Uneven distribution, bureaucracy hamper Indonesia's COVID-19 national vaccination efforts
As COVID-19 rages in Southeast Asia, regional governments are racing to roll out their national vaccination programmes. In the first part of a series, CNA looks at how vaccine distribution and bureaucracy are affecting Indonesia’s efforts.
JAKARTA: Dian Anggraeni has been trying to get herself vaccinated against COVID-19 for the past two months. But so far, her attempts have been unsuccessful.
The 22-year-old student from the city of Malang, East Java province, said she had filled in countless online registration forms only to be told later that the available slots for the day had been fully booked.
“The vaccination slots can be completely full within minutes after they are announced on social media,” Ms Anggraeni told CNA.
Only a handful of hospitals and health clinics in Malang are organising vaccination drives, most of which only have a small quota of around 150 people each day.
Occasionally, massive vaccination drives are held in the city which attract huge crowds of people without social distancing, all jostling for the 1,000 to 5,000 slots available. “These (massive) events are scary. I wouldn’t dream of going to one,” the university student said.
Complicating the matter is the fact that Ms Anggraeni’s parents are against vaccinations, fuelled by the many hoaxes and rumours circulating online. “There are many people in Indonesia who are like my parents,” she said.
With the Delta variant sweeping across the country, causing cases to rise and overwhelming Indonesia’s healthcare system, more and more people are racing to get themselves vaccinated.
The Delta variant, which was first identified in India, has been found in 11 areas outside of the densely populated Java island, according to Health Minister Budi Gunadi Sadikin. Indonesian Institute of Sciences was also quoted as saying that more than 95 per cent of samples, examined in a June research over a span of eight days in a Jakarta lab, were Delta variant.
But the complicated bureaucracy, uneven distribution and growing anti-vaccination sentiment are hampering the country’s vaccination efforts.
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The archipelago has a population of over 270 million. According to the Indonesian health ministry, the country has so far received 144 million doses of COVID-19 vaccine.
Of this figure, Indonesia received 27 million ready-to-use Sinovac vaccines and ingredients to produce 93 million more. The country has also received 15 million doses from AstraZeneca while the remainder included Moderna and Sinopharm.
The country is planning to inoculate 208 million people aged 12 and over by mid-2022. To achieve this, the government is targeting 2 million vaccinations per day starting next month. This is twice the target of 1 million jabs daily this month.
So far, Indonesia has logged over 3 million COVID-19 cases and 79,000 fatalities.
According to the health ministry, at least 16 million Indonesians have been completely vaccinated with another 26 million already receiving their first jabs. But the vaccines are not distributed equally across the country.
In Jakarta for example, 6.6 million of its 8.8 million target population had received their first jab. More than 2 million people in the capital had been completely vaccinated.
Meanwhile in Malang, out of the targeted 1 million population, only 239,000 people have received their first jab, 64,000 of whom have been completely vaccinated.
Husnul Muarif, chief of Malang City health agency, said the city initially planned to vaccinate 20,000 people per day but had to scale down its vaccination drive because of depleting supply.
“We only have 43,000 doses in stock. That is only enough for one week. We are asking the central government for more but so far there has not been any further shipment,” he told local media on Monday.
The fast spread of the Delta variant has caused a spike in demand for vaccination across Indonesia, officials have said. Sometimes, the surge caught local health authorities off guard.
The city of Banjarmasin in South Kalimantan province and Kendari in Southwest Sulawesi province are among the cities in Indonesia which had to postpone their vaccination programme because of depleting vaccine supply.
Dr Siti Nadia Tarmizi, Ministry of Health’s Director for Infectious Disease Prevention and Control admitted that most of the vaccine distribution is still focused on the islands of Java and Bali.
Java is the country’s most populous island where 56 per cent of Indonesia’s population reside. As for Bali, officials are expediting the vaccination drive in a bid to reopen the tourism-dependent island to international travellers.
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“Java and Bali are seeing a huge increase in confirmed cases because of the Delta variant. Which is why we are prioritising the two islands,” she told CNA. Mdm Tarmizi is also the spokesperson for the national vaccination programme.
Java and Bali were until recently under the so-called Emergency Implementation of Public Activity Restrictions or PPKM Emergency to curb the spread of COVID-19. The policy has since been relaxed in several areas across the two islands.
About 2.5 million people or 84 per cent of its 3 million target population in Bali have received their first jabs. Another 660,000 people or 22 per cent of the target population had been completely vaccinated.
Parliament speaker Puan Maharani is calling for the government to address the uneven distribution of vaccines.
“(The government) cannot let people’s enthusiasm to get vaccinated in some areas diminish because vaccines are not available (to them),” she said in a statement on Wednesday (Jul 21). “The (central) government must act quickly to distribute these vaccines.”
Ms Anggraeni, the resident in Malang, said she felt jealous of her peers in Jakarta.
“The conditions in Malang and Jakarta are like night and day. In Jakarta, there are many vaccination centres. You can register using an integrated app or website without the hassle of registering (with different vaccination centres) one by one. You can even get vaccinated at shopping malls,” she said.
“People’s enthusiasm (to get vaccinated) is really high but it is not met with sufficient supply from the government. And it’s happening everywhere across Indonesia. I feel that people who are not in Jakarta like myself are being discriminated against.”
Like many other cities, most vaccination centres in Malang only accept those who can prove that they reside in the city, a major hinderance for Ms Anggraeni who recently moved from Jakarta to Malang. Her identity card still lists her old Jakarta address.
The city’s health agency said that since vaccine supply is limited, they prioritise those with Malang-issued identity cards or those who carry an endorsement letter from their respective neighbourhood unit, verifying that they are indeed residents of the city.
The same bureaucracy is also imposed in other towns and cities. Jakarta also requires applicants to have locally-issued identity cards or recommendation letters from neighbourhood unit chiefs if they want to be inoculated at facilities run by the city.
“There is just too much bureaucracy for something as critical to our lives and wellbeing,” Putri Dian Sari, a resident of Surabaya, East Java said.
“It makes you wonder. The government can allocate a lot of money to stage elections with polling stations everywhere and break the barriers of bureaucracy by allowing people to vote wherever it is convenient to them. Why can’t they do the same for vaccination?”
The central government has been trying to combat this issue by eliminating such requirements at 51 vaccination centres run by the Ministry of Health which are only available in major cities. Malang, for example, has one such facility. Jakarta has 11.
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Dr Windhu Purnomo, an epidemiologist from Airlangga University in Surabaya said the move is not enough and questioned why such bureaucracy is in place.
“The coronavirus doesn’t care whether you are a local, a tourist, a visitor or a newcomer. Why make a fuss about resident or non-resident, especially in urban areas where many people reside in the suburbs but work in city centres?” he told CNA.
In another bid to address complicated bureaucracy and overcrowding at vaccination centres, the government last week initiated a programme to have health workers vaccinating people door-to-door, particularly in densely populated urban areas.
About 49,000 people were inoculated during last week’s trial run. The government is hoping that it can be expanded into a large-scale national programme.
NOT ENOUGH VACCINES FOR THE PRIVATE SECTOR
But not all government programmes went according to plan.
In a bid to boost productivity and protect workers, the government in March allowed the private sector to be involved in the vaccination programme, through the so-called “Gotong Royong” vaccination scheme. Under the scheme, companies can pay the government to have their workers vaccinated.
At the time, Indonesia was still busy inoculating the elderly and other priority groups.
According to the Indonesian Chamber of Commerce (KADIN), which oversees the Gotong Royong vaccination scheme, more than 28,000 companies had applied to have their workers vaccinated.
But the programme hit a snag when they could not secure enough vaccines, which by law had to be different from those used in the regular programme. The Gotong Royong scheme is currently using Sinopharm. Indonesia has so far only procured 4.8 million Sinopharm vaccines.
“We are competing with other countries to procure vaccines,” KADIN chairman Arsjad Rasjid told a press conference on Wednesday.
“We want to help the government in expediting the national vaccination programme and achieve herd immunity. We hope the government can help us by allowing us to conduct (the procurement process) ourselves so the government can focus on the people while we focus on our workers.”
With limited supply, several companies continued to struggle to have their workers vaccinated.
One worker, Agus (not his real name), said he was enrolled by his company to participate in the Gotong Royong scheme back in March. After months of uncertainty, Agus decided to enrol in the free vaccination programme in June, when the government finally allowed non-priority groups to be inoculated.
“I managed to book an appointment to be vaccinated on Jun 12. However, on the day of my appointment, I was vaccinated but officials there said they cannot input my personal data into the system because I was already registered under the Gotong Royong scheme,” he said.
“I got my first jab but I don’t have my certificate and it is unclear whether I can get my second vaccination.”
Dr Pandu Riono, an epidemiologist from Jakarta’s University of Indonesia, said the Gotong Royong scheme was problematic from the start.
“The idea was to fast track workers from getting vaccinated so they can get back to work, at a time when we were trying to vaccinate health workers and the elderly,” he said.
“The programme is unconstitutional because vaccination should be the responsibility of the state and everyone should have equal access to vaccines.”
While the vaccine supply for the existing Gotong Royong scheme has yet to be sorted out, the government on Jun 26 announced that it was extending the scheme to include individuals. This meant that anyone can pay to have themselves jump the queue to get vaccinated using Sinopharm.
The government said the policy is meant for businesses too small to be included in the KADIN programme, as well as expatriates and foreigners who would otherwise struggle to have themselves vaccinated.
Currently, only expats working in the education sector, diplomats or those over 60-years-old can have themselves inoculated under the free national programme.
“The government should have let all foreigners get vaccinated for free. If they are not vaccinated, not only will they become vulnerable (to infection) but they can pass on the virus to others. Endangering the general population,” epidemiologist Dr Purnomo said.
“Why do we need to have them pay (to get vaccinated)? What if they don’t want to pay? Will we just let them roam around unvaccinated?”
Following criticisms, President Joko Widodo last week instructed for the paid vaccination scheme for individuals to be cancelled.
Although the spread of the Delta variant had inspired more and more Indonesians to get vaccinated, not everyone shared the same view, let alone enthusiasm.
“Despite my best efforts, my parents refused to get vaccinated. They were even against the idea of me getting vaccinated,” said Central Java resident Anggun Munawar.
Ms Munawar said her parents were anxious seeing various media reports of people dying after getting the jab. “I tried explaining that there had only been a handful of deaths out of millions who were vaccinated. But they wouldn’t listen,” she said.
Liza Suherman from Jakarta is also facing a similar problem. “My parents believe getting vaccinated would lead to detrimental side effects in the long run. They even believe that COVID-19 is not as dangerous as the vaccination and medications given to COVID-19 patients,” she said.
“I’m not sure where they got this idea from. But there are many people who are feeding all sorts of misinformation about vaccination online and COVID-19 in general.”
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The Ministry of Communications and Information Technology said as of Tuesday, they have discovered and taken down 1,870 false and misleading posts and videos on various social media platforms.
These anti-vaccination campaigns appeared to have made many people reluctant to get the jab.
Although the government began to roll out vaccination for those aged 60 and over back in late February, only 2.9 million out of a target of 21 million elderly people are completely vaccinated.
Head of the National Police’s criminal investigation division Commissioner General Agus Andrianto said police will not tolerate those who spread lies about vaccination adding that so far law enforcers had criminally prosecuted more than 150 cases.
“We will take firm actions because these hoaxes are hampering the government’s efforts in mitigating COVID-19,” the three-star general said in a press conference on Tuesday.
Aware of the problems, the government is working to tackle the hiccups.
Mr Sadikin, the health minister, said the government is increasing the number of vaccine recipients as well as the average vaccine efficacy.
“In our previous vaccination plan, we are targeting 100 per cent of people above 18 years old. We have increased this target to cover 100 percent of people above 12 years old,” the minister said during a press briefing last week.
Mr Sadikin added that the government previously targeted an average efficacy of 60 per cent among the vaccinated population. Indonesia has been relying heavily on Sinovac vaccine, which had an efficacy of 65 per cent, according to the Indonesian Food and Drug Agency when they approved it for use.
“It was very low. We have increased the average efficacy (target) to 80 per cent,” he said, adding that to achieve this, the government plans to rely more on Moderna and Pfizer vaccines which have higher efficacy rates.
The minister also promised to address a number of issues hampering the vaccination programmes. “We are continuously trying to improve the way we stage our vaccination campaigns,” he said.
Dr Purnomo, the epidemiologist, said the government must ramp up Indonesia’s vaccination drive before an even more virulent variant comes along.
“We can see clearly that those who are vaccinated had less symptoms and can recover quicker than those who had no protection at all,” he said. “If this Delta variant teaches us anything, it would be vaccination matters. Vaccination saves lives.”