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Cambodia’s Vaccine Drive Off to Quick Start with A Dose of Coercion

A man receives a dose of the Sinovac vaccine from China against the Covid-19 coronavirus at the Australian Centre for Education in Phnom Penh on May 1, 2021, as part of the government's campaign to halt the rising number of cases of the virus. (Photo by TANG CHHIN Sothy / AFP)

Cambodia has administered at least one shot of a COVID-19 vaccine to over 2 million residents in an aggressive vaccination drive that kicked off in early February. The effort resulted in a high vaccination rate but has been marred with confusion and, more recently, coercion.

The country is facing its worst COVID-19 outbreak since January 2020 with more than 19,500 cases reported since February this year. In the last 12 months, Cambodia has reported less than 500 cases with small spikes in March and November 2020.

As of Friday, roughly 20 percent of Cambodia’s adult population had received at least one dose of the available vaccines, or about 13 percent of the total population, according to Health Ministry figures.

Dr. Nuth Sambath, who heads the Institute of Biology, Medicine, and Agriculture at the Royal Academy of Cambodia, said fear of contracting the disease was likely a motivating factor for many to get the vaccines.

“The February 20 domestic infection situation became worse, so more people who were experiencing the real impacts of COVID-19 forced themselves to get vaccinated,” Nuth Sambath said.

The recent outbreak has also resulted in Cambodia’s first reported COVID-19 death with 147 deaths reported as of Friday. Shortly after Phnom Penh saw a significant spike in daily cases in early April, photos on social media showed large crowds gathering around hospitals hoping to get vaccinated and protect themselves from the disease.

Observers said the decision to make vaccinations mandatory in red zones – areas with high case counts and with strict lockdown rules – coupled with the easy access of China-made Sinovac and Sinopharm vaccines has aided the government’s push to reach herd immunity.

Cambodia has received 4,524,000 doses of COVID-19 vaccines including 1.7 million doses of the Beijing Bio-Institute of Biological Products’ Sinopharm vaccines, 2.5 million doses Sinovac’s Coronavac jab, and 324,000 doses of AstraZeneca’s Covishield vaccine. The latter supplied through a global vaccine-sharing scheme called COVAX.

Medical workers perform COVID-19 testings on residents living in Toul Kork district, Phnom Penh, Cambodia, May 13, 2021. (Malis Tum/VOA Khmer)
Medical workers perform COVID-19 testings on residents living in Toul Kork district, Phnom Penh, Cambodia, May 13, 2021. (Malis Tum/VOA Khmer)

The government has ordered six million more doses from China to supplement its push in areas with high case counts. A majority of doses administered to groups who have no choice but to get the vaccine – red zone residents, government employees, and military and security personnel.

In early April, Prime Minister Hun Sen expressed displeasure at some civil servants who were reluctant to get the vaccine. He immediately issued a sub-decree on April 11 that allowed for the dismissal of government employees who didn’t get vaccinated.

Most red zones in Phnom Penh have a high concentration of factories, manufacturing units, and low-cost worker housing. The government has made factory workers a priority group for vaccinations since many live in red zones.

Labor Ministry Spokesperson Heng Sour said garment workers who were not vaccinated by the end of the mass vaccination campaign could face job losses. The government quickly reversed this position after a few worker protests in red zones.

Soeng Senkaruna, a senior investigator at local rights group ADHOC, said the multiple rules and statements from senior government officials were placing pressure on individuals who should be taking these decisions keeping in mind their health.

“There are of course some people who have turned up voluntarily for vaccines and there are some people who feel compelled by different factors including [comments] from the top leadership after which they decided to get vaccinated,” Soeung Senkaruna said.

The government has also caused confusion with some of its announcements and back-peddling on the vaccine issue. After announcing that Cambodia would only use World Health Organization-approved vaccines in the country, Prime Minister Hun Sen had a quick change of heart. The Sinopharm and Sinovac vaccines were not approved by the global health body when Hun Sen reversed his decision and is now largely reliant on the two vaccines.

The World Health Organization issued the approval for Sinopharm vaccine last week, after weeks of delays and suspense. Sinovac is expected to get approval in the coming weeks. The clearance means that the WHO can use the vaccine through the COVAX mechanism making them more accessible to low- and middle-income countries.

Cambodians at a COVID-19 vaccination drive in Phnom Penh, Cambodia, May 10, 2021. (Malis Tum/VOA Khmer)
Cambodians at a COVID-19 vaccination drive in Phnom Penh, Cambodia, May 10, 2021. (Malis Tum/VOA Khmer)

Dr. Swee Kheng Khor, an independent health policy and global health specialist, said Cambodia’s reliance on Chinese-made vaccines was “not unusual” amid a global shortage of vaccine supplies.

“Most of this reliance is due to ability to access supplies, prices and familiarity with the vaccine manufacturers, and only partially due to geopolitics, ideology or foreign policy,” Kheng Khor told VOA Khmer in an email.

Khor said Cambodia should also seek to diversify its vaccine offerings.

“One, a diverse set of vaccine suppliers will reduce the risk of supply disruptions or to be held hostage by price hikes or changes in commercial decisions. Two, a diverse set of vaccine suppliers may help Cambodia and other countries get adequate vaccine supplies faster, which will help reach herd immunity faster,” he added.

“Three, a diverse set of vaccine suppliers will provide vaccine choices to citizens, which could encourage the vaccine take-up rate because citizens will feel like they are actively in control of their vaccination status,” said the Kuala Lumpur-based expert.

While the government pushes forward with its vaccination drive, health officials said there were no plans to monitor the effectiveness of the vaccines being used in the country. Vaccine effectiveness is measured in real-world settings and on a large sampling of the population.

The Indian government in April released data showing that 0.03 percent of people who had taken both doses of Covishield, which is the AstraZeneca vaccine produced in India, had been infected with COVID-19 with many patients only having mild symptoms.

A real-world effectiveness study of Sinovac in health workers in Indonesia and found the vaccine to be 98 percent and 96 percent effective in preventing deaths and hospitalizations, respectively. There is no publicly available data or real-world study for Sinopharm, which has an efficacy of 79 percent.

Health Ministry Secretary of State Or Vandine said there is no plan for vaccinated people to go through antibody tests to measure their immune response or to conduct an effectiveness study in the country.

“We have not conducted it yet because there has been no policy or plan to do so,” said Vandine, who also leads the government’s Ad Hoc Commission on COVID-19 Vaccination.

Dr. Nuth Sambath, from the Royal Academy of Cambodia, said the government should invest in monitoring the effectiveness of its immunization campaign.

“Yes, there should be a study [antibody tests] … in order to check the immunization and the effectiveness after the vaccination,” Sambath said.