Various reports reveal disrupted routine immunization across the archipelago, including in areas where immunization rates are already worrying. Physical distancing has made it difficult for many parents to take their young children to clinics and hospitals for vaccinations. Visits to community health centers (Puskesmas) and integrated health services posts (Posyandu) for infant and child vaccine services have declined, the reports say. Meanwhile concerns about inadequate resources, including health staff, have forced primary healthcare facilities in many areas to reduce services, including immunization.

Physical distancing and large-scale social restrictions (PSBB) have worsened the problems of Indonesia’s immunization programs, already hampered by poor public awareness, misinformation and poor access to healthcare facilities. Vaccine rejection and hesitancy, driven either by religious concerns over the halal status of the vaccine or fear of immunization side effects, are other constraints.

Fear of virus exposure has been preventing parents from taking children to hospitals or clinics for routine vaccinations. With the extension of the PSBB, Indonesia is likely to see a significant decline in its immunization coverage unless breakthrough steps are taken to ensure safe immunization services during the pandemic.

Read also: Are children forgotten in the response to the pandemic?

According to the Health Ministry’s health profile data, the national coverage rate of complete-basic childhood immunization stood at 93.7 percent in 2019, up 3.1 percentage points from 90.6 percent in the previous year. However, the health profile per province reveals that, in 2018, only 14 of 34 provinces had a complete-basic immunization rate of over 92.5 percent.

Together with East Nusa Tenggara and Papua, Aceh is one of the three provinces with the lowest immunization coverage – only 49 percent in 2019. Concerns over the halal status of vaccines are among the main reasons. More worryingly, according to the Basic Health Survey (Riskesdas), the coverage rate of complete-basic immunization for children aged 12-23 months stood at 57.9 percent in 2018 nationally, down from 59.2 percent in 2013. According to the 2018 Riskesdas, continued immunization coverage for children aged between 23–34 months in Aceh was 19 percent.

“The ongoing pandemic can push the immunization coverage rate in those provinces even lower than their current level,” Arifianto of the Indonesian Pediatric Society (IDAI) told The Jakarta Post in a phone interview on May 3. “And, we don’t know when an outbreak is coming. It can happen at any time. The current situation is alarming,” he said.

The potential decline in Indonesia’s achieved immunization coverage target is inevitable during the pandemic, the paediatrician said. He praised the COVID-19 protocols, such as physical distancing at healthcare facilities to ensure the safety of both healthcare workers and visitors.

All facilities, including Posyandu and Puskesmas, for instance, now must schedule childhood immunization separately to prevent healthy children from exposure to diseases from patients and sick visitors. Mask-wearing is mandatory for both health workers and visitors. All immunization rooms must be clean and hygienic.

Without appointments at hospitals or clinics, parents will not be able to get their children vaccinated, Arifianto said. The reservation requirement aims to reduce waiting time, preventing them from possible disease exposure. “With such protocols […] parents should not worry too much about bringing their children to immunization facilities,” he said.

Other countries have also raised concerns about infectious disease threats and outbreaks from immunization delays caused by the coronavirus pandemic. To help countries continue immunization activities amid the virus crisis, the World Health Organization issued special guidelines on March 26. It urges governments to temporarily halt preventive immunization campaigns in the absence of an active outbreak of a vaccine-preventable disease. Countries should continue routine immunization services while ensuring the safety of both the general population and health workers.

Read also: UN chief calls to protect children from COVID-19 consequences

In April, the WHO and the United Nations Children’s Fund (UNICEF) stated that more than 117 million children worldwide were at risk of missing out on measles immunization due to the COVID-19 pandemic. These children live in 37 countries, many of which are still dealing with measles outbreaks.

Naveen Thacker of the International Pediatrics Association’s Immunization Committee said immunization services needed to continue with caution – even in zones with suspected COVID-19 cases – and they should be made part of essential services.

“Pediatric societies across the world can help governments plan catch-up campaigns [for immunization]. Health workers have to take necessary precautions and wear the required protective gear, the staff at facilities must plan well, build a systematic approach, while keeping in mind the need for social distancing,” Thacker told the Post in an email interview on May 7.

Across nations, immunization services had to remain accessible as essential services, Thacker said. “We must ensure the stock of vaccines and availability of health staff. […] We also need to communicate well with people, so they seek vaccination services even during such times.”

Ensuring routine immunization services is urgent to protect young children from infectious diseases, such as measles, diphtheria and polio. Children with incomplete immunization are more susceptible to vaccine-prevented infectious diseases that could cause physical disabilities and even death.

The ongoing global competition to create a COVID-19 vaccine should be a wake-up call to realize that vaccination is one of the best ways to avoid infectious disease. Vaccine rejection by some parents will only put children at higher risk of contagion. There should be no more doubt about the benefit of vaccination to protect people from serious illnesses. 

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