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By Rebecca Henschke and Pijar Anugrah
BBC World Service

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Indonesia has put in place a mass-free Covid-19 vaccination program to stop the spread of the virus and get its economy back on track.

But the country approaches others significantly differently. Rather than vaccinating older people in the first stage after frontline workers, it targets younger workers aged 18 to 59.

President Joko Widodo, 59, was the first in the country to receive the vaccine on Wednesday. Vice President Ma’ruf Amin, 77, won’t get the sting early because it’s too old.

Why Target Young Working Adults?

Professor Amin Soebandrio, who advised the government on its “youth first” strategy, argues that it makes sense to prioritize immunization of workers – those “who go out of the house and everywhere, and then to their homes at night return families “.

“We are targeting those who are likely to spread the virus,” he told BBC Indonesia.

He argues that this approach will give the country the best chance of achieving herd immunity. This occurs when a large section of a community becomes immune from vaccination or the mass spread of disease.

Image rightsEPAImage descriptionOn the eve of the rollout, vaccine stocks were prepared across the country

It was believed that 60-70% of the world’s population would have to be immune to stop the easy spread of the coronavirus. However, those numbers will increase significantly as the new, more transferable variants become widespread.

“That is the long-term goal – or at least we will reduce the spread of the virus considerably so that the pandemic is under control and we can get the economy going again,” said Prof. Soebandrio.

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Indonesia has the highest cumulative number of Covid-19 cases in Southeast Asia with a population of 270 million. According to the government, 80% of the cases are in the labor force.

While schools and government offices have been closed for nearly a year, the government has refused to put in place strict lockdowns fearing the impact on the country’s economy. More than half of the population works in the informal sector, so working from home is not an option for many.

The country’s new health minister, Budi Gunadi Sadikin, defended the strategy, insisting that it is not just about the economy, but “protecting the people and targeting those who are likely to get and spread them first”.

“We focus on people who have to meet a lot of people as part of their work; motorcycle taxis, police, military. So I don’t want people to think that it’s just about the economy. This is about protecting people. ” he said.

What about the elderly?

The government also argues that it will provide some protection to the elderly.

“Immunizing working household members means they won’t bring the virus into the house where their elderly relatives are,” said Dr. Siti Nadia Tarmizi, spokeswoman for the Ministry of Health for the Covid-19 vaccination program.

Most of the elderly in Indonesia live in intergenerational households and it is often impossible to isolate them from the rest of the family.

“So it’s an added benefit of this approach that by vaccinating people between the ages of 18 and 59, we are also providing some protection to the older people they live with,” she said.

Image rightsEPAImage descriptionIndonesia has recorded more than 600,000 cases of Covid-19 since the pandemic began

However, this depends on the vaccine preventing people from transmitting and passing the virus on.

“We just don’t have this information yet,” said Professor Robert Read, a member of the Vaccination and Vaccination Committee (JCVI) that advises UK health officials on vaccination.

“The reason the UK didn’t go for the younger population is of course because A, they don’t get such a serious illness and B, we haven’t yet been able to prove that the vaccines have any effect on transmission,” he said.

The Indonesian approach would require very high vaccine intake – “in all likelihood at least 50% to halt death and hospitalization in the elderly”.

“It is possible that if you are getting very high coverage rates, it will have an impact on transmission, although we obviously haven’t seen it yet.”

What experiments has Indonesia carried out?

Indonesia has adopted its unique approach in part because the main vaccine it uses has not been tested in the elderly.

Image rightsReutersImage descriptionIndonesia has a huge, young population, but spends comparatively little on health

The country relies heavily on the CoronaVac made in China by Sinovac to vaccinate its population. Three million of the 125 million promised doses have already been dispensed and distributed to healthcare facilities across the country.

Indonesia says the China vaccine has an effectiveness of 65.3%. However, the government has only carried out tests for the 18 to 59 age group in several countries as part of the Sinovac process.

“Each country could form a different age group and Indonesia was asked to bring the working people to trial,” said Dr. Nadia. They will start immunizing the elderly in the second round of vaccination as soon as they receive data from other countries participating in the study.

But even if they were asked to test it on people over 60, they would most likely still focus on immunizing the working population first as they believe this will protect most people.

How do scientists see the experiment?

“We don’t know if it will work and it needs to be evaluated,” said Peter Collignon, professor of infectious diseases at the Australian National University.

But he said it made sense to adapt the introduction of the vaccine to a country’s circumstances.

“If you are in a developing country, I can see how a policy to protect your young working adults, those who are more likely to spread the virus, could be a sensible practice because you can’t really tell people to stay home . “

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Prof. Read agreed, saying, “It is not our job in rich western countries to tell other countries around the world what to do.” He said he thinks the Indonesian approach “might be right for his country”, pointing out that everyone around the world is unsure about what is right now.

Professor Dale Fisher of the National University Hospital said Indonesia was taking a “pragmatic approach”.

“They say we’re going to vaccinate this age group that we have the data on. It’s an accessible group and it will certainly help keep businesses and the food pipe going,” he said.

How is Indonesia dealing with this?

Indonesia’s ambitious roll-out will not be easy.

The population is the fourth largest in the world and extends over a huge archipelago near the equator. Therefore, there are great logistical challenges in keeping the vaccines at the required temperature.

And health experts warn that the government’s policy focus on the vaccine and little else to contain the virus is fraught with danger as the health system is already creaking beneath the number of rising cases.

The cemeteries in Jakarta, the epicenter of the pandemic, are full and hospitals say they are struggling to cope with the number of patients.

Public health expert Dr. Dicky Budiman, of Australia’s Griffith University, said the government must do more to protect the vulnerable by strengthening what he calls a fundamental pandemic strategy: test, track and treat, and enforce social distancing.

Jakarta local journalist Citra Prastuti, who has just recovered from the virus, said: “Leaving your home is like entering a war zone with the increasing number of family clusters – it seems like nowhere is safe enough for us.”

She said the public health news has been confusing and contradicting. “People are encouraged to stay home while on vacation, but the hotels then offered discounts and there were no transportation restrictions.”

And there was no trace or trace of her case, she said after reporting it to her local health authorities.

“So I do not know whether or not I am included in the total data from Covid,” she said. “I think a lot of people see the vaccine as an easy way out, a cure for all diseases, like the ultimate savior.”

Are the vaccines halal or not?

Pig-derived gelatin is used as a stabilizer in some vaccines, but the consumption of pork is banned by Muslims, who make up around 90% of Indonesia’s population.

In Indonesia, news spread on social media that the Sinovac vaccine contains elements from monkeys.

President Widodo, himself a Muslim, has said it shouldn’t matter because it is a health emergency, but some have sought religious guidance.

The Indonesia Ulema Council or (MUI), whose job it is to decide such things, had long discussions and after an in-depth review announced that the Sinovac vaccine is halal.

Previously, 30-40% of people surveyed by the Ministry of Health had expressed doubts about the Covid-19 vaccine, and 7% said they did not want to be vaccinated.

Concern about whether or not the vaccine was halal was one of the main reasons, said Dr. Nadia.

“Praise be to God, that has been resolved,” she said.

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