Indonesia has rolled out a mass free Covid-19 vaccination programme in an attempt to stop the spread of the virus and get its economy going again.
But the country is taking a markedly different approach to others. Instead of vaccinating elderly people in the first phase, after frontline workers, it will target younger working people aged 18 to 59.
President Joko Widodo, 59, was the first person in the country to receive the vaccine shot on Wednesday. Vice-President Ma’ruf Amin, 77, will not get the jab early as he is too old.
Professor Amin Soebandrio, who is on a board that has advised the government on its “youth first” strategy, argues that it makes sense to prioritise immunising working people – those “who go out of the house and all over the place and then at night come back home to their families”.
“We are targeting those that are likely to spread the virus,” he told BBC Indonesia.
He argues this approach will give the country the best chance of achieving herd immunity, something that occurs when a large portion of a community becomes immune through vaccinations or the mass spread of a disease.
It was thought that 60-70% of the global population must be immune to stop the coronavirus spreading easily. However, those figures will rise considerably if the new, more transmissible, variants spread widely.
“That’s the long-term objective – or we at least reduce significantly the spread of the virus so that the pandemic is under control and we can get the economy going again,” said Prof Soebandrio.
Indonesia, with its population of 270 million, has the highest cumulative number of Covid-19 cases in Southeast Asia. According to government data, about 80% of cases are among the working population.
While schools and government offices have been closed for almost a year, the government has resisted putting in place strict lockdowns, fearing the impact on the country’s economy. More than half of the population works in the informal sector, so for many working from home isn’t an option.
The country’s new health minister, Budi Gunadi Sadikin, defended the strategy and insists it is not just about the economy but about “protecting people and targeting first those who are likely to get it and spread it”.
“We are focusing on people who have to meet lots of people as part of their work; motorbike taxi, police, military. So, I don’t want people to think this is about just the economy. This is about protecting people,” he said.
The government also argues it will offer some protection to the elderly.
“Immunising the working members of a household will mean they are not bringing the virus into the home, where their older relatives are,” said Dr Siti Nadia Tarmizi, the Ministry of Health’s spokesperson for the Covid-19 vaccination programme.
Most elderly people in Indonesia live in intergenerational households, and isolating them from the rest of the family is often impossible.
“So, it’s one additional benefit from this approach, that by vaccinating people 18-59 years old we are also offering some protection to the elderly they live with,” she said.
But this relies on the vaccine preventing people from carrying the virus and passing it on.
“We simply don’t have that information yet,” said Professor Robert Read, a member of the vaccination and immunisation committee (JCVI) that advises the UK health departments on immunisation.
“The reason the UK hasn’t gone for the younger population, of course, is that A, they don’t get such a severe disease and B, we haven’t been able to demonstrate yet that the vaccines have any impact at all on transmission,” he said.
The Indonesia approach, he said, would need a very high vaccine uptake – “at least 50% in all likelihood, to stop death and hospitalisation in their older population”.
“It’s possible that if they get very high coverage rates then there will be some impact on transmission, although we haven’t seen it obviously yet.”
