When Indonesia, home to some 270 million people, launched its massive coronavirus vaccination campaign on Wednesday, President Joko Widodo was first in line. As a 59-year-old, he was lucky. That’s because, according to the country’s guidelines, vaccines should be reserved for adults under the age of 60. With that, Indonesia is going against other countries that vaccinate their oldest residents first. Why?
Indonesia, an archipelago encompassing thousands of islands, has recorded more than 860,000 confirmed coronavirus cases and 25,000 deaths in the past year – one of the largest outbreaks in Asia.
The government has given two main reasons for its divergent approach to vaccination. For one thing, officials are concerned about what they described as a “lack of adequate research” into the effects of the CoronaVac vaccine, developed by the Chinese company Sinovac, on older people. The trials with this in Indonesia did not include participants over the age of 60.
But the main reason is that according to Indonesian policymakers, vaccination of the young could be the best way to dampen the widespread transmission of the virus. Health Minister Budi Gunadi Sadikin has said the government wants to target “those who are likely to get it and spread it.” In Indonesia, this means that priority must be given to the working population, who are responsible for the majority of confirmed cases in the country.
The Chinese vaccine
Indonesia approved the Chinese vaccine for emergency use on Monday after announcing that a clinical trial showed it to be 65.3 percent effective. This made Indonesia the first country outside of China to approve the CoronaVac vaccine. But a Brazilian analysis released this week stated that the effectiveness of that Chinese vaccine is even lower. Just over 50 percent, raising concern in the South American country that experienced one of the world’s worst outbreaks and that had made its vaccination campaign largely dependent on the Chinese vaccine from CoronaVac.
Like many countries, Indonesia has secured doses of several vaccines, including those from Pfizer-BioNTech and AstraZeneca, which will be distributed at a later date. First, the Indonesian government is going to vaccinate about 1.5 million health workers with the Sinovac vaccine by next month. Police officers, members of the military, teachers, and civil servants will be given priority before the vaccine is offered to the wider population of adults under 60.
Indonesia’s hope is that by slowing the spread among younger residents, they will still protect older people from contamination from family members or close contacts. Many families in Indonesia live in intergenerational households that make it nearly impossible for older relatives to isolate themselves from younger relatives.
Most other countries have taken a different course and have chosen to give priority to older residents over younger ones, because the older ones are most likely to suffer from serious disease symptoms and death. Which is the right strategy?
Most experts say that the choice to start vaccinating that portion of the population believed to be spreading the virus is a reasonable argument from a scientific standpoint. Rather, the problem is the moral dilemma public health officials face when they start rolling out vaccination plans: choosing whether to use the early doses of the vaccine to reduce transmission or to prevent people from becoming seriously ill and dying.
If Indonesia succeeds in vaccinating a large number of people who are believed to be spreading the virus, it will indeed reduce the number of deaths. However, it can take a huge amount of time to see those results. Other countries are prioritizing the oldest populations to a large extent to see a rapid decline in deaths from the virus.
In addition, an effort to reduce transmission and deaths through targeted vaccinations of those who spread the virus relies heavily on the hope that the vaccine will not only protect people from developing serious illness, but also from passing the virus on to others . There is absolutely no clarity about that yet. It is currently far too early to see how the number of cases will change as a growing number of people worldwide receive vaccine doses.