Emma Connors, Jakarta/Sydney – Regional neighbours are being asked to do more to help after Indonesia this week joined 18 other nations that have reported more than one million COVID-19 cases.
Epidemiologist Dicky Budiman believes the true number of infections is likely to be three times the official count. This would mean the country would be among the 10 worst affected worldwide. He said Australia could assist Indonesia reduce transmission of the virus among its 270 million people by sharing its expertise in testing and treatment regimes.
"Indonesia has a lot of work to do to track down the many unidentified cases now spreading infection in the community," said Dr Budiman, formerly a health official in Indonesia and now a PhD candidate at Queensland's Griffith University in the Centre for Environment and Population Health.
On average Indonesia has conducted 32,276 tests per million people, according to World in Data. This is the lowest rate of testing reported by the 20 countries that have or are nudging 1 million cases (the Netherlands is at 956,867).
More than one in four – 27.7 per cent – of the COVID-19 tests in Indonesia are positive. In Australia, the positivity rate peaked at 3.8 per cent in March. The World Health Organisation regards a positivity rate of less than 5 per cent as a sign a country has the pandemic under control.
"Indonesia is a very close neighbour and what is happening there will of course influence Australia," Dr Budiman said. "The two countries already have strong links in health and we need to support the national testing system. Australia could also share with Indonesia its success with fever clinics."
These facilities, organised by Australian state governments and dedicated to assisting people who think they may have COVID-19 proved effective in the pandemic's early days and would be a good fit for Indonesia, Dr Budiman said.
"These could be set up in hard-to-reach areas in Kalimantan or West Papua, for example, so if health workers lacked the capacity to test, they could at least isolate those with symptoms," he said.
Indonesia's strong community and family networks that provide invaluable support for individuals when they get ill can also get in the way with infection and isolation protocols.
On January 11, the family of Sutomo, a resident of Bekasi in West Java, refused to sign a hospital transfer authorisation letter after he tested positive for COVID-19.
Family members feared they would not see him again, Sutomo told The Australian Financial Review. "If I had died, my family would not have been able to come. My body would have been wrapped and buried in a COVID-19 manner," he said.
Eventually he was forcibly taken to hospital. After 11 days, he was well enough to return home where he is now self-isolating, even though he has recovered. "I don't want to infect anyone. I know my neighbours are now afraid," he said.
Indonesia has begun an ambitious vaccination program that aims to reach 181.5 million people, but there are some big logistical and societal obstacles to be overcome. Data problems have already become a challenge, distribution and transport across thousands of islands is still to be worked out, and a troubling percentage of Indonesians are not yet convinced of the inoculation's merits.
On Wednesday, Indonesian President Joko Widodo became the first in the country to become fully vaccinated against COVID-19 after receiving a second jab. The Palace hopes his example will reassure others. Recent surveys suggests many remain dubious about the merits of vaccination.
One poll by the Democratic Party Research and Development Agency found only 31.2 per cent of 1000 respondents backed the vaccine. A government survey of 115,000 conducted last year was more optimistic, with fewer than 8 per cent rejecting a vaccine outright. However, 27 per cent said they were unsure.
The country's health workers are first in line and so far 245,685 have received their first jab.
The government hopes 1.49 million doctors and nurses will have been vaccinated by April. However, there have been problems with the database that prioritises workers for vaccination, with some who qualify failing to be registered and others who shouldn't be on the list – such as pregnant women – getting called up.