- The swelling ranks of antivaxxers in Indonesia are highlighting a global trend of rising vaccine opposition and may threaten the global recovery from COVID-19. Indonesia is the largest country in Southeast Asia and has the largest Muslim population in the world.
- Laws under consideration would make it illegal to not take a COVID-19 vaccine once one is available.
- Growth of antivaxxers movements in Indonesia track the rise of similar movements elsewhere in the world.
VANCOUVER. The swelling ranks of antivaxxers in Indonesia are highlighting a global trend of rising vaccine opposition and may threaten the global recovery from COVID-19.
Indonesia, the largest country in Southeast Asia, is considering laws that would make it illegal not to take a COVID-19 vaccine.
The governor of West Java, Ridwan Kamil, said his staff is “looking into the issue of whether people who refuse to get the COVID-19 vaccine” will hurt others or “if sanctioning them would violate their rights,” The Jakarta Post reported.
West Java plans to ramp up education programs even as the country gets ready to launch a COVID-19 vaccination program. In Jakarta, the capital, the municipal government passed a bylaw that sanctions people who resist COVID-19 vaccines with fines of up to Rp5 million (about US$340).
Indonesia has not approved any vaccines yet but it is testing three for emergency-use approvals. All three were developed in China. Indonesia has also put in place manufacturing capacity to rapidly roll out vaccines across its 270 million people.
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But Indonesia is battling swelling ranks of antivaxxers and people hesitant about vaccines. In general, these people worry about the safety of vaccines. In Indonesia and other Muslim countries, there are also concerns about whether vaccines, once approved, will be halal – or permitted – under Muslim religious laws. Indonesia has the largest Muslim population in the world. (Read more in Anticentric, August 6, 2020.)
“Public communication regarding the halal status, price, quality and distribution must be well-prepared,” said President Joko Widodo.
Swelling ranks of antivaxxers
Indonesia has a fair amount of experience with vaccine hesitancy and the swelling ranks of antivaxxers. Health authorities are fully aware that this is a big issue for Indonesia and that it could set back the fight against COVID-19.
In 2018, the Indonesia Ulema Council (MUI), the top religious authority, declared a vaccine against measles and rubella to be haram or forbidden and that led to a rapid drop in vaccinations. In the more traditional provinces such as Aceh, less than one in 10 children were vaccinated after the declaration, BioWorld (paywall) reported.
A paper published in the journal Vaccine in March 2020 found a that 15 percent of respondents in Indonesia felt hesitant about taking a vaccine against the Zika virus. The paper suggested a solution might be more information. The research was led by Amanda Yufika, of the School of Medicine at the Universitas Syiah Kuala in Banda Aceh, Indonesia.
Indonesia is hardly alone in facing issues related to vaccine hesitancy but it is one country where “confidence in the importance, safety, and effectiveness of vaccines” fell between 2015 and 2019, according to a study published in September in The Lancet.
Indonesia not alone
Researchers led by Alexandre de Figuiredo of the Vaccine Confidence Project at the Department of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine found “significant increases in respondents strongly disagreeing that vaccines are safe”. Similar findings were observed in Afghanistan, Azerbaijan, Nigeria, Pakistan and Serbia.
The researchers found that “vaccine confidence plummeted” in Indonesia between 2015 and 2018.
The rise of vaccine hesitancy in Indonesia tracks similar developments globally with swelling ranks of antivaxxers – and more recently anti-masker – movements. Both are based on distrust of government and skepticism of scientific data.
“When you don’t trust the sort of basic infrastructure that’s supposed to support public well being, you’re going to come up with all kinds of tactics to try to resist it,” Maya Goldenberg, an associate professor of philosophy at the University of Guelph and an expert on vaccine hesitancy told the CBC.
In Canada, a majority of people support masks. Polls suggest 86 percent of Canadians think wearing a mask on public transit should be mandatory. In many cities, it already is. In the U.S., 79 percent of people support making masks mandatory in public transit.
Vaccine nationalism and antivaxxers
Adding to the complexity of the problem is an increasingly visible trend of vaccine nationalism, particularly among rich countries. The US has refused to join the COVAX facility, pushing instead to secure doses of vaccines developed by domestic companies for itself first. China also resisted joining at first but joined in October 2020.
The World Health Organization wants people at the most risk around the world to be vaccinated first against COVID-19, but this may be difficult if rich countries stockpile vaccines, even before a vaccine is available.
Canada, for its part, has made deals to secure some 282 million doses of various vaccines for its population of 38 million. The idea is that such a high number would help deal with the potential failure of any of these potential vaccines.
COVAX would also allow for countries that have secured vaccines that ultimately fail to access other vaccines to cover 20 percent of the population.
Models suggest that if rich countries monopolize vaccines, the world could suffer twice as many deaths.
A team of researchers led by Matteo Chinazzi of Northwestern University considered what would happen if countries cooperate or not in the distribution of the first 3 billion doses of vaccines. The cooperative scenario could help avert 61% of deaths but the uncooperative scenario just 33 percent, assuming the vaccine is 80% effective.
Australia, Canada consider options
Australia is trying to get ahead of the game. Prime Minister Scott Morrison told anti-vaxxers to get behind the idea of immunization to achieve herd immunity.
“You have got to get to herd immunity with any vaccines, and for those who are unable for absolute medical reasons, not able to take vaccines… they are the ones who rely on everybody taking it even more,” Morrison said. “So you have got to do it for yourself, your family and for your fellow Australians… I mean people can’t think of just themselves in these situations.”
Australia has locked in 25 million doses of vaccines for the country.
Despite the growing doubts about the effectiveness of vaccines in Indonesia, the country is laying the groundwork to vaccinate large tracts of its population. Indonesia has laid the groundwork to manufacture hundreds of millions of doses of vaccine through the national biotech company PT Bio Farma.
The company has put in place the necessary infrastructure to manufacture between 16 and 17 million doses per month of a COVID-19 vaccine, The Jakarta Post reported. The country needs 340 million doses of vaccines to reach about two-thirds of its population.