Government Does Not Ban Independent Vaccines

Sapto Yunus ()

THE recent alleged corruption in the social aid package distribution program for people affected by the Covid-19 pandemic has spurred the government to modify its Covid-19 response assistance program. “The assistance will now be in cash form and will be distributed throughout the country,” Human Development and Culture Affairs Coordinating Minister Muhadjir Effendy said during a special interview with Tempo on December 15.

The cash payment for 38.8 million recipients began on January 4. The total fund earmarked for Family Hope Program (PKH), Kartu Sembako (Provision Card) and direct cash assistance throughout 2021 amounts to Rp85.82 trillion. Muhadjir, 64, explained that the new scheme could help minimize potential misappropriation by rent-seeking opportunists although he added that the new program was not without shortcomings, because other than for basic supplies and school needs, recipients often spent it on non-essential items such as mobile phone credits, cigarettes or even alcoholic drinks.

Besides personally overseeing the distribution activities, Muhadjir is also involved in the preparation of the vaccination scheme. Muhadjir, who also holds the position of 3rd Deputy Chair of the Covid-19 Mitigation and National Economic Recovery Committee (KPCPEN), is one of the ministers who promoted independent or paid vaccination. He reasoned that as in the case of swab test, it would not be possible for the government to take full control of vaccination activities. “That’s why we engaged the private sector to provide vaccination services at competitive prices and convince (the public) of the quality of the vaccines they offer,” he added.

Accompanied by his deputies, Muhadjir received Tempo’s Stefanus Pramono, Mahardika Satria Hadi and Linda Trianita at his office. The former education and cultural affairs minister talked about the issues surrounding the Covid-19 social assistance program, a tug-of-war over vaccination as well as his view regarding the alleged corruption charges against Juliari Batubara. The interview was supplemented by WhatsApp chats last Friday, January 8.

Since your appointment as the ad interim social affairs minister, what actions have you taken to improve the problem-plagued aid distribution system?

As an acting minister, I have limited authority and as such I am not allowed to take strategic decisions. I’ve taken some steps to improve instrumental areas. For instance, for the PKH, I’ve proposed to eliminate the student section from the card because it overlaps with the Smart Indonesia Card (KIP). Even if it isn’t eliminated, (the allowance) should be reduced and the fund diverted to tuberculosis control or anti-stunting programs. Then the cash assistance program needs improvement as it has weaknesses.

What kind of weaknesses?

We can’t control how the recipients use the money. That is the most fundamental loophole of the program. Based on our internal survey, the cash is primarily used for basic necessities, school needs and cigarettes. So, our poor people still put cigarette as their number three priority. We’ve made a list of positive and negative spending from the cash assistance. Besides cigarette, other items in the negative list include mobile phone credits and alcoholic drinks.

How will you overcome these weaknesses?

There will always be weaknesses in any system we set up. We just have to minimize the negative effects. We provide a kind of shopping guide to the recipients so that they don’t deviate from the rules. Before the next round of distribution, we will check their shopping list to see if it’s in line with the items (in the guide) and where they shop to ensure they don’t shop in e-warong. We let them shop freely and from the (shopping) list we will map stalls in Jakarta that have the potentials to become shopping places (for the recipients). This will also help breathe life back into micro, small and medium enterprises (MSMEs) and sever the chain of rent-seekers.

Did you feel surprised by Juliari Batubara’s arrest in early December?

I was in shock.

Why?

He’s a hard and fast worker. We don’t always get along but I was happy to have (him as) a partner. I was mostly in the field during the fasting month. Until 10 days before the end-of-the-fasting-month celebration Lebaran, I and Pak Ari (Juliari) were still in the field making sure everything, particularly for the Jabodetabek (Jakarta, Bogor, Depok, Tangerang and Bekasi). That’s why I know all the details of the cases on the ground.

Didn’t your ministry keep watch on the procurement process for the basic food items?

That is entirely the jurisdiction of the technical ministry (the social affairs ministry) so I didn’t interfere.

What did you find during the inspection?

The goods were in good condition, packing was good and distribution was good. Shortcomings, if there were, were minor. In Jakarta, for example, there was a neighborhood or community unit chief who asked for compensation to deliver the aid packages to the residents’ houses. I also saw in some places that the aid especially rice was not distributed to individuals but shared equally among the residents. We can’t forbid them once the aid is already in their hand.

Where did you usually find cases like these?

In several places in Jakarta. To avoid commotion, neighborhood chiefs decided to distribute the aid equally to everyone in need. For example, in a given block, 100 families were expecting to get the aid but only 50 families got it. So, it was divided equally. I think that’s fine. Helping one another.

Does it still happen until now?

I guess not after we regulated it.

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Before deciding to give free vaccination to the public, the government mentioned independent or paid vaccination. What was the reason behind the change?

Initially, independent vaccination was meant for those who indeed prefer to be independent, for example, to have preferential treatment. Vaccines can be a public good or a good under the government’s control and also a private good or a good supplied by the private sector. This approach has been proven to work as seen in swab test. It wasn’t possible for the government to control swab testing as the private sector offered services at competitive prices by convincing the public of the quality of the testing they offer. The same goes for vaccination.

Why did the government finally decided to provide the Covid vaccination for free?

It was the President’s decision. Before that, there were differing opinions among some ministers, including myself, regarding the appropriate ratio of free and paid vaccination, possible complexity in executing the policy, the operational definition of herd immunity and the budget availability. I’m glad that to resolve complex issues, the President always opens room for debate among his assistants before taking final decisions.

What percentage of the population will get vaccinated?

The problem now is the definition of herd immunity. The purpose of vaccination is to create herd immunity. According to the WHO (World Health Organization) it has to be 70 percent but what the WHO doesn’t discuss is the viral load factor.

How did the discussion about it go in the cabinet meeting?

For Singapore, for example, we can assume that the entire island is prone to high viral loads. So, 70 percent of its total population of six million people will be vaccinated. Meanwhile, the virus doesn’t spread evenly in Indonesia. Well, to explain it roughly, the Covid has struck Java, Bali, part of South Sulawesi, South Kalimantan, South and North Sumatra. Then, do we need to consider the populations in other regions which don’t have extremely high viral load levels for vaccination?

Should they be?

I don’t think they should be. For Indonesia, we need to calculate carefully as it concerns costs. A common belief is that the more people are vaccinated, the bigger the impact will be. But this is a matter of cost and most of it is funded from the state budget. If the money has to be borrowed, it will become the public’s burden. President was very cautious about it. So, he ordered to calculate everything thoroughly.

Why did the government decide to give it free if it’s facing budget constraints?

Because the budget issue was finally resolved. If I’m not wrong, Ibu Finance Minister (Sri Mulyani) has made available Rp73 trillion.

Was it the president who asked to change the scheme to a free program?

Yes, the initial scheme proposed by me and the health minister (formerly Terawan Agus Putranto) was 30 percent free and 70 percent independent.

What was the rationale behind your proposed scheme?

My assumption was that many would be interested in the independent scheme. In principle, to take joint responsibility in helping one another for the mutual interest of all of us. Those who can afford it even though they may have the BPJS (the state health care and social security services) subsidies, please spend the money if possible, for the common interest.

Some people are willing to spend and go for other vaccines instead of the Sinovac vaccine as they are not sure about the quality.

I guess it’s okay. The government is responsible for the safety of the public good. The free vaccine is a public good so its safety and efficacy has to be guaranteed. But the government will not stop those who don’t have faith in it from looking for other alternatives. That’s why it allows an alternative called independent vaccination.

To achieve herd immunity, is it sufficient to vaccinate just 70 percent of the population in the regions with high infection rates?

That’s my view and the President concurred in that context, but for sure it’s not easy to map out. We already have the map but not in detail since the public has long been fed a map of color-coded zones which in my opinion is misleading.

Why is it misleading?

I think in certain ways it can cause misunderstanding or even panic and despair.

Minister Muhadjir Effendy in a discussion on optimizing human resources in the midst of the Covid-19 pandemic, at the Parliament Complex, Senayan, Jakarta, December 2. Antara/Akbar Nugroho Gumay

How so?

Well, okay, Jakarta was said to be all red but were all places in Jakarta red? No, right? They should have done a more detailed mapping as the President has advised from the beginning. If a city turns to a red zone, find out where the infections are happening. Then immediately order limited isolation or quarantine. There was a regency declared as red but it turned out infection occurred only in two subdistricts. Upon checking, it was only in two villages. After further tracing, only in one neighborhood unit. So, they should have quarantined that neighborhood unit only and done contact tracing.

What is the final vaccination concept agreed upon by the government like?

Pak Airlangga (Coordinating Minister for the Economy and Chair of the KPCPEN, Airlangga Hartarto) said we should keep moving. The agreed doses for the time being is 182 million doses. That is a maximum figure including those below 19 years old and above 59 years old who will not be receiving (Sinovac) vaccine. After excluding them, it comes to about 160 million doses. That’s why the President has mandated to quickly search for vaccines that could be used at least for the people over 59 years of age.

Is it the reason why the government is exploring to procure Pfizer-BioNTech’s vaccine?

Yes, but we are facing tough negotiations as the vaccine has to be stored at a minus 70 Celsius room. That poses difficulties except for major cities such as Jakarta. The President has instructed to pay attention to this matter. Otherwise, I will also be among those who won’t get vaccinated, (chuckles)...

Do you also want to be vaccinated?

I believe this isn’t about what I want or don’t want. If I have to be vaccinated, I have to get vaccinated.

Given the pandemic, shouldn’t vaccination be made compulsory for the whole population?

There is no plan yet for that.

The WHO has already urged the nations to not impose mandatory vaccination on their citizens. Will the government follow the advice?
There hasn’t been any discussion to this effect. We are still in the process of convincing the public that the vaccine is safe, halal (permissible in Islamic law) and not dangerous.

The Food and Drug Monitoring Agency (BPOM) has not issued the emergency use authorization for the Sinovac vaccine. Why has the vaccine distribution already begun and vaccination is already scheduled for January 13?

For the sake of time efficiency. To expedite the process. That’s why the distribution is done in parallel with the analysis for safety, efficacy, and halal quality.

Because of their doubts about the quality of the Sinovac vaccine, some people prefer other vaccines that are either still not available or available in small quantity. How will the government overcome this issue?

For halal analysis, the Indonesian Ulema Council (MUI) visited the factory in China and did a preliminary test before the vaccine arrived. For efficacy and safety, apart from relying on the clinical trial carried out in Indonesia, we also refer to the promising clinical trial results from other countries that will be using the same vaccine such as Turkey and Brazil. We estimate the result of the trial in Indonesia to be more or less the same. In the latest development, it is reported that several other vaccines will also be brought in. Even though the vaccination is free, I think people can still opt for independent vaccination in line with their preferences.

(The fatwa (edict) commission of MUI on January 8 declared that the Covid-19 vaccine made by Sinovac is pure and halal.)

Is it true that the BPOM has been pressured to promptly issue the emergency permit for the Sinovac vaccine?

Pressured, no. But urged to expedite the process, yes. But it doesn’t mean they should forgo the procedure. That’s why the President has asked them to prepare a type of roadmap so that we know what kind of procedures—both administrative and medical—that the BPOM needs to go through in order to issue the emergency use authorization. Also how long does it take? Is it possible to shorten it? Only that. There’s no pressure.

MUHADJIR EFFENDY | Place and Date of Birth: Madiun, East Java, July 29, 1956 | Education: Bachelor’s Degree, Tarbiyah Faculty, Malang State Islamic Institute (1978); Bachelor of Social Education, Teachers’ Training and Education Institute Malang (1982); Master of Public Administration, Gadjah Mada University, Yogyakarta (1996); PhD in Social Sciences, Airlangga University, Surabaya (2008) | Career and Organization: Member, Ma'arif Institute Board of Trustees (Since 2010); Member, Expert Council of the Indonesian Muslim Intellectuals Association (ICMI) East Java (2010-2015); Professor of Sociology of Outdoor Education, State University of Malang (2014); Member, East Java Regional Research Council (since 2014); Chairman, Muhammadiyah Center for Higher Education, Research and Development (2015-2020); Rector, Muhammadiyah University, Malang (2000-2016); Minister of Education and Culture (2016-2019); Coordinating Minister for Human Development and Culture (Since October 2019) | Award: Satyalencana Karya Satya XX (2010)