Anne Barker – Indonesian President Joko Widodo has received the first dose of a Chinese-made vaccine as part of the launch of the country's ambitious plan to vaccinate up to 180 million people within a year.
On Monday, Indonesia became the first country outside of China to approve the CoronaVac vaccine, which was developed by Sinovac Biotech in Beijing, after its food and drug authority BPOM gave the greenlight for its emergency use.
President Widodo received the first dose to instill confidence ahead of the mass vaccination rollout. Clinical trials have suggested the Chinese-made vaccine may only be 50 per cent effective against COVID-19.
An initial 3 million doses of CoronaVac arrived in Indonesia in December, though only 1.2 million doses have been distributed so far across the country.
Indonesia has signed deals to secure about 330 million doses altogether – including 1.25 million from Sinovac, and smaller amounts of the Pfizer, Moderna and AstraZeneca vaccines.
The country, with a population of 270 million people, has by far the highest death toll and infection rate from COVID-19 in South-East Asia.
Doctors and medical staff – of whom about 500 have died from COVID-19 – along with other frontline workers who deal with the pandemic will be among the first to receive vaccinations from this week, ahead of the elderly and public servants.
But some health experts are doubtful about the vaccine's efficacy and sceptical that two-thirds of Indonesia's population can be vaccinated within a year.
Results from human trials at Bandung in West Java – which involved 1,640 volunteers – showed the vaccine was 65.3 per cent effective against COVID-19. But none of the volunteers were over the age of 59.
"We don't have a vaccine for elders because the Sinovac vaccine... is for those 18-59 years old," epidemiologist Pandu Riono from the Public Health Faculty at the University of Indonesia said.
"Everyone knows that most people who die from COVID-19 are older. To fight the pandemic we have to push down the death rate among the elderly, but we haven't prepared a vaccine that can be used by elderly people."
A similar trial in Brazil involving 13,000 people – that did include elderly volunteers – was just 50.4 per cent effective at preventing symptomatic infections, researchers said.
It is much lower than researchers had earlier suggested and barely enough for regulatory approval. A third study in Turkey showed the vaccine was 91.25 per cent effective, although the trial involved only 1,300 people.
Nevertheless, BPOM said the Bandung results were still higher than the 50 per cent efficacy rate set as a threshold by the World Health Organization.
"The CoronaVac vaccine has shown it can form antibodies that can kill and neutralise the virus," BPOM's head, Penny Lukita said. "It has fulfilled the requirements to be granted emergency use authorisation."
Public trust in vaccines is low in Indonesia. A recent survey by LaporCOVID-19 – an independent data website – found 69 per cent of Indonesians were uncertain about being immunised.
Indonesia's influential Ulema Council, the peak council of Muslim clerics, last week declared the Sinovac vaccine was "holy and halal". It's an important assurance in a Muslim majority nation, where many Indonesians refuse vaccines that contain pork DNA.
So can Indonesia fulfil its mass vaccination target?
Health Minister Budi Gunadi Sadikin expects more than 100 million vaccines could be rolled out across Indonesia by the end of February. "The president gave me a challenge to complete this within 12 months, I will try hard to achieve that," he said.
But Indonesia faces enormous logistical hurdles to achieve mass vaccination across such a vast archipelago of about 17,000 islands. Tens of millions of people live in far-flung areas accessible mainly by boat or poor roads.
The Pfizer and Moderna vaccines need to be transported at much cooler temperatures than normal vaccines, creating huge challenges for transportation and costs.
The Health Minister has questioned whether health clinics in many remote areas of Indonesia have adequate refrigeration to store even the Sinovac doses.
The sheer number of vaccines needed poses undoubtedly the biggest challenge in the world's fourth biggest nation, where Mr Widodo has promised the coronavirus vaccine will be free to all Indonesians.
The 330 million doses that have been ordered won't be enough to vaccinate the entire population, given two doses are needed to give lasting immunity.
And even after the first doses are given, the Government has given no detail on how or when the second dose will be distributed.
Experts estimate closer to 400 million doses or more are needed to achieve herd immunity, where at least two-thirds of the population are inoculated.
Though some health experts including Pandu Riono warn that even in the best-case scenario, vaccines alone won't achieve herd immunity this year at least.
"Herd immunity is when we want to eradicate COVID-19, and that is not realistic," he said.
"More important is controlling the pandemic, by bringing the number of cases down, and reducing the reproductive rate from 1.5 to below one so the spread decreases.
"We should try everything to push the infection rate down, not just with vaccines, but by increasing testing, social distancing and so on. A combination of those measures will help us control the pandemic."
Mr Sadikin predicts it will take at least 15 months to vaccinate all Indonesians, and three-and-a-half years to vaccinate the whole world.
Indonesia's state-owned pharmaceutical company BioFarma has signed a deal to produce at least 40 million doses of the CoronaVac vaccine, but it is also trying to develop an Indonesian vaccine.
The plan is only in early animal trials, and it could be years before the project leads to a successful vaccine, if at all.
What is happening with coronavirus in the country?
Almost 850,000 people have been infected so far in Indonesia, and more than 24,000 people have died.
More than 10 per cent of deaths and cases have been in the past two weeks alone, since the Christmas-New Year holiday sparked a new surge of mass movement.
In recent days, the number of new daily cases has hovered around 10,000, a huge spike in the past month.
Recent testing rates suggest as many as 30 per cent of those tested are proving positive, meaning the true number of cases is undoubtedly higher.
Indonesia has imposed only partial restrictions on movement, and no full lockdown since the pandemic first hit in March. It is banking on the CoronaVac and other vaccines to bring down its skyrocketing rates of infection.