The following section covers the interventions that were deployed in Thailand to respond to COVID-19 and maintain essential health services (EHS). Unlike context and systems factors which cannot easily be changed when an outbreak occurs, policies or interventions can. Interventions during the early months of the coronavirus pandemic in Thailand fell into three main categories: national, governmental, and population-level measures, health system-level measures, and patient-level measures.
Exemplars in COVID-19 conceptual framework for assessing epidemic preparedness and response
In March 2020, Thailand established the , chaired by the country’s prime minister, to manage Thailand’s COVID-19 response from the national level., The CCSA’s members are top-level administrators from all government ministries empowered to implement a collaborative whole-government response to the pandemic. The CCSA delegated some actions to provincial governors, such as establishing local lockdowns and closing public venues. For other actions, proposals were submitted to the CCSA for decision, endorsement, and nationwide implementation. This approach ensured unified command and integrated responses and collaboration across all agencies. Proposals covered areas including personal protective equipment (PPE) procurement, economic support, designated facilities for COVID-19 treatment, and holiday cancelation.
Thailand’s pandemic response started months before the CCSA was established, however—even before the country reported its first case of COVID-19. On January 4, 2020, within a few days of the report of a cluster of pneumonia cases in Wuhan, China, the Thai Ministry of Public Health (MOPH) Department of Disease Control activated its Emergency Operations Centre.,
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Thailand’s Emergency Operation Center (EOC) Structure
On March 1, a month after the World Health Organization (WHO) director general declared COVID-19 a public health emergency of international concern, the Emergency Operations Centre officially declared COVID-19 a dangerous communicable disease in accordance with the Communicable Diseases Act of 2015 (CDA). The CDA empowered government agencies to mount a top-down response to public health emergencies, such as the COVID-19 pandemic, and the Emergency Operations Centre’s March 1 declaration enabled public health officials to test, treat, isolate, and quarantine cases in affected areas. Those who did not comply with public health officials were penalized through fines and jail time in accordance with the CDA.
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The CDA was written to support local responses to small outbreaks, however, not whole-government responses to nationwide crises. On March 26, officials therefore declared a one-month state of emergency. This enabled the implementation of public health measures such as curfews, travel restrictions, state quarantine, and the closure of schools and nonessential businesses. Officials promoted social distancing, the use of alcohol-based hand sanitizers, and mask wearing, although the country’s supply of hand sanitizer, and surgical masks quickly ran low., The emergency decree declared the national government as the only official source of information about the COVID-19 pandemic and enabled police action to enforce curfews and other pandemic response rules. It also granted the prime minister certain powers, such as prohibiting certain means of transportation, certain establishments, and assemblies.,
MOPH personnel in Thailand have been trained to operate within an incident command system during health emergencies and to adapt and share policies and procedures for a streamlined, centralized response. The MOPH’s Department of Disease Control developed COVID-19 standard operating procedures for all health facilities, including management protocols for acute respiratory infection clinics and guidelines for disinfecting health facilities.
Financing Thailand’s COVID-19 response
The federal budget and supplementary emergency loan decrees were Thailand’s two main sources of COVID-19 response funding.
The central budget allocated about 15 billion Thai baht, or over US$400 million, to the COVID-19 response in early 2020—6 billion baht for testing, medical care, and laboratory tests and the rest for quarantine, patient-transfer costs, and vaccines.
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Emergency loan decrees (45 billion baht, or about US$1.3 million, and 30 billion baht, or about US$850,000) were earmarked for additional risk compensation for public health–related workforce; procurement of medical supplies, drugs, and vaccines; disease control, research, and vaccine development; treatment and quarantine; and COVID-19 response logistics such as cars for screening teams and technology for communication systems.
, which manages the country’s universal health coverage program, also directed funding to pandemic‐related services, such as COVID-19 screening for Thai citizens. All three national coverage schemes and the voluntary migrant health -insurance scheme extended their benefits to cover services such as personal protective equipment, testing, and treatment, and other services. Uninsured non-Thai citizens were covered by the government’s contingency fund.
associated with the pandemic. This included economic and other supports for individuals, including vulnerable populations, such as low-income people and workers in the informal sector.
Key informants reported that funding disruptions for routine public health services, such as immunizations and noncommunicable disease services, were minimal because officials designated these separate pots of funding for the COVID-19 response. The health system maintained the delivery of key health services even during the peak of the first wave—services such as antenatal visits; child immunization; treatment of noncommunicable diseases, including diabetes and hypertension; end-stage renal disease hemodialysis or peritoneal dialysis; tuberculosis treatment; support for patients on antiretroviral therapy for HIV/AIDS; and management of acute myocardial infarction.
Interventions to limit the spread of COVID-19 and maintain essential health services during the early months of the COVID-19 pandemic in Thailand fell into three main categories:
- National, governmental, and population-level measures
- Health system-level measures
- Patient-level measures
National, governmental, and population-level measures
Health system-level response measures
In the early months of the pandemic, Thailand’s health system-level response measures fell into two main categories: direct responses to COVID-19 and interventions to maintain essential health services despite COVID-19-related disruptions.
Supply- and demand-side barriers to essential health service maintenance in Thailand during the COVID-19 pandemic
In many countries around the world, the COVID-19 pandemic and efforts to mitigate it caused supply- and demand-side barriers to essential health services delivery. In Thailand, these barriers included movement restrictions that kept people from visiting health facilities and fear of contracting COVID-19 that made people reluctant to seek treatment and health care providers to offer treatment.
In a survey of 160 health care practitioners in four hospitals in different parts of Thailand, almost all reported mild or severe anxiety and fear of contracting COVID-19. The study showed that Thai health care professionals who reported fear and anxiety over the pandemic were less willing to see admitted clients and to accept new admissions during the early parts of 2020.
Researchers have also reported reductions in the use of primary and secondary health care services (such as maternal and child health care and family planning) because of the public’s fears of contracting COVID-19. According to a 2021 World Bank poll, around one-third of households in Thailand whose members needed medical assistance did not access it because of concerns about contracting the COVID-19 virus. These fears were most pronounced in the northern part of the country and among low-income households.
In Thailand, researchers have observed decreases in some types of outpatient service use during each of the three pandemic waves.
Outpatient visits before and during the COVID-19 pandemic, 2017-2019 and 2020-2021
National Health Foundation analysis of data from Thailand Ministry of Public Health’s Health Data Center Reporting System for utilization rate and from Thailand Ministry of Public Health Department of Disease Control for COVID-19 cases
These declines also may have been due, in part, to public health and social measures, such as movement restrictions. In March 2020, the national State of Emergency Act recommended that people in high-risk groups—including older people, very young children, and people with underlying diseases, such as chronic noncommunicable diseases—remain in their residences, which restricted their access to in-person essential health services.
Movement restrictions also restricted the supply of these services. Between March and May 2020, hospitals canceled services such as elective surgeries and nonurgent follow-up visits. Telehealth consultations and medication delivery were primarily used in place of in-person visits for nonurgent ambulatory care and well-controlled noncommunicable diseases. This policy protected people from the risk of infection during a hospital visit and reduced the routine workload of health care workers, allowing them to direct their attention and resources toward the treatment of COVID-19 patients.
As restrictions eased between May and June 2020, use of outpatient services rebounded. Researchers observed similar patterns of disruption and rebound during the second and third pandemic waves in January and April 2021. Yet although Thailand was affected by the pandemic much more severely during these subsequent waves, with higher reported COVID-19 cases and deaths, the magnitude of the drops in outpatient service use was smaller than that during the first wave—perhaps because officials had adapted public health and social measures to be less strict, because of the many interventions officials had implemented to mitigate their impact, or because of a reduction in fear of COVID-19.
Researchers have found similar patterns for other metrics and indicators, as illustrated in the figures below.
Inpatient visits before and during the COVID-19 pandemic, 2017-2019 and 2020-2021
National Health Foundation analysis of data from Thailand Ministry of Public Health’s Health Data Center Reporting System for inpatient admissions and from Thailand Ministry of Public Health Department of Disease Control for COVID-19 cases
Inpatient bed capacity before and during the COVID-19 pandemic, 2017-2019 and 2020-2021
National Health Foundation analysis of data from Thailand Ministry of Public Health’s Health Data Center Reporting System for inpatient bed capacity and from Thailand Ministry of Public Health Department of Disease Control for COVID-19 cases
Dental care visits before and during the COVID-19 pandemic, 2017-2019 and 2020-2021
National Health Foundation analysis of data from Thailand Ministry of Public Health’s Health Data Center Reporting System for dental visits and from Thailand Ministry of Public Health Department of Disease Control for COVID-19 cases
Researchers have observed a similar pattern for dental care services between 2020 and early 2021: dramatic decreases during the first lockdown period were followed by a rebound and then subsequent disruptions during the second and third waves. Moving into the latter parts of 2021, however, dental care services in particular saw continued disruptions compared with baseline levels from previous years. In fact, dental visits still did not reach pre-pandemic baseline levels by the end of 2021. This suggests that dental services were particularly hard-hit by the pandemic during these later waves, despite loosening of policies around both essential health services delivery and overall mobility restrictions, as well as innovative interventions. Moreover, providers’ and patients’ fear and anxiety around contracting the virus could explain lower rates of dental service use.
Routine immunization services
Although Thailand has been recognized as one of a few countries in its region to continue routine immunization services uninterrupted throughout the COVID-19 pandemic, overall reductions in coverage have been reported.
Analysis from the Institute for Health Metrics and Evaluation of administrative data from countries shows that there were only relatively small disruptions to routine immunization coverage during the COVID-19 pandemic, with recovery to previous levels within two months. The figure below shows the ratio of the monthly number of doses of DTP3 vaccine (third dose of diphtheria, tetanus, and pertussis vaccine) given to children younger than one year old in 2020 as it compares with the same month in 2019. A value of 1 represents no change and values less than 1 indicate delivery disruption.
Disruption in DTP3 vaccines doses in Thailand
Causey K, Fullman N, Sorensen RJD, Galles NC, Zheng P, Aravkin A. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet. 2021;398(10299):P522-P534.
has also identified health equity concerns in immunization coverage in Thailand during the pandemic, with low or uncertain coverage for vulnerable populations (such as migrant groups in the deep southern provinces) and in urban areas across the country. Researchers have noted that religious beliefs and conflict situations in those provinces also could have been a cause of vaccination gaps in children.
Health officials also implemented catch-up immunization efforts for infants and children who were behind schedule because of COVID-19 lockdowns or restrictions to care delivery.