The Indonesian government’s Covid-19 vaccination program will initially prioritise adults of ‘productive age’ over the elderly. Photo by Antara/Setpres/Agus Suparto.
On 16 December 2020, President Joko “Jokowi” Widodo relented to public pressure and pledged that Covid-19 vaccination would be offered free to all Indonesians. The decision received widespread support from experts and public policy practitioners.
A month later, on 13 January, Indonesia officially launched its vaccination program, with the president the first to get the jab. The vaccination program rollout could not come soon enough for Indonesia, which has seen Covid-19 claim more than 25,000 lives and push the country into its first recession since 1998.
Indonesia’s drug authority said that the CoronaVac vaccine, developed by Sinovac Biotech, was 65.3% effective based on clinical trials conducted jointly by Universitas Padjajaran and Bio Farma in Bandung.
But following the lead of the initial Sinovac trials in China, the CoronaVac trials only included adults aged between 18 and 59. The clinical research team leader, Kusnandi Rusmil, told BBC Indonesia in July 2020, “Why do we target people of a productive age? These people can work hard, so the country will not have a deficit”.
In December, former health minister Terawan Agus Putranto confirmed that the target was to vaccinate 107,206,544 people aged between 18 and 59. This figure later was later revised by the newly appointed health minister.
One problem with only including people of productive age in the trial is that there is not enough accurate information on the efficacy of the vaccine among the elderly in Indonesia. This appears to be the reason why newly appointed Health Minister Budi Gunadi Sadikin said that further studies need to be carried out to ensure the vaccines are safe for senior citizens.
In any case, Indonesia has signed deals to secure 330 million doses of vaccines, with 125 million from Sinovac, and the rest from Novavax, AstraZeneca, and BioNTech-Pfizer.
The Indonesian government now claims it plans to vaccinate 181 million people, with people aged 60 and above to be included only after medical workers and public officials are given the vaccine. But a close look at Article 8 of the regulation on the Covid-19 vaccination program (Health Ministry Regulation No. 84 of 2020) shows that older people and those with comorbidities (such as diabetes, lung problems, and hypertension) are, in fact, not included in priority groups.
The vaccination program is focused on reaching herd immunity as soon as possible, with the hope of quickly jumpstarting Indonesia’s flagging economy. The decision to exclude older people from the initial phase of vaccination seems to be based on an instrumentalist view of the elderly, in which they are judged based on their value to the economy. Senior citizens are apparently seen as not deserving of Covid-19 vaccinations because of their limited capacity to contribute to economic development.
But by not vaccinating the elderly, there is the possibility that large numbers will die, as they are especially vulnerable to Covid-19.
The Indonesian government’s policy is starkly different to the approach taken in many developed countries, whereby those older than 60 years or those who have health conditions are the first to be vaccinated, due to their high-risk status. In the UK, for instance, Margaret Kenan, a 91-year-old British grandmother, was the first person to receive a dose of the Pfizer vaccine.
The decision to prioritise the elderly is backed up by the fact that 9 in 10 people who have died from Covid-19 in the UK were over 65. In Indonesia, the situation is not so different. In mid-December, the nation’s Covid-19 task force spokesperson, Wiku Adisasmito, said that Covid-19 patients aged 60 and above are at the highest risk, and are almost 20 times more likely to die of the disease than young people. So why is Indonesia making them wait?
To be sure, conducting a mass vaccination program in one of the world’s most populated countries is not easy. The Indonesian government’s mass vaccination policy must balance limited resources and infrastructure with the need to secure vaccines for hundreds of millions of people.
Some commentators have acknowledged there may be benefits to the government’s approach of prioritising those of productive age. According to one Indonesian economist, it could revive the economy faster because the 18-59 age group has higher consumption needs than other groups, and contribute more than 50% of Indonesia’s economy. Moreover, it could be effective in slowing community transmission, because younger working adults are typically more active.
The problem is that this approach may not affect mortality rates, particularly among the elderly, who are at much higher risk of dying than younger Indonesians. Vulnerable and high-risk groups, including people aged 60 and above, should not be denied access to Covid-19 vaccines. After all, the Constitution grants all Indonesians the equal right to health and the right to be free from discriminatory treatment, including on the basis of age (Articles 28H(1) and 28I(2)).
Excluding the elderly from vaccination because of their age and their supposed limited social and economic value is discriminatory. The government must include the elderly as a priority group for Covid-19 vaccination and ensure that the vaccines they receive are safe and effective.
Unfortunately, this kind of crude economic pragmatism is not a major surprise from the Jokowi administration, which seems to repeatedly put economic concerns ahead of the rights of citizens. Jokowi is lucky he is 59 this year. If he was one year older and worked outside government, his own policy would have stopped him being protected from the disease that has killed tens of thousands of his citizens.
