Medan, Indonesia – Indonesia formally kicks off its vaccine booster programme on Wednesday, with free jabs for the aged and people with out the means to pay, in response to the Ministry of Health.
But the choice to make the vast majority of Indonesia’s 270 million inhabitants pay for the boosters out of their very own pockets has fuelled controversy.
“Why has the government suddenly come up with the idea of boosters? If it is because the government is worried about waning antibodies, then it is OK as that is relative to the pandemic,” Pandu Riono, an epidemiologist and professor on the University of Indonesia, informed Al Jazeera.
“But if it is related to the pandemic, then the vaccines should be free.”
The authorities has but to substantiate how a lot the vaccine booster photographs will price, though estimates have circulated on-line utilizing information from the UNICEF Vaccine Market Dashboard, which lists the worth of vaccines throughout completely different nations.
Potential costs vary from as little as $2.75 for a shot of AstraZeneca to $23 for a Pfizer booster.
“There is talk that the vaccines will be around 300,000 Indonesian rupiah ($21) but in practice, they could potentially charge more in a private clinic so the price could go up to to 1 or 2 million ($70-140) per shot,” Alexander Arifianto, a analysis fellow on the Indonesia Programme on the S Rajaratnam School of International Studies in Singapore informed Al Jazeera.
“Putting a price tag on the booster will add to vaccine hesitancy. The more it costs, the more people will be hesitant to have it.”
Indonesia’s vaccine programme has already had its share of struggles, together with a sluggish rollout and vaccine procurement points.
Only about 117 million Indonesians have been totally vaccinated out of a inhabitants of greater than 270 million because the marketing campaign started on January 13 final yr.
Most individuals have been given the Chinese-made Sinovac vaccine after Indonesia participated within the producer’s late-stage trials.
There are additionally giant discrepancies in vaccine protection between completely different areas of the archipelago.
Populations in Jakarta and Bali are almost totally vaccinated, whereas areas comparable to Aceh and West Papua have managed to vaccinate solely about 20 % of residents, in response to information from the Ministry of Health.
“I’m not sure that the paid vaccine programme is going to help Indonesia reach a large number of people. With less than 50 percent of [all] Indonesians fully vaccinated, the government needs to encourage the rest of the population to get vaccinated first,” mentioned Arifianto.
With so many individuals nonetheless awaiting the all-important first photographs, “Indonesia will continue to be vulnerable”, he mentioned.
He provides that whereas anticipating individuals to pay out of pocket for the booster is a severe concern, a extra urgent drawback for the federal government is sourcing the mandatory vaccines.
“Middle-income nations like Indonesia have struggled to get vaccines like Moderna and Pfizer because [the makers of those vaccines] have prioritised countries that can pay upfront quickly,” he mentioned.
When the booster scheme was introduced early this month, Health Minister Budi Gunadi Sadikin informed the media that Indonesia would wish 230 million doses of booster photographs and that it at present had roughly half that quantity in inventory. It is unclear the place Indonesia is planning to supply the extra photographs.
On Sunday, Indonesia’s Food and Drug Monitoring Agency authorised the usage of Sinovac, Pfizer, AstraZeneca, Moderna and Zifivax, one other Chinese-made vaccine, for the booster programme.
The subsequent day, the ministry launched a convoluted set of directions explaining which booster photographs individuals might get primarily based on their preliminary photographs.
Unlike different nations around the globe, Indonesia is advising individuals to stay with a single product – people who obtained two doses of Sinovac have been informed they will solely have a Sinovac booster, those that bought Moderna can solely have Moderna and those that bought the Pfizer jab solely a Pfizer or Moderna booster.
Neighbouring nations comparable to Singapore and Malaysia, in the meantime, have inspired vaccine mixing and advisable that these vaccinated with Sinovac have an mRNA booster of Pfizer or Moderna.
Many nations globally have additionally advisable a mixture of photographs as a result of it’s thought to immediate a greater immune response.
In December final yr, a research carried out in Oxford within the United Kingdom discovered that folks had a higher immune response after they obtained a primary dose of AstraZeneca or Pfizer-BioNTech photographs adopted by Moderna 9 weeks later.
But Indonesia’s coverage on boosters could also be a mirrored image of what the federal government has obtainable and the difficulties it has had with procurement, analysts mentioned.
“If the government can’t source enough vaccines, only giving booster vaccines to priority groups like the elderly looks like a kind of vaccine rationing,” mentioned Arifianto.
“That will create a problem with the rest of the population. This is a huge country with a huge population and an uneven health structure.”
Indonesia has reported greater than 4 million instances of COVID-19 because the begin of the pandemic and almost 150,000 deaths, the very best toll within the Asia Pacific.
And whereas present instances fluctuate between 400 and 500 a day – a fraction of the height recorded final July – there are issues about Omicron.
New survey launched by @indikatorcoid signifies 55% of Indonesians opposed the govt. vaccine booster programme. Likely attributable to its price (since a major share will probably be delivered by non-public MDs and clinics on fee-for-service foundation) & lack of information about focused inhabitants https://t.co/4LPVMNeY8N
— Alexander Arifianto (@DrAlexArifianto) January 9, 2022
More than 150 individuals have been confirmed to have the extra transmissible variant because it was first reported in Indonesia final month. The majority of instances have been linked to worldwide travellers getting into Indonesia, however instances of native transmission have additionally been detected in cities together with Jakarta, Surabaya and Medan.
The arrival of Omicron contributed to the federal government’s determination to deliver ahead the beginning of the booster programme, which was initially purported to get below means as soon as vaccine protection had reached 70 %.
But analysts fear it dangers additional undermining the prevailing vaccination programme.
“Maybe some people don’t need a booster but they are worried, so they will pay for it and use up a vaccine,” mentioned Riono.
“In some areas, individuals haven’t had their first or second dose. The authorities ought to make a rule that solely individuals in areas the place 60 or 70 % of the inhabitants has been vaccinated can have a 3rd dose.
“Even then it should only be people in priority groups such as the elderly and people with comorbidities or those who deal directly with the public.”
In the town of Medan, a trainee Catholic priest, Friar Fernando, informed Al Jazeera that he was nonetheless ready to listen to a few potential booster shot. He most well-liked to not share his full identify.
In the preliminary vaccination marketing campaign, members of the clergy got precedence due to their interactions with the general public.
He mentioned it was unclear who would qualify for a free vaccine this time round.
“As far as I am aware it is only healthcare workers who were considered essential workers this time,” Fernando mentioned. A booster effort for front-line employees begun final July because the Delta wave hit means about 1.three million individuals have already had a 3rd shot, most of them healthcare employees.
Before Wednesday’s marketing campaign, survey group Indikator.co.id discovered that 55 % of Indonesians disagreed with the idea of booster vaccines, which Arifianto mentioned might be resulting from price coupled with an absence of clear public well being messaging.
In Medan, scholar Glory Nainggolan, who’s totally vaccinated, informed Al Jazeera that she was apprehensive concerning the impact of a 3rd vaccine on her well being.
“I think two vaccines is enough. I’m worried that the side effects will be really strong if I have a third vaccine,” she mentioned. “The side effects I experienced last time were already much stronger after my second vaccine.”
“I think it is unnecessary for ordinary people and boosters should be reserved for healthcare workers who battle the virus on a daily basis.”