News analysis

Doubts over Indonesia's Covid-19 plan to transition to endemic phase

Health experts say Indonesia still has a long way to go to overcome Covid-19. PHOTO: REUTERS

Indonesia's government in recent weeks appears to have shifted its focus on the battle against Covid-19, and is exploring the idea of transitioning from treating it as a pandemic to an endemic.

Neighbouring Singapore has started doing so, and Malaysia has also said it would do so by the end of October.

Health Minister Budi Gunadi Sadikin said on Aug 23 that the government is formulating protocols to "coexist with Covid-19" and this included accelerating vaccinations as well as improving tracing and testing rates.

Indonesia has struggled to reach its aim for herd immunity through vaccinations, an effort further derailed by a new wave of infections since June, caused mainly by the highly transmissible Delta variant of the coronavirus.

But the situation has eased somewhat, with the number of cases dipping under 10,000 and deaths falling to below 1,000, although the country remains the region's worst, with more than 4.1 million cases and over 134,000 deaths. It still has the highest daily death toll globally.

As far as vaccination goes, 31 per cent of the country's eligible 208 million population, the world's fourth largest, have received their first dose, while nearly 18 per cent are fully inoculated - still well below the government's target of 70 per cent to achieve herd immunity.

The government has to a large extent regarded vaccination as a silver bullet to end the pandemic, which has brought Indonesia's healthcare system to its knees, seen its upper-middle-income status downgraded to lower-middle-income by the World Bank, and battered thousands of businesses and livelihoods.

Despite the country ramping up its vaccination drive, limited global vaccine supplies - against the need for at least 416 million doses - means that achieving herd immunity may take longer than its target, which is by the end of this year.

Health experts say Indonesia still has a long way to go to overcome the disease.

Dr Hermawan Saputra from the Indonesian Public Health Experts Association told The Straits Times that vaccines were still in short supply and could not cover remote regions outside Java island, such as Kalimantan, Sulawesi and Papua.

"Even with the best efforts, Indonesia can achieve herd immunity only in 2022 to 2023," he said.

Indonesia must be prepared for when the World Health Organisation (WHO) redesignates Covid-19 as an endemic disease, said Dr Hermawan.

One way to do this is to put in place community-based programmes to control the virus' spread, he said.

"To prevent a prolonged pandemic in Indonesia, we need to push for more community-based initiatives in rendering first aid," he said.

"So if people were to fall ill, their community can link them to health facilities and in cases that are less severe, the people are provided support, from logistics to mental health," he added.

Dr Masdalina Pane of the Indonesian Epidemiologists Association noted that among the conditions for the disease to be classified as endemic, countries must keep the number of cases low at 20 per 100,000 people and death rates to under one per 100,000 people. They must also maintain a positivity rate of less than 5 per cent, and hospitalisations at only five per 100,000 people.

As at Sept 3, the number of cases stood at 29.99 per 100,000 people and the death rate was 1.75 per 100,000. The positivity rate was at 10.36 per cent, and hospitalisations at 12.32 per 100,000 people, according to Health Ministry figures.

Indonesia has yet to fulfil those conditions, she said, adding that it is currently classified under WHO's situational level three, which is defined as "a situation of community transmission with limited additional capacity to respond and a risk of health services becoming overwhelmed".

Indonesia could reduce its dependence on expensive imports of vaccines, test kits, medicines and medical equipment, such as ventilators, by producing its own, she said.

"As long as we remain reliant on other countries, the situation will be difficult," Dr Pane said

Entering the endemic phase also requires people to be more responsible for their own well-being, she added.

The community "must also do its part" and get tested whenever people experience symptoms, she said.

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