Indonesia’s Covid-19 vaccination roll-out challenge could hurt path to immunity

With new cases topping 30,000 a week, Indonesia faces the urgent task of inoculating 270 million people across 17,000 islands once the vaccines are available
In places like the hotspot of Central Sulawesi, there is no airport and the only delivery route is via a seven-hour ferry ride

Coronavirus pandemic

Bloomberg

Published: 1:00pm, 27 Nov, 2020

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In Indonesia, pressure is building for authorities to get coronavirus vaccines to 270 million people living on 17,000 islands in its vast archipelago.

The government has orders with at least four vaccine suppliers, including Sinovac Biotech and AstraZeneca. That access ranks Indonesia second in Asia after China, and on par with Japan and India, for securing much-anticipated immunisations, according to data compiled by Bloomberg.

Few countries are relying more fervently on Covid-19 vaccines to blunt the pandemic than Indonesia.

The world’s fourth most populous nation has avoided strict lockdown measures in favour of physical-distancing guidelines that vary from province to province – a situation reminiscent of the United States, which is suffering the worst coronavirus crisis.

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With new cases topping 30,000 a week, Indonesia faces an urgent logistical challenge to ensure that vaccines – once licensed and available for widespread use – are distributed across a country spanning more than 4,800 kilometres in sufficient quantity for two doses per person administered a month apart.

“The government’s effort in trying to secure a vaccine is good, but the biggest challenge will be for Indonesia to get 400 million-plus shots into people in the shortest time possible to achieve a sufficient level of immunity in the population,” said Ngurah Mahardika, a virologist and professor of veterinary medicine at Udayana University in Bali.

Indonesia is capable of delivering vaccines to remote areas, but the scale and speed of the proposed pandemic immunisation campaign “has never been attempted before”, he said in an interview.

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AstraZeneca has been contracted to supply 100 million doses, with half due by the end of the year. The Indonesian government has also agreed to buy doses from Novavax Inc., while developing its own vaccine called Merah Putih, after the nation’s red-and-white flag, which is set to undergo preclinical testing in animals in December.

The government aims to provide free vaccination for as many as 120 million Indonesians at a cost equivalent to 0.5-1 per cent of gross domestic product through 2022, Finance Minister Sri Mulyani Indrawati said last month. Those unwilling to line up for a free shot at one of about 10,000 government-run clinics can pay for the inoculation privately.

Health care workers collect specimen samples during a Covid-19 swab test in Medan on November 25, 2020. Photo: EPA-EFE

President Joko Widodo had been counting on starting next month as part of an effort to help pull Southeast Asia’s largest economy out of its first recession in more than two decades. Jokowi, as he’s commonly known, said that the regulatory approval process might push deployment back to January.

Penny Lukito, the Food and Drug Monitoring Agency’s chairwoman, indicated that Jokowi’s time frame was too ambitious, telling reporters that approval may come in mid January at the earliest.

It is starting to be too late for Indonesians growing weary of guidance aimed at stemming the coronavirus’s spread. Officials donated face masks to thousands of people at a high-profile wedding in Jakarta this month after attendees of the indoor event failed to wear them. Jokowi chastised his ministers and called on them to uphold physical-distancing measures.

“This country has no credible road map to fight a pandemic,” said Pandu Riono, an epidemiologist at the University of Indonesia. “The government simply refused to tackle this crisis based on data and scientific evidence.”

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Infrastructure is also a barrier. Modelling by West Java, one of Indonesia’s most developed provinces, found insufficient capacity to deploy pandemic vaccines through its state-run polyclinics known as Puskesmas, and that it may take as long as 18 months to immunise every Indonesian using only that network.

A new plan utilising convention centres and exhibition halls, with military and police aiding teams of vaccinators, aims to cut the time to four months, Ridwan Kamil, West Java’s governor, said in an interview Thursday.

Challenges may be greater in places like Central Sulawesi, whose islands – located 1,900km from Jakarta – were declared a Covid-19 hotspot after cases jumped about 74 per cent in one day. There is no airport and the only delivery route is via a seven-hour ferry ride.

Local officials contacted by Bloomberg declined say how they will administer vaccines to the islands or if they have coordinated a distribution plan with the central government.

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