Young people first
\nIndonesia starts mass vaccination on Wednesday, but experts say inoculating young people first will not help reduce fatalities because it is the elderly who are most at risk.
\nMonitoring Desk
\nJakarta, Indonesia
\nIn the UK, the first person to receive a COVID-19 vaccine outside trial conditions was a 90-year-old pensioner. In Canada, the first recipient was only marginally younger at 89. In Germany, a 101-year-old nursing home resident was first in line.
\nBut in Indonesia, the country worst affected by the virus in Southeast Asia with 836,718 confirmed cases and 24,343 deaths, the government has chosen an unorthodox vaccination strategy.
\nIn the first phase that begins on Wednesday and continues until the end of March, 1.3 million healthcare workers and a further 17.4 million workers from the public service \u2013 police, soldiers, teachers and bureaucrats \u2013 will receive free jabs of CoronaVac, the vaccine developed by Chinese firm Sinovac Biotech. After that, it will be working adults.
\n\u201cIndonesia is targeting the productive age at 18 to 59 years instead of elderly people because we have not completed the stage three clinical trials for people this age range with the Sinovac vaccine,\u201d Ministry of Health spokesperson Dr Nadia Wikeko told Al Jazeera. \u201cWe are still waiting for the BPOM (Indonesia\u2019s agency for drug and food control) review to see if the vaccine can be used safely for people over 60.\u201d
\n\u201cBecause older people in Indonesia mostly stay at home, the chance of being infected is lower than that of people of working age,\u201d said Putu, a 56-year-old Balinese woman who like many Indonesians goes by only one name. \u201cSo, if younger people get vaccinated first, they can visit older people safely.\u201d
\n\u201cWe know that older people who have already been vaccinated in China and the Middle East have responded as well to the vaccines as younger people,\u201d said Kim Mulholland, a professor of vaccinology at the London School of Hygiene and Tropical Medicine who is based at the University of Melbourne. \u201cSo the argument that older people should not be vaccinated because they have not been included in trials in Indonesia is not valid.\u201d
\nIndonesia\u2019s strategy is the reverse of the accepted wisdom on vaccination, with medical experts saying the first groups to be vaccinated should be front-line medical staff and then the elderly.
\n\u201cOlder adults, particularly those who are frail or living in long-term care facilities, have been disproportionately affected by the COVID-19 pandemic,\u201d found a recent study published in The Lancet, the world\u2019s leading medical journal. \u201cVaccines that are safe and effective in this population have been eagerly anticipated.\u201d
\nMulholland puts it like this: \u201cIf you look at all the studies conducted in every country in the world, the evidence overwhelmingly shows the greatest risk factor for becoming gravely ill from COVID-19 is age. Even in Indonesia which has a young population, the most deaths are people over 60.\u201d
\nData released by Indonesia\u2019s Ministry of Health corroborates the argument. People over 60 years of age represent only 10 percent of Indonesia\u2019s population but 39 percent of COVID-19 fatalities.
\n\u201cSo that makes me think about what my Indonesian colleagues have been telling me: that what the Indonesian government might really be trying to do is to achieve herd immunity by vaccinating young adults who are the most potent spreaders of the disease,\u201d Mulholland said.
\n\u201cBut the problem with this strategy is that there is no evidence to suggest that vaccinations prevent recipients from acquiring and transmitting the disease. Effective vaccines have only been shown to prevent recipients from getting sick.\u201d
\nThe wrong vaccine?
\nIndonesia is one of six countries where Sinovac, a Chinese pharmaceutical firm, conducted phase three clinical trials for its CoronaVac experimental shot. Some 1,620 volunteers joined the trials which began in August, as the government secured 125 million doses of the vaccine and an option to secure an additional 100 million doses, 18 million of which have already been delivered.
\nIn December, the country spread its bets by placing firm orders for hundreds of millions of more doses from vaccine makers AstraZeneca, Novavax and Pfizer. It has also announced plans to develop and produce its own COVID-19 vaccine by mid-2021.
\nBut CoronaVac is the only vaccine that has received regulatory approval, and the only one already delivered in large numbers to Indonesia.
\n\u201cI think Sinovac is a good vaccine for this country because Pfizer\u2019s has to be kept frozen at -70C and we do not have \u2018freeze chain\u2019 logistics across Indonesia,\u201d said Dr Panji Hadisoemarto, an epidemiologist at Padjadjaran University in Java. \u201cBut with the Sinovac vaccine, you can store it in a cold-chain, which we have in Indonesia.\u201d
\n\u201cAnother benefit from using Sinovac is that it\u2019s an \u2018inactivated\u2019 vaccine,\u201d Panji said, using the term to describe vaccines with virus particles that are dead instead of alive. \u201cIt\u2019s the type of vaccine we use all the time in Indonesia for immunisation campaigns. They do not take a lot of training to administer.\u201d
\nBut Dr Dicky Budiman, an epidemiologist who helped lead the team that formulated Indonesia\u2019s strategic response to SARS, HIV, Avian Influenza, Swine Flu, tuberculosis and malaria, says Sinovac\u2019s is the last vaccine he would choose.
\n\u201cI would choose AstraZeneca\u2019s first because it can also be stored in a refrigerator like Sinovac\u2019s and they have a great track record, whereas Chinese vaccine makers do not,\u201d he said.
\nBudiman\u2019s equal second choice \u2013 Pfizer\u2019s and Moderna\u2019s vaccines \u2013 are harder to transport, but contain messenger RNA technology that makes the vaccine flexible and able to deal with new mutations of the virus.
\n\u201cEven a small mutation will have a significant impact on the effectiveness of a vaccine strategy and 40,000 mutations of COVID-19 have been found,\u201d he said. \u201cBut Sinovac\u2019s vaccine doesn\u2019t have any vac-flexibility so it would be the last one I would choose.\u201d
\nHe added, \u201cWe have a proverb in Indonesia \u2018Tidak ada rotan, akar pun jadi\u2019. It means \u2018make do with what you have \u2013 even if it\u2019s not good\u2019. That\u2019s what happens with rapid antibody tests in Indonesia,\u201d he said, referring to the epidemiological tool that was improperly used to screen domestic passengers at Indonesian airports last year. \u201cNow, they\u2019re doing it again with the vaccine. They already have millions of Sinovac vaccines, so they\u2019re going to use them.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
Young people first Indonesia starts mass vaccination on Wednesday, but experts say inoculating young people first will not help reduce fatalities because it is the elderly who are most at risk. Monitoring Desk Jakarta, Indonesia In the UK, the first person to receive a COVID-19 vaccine outside trial conditions was a 90-year-old pensioner. In Canada, […]<\/p>\n","protected":false},"author":2,"featured_media":168192,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-168173","post","type-post","status-publish","format-standard","has-post-thumbnail","category-world"],"yoast_head":"\n