As an American living in Thailand I have puzzled over the fact that Thailand has so far outperformed the United States in its handling of the Covid-19 pandemic. This was also true during the 1918-1920 Spanish Influenza pandemic, a crisis we will explore in Book 2 of our historical novel series, “Beads on a String.” Thailand, although seriously affected, had fewer deaths as a percentage of the population than the United States and Europe despite rather primitive public health and medical capabilities.
Throughout my 19 years with the Kenan Institute Asia (KIAsia) the institute facilitated the transfer of US expertise on public health to Thailand. Already competent Thai officials looked up to American experts as mentors. After the spread of Avian Influenza in 2004, for example, KIAsia worked with Thai and US experts to hold trainings on preparing for the next pandemic. When the Covid pandemic arrived last year, however, the student did far better than the teacher.
Why? What are the factors that allowed one country to protect its citizens much better than another. Is it type of government? Size? Level of development? Culture? Wealth?
The Lowy Institute in Australia recently released an interactive report that seeks to answer some of these questions. You can find it at: https://interactives.lowyinstitute.org/features/covid-performance/?fbclid=IwAR24PbO_h5pWnlG-LFtiK1IllcExkJ14LfCDREQdGMTv4qpBul-RSFvsLJw
Fourteen-day rolling averages of new daily figures were calculated for confirmed cases, deaths, cases per million, deaths per million, cases as a proportion of tests and tests per thousand people.
They ranked the effectiveness of each country for which this data was available (notably, China did not provide sufficient data). A score of 100 shows a country achieved the best average score. A score of 0 indicates that a country had the worst average score at a given moment.
The chart below compares the United States and Thailand:
Although the US has more resources and medical expertise than Thailand, it handled Covid much worse.
Thailand’s score dropped after about two weeks following its 100th case, but then rapidly improved by week 8 and maintained a high score through 36 weeks. The US score did the reverse, dropping quickly after the first two weeks and failing to improve much after that.
With an overall score of 84.2, Thailand came out in the top five in the world. The Lowy institute provided the following chart of the best performing countries:
While New Zealand and Cyprus are small, Vietnam and Thailand have populations of more than 70 million.
Despite its wealth and highly developed medical expertise, the United States had an average score of 17.3, only slightly better than Iran. Here are the worst-performing countries in the world, according to the Lowy Institute:
Except for Iran, all the worst-performing countries are in the Americas.
Response by region also showed significant differences, with Asia and the Pacific, with an average score of 58.2, doing a better job of controlling the outbreak than Europe-51.0, with the Americas, both north and south-33.8, falling even further behind.
Why?
The institute looked at a number of factors that might explain the differences. It concluded that no single type of government was a clear winner. Individual countries varied far more than broad categories of countries based on their type of government. Democratic countries did fare best with an average score of 50.8, but that was only slightly better than authoritarian countries that had an average score of 49.2. Hybrid governments, presumably including Thailand, scored lowest at 41.6. The Lowy Institute report said no single political theory convincingly explained the differences in national outcomes.
The report, however, noted that smaller countries (with populations of fewer than 10 million people) proved more agile and effective than most larger countries. Differences in economic development and differences in political systems had far less impact. The relatively low tech nature of the most effective responses in the first year of the pandemic (social distancing, mask-wearing and hand-washing) presumably allowed even relatively poor countries to do as well as far richer countries. Even technology-dependent actions such as contact tracing depended more on effective government organization at the local level rather than advanced technology, allowing some developing countries, such as Thailand, to succeed.
The Lowy study suggested there was merit in the argument put forward by the American political scientist Francis Fukuyama, who said effective Covid crisis response did not depend on regime type, “but on whether citizens trust their leaders, and whether those leaders preside over a competent and effective state”.
In the US, of course, much has been made of the mixed response and confusing messages from the Trump administration. In Thailand, another country with sharply divisive politics, political leaders stumbled initially, but then allowed the public health professionals to orchestrate the coronavirus response and messaging. That decision won public trust appears to have paid off in fewer infections and deaths.
The Lowy Institute report said that Covid responses varied over time. After the first wave of infections, it said, Europe “registered the greatest improvement over time of any region.” But then both Europe and the Americas succumbed to a second, more severe wave of infections in the final months of 2020. Thailand too is suffering from another wave of Covid infections, but so far it is far less serious than in the Americas and Europe.
The Lowy Institute did not mention it, but my guess is that another, rather subjective, factor has been at work: social and cultural cohesiveness. The Asian countries that have dealt effectively with Covid, even those like Thailand that have serious political conflicts, have societies that are willing to follow reasonable recommendations by their leaders.
In Thailand, at least, it seems that mask-wearing quickly became a social norm that showed one’s care for the well-being of others. Unlike in the United States, there was no anti-mask movement in Thailand. There were no claims that shut-downs and social distancing were violations of civil rights. Response to the virus was not politicized. There were no Covid parties by young people who felt they were not at risk. Although there were isolated cases of people ignoring social distancing and mask requirements at boxing matches and illegal casinos, there has been general condemnation of such behavior as anti-social.
Unfortunately, the Covid-19 pandemic is far from over, with record levels of infections and deaths continuing in several countries. Dealing with changes in the virus, securing vaccine supplies and inoculating sufficient numbers of the population are serious challenges, but all countries should be trying to understand what has worked elsewhere if they hope to face those challenges effectively.
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