Failure to step up responsively with the right public health strategy to mitigate and control the pandemic would result in slower recovery. Hence, it is important for the government to focus on public health as part of its path to economic recovery.

As an archipelagic country with 17,000 islands, Indonesia already has challenges in logistics and infrastructure. Located on the Ring of Fire, Indonesia is also prone to various natural disasters, including volcanic eruptions, typhoons, landslides and floods. The COVID-19 pandemic has thus had a severe impact on its 260 million population, mainly due to a delayed response to the crisis as well as an inadequate public health system and infrastructure.

The fatality rate as of April 17, 2021 stood at 2.7 percent, or 43,328 deaths out of 1,599,763 confirmed cases, according to Health Ministry data. Although the recovery rate has increased to 90.7 percent, the positivity rate remains high at 17.3 percent and the infection rate at 6.6 percent, ranked the fifth highest in Asia. 

Despite the ministry’s 2015-2019 Strategic Plan (Renstra), which targets several key concerns such as better health services for mothers and children, improving disease control, expanding coverage under the national health insurance (BPJS Kesehatan) and more access to medicines and vaccines, Indonesia still faces several public health challenges, especially in containing and mitigating COVID-19.

To support economic recovery, the government launched the National Economic Recovery (PEN) program with a 2021 budget of almost Rp 700 trillion (US$48.3 billion). The health sector allocation as of March 2021 was Rp 176.40 trillion, or 25.2 percent of the program’s total budget. However, less than 45 percent of last year’s health allocation was realized.

In the health sector, the PEN program provides incentives to health workers, procures medical equipment, supports COVID-19 treatments, sets up isolation facilities and most importantly, rolls out the mass vaccination program. The government has targeted vaccinating more than 181 million Indonesians this year, or 70 percent of the population.

Despite the urgency, the vaccine supply might not be available to meet this target in such a short period of time. As of April 17, only 9.2 million Indonesians, or 5.1 percent of the population, had received their first dose, and less than half of this figure had received their second and final dose. Of the targeted 21.5 million elderly people, only 1.4 million people, or less than 7 percent, have received their first jab.

Bio Farma, the state-owned COVID-19 vaccine producer, will not have enough capacity to supply vaccines to meet the 2021 target. Indonesia’s vaccine program still relies on the CoronaVac vaccine from China's Sinovac and the AstraZeneca vaccine through the World Health Organization-coordinated COVAX Facility. Aside from that, the government is also planning to source vaccines from Moderna, Pfizer and Sinopharm for its nonsubsidized program, slated for rollout in May 2021.

Even with meticulous planning, such as securing 140 million vaccine doses from producers since 2020, Indonesia’s COVID-19 vaccine supply risks stagnation due to shipping embargoes by several countries that are fighting over vaccine availability.

The COVID-19 pandemic has shown that economic recovery and public health transformation must occur concurrently. The pandemic can be used as an opportunity to improve the health sector, starting from basic health education and sanitation. Public communication should be intensified on how to prevent communicable diseases, such as tuberculosis, dengue, malaria and now, COVID-19.

Hence, it is essential for the government to encourage community movements that support a healthy life paradigm through both promotional campaigns and preventive efforts. Primary healthcare facilities such as Puskesmas (community health centers) and regional hospitals (RSUD) still need continuous quality improvement, especially during the vaccination rollout.

As a country with logistics challenges, Indonesia needs to pay close attention to vaccine storage and distribution, which require a controlled environment due to the expiry date and fragility of the vaccines. Apart from that, Indonesia needs to consistently improve its national identification system and integrated population data center to ensure the accurate registration of vaccine recipients.

Meanwhile, although the private sector is willing to contribute to the nonsubsidized vaccine program, the insurance industry also needs to step up its coverage policies to include vaccinations.

***

Researcher at Mandiri Institute

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