There was a consensus among the panelists that the main ethical challenges emerging in the Thai context during the COVID-19 pandemic are categorized into three domains;
- Public Health Setting: How to maintain economic development while the nation is locked down.
- Medical Service Setting: An equality to access the healthcare system
- Research and Clinical Trials Setting: The integrity and accuracy of the information as well as the technology verification during the crisis period
1) Public Health Setting: the effect on the economy
The Covid-19 pandemic has triggered the most severe economic recession in nearly a century and has caused enormous damage to the health, jobs, and well-being of the people (OECD’s latest Economic Outlook). The critical question is what the solutions are to secure our businesses, maintain our jobs, and stabilize financial markets and economies from now on.
In the case of Thailand, saving lives was the top policy priority in the early phase of the pandemic. In the meantime, the impact on people’s well-being and the economy was also considered.
“By effective implementation of containment measures, the impact on the economy would be minimized and it will completely shorten the cycle of the pandemic spread” Dr. Tanarak Plipat.
Unavoidably, after the lockdown measures were implemented, several groups of people, especially those who are vulnerable e.g. elderly, disabled, or low-income people, were affected severely from their inability to earn their living. In this case, the key ethical challenge is to find a balance between the economic well-being of people and respect of human rights on the one hand, and control of the pandemic on the other. From the beginning of the pandemic, the Thai authorities have used a vast array of measures to support healthcare systems and maintain people’s earnings, as well as to help businesses and to stabilize financial markets. A government subsidy program in the form of 5,000 baht payout for three months was one of the urgent actions designed to alleviate the hardship of the people who were affected by the crisis. Regarding the financial sector, the authorities took action proactively through government interventions to stabilize the mutual fund and the bond markets to prevent meltdown and spillover to financial institutions. A major soft loan program for banks' SME customers has also been deployed to ensure that viable SMEs have access to the needed liquidity (Bank of Thailand, 2020).
In particular, SMEs were found to be one of the most vulnerable groups. At least 1.3 million cases were affected by business closure and the decline of overall demand (as of 2 June 2020), according to the National Research Council of Thailand’s analysis of the Covid-19 effect on the Thai economy. The industrial sectors, including tourism, financial, commodity, and export businesses, were enormously damaged, requiring a massive amount of help from the government. The establishment of new businesses tended to decrease. Nonetheless, there were some positive consequences, such as the markedly lower number of cases of respiratory tract infection in the country (Suntronwong et al., 2020), lower incidences of car accidents compared to the same period time of the last year (MoPH, 2020), and recovery of the environment and natural resources (WHO, 2020).
To address the effect on the economy, a policy framework for dealing with the situation was developed to help the vulnerable people associated with each phase of the outbreak as shown in Figure1. The framework illustrates the combination of the measures of public health and financial supports at each stage of the crisis.
Another problem arising from the enforcement of social distancing measures is a threat to personal rights and privacy. Locking down the whole country resulted in the people’s daily activities being suspended, including hanging out with friends, traveling with family, shopping outside, visiting parents, and many more. Many were prevented from conducting their daily work, which resulted in economic hardships. Thus, a balance needs to be found between alleviating these hardships and the threats to personal rights, as well as maintaining effective control of the pandemic.
2) Medical Service Setting
Fair allocation of scarce medical resources was raised as another significant ethical aspect in the meeting. Not only Thailand, but also the world was facing a shortage of medical supplies and services ranging from hand sanitizers, masks, drugs, PPE, ICU beds to ventilators. Mechanical ventilation will be the most problematic issue if the pandemic reaches an uncontrollable point (Truog et.al, 2020). When the demand for ventilators and other respiratory devices outpace the supply available to health care facilities, decisions would have to be made as to who will get to stay in the available hospital beds or to use the ventilators. Although Thailand has not yet come to that point, the triage decision needs to be set up beforehand with consideration of human rights and equality.
There are some relevant ethical principles as the choices for doctors to make the decision when the medical healthcare services are insufficient, including the approaches of utilitarianism, first-come-first-served, autonomy, and respect for human dignity or justice (DePergola, 2020). Combining these approaches in order to find best the situation should be considered as another choice as suggested in the meeting. Recently, this ethical issue has still been argued widely all over the world by which approach could save lives most for the Covid-19 pandemic. There are several ethical considerations to deal with this triage decision making which have to be transparent and non-discrimination. Many countries have bioethical committees or guidelines to support such triage decision making. For this reason, setting a national Covid-19 protocol in Thailand to have a practical guideline in advance would be needed. Available empirical data should be exploited to support guideline development.
3) Research and Clinical Trials Setting
Another current ethical dilemma is that there is a high demand for medical devices and services, while these technologies are still in the developing stage. The lengthy process of technology development would be problematic in this situation due to the fact that a full recovery of our economy would be impossible until the supply of the Covid-19 vaccine taken place. Besides the time-consuming technology development, we still need to shorten the process of research funding considerations in this rush period as well. Although there is plenty of research funding available from both domestic and international organizations, the world is still facing the shortage of medical goods, the Covid-19 vaccine and treatment in particular.
“Since there is tremendous pressure from all sides for achieving the vaccine development and production as quickly as possible, there is a question of whether the usual steps required in such development should be sidestepped or not. Is this justified?” Prof. Soraj Hongladarom.
Moreover, lacking a certification body for medical devices and treatment is another significant problem in Thailand, although such technologies are ready to be implemented locally.
Similarly, there is another question about an ethical point of the accuracy of published data during this crisis time. There has been much information regarding Covid-19 published recently without reviewing or verification, giving and taking false information or unverified information will cause fear, confusion, and traumatic stress among people. On the other hand, it is crucial for the government to provide accurate and up-to-date information to their people, particularly during times of crisis. Disclosing necessary information to the public regarding the fact of the Covid-19 pandemic is one of the ethical considerations that are also influential in this situation. Juggling between obtaining precise information and quick communicating to people sufficiently during such a decisive period may need to be further managed systematically.
Moreover, technology exploitation to solve the ethical challenges mentioned above was recommended extensively in the meeting. Technology development associated with this situation was mentioned widely in various dimensions, such as data collection, digital divide, tracking people’s movement, evaluating economic impact, and using digital currency, etc. Digital technologies have been adopted extensively to contain the Covid-19 pandemic in many countries (Dubov and Shoptaw, 2020). For example, China uses the Alipay Health Code app to track its citizen’s travel history and current symptoms (Tan, 2020). Similarly, Israel has been tracking people’s phones in order to track a suspected carrier movement and whom they contact. Through this tracking, the potential contacts will be ordered to self-quarantine through text messages in a timely manner. These measures need scrutiny and refinement in light of ethical implications. Furthermore, several organizations of academic, public and private sectors in Thailand have adopted digital technologies widely for many activities such as remote learning, meeting and working, using Thai Chana mobile application for tracing people’s activities in this situation. The Thai government has further utilized social media platforms to connect with people. These ways of technology adoption could help the lockdown measure to be more relaxed that would lead to more alleviate the subsequent effect on the economy eventually (Chen, 2020).