Vaccines won't bring back normal life at once: Experts Dipublikasikan 11.29, 06/08/2020 • The Jakarta Post
A small bottle labeled with a 'Vaccine' sticker is held near a medical syringe in front of displayed 'Coronavirus COVID-19' words in this illustration taken April 10, 2020
A small bottle labeled with a 'Vaccine' sticker is held near a medical syringe in front of displayed 'Coronavirus COVID-19' words in this illustration taken April 10, 2020

The possible development of a vaccine has brought as much hope to Indonesia as it has to any other country battered by the COVID-19 pandemic.

President Joko "Jokowi" Widodo said in late July that he expected that next year the Indonesian economy would be able to recover and that a vaccine would be discovered and mass vaccination for "all the people in the country" would be rolled out.

Indonesia saw its GDP contract 5.32 percent in the second quarter of this year, the worst contraction since the 1998 Asian financial crisis, and unemployment haunts around 10 million people.

COVID-19 cases and deaths, meanwhile, continue to soar. The government reported 1,815 new cases and 64 new deaths on Wednesday, pushing the national tally to 116,871 confirmed cases -- including 42,982 active cases -- and 5,452 fatalities.

Government officials have nevertheless echoed Jokowi's sentiment. State-Owned Enterprises (SOEs) Minister Erick Thohir, who also helms the national economic and COVID-19 recovery committee, has claimed that state pharmaceutical holding company Bio Farma is ready to produce 250 million doses of a vaccine, although no vaccine has yet been approved for commercial use.

Experts firmly believe that vaccines will be effective in arming the people to better fight the coronavirus that causes the COVID-19 disease, and thus help to contain the pandemic sooner, as they have done with many other diseases.

However, many also believe that vaccines should not be seen as the only way out and that trials under way might fail. Even if they do succeed, experts say that the vaccines' efficacy may vary and immunity developed by vaccines may not last forever, while it might also take some time to leverage the vaccination drive in Indonesia, the world's largest archipelago of some 271 million people.

"We're working hard on developing the Merah Putih vaccine, but we hope all layers of society won't expect too much -- thinking that we already have the vaccines so we can loosen [health protocols] and that all the problem will end with a vaccine," said Amin Soebandrio from the Eijkman Institute for Molecular Biology.

Indonesia's Merah Putih candidate vaccine, named after the colors of the national flag, has yet to enter the pre-clinical phase and is not expected for mass production by Bio Farma until 2022.

Read also: What you need to know about Indonesia's vaccine development

Amin said that even with vaccines ready for public use, it did not mean the "virus would be gone" because the process to build immunity among those vaccinated, who in turn will protect those yet to be or not vaccinated, would be gradual rather than instant.

"We want to achieve the so-called true herd immunity, which is developed through vaccination," he said. "Indonesia has a large population. If [the threshold of vaccination coverage was to reach] 70 percent, then we'd have to vaccinate some [189] million people; and we couldn't possibly get to everyone in a week or two."

Achieving herd immunity would not only protect those vaccinated, but also immunocompromised individuals and those not yet vaccinated, hence preventing outbreaks.

Bio Farma's research and development project integration manager Neni Nurainy said that how far vaccines could protect the people would depend on their eventual efficacy, and whether people could possibly go back to their normal pre-pandemic life would also depend on the vaccination coverage to achieve the desired herd immunity.

According to the World Health Organization, no vaccine is 100 percent effective -- most routine childhood vaccines are effective for 85 to 95 percent of recipients and not all vaccinated persons develop immunity for a variety of individual reasons.

In another vaccine-making scheme, Bio Farma has partnered with China's Sinovac Biotech to roll out the last phase of clinical trials on humans for Sinovac's potential vaccine, and if it proves effective, it expects to produce 40 million doses in the first stage.

"In order for people to remain productive, people in the seven hardest-hit regions will be vaccinated first; Jakarta, Surabaya, Semarang, Yogyakarta, Bandung; big cities where the case numbers are high. So not all provinces will be given [the vaccine at first]," clinical trial research team leader and Padjadjaran University professor Kusnandi Rusmil said.

Read also: Wanted: Volunteers for first human trial of COVID-19 vaccine in Indonesia

The high hopes for vaccines are justified, epidemiologist at Airlangga University Laura Navika Yamani said, but there was always the possibility of candidate vaccines failing, such as with HIV, or not working as well as expected.

A working vaccine, she said, typically also needed further studies to find out whether the antibodies formed would remain strong enough or wane as time passed, and, therefore, require booster doses.

"Vaccines do bring hope, but it shouldn't be the only hope. Don't be too transfixed on vaccines so that if they fail, we'll be too disappointed […] There are many other efforts we can make to contain COVID-19," she said.

Another concern was the vaccination coverage rate needed to reach herd immunity, which varied according to viruses' characteristics, such as their reproduction number, Laura said.

She said that even with existing vaccines, Indonesia faced difficulties reaching the threshold, for several reasons, such as the vast geographical distances between regions, poor logistics, misinformation and antivaccine stances fueled by religious concerns over the vaccines' ingredients.

Production capacity of COVID-19 vaccines to meet the needs of all Indonesians is also a concern, hence authorities should communicate early to the public about any prioritized target groups, such as younger people who could produce antibodies better than the elderly, to prevent social jealousy, Laura said.

"What we want is to develop immunity through vaccination, not through natural infection. One of the ways to end the pandemic is to have people infected naturally, but if we let this go on now there'll be victimized groups. Susceptible groups will die,” she said. “With the COVID-19 mortality rate in Indonesia and globally now at around 4 percent, are we ready for that?"

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