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Thai initiative may show the way

The strong ethical, as well as legal base of providing adequate compensation to persons who suffer harm from side-effects of medicines, treatments and vaccines, is well-established.

BHARAT DOGRA | New Delhi |

Generally Western, developed countries are supposed to take the lead in matters relating to medical ethics while developing countries lag behind and have to be reminded by developed countries and international agencies to give adequate attention to ethical aspects. For once, however, a developing Asian country—Thailand – has taken the lead in an important issue relating to medical ethics and is getting increasing appreciation for this.

The strong ethical, as well as legal base of providing adequate compensation to persons who suffer harm from side-effects of medicines, treatments and vaccines, is well-established. However, despite being a widely recognized principle, this has been frequently violated and these violations have increased in recent times due to the ever-increasing power of large multinational pharmaceutical companies.

Due to their immense power it has become increasingly difficult to legally and technically establish adverse impact (or a precise cause and effect relationship) even though many complaints from suffering people are being voiced. In this context it is interesting and useful to know that Thailand has paid $45 million (1,500 million baht) to 12,714 people during the last 10 months or so in Covid vaccine injury claims. This could happen because Thailand set up a well-administered system to receive and settle such claims.

This covers payments made up to March 8, with 891 complaints pending and 875 appeals pending. The data relating to these claims shows that in most cases complaints of adverse impacts arising due to Covid vaccine have been accepted and settled in an efficient way; 2,328 claims have been rejected. In the case of rejection, appeals are allowed and over 800 have been made already.

According to reports, the Covid vaccines more frequently used in Thailand have been British-Swedish as well as Chinese. It is likely that more claims will be received as claims can be made within two years, and so there is room for some relatively longer-term impacts to be covered too. This system was established by the Thailand National Health Security Office and started operating from 19 May 2021. At that time, an amount of $3 million or 100 million baht was provided for this fund, but soon this had to be increased as claims of vaccine injuries were simply too high. Already the amount paid is nearly 15 times the original size of the fund.

The claims have been processed roughly on this basis:  Category 1: Death or permanent disability – 400,000 baht ($11,928). Category 2: Disability that affects livelihood, loss of a limb – 240,000 baht ($7,157). Category 3: Other injuries or illnesses as a result of vaccine – various amounts up to a maximum of $100,000 baht ($2,982).

The administration of this compensatory regime has triggered a debate in other countries particularly the USA regarding why such compensation has not been provided to victims there. While a large number of post-vaccine adverse impacts have been recorded here, the main argument for denying compensation has been that a cause-and-effect relationship has not been established yet. But critics have questioned how such a relationship can be established unless the complaint is pursued adequately.

Without investigating complaints in detail, how can authorities simply say cause and effect is not established? According to the officially recognized Vaccine Adverse System Recording System (VAERS) of the USA, till 4 March 2022, following administration of Covid-19 vaccines, 1,168,894 adverse events, 25,128 deaths and 46,515 cases of permanent disability had been recorded.

Even assuming that several of these were incidental and only about half or even just a fourth pass the test of a cause-and-effect relationship, massive compensation should have been disbursed in the USA, but till March 4 not even a penny had been given. Hence the record of various countries in this context is very different, and the wider response has been to deny any compensatory payments. This is clearly unjust.

As stated at the outset, the principle of compensating those who suffer from adverse impacts of vaccines and medicines is well established in law and ethics, but it is nevertheless widely violated. It has been suggested that the Thailand system of compensatory payments could progress only because it avoids fixing blame and there is no provision for punitive action or fixing specific accountability for the damage suffered.

Some people say punitive aspects are also important but others argue that this creates a lot of difficulties, complications, obstructions and delays. Therefore, they argue, what is more important is that relief should speedily reach those victims who deserve it. Hence, according to this latter viewpoint, the system established by Thailand has really served its purpose of helping victims and this is more important.

The most basic concern should be to ensure that the basic principle of causing no harm should get the highest priority and in all medical matters, truth and transparency should prevail. Medical research should be unbiased, entirely free from profit motive and devoted only to the welfare of people.

The Thailand system may not cover all essential aspects but nevertheless, even its limited success in at least establishing a compensatory system that works for the victims should be widely appreciated. In fact a significant number of people even in the USA are expressing their appreciation and admiration for this achievement of Thailand.

(The writer is Convener, Campaign to Save Earth Now. His recent books include Man Over Machine and Planet in Peril.)