The Jakarta Post
The government is drafting a presidential regulation for the national COVID-19 vaccination program, with President Joko “Jokowi” Widodo demanding that a detailed roadmap be ready within two weeks.
But the lessons learned from previous immunization programs have experts advising officials to tread carefully and prepare for a bumpy road ahead.
At the start of Monday’s weekly Cabinet meeting, the President demanded that the national economic recovery and COVID-19 response team come up with a plan for the state to distribute vaccines as soon as they are ready.
"I demand that a detailed plan be ready within two weeks. [I want to see] the commencement date, the locations, who will carry out [the program] and who will be vaccinated,” Jokowi said, according to a transcript.
Coordinating Economic Minister Airlangga Hartarto said after the meeting that preparations for a presidential regulation on vaccinations and the accompanying national roadmap were already underway.
“There’ll also be a tracing dashboard [to determine] who needs [vaccines] and how effective they are,” he said at the Presidential Palace.
Airlangga, who also chairs the national economic recovery and COVID-19 response team, said the state had allocated Rp 3.8 trillion (US$255 million) for vaccines from the 2020 state budget and Rp 18 trillion from the 2021 budget.
Based on his presentation at the briefing, the government plans to administer vaccines to six priority groups in up to five stages over a year beginning in January 2021: 1.3 million frontline medical workers; 50,000 people in close contact with COVID-19 patients; more than 715,000 public service workers; 92 million members of the general public; 4.3 million educators and 3.7 million government and legislative officials.
As early as May, two months after Indonesia recorded its first COVID-19 cases, the President started informing the public about plans to develop a vaccine locally.
And with the government moving quickly to secure deals for crucial vaccine supplies from other countries, and amid the soaring case numbers and a faltering economy, it began pinning its hopes on a medical miracle.
While a proven COVID-19 vaccine does not currently exist, and the most promising vaccine candidates are still in the latest stages of clinical testing, officials have started presenting estimates on when vaccinations could commence – with some proposing an early December roll out.
But experts, who have no doubt as to how vaccines would help in the fight against COVID-19, have nonetheless urged the government and the wider public to refrain from putting all their eggs in one basket.
Developing a vaccine and carrying out vaccinations are two entirely different things, as experts have surmised from the country’s previous vaccination programs.
According to a survey published this month, which was carried out between November 2015 and December 2019 in more than 149 countries and was described by health journal The Lancet as the "largest global vaccine confidence survey", Indonesia has seen “large drops in confidence" in three key aspects: vaccine safety, significance and effectiveness.
This has partly been caused by Muslim leaders questioning the safety and halal status of the measles, mumps, and rubella (MMR) vaccine, which led to the issuance of a fatwa declaring it haram. The promotion of natural alternatives to the vaccine also contributed to the decline in confidence in vaccines, the study found.
A health worker wearing protective suit and patients exercise at the Patriot Chandrabhaga Stadium which has been converted into a quarantine house amid the coronavirus disease (COVID-19) outbreak, in Bekasi, West Java, on Sept. 28. (REUTERS/Ajeng Dinar Ulfiana)
“What happened in 2018 was a very good lesson learned. At the time, the MUI [Indonesian Ulema Council’s central board] was on board, but people in certain regions apparently did not follow their lead, saying they had their own beliefs,” said Anung Sugihantono, the Health Ministry’s former director general for disease control and prevention, in an interview on Sept. 21.
Anung, who retired from the post just days after Indonesia's first COVID-19 cases were announced, oversaw the program during his time in office.
“Almost all regions in Indonesia have problems with vaccination [to] varying degrees,” he told The Jakarta Post. There is “no one size fits all".
Based on his experience, he said for a vaccination program to be effective, religious leaders down to the village level must be involved.
The rampant spread of misinformation on social media could also hinder vaccination efforts, he said, which made it all the more important for the government to provide clear information on the development of vaccines and their efficacy.
A cross-sectional online survey published in July found that 93.3 percent of respondents in Indonesia were willing to be vaccinated with a 95 percent effective vaccine. However, this acceptance rate dropped to 67 percent for a vaccine with 50 percent effectiveness.
Another challenge to the distribution of vaccines is their sensitivity to heat and freezing.
A 2004 study on Hepatitis B vaccine freezing in the Indonesian cold chain, available on PubMed.gov, stated that "inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia". It found that "the highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centers".
"Can you imagine having to transport vaccines, which, let's say, must be stored in 2 to 8 degree Celsius environments over 12 hours [while being transported to rural areas]?” Anung said. “We can't simplify this, it must be planned thoroughly."
Sufficient numbers of competent medical workers is another prerequisite, Anung said, while the length of the program would also depend on the particular characteristics of the coronavirus and how quickly herd immunity could be achieved.
Epidemiologist Laura Navika Yamani from Airlangga University said that even if a COVID-19 vaccine already existed, it still needed to be determined whether the protection it offered would last a lifetime, or whether people would need to be injected repeatedly over a certain period of time.
If this were the case, the government would need to secure a sustainable supply of vaccines for the country’s large population, amid a global race to secure early access.
“Don’t let people underestimate [the virus] just because there’s going to be a vaccine. The number one effort should be implementing health protocols,” she said.
According to an online survey conducted by Statistics Indonesia (BPS) earlier this month, about 92 percent of respondents nationwide wear face masks in public, while 75.38 percent regularly wash their hands and 73.54 percent maintain a safe physical distance from others.