Dear vaccination candidates, in the following, we present information for the vaccination event,” read the WhatsApp message. “Please arrive on time and bring your original ID card, and your cooperation so that this information is not shared with others.”
The secretive tone from the nameless author was with good reason: it was an invitation to receive a third dose of the limited Moderna COVID-19 vaccine in a country where over 50 percent of the population have yet to receive their first dose, where only 28 percent have been vaccinated twice, and where only health workers are permitted to receive boosters.
Ahmad Arif, journalist and co-initiator of the citizens’ reporting platform LaporCOVID-19 (Report COVID-19), on 6 September posted a screenshot of the message on Twitter. “This was leaked by a colleague,” he wrote. The vaccination was to take place quietly that Wednesday at one of the skyscrapers on posh Sudirman Road in Jakarta’s central business district.
“[The source] reported that booster vaccines had been given to non-health workers, especially to the business elites and officials and their families,” Arif said when contacted by Asia Democracy Chronicles.
Global vaccine inequity has made it difficult for developing countries like Indonesia to secure enough doses to cover their populations, while rich countries like Canada, Australia, the United States, and members of the European Union have hoarded supplies that are enough for them to vaccinate their populations four times over.
Such scarcity has, in turn, made access to vaccines in developing countries a luxury and privilege for many. In Indonesia, inequity is exacerbated by the country’s elites taking advantage of vague regulations to get booster doses for themselves, in addition to slow vaccine distribution to remote areas. Rampant misinformation, poor access to public health services, and the appointment of distrusted actors such as the military and police meanwhile have pushed members of marginalized communities out of the queue.
Like many other developing countries, Indonesia relies on inactivated virus COVID-19 vaccines Sinovac and Sinopharm, as well as the adenovirus-based vaccine AstraZeneca — most of which are delivered through the global joint project COVAX facility. With developments around the new Delta variant, however, there are renewed concerns about the efficacy of these types of vaccines.
The mRNA vaccines like Pfizer and Moderna are thought to be more potent in preventing serious symptoms from the new variant. This cements the perception that the two — whose supplies rich countries have bought up — are the “better” vaccines, and thus coveted by Indonesian elites.
Only 28 percent of Indonesians have been fully vaccinated against COVID-19. More than 50 percent have yet to receive their first dose. For now, only health workers are authorized to receive booster shots, but it seems there are those outside of health care who have jumped the line.
Grab for boosters
The first batch of three million Moderna vaccines donated by the United States arrived on Indonesian soil on 11 July, and another 3.5 million on 1 August. The Health Ministry — which is in charge of the procurement of COVID-19 vaccines and vaccination — declared that the Moderna vaccines would be given as boosters exclusively for healthcare workers. The rest of the batch would go to those who have never received their first dose.
Soon after, a regent deputy in North Toraja, South Sulawesi admitted to receiving his third dose on 10 August. Then, on 24 August, a number of public officials were caught on a (now deleted) live stream video nonchalantly telling President Joko Widodo during his official visit to East Kalimantan that they also had received boosters. Engaging in casual conversation, the president told the officials that he was waiting to get the Pfizer vaccine for his third dose.
The news sparked public outrage. But the Health Ministry merely reiterated its instructions that boosters are to be given only to health workers while deflecting calls for it to do more.
“The function of supervision and guiding is carried out by the provincial and district governments as well as law enforcement authorities if there are violations,” ministry spokesperson Siti Nadia Tarmizi told Asia Democracy Chronicles via WhatsApp, before declining to comment further.
Jakarta City’s health department and regional police did not respond to questions to confirm responsibility for handling violations.
Alleged violations are common enough to be visible on social media: an influencer posting a picture claiming to get a third dose at the Jakarta regional council building, a user claiming third doses are available for top executives at a large firm in Lampung Province, and some others claiming to know acquaintances who do not work at a health facility getting booster jabs.
Violations have even been reported among law enforcement authorities themselves. A vaccination event hosted at the national police headquarters allegedly gave a Moderna booster shot to a non-eligible person, who then showed off their vaccine certificate on social media, according to LaporCOVID-19 volunteer Firdaus Ferdiansyah.
“An investigation we conducted into the person’s identity status confirmed that they did not work at a health facility nor were they a medical student,” Ferdiansyah said.
National police spokesperson Argo Yuwono has insisted that boosters had been given only to health workers, ambulance drivers, and the cleaning staff working at the police health facilities. But Ferdiansyah said that LaporCOVID-19’s request for the national police to release data of the booster receivers remains unanswered. He also noted that health workers at local hospitals and community centers, along with working medical students, are facing difficulties accessing their rightful booster shots.
Health workers are considered a priority group eligible to receive booster shots of the anti-COVID-19 vaccine. However, some 30 percent, or more than 450,000 health workers, have not received their third jab.
Patchy distribution
The Health Ministry’s own vaccine tracker shows that there are still over 450,000 (30 percent) health workers who have yet to receive their booster jab. Coverage for priority groups is also weak; just about 30 percent of Indonesian senior citizens have received their first dose, and only around 20 percent of the group have received their second dose, according to the tracker.
Indonesia’s unequal vaccine distribution has also left some provinces with excess doses, and some others with shortages and delays.
A vaccination organizer in Jakarta described how staff are now forced to grab any arm — even of those who have received the full two jabs — to get injected with leftover Sinovac or Sinopharm vaccines that would have otherwise been thrown away.
“At the beginning of the vaccination period, we had no problem (finding people) — there were still very few people who had gotten their first or second dose,” said the organizer, who requested anonymity. “Today we have no choice but to give away the leftovers.”
One vial of Sinovac vaccine can accommodate 10 to12 people, he explained. As fewer and fewer people in the capital city are now coming to vaccination centers, organizers often find themselves at closing time with the last opened vial but not enough people. They have now resorted to giving out third boosters, unrecorded.
Nine months since COVID-19 vaccination in Indonesia began in January 2021 with President Joko Widodo getting his jab at the presidential palace, nearly 90 percent of Jakarta residents have been fully vaccinated — the highest vaccination rate among cities and towns in Indonesia, and well above the second placer, Bali (70 percent).
By contrast, residents in eastern provinces like East Nusa Tenggara would wait in line for hours for a chance to get their jab. Many times, people would go home, still without getting vaccinated. So far, 32 percent of East Nusa Tenggara have had the first dose and 17 percent the second dose.
Mollo resident Dicky Senda queued for a whole day in late July for his second dose and failed. There were only 143 doses for more than 500 people who turned up at the town’s vaccination center. Recalled Senda: “The people were enthusiastic, but the stocks were limited. The service was also bad, so there was a fight and it was a mess.”
Senda finally got his second dose two weeks later. By then, he said, there was no queue and the doctor had to call people in one by one.
“I suspect people became lazy after a few times of coming to the health center and not getting the vaccine,” said Senda. “The distance between the village and the center is far, so people have to pay quite a lot for transportation. The information about availability is also very sudden, and not everyone in the village has WhatsApp or social media.”
Many left out of the queue
Marginalized populations across the country, such as the refugees and asylum seekers in Serpong, Banten, and Makassar in South Sulawesi, have not even heard of plans to receive their first dose, members of the community said.
In Surabaya, East Java, only 35 percent of transwomen registered with the Surabaya City Transwomen Association (PERWAKOS) have received their first dose, and less than five percent have been fully vaccinated, according to PERWAKOS coordinator Febi Damayanti. Many vaccination centers still require social ID cards, which many transwomen do not have because of their gender identity.
“The bureaucracy is too difficult, so many have become reluctant,” Damayanti said. Some have fallen prey to the fast-spreading hoaxes and misinformation, she added.
Long excluded from public health services and the society because of their gender identity, it has been difficult for the transgender community to receive adequate and accurate information about vaccines, queer author and researcher Nurdiyansah Dalidjo said.
“Did the government give them access to education, COVID-19 tests, or general health checkups before vaccination? No!” Dalidjo pointed out. “So, if [the transgenders] fall into hoaxes or are reluctant (to get vaccinated), we need to question who the government has been talking to all this time when giving information.”
In conflict-ridden Papua, where trust in the Indonesian authorities has been eroded after decades of human rights abuse against the indigenous people, only a little over 20 percent have gotten their first shots and less than 15 percent have received their second. Ferdiansyah of LaporCOVID-19 said that residents in Papua are afraid and reluctant to go to vaccination events hosted by the Indonesian military and police.
While Ferdiansyah appreciates the government’s quick maneuvers to secure vaccines supplies, he believes ending the pandemic in Indonesia requires a complete reevaluation of the distribution strategies, in addition to consistent mobility interventions, higher testing, tracing, and treatment (3T protocols), and overall better public health services. Excluding the most vulnerable groups from this equation would be “quite dangerous,” he said.
“How can the government ensure that accurate information and good health services truly reach … transwomen, indigenous peoples, those who have been excluded from health services?” he asked. “This is the big question.” ●
Antonia Timmerman is a Jakarta-based independent journalist covering human rights, technology, and culture.
