Indonesia’s big gamble: Covid-19 Vaccination strategy

Alternative strategy

Judging from the obstacles encountered in the first month, Indonesia needs to come up with alternative strategies to make the vaccination more systematic and measurable, while addressing technical realities in the field.

First, it is difficult to have a centralized database, given the limitations of the current information system. Many complaints have been raised during the registration process for health workers  vaccination’,  directed  via WhatsApp, email and website. Apart from registration failure, many health workers were directed to vaccination sites far from where they work and with significant delay in response. This information system failure caused frustration – which may lead to chaos if it is to be scaled-up to include a larger population.

Spokesperson for Covid-19 vaccination Siti Nadia Tarmizi announced the change from online registration to manual. “No more SMS blasts,” she said, referring to the initial strategy and directing health workers to reregister for vaccinations. Data collection is now carried out through the PCare system synchronization and the PeduliLindungi application, as well as manual registration, through the Health Human Capital Information System (SISDMK). The manual data collection process seems to be the most reliable strategy for the implementation of group vaccination of public servants. As the state civil apparatus (ASN) is widely dispersed, forced centralized data collection and registration processes will only complicate implementation, especially if there is no clear definition of the public service workforce: who, in what sector, and at what level.

According to the National Civil Service Agency (BKN) data, there are 4.12 million ASN across Indonesia, dominated by ASN at the regional level (77%) and certain functional positions (51%). This indicates that the vaccination strategy for public servants would be better conducted locally, as opposed to be centralized. With almost 70% of functional ASN being teachers, a teacher database should be improved from early on, by identifying suitable locations for vaccination drive in each region. In addition, it is necessary to include honorary teachers, for the sake of fairness. However, this will require additional doses, identification of targets, and wider inclusion criteria.

Second, improving the general population database. Health Minister Budi Gunadi considers General Elections Commission (KPU) data to be the most valid and accurate currently available, and could be used as the basis for estimating intended vaccine recipients. However, KPU data cannot identify targets with comorbid risks. Such data can be obtained from the Healthcare and Social Security Agency (BPJS Kesehatan) database, which covers 80% of the Indonesian population. However, such wide coverage doesn’t necessarily indicate that all health conditions are recorded in the database and there is no integration between the population database and the health database. This has implications for data filtering in the field, which must be well synchronized: who is eligible, who has the authority, and when comorbidity screening is carried out.

Third, improving local cold chain capacity. Even though Indonesia is experienced in vaccine distribution, and the Sinovac-made vaccine is compatible with the existing cold chain system, Covid-19 vaccination remains a challenge in itself due to the larger number of recipients and very tight completion deadlines. This situation is compounded by a surplus of nonCovid-19 vaccines resulting from distribution difficulty during the pandemic.

Fourth, increase public acceptance of vaccines. National survey found that only 64.8% of 112,888 respondents are willing to be vaccinated. The proportion of the population that has yet to decide whether they want to be vaccinated or not is around 27.6%. If projected on youth population, that means there are 52 million-strong young people who still need convincing. A significant hurdle that the government must tackle.

The survey data for vaccine acceptance certainly needs to be updated, to assess the extent to which the acceptance rate changes after the vaccine has received EUA and halal certification from the Indonesia Ulema Council (MUI). They should erase public doubts about vaccine safety, effectiveness and religious permissibility, which account for 60% of the reasons for vaccine rejection.

Prioritization of Communication Tactics Based on Vaccine Hesitancy Level. Source: S.Wood, K Schulman; NEJM 2021.

After the gover nment has mapped intended vaccine recipients, the next crucial step is how to formulate a more targeted communication strategy for each of these groups. The current vaccine campaign is still heavy on ways to remind people about the importance of vaccines, encourage participation and provide appropriate incentives to groups who are still doubtful but show a positive attitude. In fact, the communication strategy in the group that refused to be vaccinated should be different from the one that was still in doubt. Do not use a judgmental approach against vaccine rebels but instead build a narrative that can change their mind without embarrassing them. Thus, for those who reject vaccine, a general campaign strategy should be complemented by continuous storytelling, involving opinion leaders in the group, and stirring up their emotion. (Figure 2)

Next : Is herd immunity rational?

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