In Indonesia, long holidays are projected to carry with them the threat of a significant increase in positive COVID-19 infections. And with 225 of its 273.5 million population adhering to Islam, the festival of Eid al-Fitr – expected to fall between May 13 and 14 this year – raises significant concerns. Around 30 million people annually participate in mudik, returning to their hometown to gather with their parents and extended family, which could potentially lead to widespread outbreaks of the virus.
And while the Indonesian government has officially issued a ban on mudik this year, suspending domestic flights and other modes of transportation, there remains the lingering anxiety that many will simply defy the prohibition, as shown by the flow of people heading to other cities despite the imposition of a similar ban last year. In 2020, the Eid holidays saw a 93 percent increase in the number of daily cases and a 66 percent increase in the country’s weekly rate of mortality from COVID-19.
Reflecting on India’s pandemic surge after its own religious mass festivity of Kumbh Mela, there are several discernible common factors suggesting the Indonesian government will not be able to cope with a huge spike in positive COVID-19 cases if mudik cannot be effectively prevented.
First, the government itself has been largely inconsistent with its policies. On paper, citizens are prohibited to undertake intercity travel up to six days before Eid on May 13; however, many are able to circumvent this restriction by simply returning to their hometown at an earlier date. This is further exacerbated as tourist attractions are allowed to continue operating to prevent economic activity from ceasing completely in the tourism and hospitality sectors, enabling local crowds to congregate and increase the number of active cases.
Second, there are few visible indications that the government is ready to face such a surge in cases. On-the-ground reporting suggests that hospitals in Java, the country’s most populous island, have already been pushed to the brink of collapse by COVID-19, even before the holiday period begins. Some hospitals have resorted to treating patients on chairs in the hallways as wards have reached full capacity, while families desperately turn from one hospital to another seeking treatment.
On top of these looming hazards is the hindered progress of Indonesia’s vaccination program. Ever since the Indonesian Food and Drug Monitoring Agency (BPOM) issued an emergency use authorization for the Chinese-manufactured Sinovac Biotech vaccine on January 11 on the basis of preliminary data, its rollout has fallen far short of the government’s initial target due to limited stocks. By April, vaccine administration numbers have dropped to 200,000-300,000 doses a day compared to half a million the previous month, with Health Minister Budi Gunadi Sadikin claiming the government would only be able to allocate 8 to 10 million doses from its goal of 15 million.
The problem with Indonesia’s vaccine logistics lies in the limited number of vaccines the government has been able to provide. The country supplies include stocks imported from Chinese manufacturers such as Sinovac or Sinopharm, and another batch ordered via the COVAX scheme – namely the AstraZeneca vaccines being produced under license in India. But in the latter case, Indonesia is now expecting a delay of incoming stock following India’s decision to halt vaccine exports in order to deal with its own COVID-19 spike.
Unfortunately, this leaves Indonesia solely dependent on Chinese-produced vaccines whose efficacy has recently been called into question. In an unprecedented acknowledgement, one prominent Chinese pandemic official claimed last month that the country’s current vaccines only offer limited protection – with protection levels ranging from around just over 50 percent to 79 percent – and suggested mixing them with other vaccines as a way of boosting their potency.
To date, there has not yet been any opportunity for the Indonesian government to procure vaccines from other manufacturers, such as Pfizer, Moderna, and Johnson & Johnson. Not only are their prices set very high; developed countries in Europe and North America that houses these Big Pharma firms have also hoarded vaccine stocks from their producers, giving rise to accusations of a vaccine apartheid separating wealthy nations from those of the Global South.
Meanwhile, the possibility of producing vaccines domestically remains very slim. Both the Indonesian and Chinese governments have yet to show a clear commitment to procure and support local production, while the aforementioned unattainable brands such as Pfizer remain incredibly difficult to license due to strict patent protections.
This has led to growing demands to push for Trade-Related Intellectual Property Rights (TRIPS) waivers for the copyright, industrial designs, patents, and undisclosed information surrounding vaccines to the World Trade Organization. The proposal, led by South Africa and India, highlights the catchup game nations have to play if vaccine rollouts are to succeed on a global scale, as the virus has demonstrated its capacity to mutate into more aggressive and resistant strains. Unfortunately, it has yet to succeed as countries such as Switzerland, Germany, Singapore, and the United Kingdom have all been adamant in blocking this initiative for myriad reasons, although the administration of President Joe Biden just announced its support for a TRIPS waiver for COVID-19 vaccines.
Current efforts to realize Indonesia’s own vaccines have also been far from promising. The controversial Nusantara (“archipelago”) Vaccine initiative spearheaded by Indonesia’s ousted Health Minister Dr. Terawan Agus Putranto – a high-ranking military physician who gained national notoriety back in 2018 for promoting an unproven and potentially dangerous intra-arterial cerebral flushing method for treating stroke patients – has not received approval from BPOM. Not only was the Nusantara vaccine said to erroneously overlook several conditions that had to be fulfilled in vaccine development, the antigen used to concoct it was delivered from the United States instead of an Indonesian COVID-19 variant, which may contain different genomic sequence and virus strain unsuitable for treating Indonesia’s populace.
Other initiatives such as the vaccine known as Merah Putih (“red and white,” referring to the colors of the national flag) are also yet to show any significant progress, and are estimated to enter production only in 2022, which is possibly way too late. Even if it succeeds, there are many foreseeable hurdles that could potentially jeopardize its implementation, such as an overreliance on imported materials or Indonesia’s lack of experience in disseminating research products.
As Indonesia runs down its depleting vaccine supply, the Eid holidays pose a different challenge – one that can and should have been sorted out prior. Were it not for a global structural blockage in vaccine production and distribution, the government would have had the wherewithal to save a lot of lives and enable people to reconnect with their loved ones living hundreds of kilometers away. As it stands, such vaccine apartheid will not only deprive people of a once-in-a-year opportunity; those who insist on participating in mudik this year, in defiance of the government’s ban, may end up paying an even heavier price for it.