with malaria containment and with pandemic planning. In my experience most ministry officials were knowledgeable, experienced and public-spirited. Unfortunately, the same could not always be said of the political leadership in ultimate control of the ministry.
The HIV/AIDS Pandemic
This was particularly true for the government reaction to HIV/AIDS. Fearful of the impact on business, successive governments downplayed the problem. Prime Minister Prem Tinsulanonda, an unelected army general like current Prime Minister Prayut Chan-O-Cha, dismissed AIDS as "just like any other disease."
Throughout the 1980s Thai leaders insisted that HIV/AIDS was limited to drug users, homosexuals and foreigners, even as it spread into the general population. Top leaders said little and did little about HIV/AIDS, apparently worried publicity would damage Thailand’s vibrant tourist industry based partly on cheap sex available at bars and massage parlors. Little attention or budget was devoted to HIV/AIDS even as the death toll rose.
In 1991, however, the government of Prime Minister Anand Panyarachun made dealing with it a national priority. Anand became personally involved as Chairman of the National AIDS Committee. He put Mechai Viravaidya, the minister of the prime minister’s office, in day-to-day charge of the effort. A gifted communicator, Mechai minced no words in warning about the disease and putting in place the means to deal with it. “Because of prostitution, Thailand, like a lot of other countries, is very fertile ground for AIDS,” Mechai said. “A lot of people would like us just to shut up about it.”
Mechai Viravaidya distributes condoms to bar girls to promote safe sex
Fortunately, the colorful Mechai was not one to shut up. He used condom-blowing contests, snappy slogans and cartoons to promote safe sex and compassionate treatment of those infected. Under the two Anand governments significant progress was made in education, testing and treatment of HIV/AIDS, and the spread of the disease slowed. However, even today, some 30 years later, the country is still paying the price for the early fumbling of the AIDS problem. It remains a significant health problem, with a total of at least 1.1 million people infected and some 600,000 dead. At least 480,000 Thais still live with AIDS, susceptible to opportunistic diseases and requiring expensive antiretroviral medicines.
Bird Flu, SARS and MERS
The Thai government responded more effectively to the Avian Influenza. Again, however, there was an initial delay in taking necessary action for fear of impacting profitable duck and chicken businesses.
When SARS broke out in 2002, Thailand’s Center for Disease Control immediately limited travel to and from affected areas. The result: only nine infections and two deaths in Thailand, compared to more than 600 deaths in China and Hong Kong.
Unlike the current Covid-19 pandemic, however, those disease threats – SARS, MERS, and Avian Flu – were relatively slow-moving. Even HIV/AIDS took years to spread.
Confused Communication
In contrast, Covid-19 has spread around the world in only a few months and threatens to overwhelm medical facilities in several countries. If fast, effective action is not taken, Thailand could suffer the same fate, even though its universal health program and excellent hospitals compare favorably to even the advanced countries of Europe.
Unfortunately, the government has not made a good start. Communications have been contradictory and confused. Some policies have been unworkable. There has been a tendency to blame foreigners long after local transmission of the virus among Thais became the main cause of infection. So far, there appears to be no single government leader people trust to give them needed information or make sound, well-coordinated policy decisions.
At the onset of the pandemic, the public health minister, Anutin Charnvirakul, insisted on stopping flights out of China, but that was challenged by the sports and tourism minister apparently fearful of a dip in tourist numbers. Ultimately the cabinet decided to veto the ban as “excessive”.
Public Health Minister Anutin Charnvirakul pulled down his face mask to speak to journalists and allowed officials to crowd around him — hardly a great example of safe conduct.
Soon afterwards, however, the Civil Aviation Authority of Thailand ordered travel restrictions first for China and three other countries. That was quickly extended to 11 countries – all without reference to the Ministry of Public Health. The restrictions required a certificate showing the traveler is virus free. This caused widespread confusion and dismay among Thais trying to return home because was no way to get such certificates in most countries. The Transport Minister denied the restrictions were in place, but then the government denied the denial. Within hours, Gen. Prime Minister Prayut added to the confusion, announcing the regulations would be extended to cover all foreigners from every country seeking to enter Thailand. He gave no further details on how travelers could get the required certificates.
Earlier this month, the government said it would close its quarantine centers and require Thais to self-isolate at home. One day later, Interior Minister Gen. Anupong Paojinda contradicted the statement, insisting the centers would stay open.
Public Health Minister Anutin, despite competent support staff, had his own communication problems. He lashed out at doctors who contracted Covid-19, saying they should be “whipped” for failing to take appropriate safety measures. The comments aroused complaints from medical personnel and the public, forcing the minister to apologize for his words, saying he did not realize the doctors had been exposed while trying to treat patients.
Despite an effective health system, the government has created confusion over the availability of personal protective equipment, such as face masks. The Commerce Ministry announced there would be no shortages because the country can manufacture 100 million masks per month. Soon afterwards, however, the Internal Trade Department corrected the announcement, saying capacity was actually 36 million masks. Will it be enough? Government assurances of a sufficient supply did not stop panic buying and shortages in the pharmacies.
As a Bangkok Post editorial put it: “The Prayut Chan-o-cha government appears to lack skills regarding crisis communication, a crucial factor which can cause a situation to deteriorate further if not managed properly.”
The Threat of 1918 in 2020
The current government has no one like Anand, widely trusted to make wise policy decisions, and it has no Mechai to communicate decisions effectively. Too many people are not following the recommended social distancing and hygiene practices. The threat is that Covid-19 will be as serious as the 1918 pandemic.
Extrapolating from the 1918 percentages for a Thai population now nearly 70 million, that would mean 25 million people infected and 700,000 deaths. The government must urgently improve its performance, especially at the top levels, and people must put aside their justified distrust of the generals and politicians to take the needed precautions. The alternative, history shows, could be grim.