Commentary: Indonesia’s vaccination policies seem to favour the young and rich

SINGAPORE: Indonesia’s pandemic response and relief efforts continue to struggle with the tensions between economic and health priorities.

Last year, this manifested itself in the uneven and changing “lockdown” policies restricting social mobility.

At the very beginning of the pandemic’s spread in Indonesia, President Widodo warned provincial governments not to endanger the economy by imposing lockdowns.

Indonesia still is suffering from its first very long wave of COVID-19 infections.

READ: Commentary: Indonesia's haphazard approach created an 'endless first wave'

READ: Commentary: Indonesia’s questionable decision on vaccinating only those aged 18 to 59

FLIP FLOP OVER PRIORITISATION POLICY

In January 2021, this unresolved tension was revealed in a new polemic and policy flip-flop.  Government statements explained that the productive age group would receive COVID-19 vaccines first and people over the age of 65 later.

To underline this prioritisation policy, President Widodo, who is 59, was vaccinated on Jan 13. Vice-President Maruf Amin, who is 77, was not. 

On the same day, Professor Amin Soebandrio, a government advisor on the pandemic, argued that it was best to immunise working people “who go out of the house and all over the place, and then at night come back home to their families” where they might infect elderly family members.

The professor’s assertion ignores the lack of confirmed data that the vaccines stop transmission. Available data only confirm that they prevent serious illness in those vaccinated.

Medical experts in and outside Indonesia have criticised the Widodo administration’s vaccination prioritisation policy.

The administration also justified this controversial prioritisation policy by noting that the National Agency of Drug and Food Control (BPOM) had not authorised vaccines for use on people over 65.

On Feb 7, BPOM approved the Sinovac Biotech vaccine for use for people aged 65 years and older. Ten days later, Vice-President Amin was vaccinated.

Two days after that, the age criterion for vaccination was dropped, and discussions over the economic benefits of vaccinating the “productive” age group first fell silent.

READ: Commentary: Indonesia’s Sinovac rollout sets high stakes for China’s vaccine diplomacy

COMMERCIAL AVAILABILITY OF VACCINES

A second prioritisation controversy has been whether people can pay for vaccination outside the government’s free vaccination programme.

On Jan 14, the Health Minister announced the government was considering allowing the private sector to purchase and distribute for free approved vaccines to their employees, alongside the government’s own free vaccinations.

Private sector lobby groups, including the powerful Indonesian Chamber of Commerce (KADIN), have been promoting this commercial alternative.

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President Widodo has announced that the government regulations for this private sector parallel programme, termed Independent Vaccination (Vaksinasi Mandiri), would be issued in late February or March.

Mandiri is motivated by businesses wishing to speed up the vaccination of their employees to minimise the pandemic‘s continuing impact on their bottom lines. Mr Rosan P Roeslani, the Chair of KADIN, told the media that “factories currently operating at half-capacity could return to normal after workers received their shots”.

As of mid-February, it is reported that the government has 28 million doses available, with more arriving in stages. The Mandiri programme would provide additional dosages, though still managed through the government.

To avoid competition for supplies, the government has stated clearly that any vaccines bought through the Mandiri programme would have to be different from the seven vaccines being purchased by the government. These seven are: Sinovac Bio Farma; AstraZeneca; Sinopharm; Moderna; Novavax Inc.; Pfizer Inc. and BioNTech; and Sinovac Biotech. 

The question remains if the Mandiri programme will be able to obtain sufficient supplies of vaccines from outside the seven being purchased by the government given current global demand.

READ: Commentary: Indonesia is reopening for business even with record high COVID-19 infections

WEALTHY CAN JUMP THE VACCINATION QUEUE

While the Mandiri scheme will not be competing with the government programme in sourcing vaccines, there are concerns that it will result in wealthy people being able to jump the vaccination queue by paying for the privilege.

The current Health Minister Budi Gunadi Sadikin has warned that this perception must be avoided.

At the same time though, KADIN’s Rosan Roselani has been quoted as saying: “It’s like going to the Disneyland … if you want to go faster, there’s a priority pass, but you must pay more”.

Meanwhile according to Statista, 78 per cent of Indonesians fear falling ill from COVID-19.

READ: Commentary: Dear Indonesia, shaming the infected is a lousy COVID-19 plan

Despite these widespread community fears, the government has decided that it needs to threaten people with fines and other sanctions to ensure they will get vaccinated, when it becomes available. These sanctions have already attracted the criticism that they will hit the poor hardest.

By the end of February, Indonesia had recorded 1,329,074 confirmed COVID-19 cases, although this is based on a very low testing rate, and 35,981 related deaths. As of Feb 22, over 700,000 people or 0.27 per cent of the population, had been fully vaccinated.

It is too early to assess what impact the economic divides reflected in these controversies will have on the management of the vaccination roll-out itself. The additional resources from the Mandiri program could possibly speed up vaccination, assuming everything goes smoothly.

Politically, policy criticism of the vaccination programme, has so far only come from experts and civil society, and not from the political opposition in the legislature.

This weakness in political accountability from within the political system may make mismanagement easier and more likely.

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Max Lane is Visiting Senior Fellow at the ISEAS-Yusof Ishak Institute. This article was first published by ISEAS-Yusof Ishak Institute as a commentary in Fulcrum.