Fri. Jan 21st, 2022

Medan, Indonesia Indonesia officially kicks off its vaccine-boosting program on Wednesday, with free samples for the elderly and those without the means to pay, according to the Ministry of Health.

But the decision to make the majority of Indonesia’s 270 million inhabitants pay for the boosters out of their own pockets has sparked controversy.

“Why did the government suddenly come up with the idea of ​​boosters? “If it’s because the government is concerned about dwindling antibodies, then it’s okay, because it’s relative to the pandemic,” Pandu Riono, an epidemiologist and professor at the University of Indonesia, told Al Jazeera.

“But if it’s related to the pandemic, the vaccines should be free.”

The government has yet to confirm how much the vaccine booster shots will cost, although estimates have circulated online using data from the UNICEF vaccine market control screen, which lists the price of vaccines across different countries.

Potential prices range from as low as $ 2.75 for a shot of AstraZeneca to $ 23 for a Pfizer amplifier.

“There are rumors that the vaccines will be around 300,000 Indonesian rupees ($ 21), but in practice they could possibly ask for more in a private clinic, bringing the price up to 1 or 2 million ($ 70-140) per shot. may rise, “Alexander Arifianto, a research fellow in the Indonesia program at S Rajaratnam School of International Studies in Singapore, told Al Jazeera.

“Putting a price tag on the booster will contribute to vaccine reluctance. The more it costs, the more people will be reluctant to have it.”

Vaccine struggles

Indonesia’s vaccine program has already had its share of struggles, including a slow deployment and vaccine procurement issues.

Only about 117 million Indonesians have been fully vaccinated out of a population of more than 270 million since the campaign began on January 13 last year.

A little girl with glasses and a white t-shirt and light blue face mask gets a COVID vaccination while her mother holds her handIndonesia has started vaccinating primary school children, but there are huge differences in COVID-19 vaccination coverage across the archipelago, with only 20 percent of the people fully vaccinated in some areas [Willy Kurniawan/Reuters]

Most people got the Chinese-made Sinovac vaccine after Indonesia participated in the manufacturer’s late-stage trials.

There are also large differences in vaccine coverage between different areas of the archipelago.

Populations in Jakarta and Bali have been almost completely vaccinated, while areas such as Aceh and West Papua have managed to vaccinate only about 20 percent of the population, according to data from the Ministry of Health.

“I am not sure that the paid vaccine program will help Indonesia to reach a large number of people. With less than 50 percent of [all] “Indonesians who have been fully vaccinated, the government must encourage the rest of the population to be vaccinated first,” Arifianto said.

With so many people still waiting for the crucial first shots, “Indonesia will still be vulnerable,” he said.

He adds that while it is a serious concern to expect people to pay for the booster out of their own pocket, a more urgent issue for the government is to obtain the necessary vaccines.

“Middle-income nations like Indonesia have struggled to get vaccines like Moderna and Pfizer because [the makers of those vaccines] has prioritized countries that can pay quickly in advance, ”he said.

When the booster scheme was announced earlier this month, Health Minister Budi Gunadi Sadikin told the media that Indonesia needs 230 million doses of boost shots and that it currently has about half of that number in stock. It is unclear where Indonesia plans to obtain the additional shots.

Mixed messages

Indonesia’s food and drug monitoring agency on Sunday authorized the use of Sinovac, Pfizer, AstraZeneca, Moderna and Zifivax, another Chinese-made vaccine, for the propulsion program.

A masked woman in a black headscarf and peach-colored jacket stands with other passengers on a Jakarta metro train while COVID cases decrease to several hundred a dayCoronavirus cases are just a fraction of what they were at the height of the Delta wave last July, but the government has brought forward the country’s drive campaign amid concerns over Omicron [File: Tatan Syuflana/AP Photo]

The next day, the ministry released a complicated set of instructions explaining what booster shots people can get based on their initial shots.

Unlike other countries around the world, Indonesia advises people to stick to a single product – individuals taking two doses of Sinovac It was said they could only have a Sinovac booster, those who got Moderna could only have Moderna and those who got the Pfizer jab could only have a Pfizer or Moderna booster.

Neighboring countries such as Singapore and Malaysia, meanwhile, have encouraged the mixing of vaccines and recommended that those vaccinated with Sinovac have an mRNA enhancer from Pfizer or Moderna.

Many countries worldwide have also recommended a mixture of shots because it is thought to elicit a better immune response.

In December last year, a study conducted in Oxford in the United Kingdom found that people better immune response when they received a first dose of AstraZeneca or Pfizer BioNTech injections, followed by Moderna nine weeks later.

But Indonesia’s policy on boosters could be a reflection of what the government has available and the problems it has had with procurement, analysts said.

“If the government cannot get enough vaccines, it just seems like a kind of vaccine rationing to give fortification vaccines to priority groups like the elderly,” Arifianto said.

“This will create a problem with the rest of the population. It is a large country with a large population and an unequal health structure. “

Indonesia has reported more than four million cases of COVID-19 since the onset of the pandemic and nearly 150,000 deaths, the highest toll in the Asia-Pacific.

And while current cases vary between 400 and 500 per day – a fraction of the peak was recorded last July – there are concerns about Omicron.

It has been confirmed that more than 150 people have the more transmissible variant since it was first reported in Indonesia last month. Most cases have been linked to international travelers entering Indonesia, but cases of local transmission have also been detected in cities including Jakarta, Surabaya and Medan.

Priority groups

The advent of Omicron contributed to the government’s decision to bring forward the launch of the booster program, which was initially supposed to get underway once the vaccine coverage reached 70 percent.

But analysts are concerned that it could further undermine the existing vaccination program.

“Maybe some people do not need a booster, but they are worried, so they will pay for it and use up a vaccine,” Riono said.

“In some areas, people did not have their first or second dose. The government should make a rule that only people in areas where 60 or 70 percent of the population is vaccinated can get a third dose.

“Even then, it should only be people in priority groups such as the elderly and people with comorbidities or those who are directly involved with the public.”

Glory Nainggolan is a student in Medan.  She is fully vaccinated against COVID-19, but is worried about a boosterGlory Nainggolan is a student in Medan. She was fully vaccinated against COVID-19, but is worried about a booster. She thinks they should be reserved for people who work in healthcare [Supplied]

In the city of Medan, a student Catholic priest, Brother Fernando, told Al Jazeera that he was still waiting to hear about a possible stimulant shot. He chose not to share his full name.

In the initial vaccination campaign, members of the clergy were given preference because of their interactions with the public.

He said it was unclear who would qualify for a free vaccine this time.

“As far as I am aware, it is only health care workers who have been considered essential workers this time around,” Fernando said. A reinforcement effort for frontline workers began last July when the Delta Gulf hit means about 1.3 million people have already had a third shot, most of them health care workers.

Prior to Wednesday’s campaign, survey group Indikator.co.id found that 55 percent of Indonesians disagreed with the concept of booster vaccines, which Arifianto said could be due to costs coupled with a lack of clear public health messages.

In Medan, student Glory Nainggolan, who has been fully vaccinated, told Al Jazeera she was concerned about the effect of a third vaccine on her health.

“I think two vaccines are enough. “I am worried that the side effects will be very strong if I have a third vaccine,” she said. “The side effects I last experienced were already much stronger after my second vaccine.”

“I think it’s unnecessary for ordinary people and boosters should be reserved for healthcare workers who fight the virus on a daily basis.”

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