In contrast to most of the world that is planning to put its vulnerable older citizens first in line, Indonesia plans to vaccinate its young working-age population against the coronavirus before the elderly.
The first country in Southeast Asia to receive COVID-19 vaccines will concentrate on immunizing people between the ages of 18 and 59, beginning with those working on the front lines of the pandemic, such as health workers, the police and the military. Last week, in line with most other nations, the UK began the Western world’s earliest vaccination program with a 91-year-old woman.
This week the US also began a vaccine program for the elderly, following its recommendation from the Centers for Disease Control and Prevention that healthcare staff and nursing-home residents should receive vaccinations first followed by those with pre-existing medical conditions.
As the death toll from the pandemic continues to increase, policymakers are struggling with the issue of who should first get the vaccinations first. While Indonesia’s strategy currently stands apart, given their struggle to acquire adequate doses to cover their population, it will signal how other developing nations may consider their own roll-out.
“Our aim is herd immunity,” said Amin Soebandrio, director at the Eijkman Institute for Molecular Biology in Jakarta. “With the most active and exposed group of population, those 18 to 59, vaccinated, then they form a fortress to protect the other groups. It’s less effective when we use our limited number of vaccines on the elderly when they’re less exposed.”
As it focuses on using the vaccine as a tool to curb the spread of infections, Indonesia targets people who are most mobile because of their work, as well as regions with the highest number of coronavirus cases.
The 1.2 million doses of China’s Sinovac Biotech Ltd. vaccine that arrived on December 6 will be given to health workers on the islands of Java and Bali, which account for more than 60 percent of reported cases in the country and will followed by front line workers in the rest of the country. A roll-out date will be set when the country’s drug regulator gives the go-ahead.
Herd immunity
In order to meet its calculation of herd immunity, the government has set a target of 246 million doses which is the amount of vaccines they need to immunize 107 million people, or 67 percent of their target 18-59 group, and just 40 percent of the entire population. This is considerably lower than the commonly agreed mass immunity concept, which covers 60 percent-72 percent of the entire population of a country.
With 155.5 million doses ordered from Sinovac and Novavax Inc., the government goal will be met, with another 116 million possible orders from Pfizer, AstraZeneca, and the Covax facility. In an attempt to supplement its stock, it is also looking to produce its own shots, called Merah Putih after the colors of the nation’s flag.
Cautious approach
Other experts view Jakarta’s vaccination plan with caution.
“Indonesia has a young population, so this may have influenced their thinking, but I think vaccinating older people makes sense,” said Raina MacIntyre, professor of global biosecurity. “In the end, however, with a limited vaccine supply, the difference between age-based strategies is not great.”
Safety concerns
The nation that is home to the world’s fourth-largest population places the aged, those with existing health issues, and pregnant women at the back of the line because it does not have the data to ensure the safety of COVID-19 vaccines for those groups, according to Health Minister Terawan Agus Putranto. The Sinovac shots were tested on those between the ages of 18 and 59, which is why the government is cautious to immunize those in different age groups.
One day after the UK started distributing the Pfizer vaccine, its National Health Service had to issue a warning that people with a significant history of allergies shouldn’t receive the shots after two people experienced reactions.
“The question is a matter of suffering,” said experts. “Who develops severe symptoms or dies from the virus and who only gets minor effects and recovers on their own, it’s by this question that we should decide who should be vaccinated first.”
As in other countries, the elderly account for most of the deaths from COVID-19 in Indonesia. Those who are 60 years old and above accounted for 39 percent of the country’s 19,111 fatalities, while 36 percent were 46 to 59 years old.
Finally, the decision on who to vaccinate comes down to how many shots a country can procure quickly.
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