When Professor Sir Nick White arrived in Thailand from Oxford University 40 years ago to join a small medical research unit, his duties included treating malaria and milking venomous snakes. Today, from his base at Bangkok’s Mahidol University, he leads an international team conducting a worldwide COVID-19 drug trial.
During Sir Nick’s four decades in Thailand, the Mahidol Oxford Tropical Medicine Research Unit (MORU) – a collaboration between Oxford and Mahidol Universities and the London-based Wellcome Trust — has grown from three researchers to 600. And its activities have spread far beyond Thailand to countries across Asia and Africa. Now, having pioneered treatments to combat deadly tropical diseases, MORU is enrolling 40,000 frontline healthcare workers as far away as Europe and South America in the only large-scale global clinical trial to test whether the drugs hydroxychloroquine and chloroquine can prevent COVID-19.
“We are doing this from Thailand because we have the experience here to conduct large multinational trials,” Sir Nick, who holds professorships at both Oxford and Mahidol and was knighted in 2017 by Britain’s Queen Elizabeth for services to global health, said in an interview. “Thailand punches above its weight in clinical medical research. It has very good academic standards and has created a milieu that prizes innovation, creativity and knowledge.”
Thailand has long been internationally acclaimed as a destination for so-called medical tourists lured by Bangkok’s world-class hospitals. Less well known is an underlying healthcare ecosystem that is helping transform Southeast Asia’s second largest economy into a much broader medical hub, attracting investors and researchers in biotechnology – including vaccines, genomics and biopharmaceuticals — as well as high-tech medical devices.
Even as the COVID-19 pandemic has crippled industries in other parts of the world, it has actually raised investor confidence in Thailand’s health care sector. In the first half of 2020, 52 medical-related businesses with projects worth 13 billion baht (more than $400 million) sought approval from Thailand’s Board of Investment (BOI) – a rise of 170 percent in project numbers and 123 percent in value over the same period last year.
In one recent example, Genexine Inc., South Korea’s largest biotech company with a market value of $2.5 billion, has teamed up with a Thai public-private consortium to establish KinGen Biotech, a manufacturer of oncology drugs and DNA vaccines for cervical cancer.
KinGen is targeting annual sales of $250 million by 2026. “The BOI is very supportive of our project,” Genexine’s Chief Financial Officer, Kim Kyu Don, says. “Our sales goal is ambitious but also very feasible.”
KinGen aims to use Thailand as a research and development hub, as well as production base for Southeast Asia, the Middle East, Africa, Latin America and Russia. “Thailand’s medical sector has big potential,” Kim added. “We want to transfer technology to help it develop further.”
Another enterprise that has just received BOI backing is Apsalagen Co. Ltd, a joint venture between Thai-owned Siam Bioscience and Germany’s Haase Investment, which is the main shareholder in Berlin-based Biotechrabbit GmbH. The partnership produces biological reagents and mastermixes used in the production of rapid tests (RT-PCR) for the detection of COVID-19.
Thailand’s success at attracting medical sector investment stems in large part from two key factors.
One is the raft of incentives offered by the BOI to qualifying Thai and foreign-owned companies, including tax breaks of up to 13 years and smart visas that enable expatriate researchers and other key employees and their families to stay in the country for up to four years. Another is Thailand’s track record both in containing the spread of COVID-19 and actively working on vaccines.
Since the pandemic began, Thailand has won international praise for the very low infection rate among its 70 million population. Over the same period, Thailand has also become one of the first middle income nations to begin clinical trials on a home-developed COVID-19 vaccine.
Separate from the Oxford-Mahidol global trial on hydroxychloroquine and chloroquine, Thai universities and biotechnology companies are working on at least three vaccine candidates.
In the most advanced of the vaccine studies, Chulalongkorn University’s Chula Vaccine Research Center is about to begin human trials on a vaccine that has already been tested successfully on mice and monkeys.
Since its founding 15 years ago, Chula VRC has quietly worked on vaccines to combat health scourges such as HIV and dengue fever, forging collaborations with several U.S. government and academic institutions including the National Institute of Health and the University of Pennsylvania.
Now its COVID-19 vaccine, based on a technology known as mRNA, has attracted international media attention. And if the upcoming human trials prove successful, the team led by Dr Kiat Ruxrungtham hopes to work with manufacturers in Thailand, North America and Germany to produce 30 million vaccine doses to supply Thailand and six other Asian countries.
Dr Kiat says his team is also collaborating with a second Chulalongkorn study in which Dr Thirivat Hemachudha of the Thai Red Cross Emerging Infectious Disease Health Science Center, working with Baiya Phytopharm, a spinoff from the university’s faculty of pharmaceutical sciences, has developed a potential vaccine that uses a different technology derived from plant protein. “It is great to have more than one vaccine candidate in Thailand among 180 candidates globally,” Dr Kiat says.
A scientist at Chula Vaccine Research Center at work on one of Thailand’s Covid-19 vaccine candidates
Simultaneously Bionet Asia, a Bangkok-based French-Thai joint venture, is both working on its own vaccine and standing by to manufacture millions of doses of whichever of the Thai vaccine candidates receives approval first.
Founded in 2001 by French and Thai partners who had previously worked with Western pharmaceutical companies, Bionet Asia opened a research and development center in Bangkok in 2009. Since then, it has developed vaccines to combat such infectious diseases as whooping cough, rabies, meningitis and dengue fever, the latter in partnership with the Paris-based Pasteur Institute.
This year, Bionet put all other work on hold to focus its 250-strong workforce on developing and producing a COVID-19 vaccine using recombinant DNA technology.
Bionet Chief Executive Officer Pham Hong Thai says that while many COVID-19 researchers in Western countries have to team up with drug manufacturers to produce the end product, his company is able to not only develop vaccines, but also manufacture them. “Within one industrial site, we have both researchers and production working hand in hand,” he says.
Back at the Oxford-Mahidol University MORU collaboration, Sir Nick White’s Bangkok-based team is working on the global study it hopes will finally determine whether hydroxychloroquine and chloroquine – used for 60 years to treat malaria and rheumatological conditions — can prevent COVID-19.
Sir Nick believes he is in the right place to do it. “In terms of a hub for an international collaboration, Thailand is very good,” he says. “COVID-19 has shown that the world is a very small place. Countries cannot just look inwards and Thailand has the vision to understand the importance of global health as well as national health.”