Medical professionals interviewed by Prachatai English blame the gap on a variety of reasons, from unfounded fears, elderly reluctance to “bother” family members, to economic necessity.

At a recent TV debate for the Bangkok gubernatorial race, candidate Rosana Tositrakul stunned the host, and perhaps her rivals as well, when she declared that vaccination is the wrong solution to the coronavirus pandemic, which has left nearly 28,000 people dead in Thailand so far.

“May I say right here that I haven’t had the [Covid-19] vaccine at all,” Rosana said at a debate organized by ThaiPBS that aired on April 1, 2022.

“Right… Huh?” show host Suthichai Yoon interjected, clearly caught off-guard. Democrat Party candidate Suchatchavee Suwansawat, seated next to Rosana, could be seen adjusting his mask, seemingly out of instinct, while independent runner Sakoltee Phattiyakul looked on in apparent amusement.

“You aren’t vaccinated at all?” Suthichai stuttered, pointing at Rosana. “Not even a single dose? Why?”

“I only use fa talai jon to protect myself,” Rosana said, referring to green chiretta, a Thai herb widely and controversially touted by government officials as a cure to the coronavirus. “Because I want to live my life to test that we can rely on Thai medicines!”

Rosana, 68, is one of at least 2 million citizens over 60 who remain unvaccinated. That’s 1 out of 6 of every uncle, aunty, grandpa and grandma across the country, in spite of the serious risks posed to them by the coronavirus. Medical workers involved in the inoculation drive who spoke to this story said their campaign to cover the elderly is being hindered by misinformation, distrust of vaccines, and even economic disparity.

“We should have many measures to encourage them to get vaccinated, so that the coronavirus will truly be an endemic disease,” Supat Hasuwankit, chairman of the Rural Doctor Society, said in an interview. “Otherwise, it’ll be just empty words.”

“First, we need a measure of knowledge. We must fight against fake news and misinformation. This is something that the government has been trying to do, but it hasn’t been very effective, because the government can’t keep up,” the physician said.

“Second, knock on doors, which is already happening. Vaccinate people at their homes. This is the job of the Tambon Health Promoting Hospitals, and that’s what they’re already doing. But they can only vaccinate people who consent to it. The rest won’t have it. So what should we do to make them accept the shots?”

An undated file photo of vaccination against COVID-19 in Thailand

 From shortage to wasted vaccine

Tambon Health Promoting Hospitals, or THPH, are one of the public health agencies tasked with providing healthcare at the tambon, or subdistrict, level nationwide. They are also responsible for organizing local vaccination drives.

But the campaigns themselves are carried out on the ground by the Village Health Volunteers, known locally as Or Sor Mor. One such volunteer, who is based in the Bang Kachao area of Samut Prakan Province, said the vast majority of elderly people in her community have received the vaccines, but pockets of resistance still hold out, largely due to fears of side effects.

“They’re afraid that once vaccinated they’ll die. That’s their only fear,” volunteer Thirada Yawawong said by phone. “For example, there’s one case in my village. No matter how many times we paid them a visit, and pleaded with them and were nice to them about getting the shot, they persisted in not getting vaccinated.”

“But just last week, they got infected with Covid. So they now regret it,” she said.

Supat added that it’s a pity to see a sizable part of the population turning down vaccines because many doses would have gone to waste, the reverse of the vaccine shortage that plagued Thailand just a year ago.

“We’ve now reached the point of having to throw vaccines away, because they’ve expired. For example, Pfizer vaccines must be kept at a temperature of about -70 degrees Celsius. Once they’re taken out of the refrigerator, they only last for a month,” Supat said. “So if no one gets the shots, we have to eventually throw them away.”

 A losing race?

According to the information published by the Department of Disease Control, no fewer than 131 million doses of COVID vaccines have been administered, with at least 80 percent of the population having received one dose and 72 percent a second. The coverage of the booster shots, said to be crucial in preventing serious illness from the Omicron variant, is much lower, at about 35 percent.

The Department also says tens of thousands of doses are still being given out daily, the capacity boosted by introduction of “walk-in” services like the one provided at Bang Sue Grand Station, which require no appointment.

But while the number may sound high, Supat warned, a breakdown shows that few of the doses are going to the elderly, who are most at risk of falling ill or dying from the coronavirus.

“The vaccination rate among the senior citizens has been pretty stagnant for several months now,” Supat said. “Most of the increase comes from students getting the shots, because vaccines for children just arrived recently.

“But vaccination of the elderly is considered to be low, about 5,000 people a day on average, which is thought to be very low. We in Thailand have 10,000 THPHs, so that means on each day, there’s fewer than one elderly person getting the vaccine per subdistrict.”

Data provided by the Department of Disease Control shows about 12.07 million senior citizens in Thailand – defined as those over 60 years of age. Within this group, 2.7 million remain unvaccinated. Millions more also have yet to receive booster shots.

“We have to think about this. Are we going to just let this situation continue?” Supat asked.

 Ticking time bomb

Even the government acknowledges that by its own standards, the vaccination drive for the elderly is failing. Department of Disease Control official Sumanee Wacharasint told the media on 6 April that only seven provinces have achieved the goal of giving booster shots to at least 70 percent of the local elderly population.

Sumanee also said only 37.2 percent of the elderly population nationwide have been given booster shots against the coronavirus.

“We are still finding reports of fatalities [among the elderly] every day. They were infected by their relatives or people who visited them,” Sumanee said. “So they need to get vaccinated, even if they stay at home.”

In the same news conference, Sumanee pointed to evidence of clear benefits from booster shots, citing reports of third doses reducing the chance of death from COVID by 31 times for the elderly, compared to those who are unvaccinated.

By comparison, Sumanee said, two doses can reduce the chance of death by about five times compared to having zero doses.

Government data also suggests that the Omicron variant continues to kill the elderly every day. For instance, of the 129 COVID deaths logged for 21 April, the majority, 108, were said to be senior citizens.

Another set of data released by the government shows at least 2,701 elderly people lost their lives to the coronavirus from 1 January to 31 March 2022. Of this figure, more than half, or 1,589, did not receive a single dose of vaccine.

By contrast, elderly individuals who received booster shots made up the smallest group of deaths, or about 112 fatalities.

“There’s one case. The person just retired 3 years ago and wouldn’t be vaccinated. He was stubborn.” said Thirada, the health volunteer from Bang Kachao. “And he later actually caught Covid. When he was starting to get sick, his family said if he didn’t get well in two or three days, they’d bring him to hospital.

“On the third day he went to get tested, and the result came back positive. He died a few days later. He was just 62.”

Thirada went on, “We want many elderly people to see this case as an example. Please, get vaccinated. Vaccines really help. It’s better than not getting it at all.”

 Fear and misunderstanding

Both Supat and Thirada say the main reason why many elderly people are resistant to vaccines is their fear of getting serious side effects; concerns of being paralyzed or dying were commonly cited, Supat said, even though the chances of this happening are miniscule.

“Some people have pre-existing conditions. They are afraid that if they get the shots, they might have an allergic reaction. They are afraid of dying. They only look at the minority [of people allergic to the vaccines],” Thirada said.

“So we told them that of course, there’s got to be one case in a thousand or one in a million. It depends on their health and immunity. We tell them it’s better to look at the majority of cases, who get the vaccine and turn out fine.”

One cause for the disproportional fear of side effects could be traced to media coverage, which was not always strictly scientific.

“In medical terms, ‘coincidence’ means things that happen at the same time,” Supat explained. “For instance, a thousand people die each day in Thailand. Every year there are about 400,000 deaths. So it means no matter what, there will be deaths.

“When the vaccine drive was new, there were people dying,” Supat recalled. “The news came out that only a few days after getting the shots, people died. It caused misunderstanding. And this misunderstanding piles up over a long time.”

He also said some individuals reject vaccines in favour of their belief in herbal medicines, or some refuse to get the shots because they are resistant to “chemicals.”

Thirada said a number of elderly people or their families turned down the chance to get vaccinated out of conviction that it’s not “necessary,” an attitude she described as dangerous.

“In some cases, their children or grandchildren won’t let them get the vaccine because they think it’s not necessary. Mom doesn’t go out anywhere, she only stays home. She doesn’t do anything,” Thirada quoted one local resident as saying.

“So we ask them: what about yourself? You don’t just stay at home and do nothing. You may get infected because you go out.”

Apart from fear and misunderstanding, Supat said some are affected by the sentiment of kreng chai – being afraid that they’ll have to bother their family members to take days off and take care of them if they fall ill because of the vaccine’s side effects.

Others say they simply can’t afford to make journeys to get the shots because it’ll affect their income, especially if they own shops or businesses.

“Some people lose their opportunity to work, some people have to take care of their shops all day,” Supat said. “If they go get vaccinated, they’ll have to close the shop. And then there’s travel fares. Some areas still don’t have vaccination services to the door.”

He went on, “And if they fall sick from the vaccine, they’ll have to come back and take a rest, keeping the shop closed for one or two days. That’s income they won’t get.”

 Building incentives

For these reasons, Supat proposes that the government hand out “compensation fees” to make up for traveling and loss of income for those who sign up to get vaccinated, especially for the elderly and those living in rural areas.

He suggested that 500 baht or 1,000 baht per dose could do the job.

“I believe it will encourage more people to come for the shots,” Supat said. “We can use other methods. But we have to persuade people to get the shots. Out of 2 million people who remain unvaccinated, if we can get just 500,000 vaccinated, that’ll be good.”

Thirada said her team in Bang Kachao has already been creating vaccine incentives for the elderly people by handing out free food and items such as eggs and rice, if they show up for vaccination. She said it’s working.

“Our Village Health Volunteers aren’t wealthy or anything. We rely on community leaders and the Subdistrict Head to help with donations. Whoever has things brings them to us to use as handouts,” Thirada said.

“Here, many people show up. Some people show up even though it’s not yet their time to get the shots, but now they want to get vaccinated,” she recalled with a laugh. “There was one uncle who got a Pfizer shot just a few months ago. He wanted to get another shot, but we couldn’t let him.”

Media coverage may have been responsible for dissuading the elderly from getting vaccinated, but it could also play out differently and change their attitudes toward vaccination.

“There was one case of a bedridden patient. In the past she wouldn’t get the vaccine, but after she watched the TV and saw the news that Omicron is killing old people every day, she was afraid,” Thirada said. “Now she just got her third shot already, from someone who wouldn’t get any shot at all.”

Teeranai Charuvastra

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