A king’s vaccine: Thailand’s struggle to deliver jabs to its people

The soaring glass and steel Bang Sue Grand Station in Bangkok, is set to become south-east Asia’s largest railway terminal when it opens later this year. But this week it occupied a different role: as the launch pad for Thailand’s Covid-19 national vaccination rollout.

With khaki-clad government officials and lilac-uniformed medical staff milling around, Thai patients lined up to receive their pre-booked shots. Anutin Charnvirakul, minister of health, repeated the government’s vow to vaccinate at least 70 per cent of its roughly 70m residents before the end of the year. 

“Vaccines will be the key to reopening the country to tourism, to rehabilitating the economy and returning to normal life,” Prayuth Chan-ocha, the prime minister, wrote in a subsequent Facebook post. “Vaccines will be the force to drive the country forward with security and sustainability.” 

Yet away from the rhetoric, Thailand’s military-backed government faces growing questions from the public and big business. Delays and what some have called a botched national vaccine plan threaten to reopen raw political wounds and have turned the kingdom from a global standout in fighting Covid-19 infections to a laggard.

Ahead of Monday’s launch, Thailand had fully vaccinated just 2 per cent of its population, a smaller share than its poorer neighbours Cambodia and Laos — delaying the reopening of its tourism-reliant economy. Normally tame Thai media have described the rollout as “shambolic”. New coronavirus cases are averaging more than 20,000 a week and almost 70 per cent of the country’s total 1,300 deaths from the virus have come in the past month. Although that is far fewer deaths than many other parts of the world, the rise in cases has sparked anger in a country that brought infections down to zero last year. 

At the heart of Thailand’s vaccination drive is an issue so sensitive that most Thais avoid discussing it openly. The vaccine is being made locally by Siam Bioscience, a biopharmaceutical company that few had heard of before it sealed a deal with the Thai government and AstraZeneca to produce up to 200m doses a year of the global drugmaker’s Covid-19 vaccine as its sole south-east Asian production hub.

The company is owned by King Maha Vajiralongkorn, the billionaire Thai monarch and head of state, who presides over the nation with an elevated status guaranteed by tradition and law. 

As a result most Thais have had to measure their words. Saying anything that might be perceived as an insult to the royal family risks criminal prosecution under the country’s censorship laws, including lèse majesté, which carries a maximum 15-year prison sentence.

Police in January charged Thanathorn Juangroongruangkit, the country’s most prominent opposition figure, under the law after he voiced doubts about the choice of Siam Bioscience to make vaccines. Some Thais are also beginning to question how AstraZeneca came to partner with the company. 

“There are a lot of questions to be asked about Siam Bioscience, but now the ball is moving into AstraZeneca’s court,” says Thitinan Pongsudhirak, a political-science professor at Chulalongkorn University. “They would have had to be aware of the politics in Thailand, and the implications of entering a contract with a palace-owned company.”

He adds: “I think they made a blunder.” 

‘Made in Thailand’

Siam Bioscience, which had never manufactured a vaccine before, declined an interview request for this article. But last week it published online photos of a launch event, presided over by AstraZeneca’s country head James Teague, to which journalists were not invited. It included images of trucks leaving its factory with the words “Made in Thailand for Thailand and South-East Asia” on their sides. The Thai government announced it had received the first 1.8m doses of the locally made vaccine.

However, there are indications that the Thai vaccine operation is not going smoothly. Since last week, authorities in the Philippines, Taiwan, and Malaysia have said that shipments of millions of doses of AstraZeneca vaccine made by Siam Bioscience had been delayed or reduced in size.

According to a Thai local doctors’ association, some vaccine doses were imported from South Korea to meet the June 7 deadline for Thailand’s national rollout. And many of those already vaccinated in the country received the Chinese-made Sinovac, which the government began importing earlier this year.

Prayuth apologised on Tuesday for delays in the rollout, and said the government planned to shore up supplies with 25m additional vaccine doses made by Johnson & Johnson, BioNTech/Pfizer and 8m more made by Sinovac. The government insists the rollout will proceed on schedule.

Thailand is not alone in falling behind on vaccinations. Other Asian countries that made it through 2020 with low Covid-19 caseloads, including Japan, Taiwan and Vietnam, are now also finding themselves vulnerable because of slow vaccination rollouts.

But the Prayuth government’s management of the vaccination scheme, and Thais’ ability to speak about it freely, are complicated by the fact it sits at the intersection of the country’s two biggest public policy challenges: the pandemic, and the unresolved political conflict between the authorities and pro-democracy activists who led nationwide protests last year and aired unprecedented criticisms of the king.

While perfectly legal for a company to partner with a business owned by a foreign head of state, lawyers say such relationships can create a need for heightened due diligence. This is in part to ensure compliance with best practice in dealings with public officials. The association with the king’s company also raises possible reputational issues for the western institutions — especially AstraZeneca and Oxford university — because of the harsh laws used to target alleged critics of the Thai monarchy, say observers. 

“The global vaccine rollout should be a moment when democratic and ethical norms are re-established,” says Susan Hawley, executive director at the UK based campaign group Spotlight on Corruption. “Businesses like AstraZeneca have a responsibility to work towards that, rather than entrenching repressive practices.”

Vaccine makers have faced an unprecedented challenge, scaling up manufacturing of a brand new product with huge global demand during a pandemic. To move fast, they all invested in manufacturing before the vaccines were even approved. 

AstraZeneca says its vaccine production deal with Thailand’s public health ministry, Siam Cement Group — in which the king also owns a controlling stake — and Siam Bioscience “was designed with our broad understanding of global supplier capabilities, combined with a focus on local manufacturing where possible”.

“All our manufacturing partners have to meet rigorous industry requirements before a licence is granted,” the British-Swedish drugmaker adds. “Siam Bioscience emerged as the best option due to its modern facilities, technical expertise and the availability of large, integrated drug substance and fill and finish capacity at short notice.” 

The company did not respond to questions about whether the local production in Thailand was now facing delays, or any issues related to doing business with a company owned by the Thai king.

Challenging the king

In Thailand, the first country to report a Covid-19 case after China in January 2020, the pandemic has coincided with the kingdom’s biggest political unrest in years.

While the Thai government’s initial reaction to the crisis was scattershot, it soon mounted a robust public health response. By mid-year, lockdown measures had been lifted to the point that restaurants, nightclubs, schools and most other public places had reopened. 

As they did so, a protest movement channelling bottled-up grievances spilled out on to the streets. Young people were angry at, among other things, a court’s banning in February 2020 of Thanathorn’s progressive Future Forward party. They gathered in large numbers to demand the prime minister’s resignation, constitutional reform and — unusually for Thailand — limits on the wealth and powers of the king.

In mid-October, the health ministry announced it had signed a letter of intent with AstraZeneca, Siam Bioscience and SCG, which was to help prepare facilities for manufacturing the vaccine.

Vajiralongkorn assumed control of billions of dollars’ worth of real estate and corporate shares, including the SCG stake and Siam Bioscience, in 2017, when he took direct ownership of a wealth portfolio formerly owned by the Crown Property Bureau, a royal trust. A Palace decree published the following year confirmed the move, which made him one of the world’s richest monarchs. His name first appeared on the pharmaceutical company’s shareholder register in 2019.

While SCG is the country’s biggest industrial group, Siam Bioscience was less well known when the AstraZeneca contract was agreed. The company, founded in 2009 during the reign of Vajiralongkorn’s father King Bhumibol Adulyadej, is chaired by a military official, Air Chief Satitpong Sukvimol, a close associate of the current king who also sits on the SCG board. The king holds all the company’s shares except for a single one held by Sukvimol, and one by Thumnithi Wanichthanom, a police colonel. 

AstraZeneca agreed to provide the vaccine at no profit, as it has done around the world. SCG said it would “help facilitate this technology transfer” and noted that it and Oxford had “been research and development partners for some time”, although the university declined to comment on the relationship. 

In November, the deal was sealed. The initial contract covered the purchase of 26m doses, mostly made locally but topped up initially with imports. This was later increased to 61m doses. Under a separate agreement funded by the Thai state, AstraZeneca is working with Siam Bioscience to mass produce up to 200m doses of the vaccine annually, including for export elsewhere in south-east Asia — a region of almost 700m people. 

In December, Nakorn Premsri, Thailand’s vaccine chief, said the country wanted to make vaccines locally as a matter of “national security” and would introduce mass production — with a capacity to make up to 18m doses a month — by the middle of 2021.

But after a new wave of infections at the start of the year — traced to illegal border crossings from Myanmar — the government ordered 2m doses of Sinovac as a back-up. With Thailand’s low-infection bubble pierced, the government’s mid-year production target began to look as if it might be too late. 

On January 18, Thanathorn stirred national controversy after a Facebook Live chat in which the opposition figure questioned Thailand’s reliance on what he called the “royal vaccine” made at a first-time producer that had in previous years reported financial losses. 

Siam Bioscience’s name did not figure on a list of institutes and organisations identified in the government’s own vaccine plan approved by the cabinet in early 2020 as having the knowhow needed to research, develop and produce vaccines — another fact highlighted by Thanathorn. 

“The direct shareholder of Siam Bioscience is King Rama X,” he said on Facebook, using Vajiralongkorn’s official title. “If this deal has a mistake, can Prayuth [the prime minister] take responsibility if the vaccine production is later than deadline?”

After Thanathorn’s comments, police charged him with lèse majesté and “computer crime”, a broad piece of legislation often used to stifle free speech. 

“It’s like letting a new pilot fly a plane,” Parit Chiwarak, one of the student protest leaders, said a few days later standing outside Siam Bioscience’s Bangkok headquarters. “How do we know the plane will not crash?” 

‘Speed is critical’

Siam Bioscience is one of 25 manufacturers in 15 countries that AstraZeneca is working with to deliver its Covid-19 vaccine globally. While the company says some of its partners have handled scaling up to the complex manufacturing process well — notably in South Korea and China — others have struggled.

In Europe, the drugmaker had to slash expected deliveries to 100m doses from 300m in the first half of the year, and is now fighting a lawsuit brought by the EU over the shortfall. In Brazil, production has been slow, with AstraZeneca’s partner FioCruz struggling to obtain enough active pharmaceutical ingredients from China.

Lawyers say AstraZeneca would have had to pay heightened attention to the Thai deal given Siam Bioscience’s ownership to ensure it followed rules that prohibit bribery of foreign public officials. The considerations have some similarities to those in the Gulf states, where multinational companies do business with groups owned by members of powerful royal families, military officers or other public officials.

“An assessment of potential risks would have to focus on factors such as how the contract was awarded, the tender process, any possible undue advantage given to the king’s company, were competitors excluded and so on,” says Michael O’Kane, head of business crime at Peters & Peters, a London-based law firm. “Given the rule of law concerns in Thailand, no doubt AstraZeneca would have been advised to tread with great care, engaging in enhanced due diligence and following their internal compliance policies.

“[But] during a pandemic, speed is critical,” he adds.

Other potential compliance questions include whether the deal might entail a “disproportionate profit”, say Robert Barrington, a professor at the Centre for the Study of Corruption at the UK’s University of Sussex. A former UK head of the anti-corruption NGO Transparency International, Barrington says that, as in the UK, procurement processes during the pandemic were facing less external scrutiny because of the health emergency.

“In normal times, there might be more eyebrows raised about the reputational aspects of this, given that the partner company has no record in the field,” Barrington adds.

AstraZeneca says it does not use suppliers unable to meet its standards, monitoring compliance through assessment and improvement programmes and training its procurement professionals in a code of ethics.

The vaccine deal also raises questions in relation to the curbs on public debate in Thailand. Oxford university, which is committed to the “vital importance” of free speech, declined to say if it was comfortable with the prosecution of the opposition leader Thanathorn over his statements. The university said the Thai case was “not a matter for the university to comment on”.

Many Thais, however, have unanswered questions about the stalled vaccine rollout.

“AstraZeneca were banking on this deal for the entire region, so it’s not only Thai public health that is at risk,” says Thitinan at Chulalongkorn University. “Siam Bioscience is supposed to be making millions of doses for a region with half the population of China.” 

Additional reporting by Ryn Jirenuwat in Bangkok