JAKARTA: Indonesia has rolled out a mass COVID-19 vaccination programme with President Joko Widodo becoming the first person in the country to be inoculated last week.
The government is aiming at vaccinating two-thirds of the population to reach herd immunity, and Mr Widodo has set a deadline of 15 months for the programme to be completed.
But the sheer size of the population and its geographical extent - with 270 million citizens spreading across more than 17,000 islands - make the vaccination task a very challenging one.
Logistics aside, feedback from the ground also highlighted data mismatch error and vaccine scepticism, the latter of which is blamed on the lack of effective policy communication on the government's part.
Indonesia said it has secured more than 300 million doses of vaccines from various producers, and has so far received 3 million ready-to-use vaccines from China’s Sinovac Biotech and raw materials to produce 15 million doses of vaccines.
This Chinese-made vaccine works by using inactivated viral particles to expose the body's immune system to the virus. The jab must be stored in a cooler with a temperature of 2 to 8 degree Celsius and the vaccine requires two doses to be effective.
Indonesia has also said that it has secured 50 million doses from Pfizer-BioNTech, which require storage at minus 70 Celsius.
According to the government's plan, about 1.48 million health workers are first in line to receive the jab produced by China’s Sinovac Biotech.
Out of the total, 560,000 health workers in about 90 provincial capitals and regencies are expected to be vaccinated this month, while the remaining 900,000 are scheduled to receive the jab in February.
About 17.4 million public officers in the high-risk category will be next in line, followed by 21.5 million elderly in April and then workers between 18 and 59 years old. In total, more than 180 million people will be vaccinated.
For the initial rounds of inoculation, the government has distributed 1.2 million doses of Sinovac Biotech's CoronaVac to around 90 provincial capitals and regencies.
While the first week of vaccination has gone relatively smoothly, Dr Pandu Riono, an epidemiologist from the University of Indonesia warned that many challenges lie ahead.
“When the vaccination enters the phase for the general population, then obstacles will appear,” he said.
LOGISTICAL HURDLE TO BE ANTICIPATED
Logistics will be a major issue in vaccinating the general public, experts have pointed out.
Dr Riono said currently, only a small number of vaccines are sent to be distributed in areas that are more developed, so the problem is not apparent yet.
“But later, once the general population needs to be inoculated, a massive storage and distribution system is needed. We can’t use the existing distribution system,” he said.
Mr Yanuar Nugroho, a visiting senior fellow at ISEAS-Yusof Ishak Institute, expressed concern that the programme would not run smoothly in areas where healthcare infrastructure and supporting infrastructure such as cold chain and storage are not readily available.
“For example, (there are) health centres where electricity is still limited. Vaccines need a refrigerator. (There are also) areas where health workers are not distributed evenly," he said.
Mr Nugroho, who is also the former deputy chief of staff to the president in Mr Widodo’s first term, suggested the government to work together with the private sector on the distribution and storage of the vaccines.
Dr Riono believed this could be a solution, but stressed that valid and reliable data is needed or it would not work.
While it has been reported in local media that the vaccination is running smoothly in capital Jakarta and Bali’s capital Denpasar, there are places that are grappling with data discrepancies.
Mr Edward Sihotang, the health department secretary in Papua's Jayapura regency, said about 1,300 health workers are expected to be vaccinated and they have already received 2,730 doses of vaccine.
However, only about 400 health workers are listed on the government app used for the vaccination programme.
Mr Sihotang believed that this happened because the data has not been updated.
“In my opinion, actually, if we encourage the relevant parties to input their data accurately, there won't be any problem. It's just because everything is rushed, it’s not satisfactory," he told CNA.
He said the solution is for the health workers to proactively register themselves if they are not listed in the database.
Meanwhile, in North Kalimantan province, secretary of the provincial health department Andarias Baso told CNA they have a vaccine oversupply because there are health workers who cannot be vaccinated due to their health conditions, which have not been reflected in the database.
In response, the government’s spokeswoman for COVID-19 handling and vaccination Siti Nadia Tarmizi told CNA that overall the vaccination has been smooth. However, she acknowledged there have been some minor shortcomings.
"We have a few obstacles related to the registration process which we previously did with the application PeduliLindungi. There were a few problems, also related to the recording and reporting system.
"They are still not well connected, so there are still little hiccups in the vaccination process but we have anticipated this," she said.
To overcome this issue, the government has asked all health workers, regardless of whether they have received an electronic ticket or not, to go to their respective health facilities to get vaccinated, she said.
Mdm Tarmizi added that the vaccination programme is on hold for now in regions which are currently dealing with disasters, such as West Sulawesi which is grappling with the aftermath of a quake and South Kalimantan with floods.
However, Dr Riono, the epidemiologist, said the mismatch in data is hindering the speed of the vaccination programme.
“This can’t be tolerated. Why? Because we knew since a long time ago that the medical workers are first in line. But the database has never been fixed,” he said.
VACCINE FEARS NOT EFFECTIVELY ADDRESSED
Even though the vaccination programme has kicked off officially, there are health workers who remain wary of the effectiveness of the new vaccines.
Indonesia's late-stage clinical trial on the Sinovac vaccine showed an efficacy of 65.3 per cent but some medical staff are not convinced. Some are also cautious of the side effects.
The hoaxes that have been circulating on social media do not help either.
In Indonesia’s westernmost province Aceh, Dr Edi Gunawan, the director of regional public health facility Dr Zubir Mahmud Hospital, told CNA there have been mixed responses among his staff.
“There are those who prefer to believe in hoax ... But I keep guiding them, including how to respond (to hoax),” he said.
The hospital's health workers are scheduled to receive the jabs in February and Dr Gunawan is currently focusing on counselling them and assuring them that they should not be afraid of the vaccine.
In January alone, the West Java provincial government's team of "hoax busters" has debunked 51 hoaxes on COVID-19 vaccination.
Among the hoaxes included chips being implanted in the vaccine doses, and claims of the vaccines being non-halal and dangerous.
Senior fact-checker JSH Alfianto Yustinova said hoaxes about COVID-19 vaccination spread quickly because they circulate on social media and messaging apps.
“There’s a video that purportedly showed a student fainting after being injected with COVID-19 vaccine. But that video has actually been around since 2018,” he said.
Mr Sihotang, the health department secretary of Jayapura, said these counterproductive news and hoaxes have affected the public and also health workers.
"Our challenge is not in implementing the vaccination, not from the health side but from the social and cultural side. There has been no risk communication,” he said.
Dr Riono, the epidemiologist, opined that the government’s vaccine communication has been far from ideal.
“We are not just injecting vaccines but we are also injecting knowledge prior to the vaccination. And some are rejecting it, not all … they should be left alone but do not let them spread hoaxes.
“But then there are others who are doubtful. And there are many of these. And this can only be overcome if there is truthful and accurate information,” he said, adding that the efficacy and side effects of the vaccines have not been communicated clearly to the general public.
Dr Riono said the government’s tactic of using a celebrity with many followers but does not have relevant medical knowledge as a role model for vaccination is wrong.
Raffi Ahmad was one of the first people to receive the jab last week along with Mr Widodo at the Jakarta palace. He shared his experience with about 50 million followers on his Instagram, but hours later pictures of him gathering with friends at a party without wearing a mask surfaced and sparked a backlash.
Mr Nugroho, the visiting senior fellow at ISEAS-Yusof Ishak Institute, told CNA that policy communication during the pandemic should be open and honest.
“So that the public has the appropriate risk perception. This perception is important so the public knows the risks they are facing.”
At the end of the day, both experts believe vaccination is not a silver bullet.
“Vaccination does not mean that once we are vaccinated we are free from the virus. But vaccination is important to be done together along with other measures such as washing hands, wearing a mask, maintaining a safe distance from one another, testing, tracing and treatment.
“This means that both the community and the government have obligations,” said Mr Nugroho.
As of Thursday (Jan 21), there have been over 900,000 COVID-19 cases in Indonesia.