With its first shipment of China’s experimental CoronaVac vaccine arriving this week, Indonesia still faces a mammoth task to combat the continuing surge in infections from the coronavirus.
About 1.2 million doses from Sinovac Biotech in Beijing arrived on Sunday, but they will barely scratch the surface of the COVID-19 pandemic in a country of 270 million people.
Daily figures continue to show the crisis is worsening in the world’s fourth-most-populous nation.
Indonesia has by far the highest number of infections in South-East Asia, and the second-highest in Asia, with almost 600,000 total cases and more than 18,000 deaths.
The vaccine still needs approval from Indonesia’s food and drug agency (BPOM) before it can be distributed.
But with only 1.2 million doses, and a second batch of 1.8 million doses of CoronaVac set to arrive in January, it would mean the vaccine will be rolled out to barely 1.5 million people once it is approved, given it needs to be administered in two doses.
Indonesia, along with Brazil and Turkey, is among several countries taking part in stage 3 clinical trials for Sinovac.
However, there have already been mixed results from early trials of the vaccine in China, which have raised questions about its efficacy.
While the vaccine has so far proven to be safe in preliminary trials, Sinovac has acknowledged that it generated lower levels of protective antibodies in blood serum than were measured in patients who had recovered from COVID-19.
Despite this, the company believes the vaccine will still induce a quick immune response.
More than 1,600 volunteers in West Java have had multiple injections since August. None has so far shown any adverse side-effects, though final results of the trial may not be known until January.
BPOM will evaluate the results next month.
If the vaccine is approved, as expected, Indonesia’s state-owned pharmaceutical company BioFarma would begin manufacturing tens of millions of doses for distribution to the wider population.
Doctors, nurses and other frontline workers would be among the few to receive early vaccinations.
Indonesia’s hospital system is already under strain
For many health workers, a vaccine will not arrive a day too soon.
Almost 200 doctors and at least 136 nurses have died from COVID-19 in Indonesia.
Many have worked in ICU wards or COVID-19 hospitals that are coming under increasing strain — partly due to healthcare workers themselves being struck down by the virus.
Radiologist Dr Sardjono Utomo, for example, admitted himself to hospital in Pamekasan, in East Java, last Friday while struggling to breathe.
But there wasn’t a single ventilator in the entire town. Hospital staff spent hours trying to source one from other hospitals in the region, including Indonesia’s second-biggest city, Surabaya.
The search was futile. Within 24 hours, Dr Sardjono and his wife Sri Martini, both in their sixties, were dead.
It has highlighted the desperate state of many hospitals in Indonesia, particularly in Java — which is the world’s most populous island and the epicentre of Indonesia’s pandemic.
“Everywhere was full. And everything is full here in Pamekasan,” Dr Syaiful Hidayat, a pulmonologist who treated Dr Sardjono, said.
“Now it is peaking.”
Some hospitals in greater Jakarta have already reached 80 per cent capacity or higher. COVID-19 beds in a hospital in Jogjakarta were 95 per cent full.
One senior doctor has warned that many hospitals and health facilities could collapse under the mounting number of COVID-19 patients.
“If patients continue to go to health facilities and then health facilities become over-capacity, the hospitals will collapse,” Dr Irwandy, the head of the Hospital Management Department for the Faculty of Public Health at Hasanuddin University in South Sulawesi, said.
“The burden for hospitals is increasing. Not only do they have to care for COVID patients, they also have to care for non-COVID patients who have increased in number as well.”
Dr Irwandy also warned that the capacity of health facilities is not only about the number of beds or ICU but also “the human resources that we have”.
Some are dying before they can get ventilators
With the healthcare system overwhelmed, many Indonesians have taken to social media to beg for ventilators, hospital beds or other treatment.
One man complained on Twitter that a family member near Jogjakarta was number 40 on a queue for a ventilator.
“Number 40!” he wailed.
“My heart is wrenched.”
By the time one became available, his relative had died.
Another doctor, Chairul Hadi, filmed himself from his hospital bed in Surakarta, pleading with Indonesians who have recovered from COVID-19 to donate their blood plasma to help people like him.
“My condition improved significantly after receiving plasma,” he said weakly.
“Though I’m not fully recovered yet.”
The recent acceleration in COVID-19 infections has been blamed on a recent holiday weekend in October, when Indonesians travelled in droves to their home towns and villages, fuelling the spread of the virus.
In one tragic case, young nurse Lidya Asmira Wati and her fiancée Agape Iriandi Padwa travelled from Jakarta in October to her home village in central Java to be married.
The 28-year old woman twice tested negative for COVID-19 before travelling. But soon after the wedding she fell ill and died less than two weeks later.
Her mother died the following day, and her father three days later.
“I told them, delay the reception till things improve,” her sister Nurohmani said.
“But my sister and our parents insisted.”
Indonesia has implemented only partial lockdowns since the pandemic began.
In Jakarta, workplaces and shopping malls are still open, while public transport is as crowded as ever.
Only a handful of districts across the country have reported success in enforcing social distancing measures or mask wearing.
The Indonesian Government recently cut three days from the upcoming Christmas-New Year holiday, in a drastic bid to try to curb the rampant spread of the coronavirus.
But it is unlikely to make a big difference.
Only this week more than 100 million Indonesians were eligible to vote in regional elections for mayors and governors across the country.
The election was already postponed from September in the hope the pandemic would ease. Instead, the mass turnout has coincided with another huge surge in infections.
The fear is that this will only get worse with the upcoming holiday period.
Dr Irwandy has already warned another wave of cases in the new year is likely.
“I think in January we will really feel the impact of the surge in cases, and in the end our health facilities, in this case our hospitals, will be impacted,” he said.