Like other countries, Indonesia is implementing a massive, free COVID-19 vaccination program, but with a very different approach than others.
Instead of vaccinating the elderly in the first phase of application, the first doses – after health workers – will be for workers between 18 and 59 years old.
President Joko Widodo, 59, has volunteered to be first in line. Vice President Ma’ruf Amin, 77, will not receive the injection soon because he is too old.
Why is this unusual approach?
Professor Amin Soebandrio, who has advised the government on its “youth first” strategy, argues that it makes sense to prioritize the immunization of workers, those “who leave the house everywhere and then return home at night. with their families”.
“We are targeting those likely to spread the virus “, he told BBC Indonesia.
He explains that this approach will give the country the best chance of achieving herd immunity, something that occurs when a large part of a community becomes immune through vaccines or the massive spread of disease.
It is known that between 60-70% of the world’s population must be immune to stop the spread of the coronavirus easily. However, these numbers will rise considerably if the new most transmissible variants are widely disseminated.
“That is the long-term goal, or at least we significantly reduce the spread of the virus so that the pandemic is under control and we can get the economy working again,” said Professor Soebandrio.
Indonesia, with a population of 270 million, has the highest cumulative number of covid-19 cases in Southeast Asia. According to government data, the 80% of cases are in the workforce.
While schools and government offices have been closed for nearly a year, the government has resisted implementing strict closures for fear of the impact on the country’s economy. More than half of the population works in the informal sector, so for many working from home is not an option.
The country’s new health minister, Budi Gunadi Sadikin, defended the strategy, insisting that it is not just about the economy, but about “protecting people and targeting first those who are likely to contract and spread” the disease.
“We are focusing on people who have to meet many people as part of their work: motorcycle taxi drivers, police, military. So, I don’t want people to think that this is just about the economy. It’s about protecting people, ”he said.
What about the elderly?
The government also argues that it will offer protection to the elderly.
“Immunizing members who work in a home will mean that they will not carry the virus there, where their older relatives are,” said Dr. Siti Nadia Tarmizi, spokeswoman for the Ministry of Health for the COVID-19 vaccination program.
Most of Indonesia’s older people live in intergenerational households and often impossible to isolate from the rest of the family.
“So it’s an added benefit of this approach, that by vaccinating people ages 18 to 59, we’re also offering some protection to the older people they live with,” he said.
But this depends on the vaccine preventing people from carrying the virus and transmitting it.
“Simply, still we don’t have that information“Said Professor Robert Read, a member of the Committee for Vaccination and Immunization (JCVI) that advises UK health departments on immunization.
“The reason the UK has not opted for the younger population, of course, is that first they don’t get such a serious disease and second we haven’t been able to show yet that vaccines have any impact whatsoever on transmission, ”he said.
Indonesia’s approach, he considered, would need a very high vaccine absorption: “At least 50% in all probability, to stop death and hospitalization in its elderly population”.
“It’s possible that if they get very high coverage rates, there will be some impact on transmission, although obviously we haven’t seen it yet.”
What tests has Indonesia done?
Indonesia has taken this unique approach in part because the vaccine it is using It has not been tested in older people.
The country depends mainly on the formula of CoronaVac, manufactured by Sinovac in China, to inoculate its population, with three of the 125 million promised doses already delivered and distributed to health centers throughout the country.
Indonesia says China’s vaccine is 65.3% effective. But the government has only tested the 18-59 age group as part of the Sinovac trial in several countries.
“Each country could have a different age group and it turned out that Indonesia was asked to do the trial on the working population,” said Dr Nadia. They will begin to immunize the seniors, He says, in the second round of vaccinations once they obtain data from other countries involved in the trial.
But even if they had been asked to test it on people over the age of 60, he says they will most likely still focus on immunizing the working population first, as they believe it will protect most people.
How do scientists view the experiment?
“We don’t know if it will work and it needs to be evaluated,” said Peter Collignon, professor of infectious diseases at the Australian National University, who felt that it makes sense to modify the launch of the vaccine according to the circumstances of a country.
“If you are a developing country, I can see a policy to protect your young adult workers, those who spread the virus the most, such as a reasonable methodBecause you can’t really tell people to stay home, ”he said.
Professor Read agreed, saying: “It is not up to us in rich Western countries to tell other countries in the world what they should be doing.”
He considered that Indonesia’s approach “may be the right thing for his country”, noting that, globally, no one is sure what is the right thing to do right now.
Professor Dale Fisher from the National University Hospital said Indonesia was taking a “pragmatic approach.”
“They say that we are going to vaccinate this age group from which we have the data. It is an accessible group and will undoubtedly help keep the business and the feed pipeline running, ”he said.
How is Indonesia coping the pandemic?
Indonesia’s ambitious deployment will not be easy.
Its population is the fourth largest in the world, distributed in a vast archipelago near the equator, so there are significant logistical challenges in terms of the temperature required for vaccines.
And health experts warn that government policy focused on inoculation and not much on containing the virus carries danger, as the health system is suffering from the increase in cases.
Cemeteries in Jakarta, the epicenter of the pandemic, are full and hospitals say they are struggling to cope with the number of patients.
Public health expert Dicky Budiman of Australia’s Griffith University said the government needed to do more to protect the vulnerable, strengthening what he called the fundamental strategy for the pandemic: testing, tracking and compliance with social distancing.
Local journalist Citra Prastuti in Jakarta, who has just recovered from the virus, said that “leaving your home is like entering a war zone, with the growing number of family groups: it seems that no place is safe enough for us” .
He said the public health messages had been confusing and contradictory. “People are encouraged to stay home for the holidays, but the hotels offered discounts and there were no transportation restrictions.”
And there was no follow-up or tracking, as in his case which he notified the local health authorities.
“So I do not know if I am included in the general data of the covid or not,” he said. “I think a lot of people see the vaccine as an easy way out, as the cure for all diseases, as the ultimate savior.”
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