Onderstaand artikel is gepubliceerd in de “Jakarta Post” van 5 jan. 2021
Doubts have been raised over Indonesia’s plan to complete the COVID-19 vaccination drive within a little over a year, with health experts not only unconvinced about its feasibility but also worrying that it may encourage a cavalier attitude toward health restrictions.
In a bid to escape the health and economic crisis through herd immunity, the government will spare only 15 months from mid-January 2021 to March 2022 to inoculate 181.5 million of the country’s 269 million citizens — or roughly 70 percent of the population. The plan was recently announced by the Health Ministry, which elaborated that the first phase would take place from January to April 2021 and would prioritize 1.3 million health workers and 17.4 million public workers in all 34 provinces, followed by the general public in the targeted age group. “We are quite optimistic about completing the vaccination in time, as we are now ready with adequate resources and facilities,” the ministry’s COVID-19 vaccine spokesperson, Siti Nadia Tramizi, told a Sunday press conference.
The same confidence was shown by newly-appointed Health Minister Budi Gunadi Sadikin, who previously laid out Indonesia’s plan to secure 426 million doses of COVID-19 vaccines needed through five international channels. The former banker said that the government had negotiated firm orders of some 330 million doses and optional supplies of 330 million more from China’s Sinovac, the United States’ Novavax and Pfizer, the United Kingdom’s AstraZeneca and the COVAX facility.
The country has imported only 3 million ready-to-use doses of the Sinovac vaccine so far, with state-owned pharmaceutical holding company PT Bio Farma starting to distribute the vaccine in 34 provinces on Sunday. Center for Indonesia’s Strategic Development Initiatives (CISDI) policy director Olivia Herlinda said the vaccination plan was “too ambitious”. “The Food and Drug Monitoring Agency [BPOM] has not issued an emergency approval for the Sinovac vaccine, but it has been distributed to 34 provinces,” she told The Jakarta Post on Monday.
To meet the 15-month vaccination target, the government must also rush the permit applications for other vaccines, like those of Novavax, a task she described as almost impossible, given that Novavax was just starting its third phase of clinical trials. And even though the government has scheduled some vaccines from various producers to arrive starting in the second quarter of 2021, some of them will not be ready to use until they are authorized by the BPOM.
In terms of community acceptance, Olivia said, the government had not done enough to reduce stigma and misinformation at the grassroots level in order to secure participants.
She said that even before the vaccination started, many community health centers had been so busy preparing the program that they had made testing, tracking and treatment a secondary priority. Hermawan Saputra of the Indonesian Public Health Experts Association (IAKMI) also cast doubt on the vaccination plan, saying that while the government might be optimistic, it was better to not create the impression that vaccines are the mainstay. “Otherwise, disciplinary behaviors and control of health restrictions may loosen too soon, and the outbreak may eventually get worse as we wait for the rest of the vaccines,” he told the Post on Monday.
He also said that Indonesia’s position in global COVID-19 vaccine share could intersect with domestic interests of the vaccine producers. “Some other countries with large populations are not only economically independent, they are also the main producers of COVID-19 vaccines, while we still rely heavily on foreign drugmakers,” he said. “Despite the commitment made, the dynamics are developing rapidly. We don’t know in the next few months how severe the outbreaks in other countries will be. The tug of war of global vaccine interests is common.”
The different sources of imported vaccines would correspond with different types of recipient populations, which would require an extra effort for data matching, distribution patterns or designations of vaccine types and provision of vaccines, he said. This took time, he went on, learning from the flawed data management over the last ten months, which had been marked by delays and institutions being overwhelmed with verifying COVID-19 case and prevalence reports.
A reasonable timeline, Hermawan said, was as conveyed by the minister himself, who previously stated that it would take 3.5 years to finish the COVID-19 vaccination. However, the ministry later clarified that the minister’s statement referred to a global projection. Most of the vaccines Indonesia is trying to secure require two shots to prime the immune system to ward off the virus.
But because the vaccines are so new, scientists cannot say how long their protection might last. Griffith University epidemiologist Dicky Budiman said the vaccines would require an evaluation of the duration of immunity in the body, which could be too short, so that bigger supplies would be needed for a revaccination. “Realistically speaking, this is certainly ambitious and may not be achieved. We have a big potential to conduct a mass national vaccination program, but in this case, the vaccines seem to be out of reach,” he said. He called on the government to carefully recalculate the vaccine logistics at each planning stage.