Indonesia: Soaring COVID-19 cases as government scrambles to roll out vaccine

The spread of COVID-19 continues to accelerate out of control in South East Asia’s largest country and economy.

In what has been dubbed an “endless first wave,” the surge in Indonesia climbed to a record 9,321 new infections on Thursday, bringing the official total to 797,723. The number of deaths rose by 224 to 23,520. The number of new cases on Thursday also broke the record set just the previous day of 8,854.

UNICEF aid workers in Indonesia (Credit: UNICEF)

In late November the total cases reached the milestone of 500,000. In other words, over a third of the total cases have occurred in the past month and a half alone since the outbreak was first recorded in March.

The increase in cases is not attributed to any increase in testing, which, according to “Our World In Data,” has remained very low at just 12 tests per 100,000 people, lower than the neighbouring, less-developed Philippines.

The accelerating number of cases is the product of criminal neglect on the part of the capitalist government, which has systematically sought to downplay the pandemic threat in order to safeguard corporate profits.

Contact tracing has been minimal and disorderly, while lockdowns have been resisted throughout, placing the full burden of the virus on the working class.

The percentage of people tested who were found to be positive spiked above 20 percent for several days in late December, according to Reuters. World Health Organisation guidelines establish a positivity rate above 5 percent as indicating that the virus is out of control and requiring lockdown measures and more extensive testing. By all reports, Indonesia has been consistently well above this threshold since the beginning of the outbreak.

Health officials have begged the government for immediate measures to contain the spread and prevent the hospital system being overwhelmed.

Epidemiologist, Pandu Riono, from the University of Indonesia made the prediction Monday that hospitals would soon collapse from a rapid rise in patients. “The problem is that in the next few weeks, all hospitals in Java will collapse, including Jakarta,” he said.

Secretary general of the Indonesian Private Hospital Association (ARSSI), Ling Ichsan Hanafi, stated in an interview with the Indonesian newspaper Tempo on Friday that the isolation beds and ICU rooms in Jakarta’s COVID-19 referral hospitals had reached an occupancy rate of 95 percent. There are 101 referral hospitals in Jakarta with 7,300 isolation beds and 958 ICU beds.

Calling for greater hospital capacity, he warned, “even new referral hospitals will likely be fully occupied once open… [because of] the rapid addition to patients’ numbers.” He also noted that there was a general increase in severe symptoms among new patients.

In response, the government announced a two-week, social restriction beginning on Monday, 11 January, across Java (including the capital, Jakarta), as well as the island of Bali.

The belated measures encompass 22 towns, regencies and regions. Three quarters of workers are instructed to work from home, shopping malls will have restricted operating hours and restaurants will operate at 25 percent capacity. A blanket closure will also be applied to the school system.

The measures come on top of the closure of borders to most foreign travellers in order to prevent the spread of the more highly infectious SARS-CoV-2 variant, which has already been reported in Australia and Singapore. At present, the travel ban is set to expire on January 14.

Amid rising public anxiety and anger, the government announced that its vaccination program would commence on January 13 with President Joko Widodo to receive the first shot of the CoronaVac vaccine. Priority is being given to health care workers and politicians, followed by others in the workforce between the ages of 18 and 59 years old. All vaccine shots are to be paid for by the government.

The national drug agency is yet to finalise its phase-III trials and issue an Emergency Use Authorization (EUA) for the vaccine produced by Sinovac. However, owing to its effectiveness overseas, the government is gambling that the EUA process can be expedited, given that the testing protocols are similar. Initial findings in a small study in Turkey show an effectiveness of 91.25 percent after a trial of 7,000 volunteers, and 78 percent effectiveness in Brazil from a trial of 12,000.

Both are well above the 50 percent threshold for emergency effectiveness set by the WHO and also demonstrate success among elderly patients, making it more reliable in this age group than prior vaccine candidates.

Indonesia is unable to access the more expensive and effective Moderna and Pfizer vaccines which require a distribution network capable of storing the drugs at -20 and -70 degrees Celsius respectively. The Sinovac vaccine is able to be stored in normal refrigerators at 2 to 8 degrees Celsius.

There are currently three million Sinovac doses in Indonesia’s possession, with 1.2 million already distributed to 24 provinces throughout the archipelago, according to the health ministry. It is planned for the other 1.8 million to be distributed by Thursday.

As with most COVID-19 vaccines, immunity is achieved through administering two shots weeks apart. So to achieve the government’s goal of herd immunity by inoculating two-thirds of the population requires 427 million doses, allowing for a 15 percent wastage rate.

The country is set to receive another 125.5 million doses from Sinovac in the initial phases, as well as 203.5 million from other sources, notably from AstraZeneca and Pfizer.

The government has set the goal of achieving herd immunity in 15 months, but has not outlined a distribution schedule. To achieve that target would require an uninterrupted vaccination rate of 12 million a month (400,000 a day). It is also unclear from the lack of testing if the vaccines, while preventing complications, can prevent the spread of disease.

Health experts have treated the target with scepticism, envisioning a much longer timeline. “Fifteen months after vaccination, this is an ambitious goal for our enormous population,” said Hermawan Saputra of the Indonesian Public Health Expert Association. He told CNN Indonesia that it could take up to three years.