Health honchos

We at PPT have just seen Andrew MacGregor Marshall’s new Secret Siam column on public health minister Anutin Charnvirakul, his wealth and his politics. This is a subscriber-only post, but is well worth a read.

It begins with an extended look at Anutin’s “lavish rural hideaway … Rancho Charnvee,” which is a resort that has rooms that can be booked by the public. With its lavish accommodation, private airport, and 18-hole golf course, it is a landmark to his family’s huge wealth.

Clipped from the Rancho Charnvee website

That wealth “… comes from the family conglomerate Sino-Thai Engineering and Construction, founded in 1952 by his father Chavarat.” The latter:

… was deputy minister of finance from 1996 to 1997 in the disastrous government of prime minister Chavalit Yongchaiyudh that presided over the collapse of the Thai economy, which in turn caused a financial meltdown across Southeast Asia. So the current coronavirus catastrophe is not the first time that a member of the Charnvirakul clan has been in a key government position at a time of crisis and failed woefully to deal with it.

In 2008, Chavarat was back, as Minister of Public Health and then as Deputy Prime Minister under Somchai Wongsawat’s pro-Thaksin Shinawatra People’s Power Party government when it was dissolved by the Constitutional Court on 2 December 2008, in a judicial coup.

The Constitutional Court ordered the dissolution of the People’s Power Party and other coalition parties, at the same time banning their chief executives. The incumbent Prime Minister, Somchai Wongsawat, was then removed along with several other members of the Cabinet. Chavarat was spared because he was not a party executive or an elected MP. He became caretaker prime minister and sank what remained of the elected government, working with the military to hand over power to Abhisit. The turncoat was rewarded by being appointed Interior Minister in Abhisit’s cabinet, a post he held until 2011. As part of his political treachery Chavarat became the leader of the Bhum Jai Thai Party, a party tied to the dark influence Chidchob family in Buriram. He was succeeded as leader by Anutin in 2012.

Marshall observes that, in 2010, Chavarat “was caught embezzling money from a 3.49 billion baht computer leasing project, and the controversy threatened to tear apart the coalition, but in the end, Abhisit didn’t dare fire him.”

Anutin unmasked. Clipped from Der Farang.

On Anutin, Marshall notes his relationship with Vajiralongkorn:

Anutin was even willing to risk playing the dangerous game of trying to get into the inner circle of the volatile future king Vajiralongkorn. He began donating large sums to the crown prince, and sought to establish himself as a friend of Vajiralongkorn, making regular trips to visit him in Europe. Vajiralongkorn was famously obsessed with flying during this period, spending most of the year staying at the Kempinski Hotel at Munich Airport where he always had at least one personal Boeing 737 parked ready for joyrides in the skies over Europe. Adopting flying as a hobby was a great way for Anutin to bond with his new royal friend.

A leaked secret US cable from 2009 identified Anutin as a new member of Vajiralongkorn’s inner circle….

We wonder how that relationship is today, with Anutin seeking to lay off blame for the Siam Bioscience-AstraZeneca failures while he’s been health minister. How did he get that position? Marshall speculates that: “It’s all because of marijuana.” And the rural-based mafia he represents, who are working to make marijuana a valuable cash crop. Marsall again:

When the pandemic struck, Thailand’s minister of public health was an unqualified political dilettante whose only healthcare experience was making wild claims
about the medical wonders of marijuana.

If readers can, look at the whole story at Secret Siam.

Incidentally, Anutin is not the only minister engaging in heath entrepreneurialism. With scant evidence, Justice Minister Somsak Thepsutin has promoted the production of green chiretta herbal pills. While there is some evidence about some of the qualities of the product, much of this is from Thai scientists keen to promote herbal medicine. Somsak’s “evidence” comes from giving pills to prison inmates and claiming “results” while clearly misunderstanding how clinical trials operate. The initial use of the pills in prisons came when the virus was raging among prisoners and vaccines were in short supply.

For ministers, there seems to be a profit motive at work rather than science and public service.

Updated: Failing virus fight

Sadly, it seems reasonably certain that Thailand’s authorities are losing the fight against the virus. It should not be forgotten that for over a year, the country did well, after several errors, gaffes and arrogant missteps, with the regime largely staying out of the way. Since early in 2021, this changed, with more errors and a botched vaccine procurement and rollout.

The big bet the regime made on vaccines was to lay out for the king’s Siam Bioscience, aiming to provide the palace with bucketloads of propaganda. But, the company was inexperienced, small, and lacking personnel and equipment. For the background on the king’s company, see this recent report.

Finally, AstraZeneca, which has been opaque everywhere, has admitted that it is unable to produce the contracted doses. The company has said it “currently has local capacity to produce only 15-16 million doses per month, 5-6 million of which are reserved for Thailand…”. The target most often cited was 10 million doses a month.

This has led AstraZeneca to ask the “Public Health Ministry to extend the timeline for delivery of 61 million doses to Thailand from the end of this year to May 2022.”

It is unclear if Siam Bioscience is producing 15-16 million doses. If it is, it must be sending them to other countries, but we have seen no evidence of that, but maybe we missed it.

Thai PBS reports that “the government will still negotiate for as much monthly supply as possible.” There was also discussion of imposing “limits on exports of the locally produced AstraZeneca vaccine because the country doesn’t have enough for its own needs.” That statement seems more like a shot in the dark than a shot in the arm.

Meanwhile, Thai Enquirer asks questions about unanswered questions. Following from others, it asks “why Buriram is getting more Covid vaccines than many other provinces that should have gotten it first.”

The report states that “according to the government’s allocation plan in May, Buriram is one of the top ten provinces to receive the locally made AstraZeneca vaccines, ranking at number nine and above Pathum Thani which is the site of several outbreaks.” Pathum Thani has had 10 times as may cases as Buriram.

Thai Enquirer summarizes: “In short, Buriram is getting more vaccines per capita than many of the hardest hit provinces.” And it observes: “everyone in the country knows that the Deputy Prime Minister and the Minister of Public Health, Anutin Charnvirakul, is largely dependent on the godfather of Buriram and the real leader of Bhumjaithai Party, Newin Chidchob.”

And, of course, the rich and the well-connected are jumping vaccine and hospital lines all over the country.

Update: It goes from bad to worse for the military-backed regime. Leaked letters between AstraZeneca in the UK and the government reveal that the “Ministry of Public Health only requested 3 million doses per month in an agreement with the vaccine manufacturer last September.” In that letter, “AstraZeneca … also urged the Thai government to join the COVAX program to get more vaccines to its citizens, something that the government has not done.”

The letter also reveals that the “letter of intent” was signed with the MOPH, the king’s Siam Bioscience and SCG – Siam Cement Group, where the king is also in control.

While the letter states that one-third of local production will go to Thailand, the letter appears to state that no vaccine had yet been exported from Siam Bioscience (although the letter is somewhat vague), saying the other governments have shown “great patience” in waiting for vaccine.

Further updated: 112 updates

It is reported that lese majeste case No. 58 of the current round of repression has been lodged – we seem to have missed cases 56 and 57 – with a 37 year-old man being charged “with the royal insult, or lese majeste, for allegedly mocking the monarchy at a shopping mall in December…”.

A fanatical royalist from Thai Pakdee accused Pawat Hiranpon “of feigning to genuflect and saying ‘Long Live Your Majesties’ at Siam Paragon on Dec. 20 when several pro-democracy activists were walking past him…”. The mad monarchist thinks he was being sarcastic.

At about the same time, UN human rights experts are reported to have “expressed grave concerns over Thailand’s increasingly severe use of lèse-majesté laws to curtail criticism of the monarchy, and said they were alarmed that a woman had been sentenced to over 43 years in prison for insulting the royal family.”

They stated: “We are profoundly disturbed by the reported rise in the number of lèse-majesté prosecutions since late 2020 and the harsher prison sentences…”. They added: “We call on the authorities to revise and repeal the lèse-majesté laws, to drop charges against all those who are currently facing criminal prosecution and release those who have been imprisoned…”. The regime will not heed such calls. It never has. It heeds the king, and it is he who has directed this repression strategy.

Meanwhile some better news, with the Criminal Court having “dismissed a petition by the Digital Economy and Society Ministry to remove a clip criticising the government’s Covid-19 vaccine policy by Thanathorn Juangroongruangkit.” The ministry claimed it constituted lese majeste. He criticized the secret deal between regime, the king’s Siam Bioscience, and AstraZeneca.

After being ordered to take down his half-hour analysis, Thanathorn challenged the order. He was successful after the full clip was played in court, with the court “saying no part of the clip clearly showed he criticised or raised questions in any way that could be deemed insulting to the monarchy.” It added: “There is no clear evidence it affects national security…”.

The court asked Thanathorn why he used the term “royal vaccines”. His reply was wonderful, pointing out that “he was not the first to use it.” He pointed out that: “It was Gen Prayut and government agencies who first used or implied it that way…”. They were milking propaganda for the king and that was turned back at them, and the court agreed: “The court viewed the term was borrowed from what the government had said earlier about the local vaccine production to show the mercy of the king. Mr Thanathorn’s use of the word was therefore not a lie, which could cause damage to the king.”

Of course, the regime is now scrambling on vaccines, issuing statements that seem designed to mollify growing criticism. For a useful report of further questioning of the king’s Siam Bioscience, see Khaosod.

Update 1: Prachatai reports on the 112 case facing Pawat (using Phawat ‘Pocky’ Hiranphon). It states that the “charge was filed by Acting Sub Lt Narin Sakcharoenchaikun), a member of Thai Pakdee…”. Further,

the investigator gave as the reason for the complaint to a cosplay activity at Siam Paragon on 20 December 2020, where Phawat was seen paying respect by bowing, giving a ‘wai’ (the Thai greeting) , saying ‘Long live the King’, and presenting flowers to Parit Chiwarak and Panussaya Sitthijirawattanakul, who cosplayed King Rama X and the Queen wearing crop tops.

The investigator alleges this was an act of mockery toward people paying respect to King Rama X.

Phawat is seeking evidence to file a complaint against Narin, as he sees the complaint as politically motivated and damaging to his reputation and income. Narin also is not the one offended by Phawat’s action.

Update 2: The Bangkok Post has an editorial calling for the regime to get on with vaccination rather than defending itself. The editorial notices:

Bombarded by criticism that it has been too slow and overly reliant on two sources, AstraZeneca and Sinovac, Prime Minister Prayut Chan-o-cha tried to explain the government’s immunisation strategy last Sunday.

The PM was far too keen on defending the government than shedding light on the crucial vaccine drive. Although he addressed some of the main points of criticism, the PM offered no new information.

His claims and promises also appeared unsubstantiated, with little or no detail at all.

Self-censoring, it doesn’t say much at all about the king’s Siam Bioscience.

The public health minister has only made things worse. Bent on protecting himself and the government, Anutin Charnvirakul essentially told people to keep quiet and stop questioning the vaccine procurement and immunisation plan. He also told other politicians who are not in the government to keep their advice to themselves.

Mr Anutin’s tantrum only reinforced his image as being out of touch.

Self-censoring, it doesn’t say much at all about the king’s Siam Bioscience.

Vaccine transparency

On Monday afternoon, “Ratsadon pro-democracy demonstrators led by Parit ‘Penguin’ Chiwarak gathered outside Siam Bioscience’s Bangkok headquarters this afternoon to protest the company’s role in Thailand’s Covid-19 vaccine programme.” Transparency remains an issue, especially as the country’s vaccination program has now been rescheduled.

But transparency is an alien concept for the regime. When it comes to the monarchy, the rule is no transparency, which leaves it open to highly speculative gossip.

Gen Prayuth Chan-ocha’s version of “transparency” had him declaring: “We don’t want to see the Covid-19 vaccine politicised because the vaccine is a matter of life and death…”. Naturally enough, the general was speaking at the Defense Ministry as he defended “the contract to Siam Bioscience, saying there were other manufacturers which had offered to produce the jabs, but Siam Bioscience was selected because it met all of the government’s criteria.”

The contract and the criteria are unknown.

Anutin unmasked. Clipped from Der Farang.

In an open letter to Thanathorn, “public health minister Anutin Charnvirakul said that the decisions to secure AstraZeneca and Sinovac vaccines against COVID-19 were made by medical experts and appropriate to the outbreak situation in Thailand.” He went on:

Speaking on behalf of the Ministry of Health and National Vaccine Institute, I say that our work is not delayed or lagging as Thanathorn has accused us of…. We act according to the calculations of medical experts who consider the national situation and citizens’ safety.

That doesn’t seem likely.

Back in December, it was reported that the “World Health Organization, national regulatory authorities and vaccine manufacturers in WHO South-East Asia Region discussed fast tracking of COVID-19 vaccine rollout in member countries…”. This was the second WHO South East Asia Region meeting with vaccine manufacturers and regulators after one held in April. The participants at the second meeting included “key global and regional partners such as GAVI and UNICEF, as well as vaccine manufacturers like Bio Farma Limited from Indonesia, and Government Pharmaceutical Organization (GPO), Bionet Asia Co Ltd and Siam Bioscience from Thailand.” That’s three from Thailand.

What was the problem with the other firms. No one knows.

A Bangkok Post editorial has observed that

In using Section 112 against Thanathorn Juangroongruangkit for raising questions about its vaccine procurement, the Prayut Chan-o-cha government could be said to have, at best, over-reacted. At worst, it’s being criticised for abusing the draconian law for political reasons.

The Post criticizes the regime’s response: “… the prime minister should know this is not the best way to secure public trust in the procurement plan. Mr Thanathorn is not the only one who has been sceptical about the procurement…. Such suspicions derive from fundamentally confusing data from the government from the beginning.”

The Post states: “What the public needs to know is a clear process and credible timetable for vaccination.”

Further updated: Thanathorn and lese majeste

When a security guard at the luxury IconSiam shopping mall – partly royal owned – slapped a university student who was holding a lone protest in front of the center, it seemed kind of “normal” for royalist Thailand. What the student was protesting was anything but normal.

A member of the activist group United Front of Thammasat and Demonstration, the student was holding a sign inscribed “Vaccine Monopoly is PR for the Royals.”

Parit “Penguin” Chiwarak highlighted the message saying: “This person came out to campaign on behalf of the interest of the people…”. As has been known for some time, the Crown Property Bureau will make the “vast majority of vaccines to be used in the [virus] inoculation campaign…”. The CPB’s wholly-owned firm, Siam Bioscience, has been handed the contract.

Now, after comments about Siambioscience, the regime has gone royalist  bonkers spilled their lese majeste marbles:

The Digital Economy and Society Ministry (DES) will file a criminal complaint of defaming the monarchy against … Thanathorn Juangroongruangkit, the ministry said on Wednesday.

The complaint against Mr Thanathorn under Article 112 of the criminal code will be filed on Wednesday afternoon, according to an official ministry memo sent to reporters.

Then, Progressive Movement leader Thanathorn Juangroongruangkit “slammed the government for its tardiness in providing Covid-19 vaccines and pointed out that the company tasked with manufacturing the vaccine locally is owned by the King.”

Thanathorn

Thanathorn concluded that “the government has been careless in negotiations for the vaccine…”. He pointed out that Siam Bioscience “is tasked with producing 200 million doses per year. Of this, 176 million will be sold to other countries in the region, while the remainder will be sold locally.” He added that the regime “has announced it will give Siam Bioscience Bt1.44 billion for the project.”

He claimed Siam Bioscience was only “established in 2009 with an authorised capital of Bt48 billion, but over the past 11 years, the corporation has made losses worth Bt581 billion…”.

And, he “pointed out that Siam Bioscience was only added to the plan in the second quarter of 2020 – when anti-establishment protesters began holding their rallies.” This, he said, may make the “AstraZeneca-Siam Bioscience deal is politically motivated.”

This led the Public Health Ministry to “clarify.” Permanent secretary for Public Health Kiattiphum Wongrajit defended the deal with Siambioscience and rejected “accusations that the government had delayed the procurement of Covid-19 vaccine, as it was expensive, and had failed to cover the public.”

One official explained:

Our deal with AstraZeneca company isn’t just a regular vaccine deal, but also involves technology transfer during the crisis period. The company that receives knowledge of the technology needs to be qualified and ready for it. Only Siam Bioscience is capable of receiving the tech from Oxford University. Even Thai Pharmaceutical Organization does not have  enough potential because of the  use of modern technology….

He added that:

Anutin unmasked. Clipped from Der Farang.

the Public Health Ministry, the NVI and SCG, as well as the government had  collaborated in the negotiations and showed the potential of Siam Bioscience, which originally produced only biological material or drugs to increase blood cells in patients with renal failure. The vaccine production plant will get Bt500-million support from the government and Bt100 million from SCG to buy the required equipment.

In other words, Siambioscience wasn’t ready to receive the technology. A deal was done. He confirmed this saying: “This success is built on a potential base.”

Then it went royalist propaganda and decidedly weird:

There is a misunderstanding about our support. I insist that it is our work in accordance with the philosophy of King Rama IX, under which Thailand has laid the health foundation and built medical expertise over 10 years.

An initial reaction from the regime came from the erratic Public Health Minister Anutin Charnvirakul who criticized Progressive Movement leader Thanathorn, “accusing him of not being grateful to the ‘Mother Land’ for his alleged attempt to politicize the government’s procurement of COVID-19 vaccines.”

Anutin went full royalist, suggesting that Thanathorn was onto something:

Anutin … said that Thanathorn appears to know everything, but doesn’t know how to be grateful to the late King Bhumibol, who set the foundation for medical and health development in Thailand for the betterment of his subjects.

He suggested that royal PR and royal business were inseparable, damning Thanathorn, asking/accusing:

… whether he knows that the 20 mobile laboratory units, being deployed across the country to carry out pro-active COVID-19 screening, were sent by the Bureau of the Royal Household.

He further said that the PPE being used by medical personnel also came from the Palace, adding that funding, amounting to several billion baht, was donated by the late King for the development of hospitals and medical services in the countryside for the benefit of rural people…. He also said that, this afternoon, he will take delivery of 770,000 PPE suits, donated by the Palace for use by medical personnel.

All of this royalist madness suggests there’s much to hide.

Mad as hell Anutin was followed by his boss, Gen Prayuth Chan-ocha, who “warned Tuesday that legal action will be taken against people, in mainstream and social media, who distort facts about the deal to procure COVID-19 vaccine from Oxford-AstraZeneca by the government…”.

The predictable result was an allegation of lese majeste that will inevitably lead to charges:

The complaint accused Thanathorn of making 11 separate counts of critical remarks about the monarchy during his Monday night’s Facebook Live titled “Royal Vaccine: Who Benefits and Who Doesn’t?,” in which he questioned the role of Siam Bioscience, a Thai firm wholly owned by King Vajiralongkorn, in the production of coronavirus vaccines in Thailand.

“His comments can cause misunderstandings in society,” vice minister of the Prime Minister’s Office Thotsaphon Pengsom said. “It can create intolerable damage to the country and the works of the government.”

He added, “Therefore, we must take legal action immediately and we will go after each and everyone who shared it.”

… The vice minister said the complaint filed today also accused Thanathorn of violating the Computer Crime Act for spreading false information, which carries a maximum punishment of five years in prison.

Because Siambioscience is so opaque it is impossible to know if any of the claims made about its capacity or lack of it are true. As far as we can tell, Siambioscience makes two products under license. But, the regime’s hostile reaction suggests that there’s plenty going on in this deal done in secret and announced in sparse press releases, none of which appear at the company’s website. We could not find an announcement of the Siambioscience deal at the AstraZenca global site.

But let’s just add a bit to this mix.

In December 2020, it was announced:

Bangkok-based Siam Bioscience signed a letter of intent with AstraZeneca late last month to make 200 million doses of the British pharmaceutical firm’s COVID-19 vaccine, AZD1222, said Nakorn Premsri, director of Thailand’s National Vaccine Institute.

Thailand’s Public Health Ministry and the local conglomerate SCG [another firm with a major palace shareholding], with its packaging and chemicals divisions, also joined the deal.

Nakorn said most of the doses would head abroad.

“Thailand will secure only 26 million doses. We may ask for more, but it will not be a big part, so maybe more than half of that [200 million] can be exported,” he told VOA.

Thailand did order more, but still only sufficient for half the population, and that was only after criticism mounted. The Chinese vaccine is linked to CP, but only a minuscule amount has so far been ordered.

There’s much in this story that needs explanation. The relish with which the regime went after Thanathorn needs no explanation.

Update 1: It is somehow “fitting” that the quisling Suporn Atthawong, now vice minister to the military PM’s Office, was the one filing the lese majeste complaint at the Technology Crime Suppression Division. Who can forget that Suporn’s own lese majeste charge evaporated when he flipped to the dictators.

Update 2: Unbowed, Thanathorn responded: “Prayut has always used the royal institution to hide the inefficiency of his administration, saying that he is loyal to the monarchy and protecting it…. Is this not why many people are raising issues with the monarchy institution?”

Updated: Virus, crisis, repression reflex

No one seems to quite understand why Thailand has not been ravaged by the virus. The New York Times and The Economist have both suggested multiple possible explanations.

While the regime’s response was initially chaotic and riddled with contradictions and errors, not least by a Minister for Public Health who sometimes appeared balmy. Perhaps one reason for Thailand’s virus success has had to do with sidelining Anutin Charnvirakul.

With the recent errors and initial attempts to cover-up and shift blame, the regime again seems prone to chaos and manic decision-making. When this happens, the regime resorts to repression:

Police spokesman Kissana Phathanacharoen said two men, identified as Nutchanon Payakaphan and Panupong Jadnok, were arrested Wednesday [in Rayong] for failing to comply with police orders. The pair, who said they were there to protest [Gen] Prayut[h Chan-ocha]’s handling of the coronavirus, said they did not do anything wrong.

“I didn’t find my action to resist police functions,” Panupong said. “When I asked why they were taking me, they didn’t say anything. They took me into the car and left me without taking me into custody, so I walked out…”.

The two were protecting as a prime ministerial motorcade was passing. Clearly, when pressed, The Dictator doesn’t need to see dissidents and so the repression reflex kicks in.

Update: As usual, the cops have been told to concoct charges against the two protesters in Rayong. The “two youth leaders from the Eastern Youths for Democracy (เยาวชนตะวันออกเพื่อประชาธิปไตย) … the police [belatedly] responded with the four following allegations against the protesters:

• Violation of Emergency Decree
• Violation of the Communicable Disease Act
• Defying official orders
• Escaping detention/arrest…”

This is the usual buffalo manure and Amnesty International Thailand has called the regime out: “Piyanut Kotesan, director of Amnesty International Thailand, said that the state officials have a duty to protect citizens’ rights and not silence and punish them merely on the grounds of exercising their freedom of speech and peaceful assembly.”

Not this regime and not its cops. Their task is repression.

Fakery and quakery

The military dictatorship’s recent claims about “fake news” have been taken up by their bossy and yellow-hued acolytes in the Ministry of Public Health

An AP report says the MOPH has announced the launch of a trial period for a smartphone app called Media Watch “that will allow users to flag media content they find ‘inappropriate’ so it can be forwarded to government authorities.”

The snitch app will “help guard, observe, investigate and support the process of having safe and positive media to benefit our youth, families and society in general…”. The MOPH seems to be into quackery.

This appears one more step in making lese majeste snitching even easier for the cyber vigilantes. It will also allow pro-junta anti-democrats to report any critical commentary on the military regime.

(As an aside, PPT has noticed intense blocking in recent days. Interestingly, the heaviest censorship of PPT is now on our posts about the regime rather than anything we post on lese majeste or the monarchy. It seems that the censors are less interested in the monarchy.)

We can’t help wondering if wags won’t use the app to report the junta’s mouthpieces who regularly concoct the information they release.

For example, The Nation reports that junta spokesman Lt-General Sansern Kaewkamnerd was assigned to denigrate one of the anti-coal protest leaders who was, for a time, out of communication with his family.

He decided that a personal attack was the “news” to be manufactured. Sansern referred to “a man who ran away with a woman.” He said:

There was one key protester named Mustarseedeen Waba. There is a photo of him being escorted by police or military officers that is being circulated online, saying that he has not returned home yet…. I’ve asked the 4th Army Area commander and provincial police commander. Neither of the authorities said that they had caught him.

He then added that Mustarseedeen’s disappearance probably involved a tryst with a woman who wasn’t his wife.

Sansern was heavily criticized. His response was junta-esque: “We need to speak the truth today. The government always talks rationally…”.

That’s another lie. “Government spokesman” seems to mean “official liar.” Or maybe he’s the regime clown.

Killing people

As most PPT readers know, General Prayuth Chan-ocha bears considerable responsibility for the murder of protesters by his soldiers in April and May 2010. Because of elite agreements and the impunity long enjoyed by murderous soldiers, he is unlikely to ever face a court for his crimes.

There are other ways to kill people that do not involve the direct use of military weapons. At the Bangkok Post Prayuth states that the “universal healthcare scheme” is nothing more than a “costly populist” policy which “helped deposed prime minister Thaksin Shinawatra win the 2001 election.”

Prayuth is correct that the the scheme was popular with electors. At the same time, Thaksin’s Thai Rak Thai Party had widespread support in that election campaign, including from the royalist elite, largely due to the failures of the Democrat Party-led government that was reviled, not least for its implementation of IMF programs that destroyed swathes of Thai businesses and failed to provide meaningful safety nets for average people.

The went further, stating that “Thailand is not financially ready for such a multi-billion-baht health insurance project.” He added that the scheme will “bankrupt a lot of hospitals in the next few years…”. And he then declared: “The universal healthcare scheme is a populist project. Though people are benefiting from it, is Thailand ready for it? Why aren’t 190 other countries doing it? Only a few countries have done it…”.

Prayuth reportedly stated that “he would not abolish the scheme, but would seek ways of increasing funding.” This is code for winding back the universalism of the scheme. As Sureerat Trimakka, coordinator for the People’s Health System Movement stated: “This government [he means the junta] is making the national health system a scapegoat.”

We have no doubt that Prayuth hates the program as it is representative of the Thaksin revolution and is still a basis of political support for Thaksin and his parties. Prayuth’s royalist supporters loathe the scheme and want to be rid of it as a way of wiping out the memory of Thaksin.

This is not the first time the royalists have attacked the scheme since the military coup. Within weeks of that coup, the first thrust was made. The MOPH leadership, dominated by anti-Thaksin royalists, is wanting to raise “co-payments.” Steep co-payments will chase patients back to private clinics where MOPH doctors moonlight and make enough money to keep their Mercedes cars on the road. Uprooting the Thaksin regime-cum-revolution will be profitable for them.

PPT has previously mentioned independent assessments of the success of the program. And we have posted on a short paper at East Asia Forum that assesses some of the post-coup  politicking over the scheme.

Prior to 30 Baht scheme, the first linked report states that in “poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht, this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates.”

If Prayuth changes the scheme, he will be personally responsible for the deaths of infants as that mortality rate climbs again. He will also be responsible for the deaths of the aged and poor patients who will no longer be able to afford health care.

This responsibility for increased deaths will be far in excess of the deaths caused by military weapons in 2010.

Health malpractice

Readers may remember that PPT posted on plans for the end to the 30 baht health scheme as part of an uprooting of the Thaksin regime. Back then, the Public health permanent secretary Narong Sahametapat said this was a beat up and that “denied it planned to ask the coup-makers to approve part payments under the scheme…”. No plans, he said.

If he was really a doctor, he’d be up on a malpractice charge. Quite simply, he is fabricating a discussion initiated in the Ministry of Public Health. The Bangkok Post reports that it was Dr. Tawatchai Kamoltham, the director-general of the MOPH’s Department for Development of Thai Traditional Medicine and Alternative Medicine, who raised the plan with the junta.

Sounding like a product of the privatized, costly and inefficient U.S. medical system than someone promoting “traditional medicine,” Tawatchai apparently “believes co-payment will see patients take better care of their health and will reduce the possibility that people who urgently need care might not be able to receive the treatment they need because their doctors are busy.”

In other words, as previously leaked, the MOPH leadership is wanting to raise “co-payments” by exorbitant amounts, especially as Tawatchai estimates that the current state payments are covering only 40-50% of the actual cost.

Steep fee increases will probably chase patients back to private clinics where MOPH doctors moonlight and make enough money to keep their Mercedes cars on the road. Uprooting the Thaksin regime-cum-revolution may be profitable for some.

Culture, medicine and politics

PPT has to admit some surprise in reading the report in the Bangkok Post (5 April 2010) regarding graduating medical doctor placements this year. The Ministry of Public Health has increased incentives for graduating medical practitioners to go to the south. However, the response on the northeast appears to carry deep political (and cultural) meaning. Most of those who get into medical schools hail from major urban centers and have a Sino-Thai ethnic background. Its been that way for decades.

Medical graduates are required to draw lots for the provinces where they will serve their rural internship. It seems that the “problem of doctor shortages in the Northeast has become more serious than ever.” According to the Post story, “there are 30,681 doctors serving an estimated 65 million population. Most of them work in urban areas. The proportion of doctors to patients per population in the Northeast is 1:5,300, compared to 1: 3,300 in the South and 1:850 in Bangkok.”

Surachat Chuaychob, a Prince of Songkla University medical graduate, drew a lot which required him to work at Si Sa Ket hospital for just three months before returning to serve the rest of his internship in his hometown of Nakhon Si Thammarat. “Dr Surachat said he had never been to the northeastern province before, but hoped he would be able to cope with the harsh environment and cultural differences.”

A Dr. Pasakorn, who was invited to coach new doctors, was born and raised in Bangkok, and “said difficulties to fit into different cultures and environments were also factors which make the Northeast unpopular with new doctors born and raised in urban areas like him.”

There was a time, during the last couple of decades of the 20th century, when service in the northeast was seen as part of a development task, and many of the doctors there were active in development projects and many were politically active. It now seems that the “cultural divide” is too great. Or is this just another reflection of the political divide?

Most medical doctors are now heavily influenced by royalism and populate the yellow-shirted side of politics. Are they punishing northeasterners for their support of Thaksin Shinawatra and the red shirts? Maybe not, but the idea that the cultural divide is getting wider deserves attention.