Surging to 678,125 COVID-19 cases prompted two immediate measures from President Joko Widodo (Jokowi). Such numbers have led to relieving the Health Minister of his appointment and an eventual U-turn to ensure that the COVID-19 vaccine is free for all Indonesians. However, it is pertinent to understand how Indonesia possesses the highest number of COVID-19 infections (and still climbing) in Southeast Asia. This commentary highlights four factors that would have prevented Indonesia’s ascend in COVID-19 cases, if had been addressed.
Missteps since the Beginning
Despite numerous countries including those in Southeast Asia reporting cases of COVID-19 in January 2020, Indonesia not only maintained status quo but also denied the presence of the virus in the country. Such stance led Indonesia to continue its detection and prevention phase. Despite referring to Presidential Instruction Number 4 of 2019 (Capacity Enhancement in Preventing, Detecting, and Responding to Outbreaks of Disease, Global Pandemic and Nuclear, Biological and Chemical Emergencies) and the 2005 International Health Regulation, no preventive measures were implemented by the government.
While countries closed their borders, Indonesia incentivized domestic and international tourists via provision of travel discounts from 1 March 2020 for the continued travel within and into the country. Complementing this was the proposed disbursement of IDR 72 billion (~USD5.1 million) to international influencers to promote tourism to Indonesia. It was evident that Indonesia was concerned with aiding the recovery of its tourism sector impacted by COVID-19. Shortly after, Indonesia reported its first COVID-19 infection.
Instead of implementing an immediate country-wide quarantine as others have done upon a COVID-19 case, the government seemed torn between prioritizing health and economy. The basis of such uncertainty was because Indonesia was believed to be vulnerable to an economic crisis if a country-wide quarantine was implemented. After a month-long deliberation and basing on inputs from local governments, Indonesia eventually implemented large-scale social restrictions (PSBB).
Unfortunately, the time taken enabled COVID-19 infections to spike. Its capital, Jakarta, for example, implemented PSBB on 10 April 2020 when there were 3,412 cases in Indonesia. Of these cases, 1,719 were from Jakarta.
In addition to the lack of coordination to implement PSBB in all regions, PSBB was also inconsistently implemented. From April to December 2020, Jakarta continuously oscillated between implementing PSBB and partial PSBB. Such back-and-forth indicated that the debate to prioritized health and economy was yet to be resolved. To confound matters, the PSBB implemented in Jakarta was not strictly enforced. For instance, travelling in and out of Jakarta continued despite being prohibited. These collective missteps consequently encouraged many to disregard health protocols, further contributing to the increasing daily COVID-19 infection rates.
Disinformation by the Government
In its attempt to allay its citizens, the Indonesian government became a source of disinformation. Numerous appointment holders within Jokowi’s inner ring frequently released statements downplaying the true extent of the situation. Not only was the severity of COVID-19 joked about, the former Health Minister accused the media of fear-mongering. Noteworthily, the herbal necklace that was claimed to prevent COVID-19 infections without scientific evidence was also heavily endorsed by numerous Indonesian artistes.
Such actions suggest that the government was focused on instilling a pseudo sense of security for its people. This was ostensibly to prevent any negative sentiments by investors to avert an economic crisis. It also highlighted the Indonesian government’s growing control over information on social media platforms via the engagement of buzzers.
Moreover, upon the announcement of its first COVID-19 case, the government had not then established a centralized information centre with accountable data. Instead, the media had to rely on their own efforts to gather and process data to provide timely and relevant updates. Currently, Indonesia’s Ministry of Health only has established a website on COVID-19 albeit still lacking in information.
The lack of accurate information and the belittling of the situation by the government, thus, contributed to many in the community to downplay the severity of COVID-19 and to have no qualms disregarding health protocols.
Lack of Capability and Accuracy of COVID-19 Tests
In numerous WHO’s weekly reports, Indonesia was recommended to increase its COVID-19 testing capability. At one point, its rate of testing was observed to be only 25 tested for every 1 million individuals. This disparity in testing is still observed today. On 22 December 2020, there were 69,343 suspected COVID-19 cases in Indonesia. However, only 48,806 specimens were tested while specimens were only collected from 30,768 individuals. Therefore, it is rather certain that Indonesia was underreporting its COVID-19 cases. Unfortunately, this would also mean that its 678,125 reported cases may not be an accurate representation of reality.
To confound matters, the level of accuracy of Indonesia’s COVID-19 tests is also questionable. A case in point would be 13 Indonesians were found positive for COVID-19 upon landing in Saudi Arabia in November 2020. These travellers had been certified COVID-19 negative prior their disembarkation. Several incidents were also reported in Taiwan on October and December 2020.
Regrettably, 202 out of 510 laboratories did not report their results on 21 December 2020. This discovery came as medical facilities and manpower continued being overwhelmed in managing COVID-19 cases. This was evident from the limited availability of negative pressure isolation wards, isolation wards without negative pressure, negative pressure ICU rooms equipped with ventilators, negative pressure ICU rooms without ventilators, non-negative pressure ICU rooms equipped with ventilators, and non-negative pressure ICU rooms without ventilators.
The misdirected and inconsistent policies, limited testing capability, inaccurate test results, overwhelmed healthcare sector contributed to Indonesia’s deterioration. When compared with Philippines, which is similar in population size, Indonesia has not only surpassed the latter’s cases, but also has five times more COVID-19 deaths and active cases.
Sole Reliance on COVID-19 Vaccine
As early as September 2020, Indonesia began touting the availability of COVID-19 vaccines by November 2020. Such reliance on vaccines and without other mitigative measures suggest that the government is solely dependent on vaccines as a silver bullet. By early December 2020, only 3 million Sinovac vaccines which has an unknown efficacy rate arrived in Indonesia. Moreover, Indonesia has yet to secure procurements of other vaccines with known efficacy such as Pfizer BioNTech (95% efficacy), AstraZeneca (62-90% efficacy) and Moderna (95% efficacy) unlike its neighbouring countries. Additionally, despite targeting the immunization of 70% of its population to elicit herd immunity, Indonesia still has yet to receive sufficient vaccines to do so.
Despite its reliance on vaccines, the Indonesian government again had to deliberate on the administration of its vaccines. At one point, there were two forms of administration, namely those from the government that were offered free of charge and those that were available to paying customers. Enabling vaccines to be purchased was met with criticisms from various quarters. A chief criticism was the worry of unequal distribution of vaccines to all strata of the community. Eventually, President Jokowi announced that vaccines will not only be free for all Indonesians but would be the first to be vaccinated in a bid to allay fears pertaining to the vaccine’s safety.
It is also still unclear how these vaccines can be effectively rolled out in Indonesia which has a large population and land size. Breaking away from other countries’ vaccination plan, Indonesia has decided to prioritize frontline staff and workers between the ages of 18 to 59 over the elderly. Only time will tell if such a gamble will go in Indonesia’s favour.