Is it Time for a Booster? Prioritize Complete Dose Vaccines for All
Jakarta, 17 December 2021 – In a statement delivered at the DPR RI Commission IX working meeting (14/12), the Indonesian Minister of Health, Budi Gunadi Sadikin, said that the government plans to implement a booster program for elderly people with the status of PBI BPJS Health participants through an unpaid scheme as of January 2022.
PRESS RELEASE
Is it Time for a Booster? Prioritize Complete Dose Vaccines for All
Joint Statement
CISDI, PUSKAPA, LaporCovid-19, and Transparency International Indonesia
We ask the government to prioritize vaccine doses 1 and 2 until coverage reaches 70-80% nationally.
We ask the government not to roll out a paid booster program because it will widen the gap in vaccine access.
We encourage the government to immediately prepare long-term Covid-19 vaccination governance based on data, communities and health centers, as well as inclusion and accountability.
Jakarta, 17 December 2021 – In a statement delivered at the DPR RI Commission IX working meeting (14/12), the Indonesian Minister of Health, Budi Gunadi Sadikin, said that the government plans to implement the program boosters The elderly have the status of PBI BPJS Health participants through an unpaid scheme as of January 2022. Meanwhile boosters for the general public will be provided through a paid mechanism in the same period. Minister of Health Budi argued that this decision was an effort to protect the elderly and vulnerable groups as well as mitigate the Omicron variant which has spread at the global level. However, in the midst of an uncertain outbreak control situation, this decision needs to be highlighted further.
The COVID-19 Pandemic Is Not Over Yet
Since early November 2021, there has been another massive spike in COVID-19 cases. This situation was made worse by the emergence of the Omicron variant mutation which spread very quickly to 77 countries. As of December 16 2021, the government has announced the discovery of the first case of the Omicron variant in Indonesia.
The decreasing trend in cases from September until now has made the government focus again on improving the economy and other political agendas. Handling the pandemic seems to have escaped priorities and protocols which have proven to be loose. As a result, the public's vigilance, which is tired and fed up, is in danger of relaxing, while vulnerable people are increasingly having difficulty protecting themselves. Population mobility in the category of public transportation use has increased 54,6% throughout July to November 2021 (CISDI, 2021).
Pandemic is like a marathon
Protocols for wearing masks, maintaining distance, cleaning indoor air, managing travel and outdoor activities if necessary with various mitigation measures including quarantine, consistently implementing testing, tracing, treatment, and vaccination must go hand in hand, not choose one or the other. Unfortunately, surveillance and protocol management have become slack due to large social costs, making vaccination the only basis for reducing the rate of transmission of COVID-19.
COVID-19 vaccination is indeed a form of defense that can be effective in overcoming this long pandemic, but only if it is given evenly to all who are eligible in the right dose. In the midst of inequality in world COVID-19 vaccination, the spread of virus mutations is a consequence. The threat of the Omicron variant, which has complex mutations and a high transmission rate, was responded to with special policies for the elderly and vulnerable residents who received PBI. However, at the same time, Indonesia has only achieved vaccination coverage for dose 2 at 50.68% as of December 16 2021, in line with the vaccination of children (6-11 years) that has just begun.
LaporCovid-19 still finds it difficult for residents to access vaccines. From August to December 13 2021, at least 308 reports were recorded informing residents of obstacles to the national vaccination program. The report explains the difficulty for residents to register and the lack of information on vaccine availability, so they have to search independently. Apart from that, the report also indicates poor governance of vaccine implementation in the field, including the administrative process of data collection and registration for the vaccination program.
Equitable access to the first two doses of vaccination depends on vaccine supply and distribution capacity and vaccination services. Accurate dose amounts require us to continue to monitor developments in science closely.
After one year of running the national vaccination program, the government is still having difficulty reaching and prioritizing vulnerable groups (CISDI, PUSKAPA, 2021). Limited and unequal vaccination distribution and service capacity between urban and rural areas also occurs. The difference in access between Java and non-Java or the western and eastern regions means that Indonesia often faces the risk of vaccination inequality. This situation is exacerbated by the lack of transparent information regarding the distribution of the first and second vaccine doses.
Deployment variants of concern administer the third dose or boosters needed (SAGE, 2021). However, administering the third dose and boosters must be based on scientific evidence regarding reduced immunity and clinical protection, reduced vaccine effectiveness, and targeted at population groups that need it most, namely seniors over 65 years and immunocompromised patients.
Due to limited vaccine supply and capacity vaccine delivery, policy boosters paid risk of exacerbating vaccination disparities and diverting supply from equal distribution of the first two doses or primary vaccination. Without speed, accuracy and wide coverage of doses 1 and 2, the prospects for pandemic mitigation could be missed and have negative implications for public health, social welfare and the economy.
On this basis, the civil society coalition CISDI, PUSKAPA, Lapor COVID-19, and Transparency International Indonesia asked the government to eliminate the paid booster policy, clarify plans to achieve 70-80% complete dose vaccine coverage, accelerate vaccination coverage among vulnerable communities, clarify the availability of supplies and capacity for third dose COVID-19 vaccination services for seniors 65 years and over, and prepare governance to ultimately provide the third dose free of charge for the entire community.
The coalition encourages the government to strengthen vaccination coverage throughout society, especially for the most vulnerable citizens by mobilizing primary health services. Community health centers are able to strengthen health capacity at the community level, including reaching vulnerable groups who have had difficulty getting vaccines.
Do not exclude health centers from the scheme boosters (third dose). Instead, provide support now for the transformation of primary health services in the form of budgets, human resources and regulations. If this is done consistently, a transformative and resilient national health system and primary health services will be built after the pandemic is over.
The coalition asks the government not to confuse residents with the narrative of paid boosters and to stick to the principles of justice and siding with vulnerable residents. Addition of paths boosters payment will burden vaccination governance, which is currently very limited and still unequal. The development of scientific evidence increasingly supports the possibility that the appropriate dosing of the COVID-19 vaccine is three injections, leading to the concept boosters (optional) could be wrong.
If this is true, the government needs to reorganize the guarantee of complete dose vaccination for all. In the future, it may be necessary boosters annual. Anticipating this, the government needs to plan a long-term COVID-19 vaccination strategy now. Increasing distribution capacity, preparing community health center infrastructure as community service centers, and integrating COVID-19 vaccination financing into the National Health Insurance system are urgently needed.
The coalition urges transparency of the national vaccination policy which consists of data through to the procurement process, distribution of vaccines to provincial, district and city governments, and distribution to individual or groups of recipients. Until now, the public still has difficulty accessing information regarding the quantity, validity period, and types of vaccines, starting from the procurement process, distribution of vaccines to provincial, district and city governments, to distribution to individual or recipient groups.
The lack of transparency in vaccine distribution makes it difficult for citizens to obtain information real-time regarding the number of vaccines that have arrived in the area and where the vaccines have been distributed. As a result, residents do not know when the vaccine will arrive and be received. The availability of this information is needed so that the public can monitor the types of vaccines distributed in proportion to regional needs, to ensure that no more people have difficulty accessing the second dose of vaccine.
Therefore, improving the data collection system should be a priority agenda for the government before the third dose of vaccination is implemented, so that citizens can get vaccine access easily.
Summary of Recommendations
- Eliminate vaccine policy boosters paid.
- Clarify the strategy for achieving full dose vaccination coverage in 70-80% of the population.
- Accelerate the outreach of the first two doses of vaccination to vulnerable residents through collaboration between community health centers and accompanying institutions in the community.
- Clarify the third dose vaccination strategy for residents aged 65 years and over with transparent information regarding the availability of supplies and capacity of vaccination services.
- Prepare long-term COVID-19 vaccination governance that is data-based, inclusive justice and accountability.
- Strengthen investment in community health centers from now on as part of the transformation of the national health system.
Contact Person:
Amru – CISDI (0877-8273-4584)
Firdaus Ferdiansyah – LaporCovid-19 ()
About CISDI
The Center for Indonesia's Strategic Development Initiatives (CISDI) is think tanks which encourages evidence-based health policies to create an empowered, healthy and prosperous Indonesian society by implementing a healthy paradigm. CISDI carries out research and program management as well as policy advocacy to create transparent, adequate and equitable governance, financing, human resources and health services. Information: https://cisdi.org/id/
About PUSKAPA
PUSKAPA, or Center for Studies and Advocacy on Child Protection and Quality of Life, University of Indonesia, is a research and policy advocacy institution that uses evidence and knowledge to actively reform social care and protection systems and services, civil registration, data governance, and access to justice for children and vulnerable groups in Indonesia. Information: https://puskapa.org/en/
About ReportCovid-19
LaporCovid19 is a forum (platforms) fellow citizens to share information regarding the number of incidents related to COVID-19 around us. Approach bottom-up through citizen reporting or crowdsourcing so that every citizen can participate in conveying information about cases related to COVID-19. For more information, visit the website: www.laporcovid19.org, IG: @laporcovid19, Twitter: @LaporCovid, FB: LaporCovid-19 Citizens Coalition.
About Transparency International Indonesia
Transparency International Indonesia (TII) is one of them chapters Transparency International, a global network of anti-corruption NGOs that promotes transparency and accountability to state institutions, political parties, business and civil society. Together more than 90 chapters Others, TII strives to build a world that is free from the practices and impacts of corruption throughout the world. Information: https://ti.or.id/
