Budi Gunadi Sadikin, Health Minister: Vaccine is Not a Political Commodity
Health Minister Budi Gunadi Sadikin
THE Covid vaccination program is now the top priority of Health Minister Budi Gunadi Sadikin. To overcome the hiccups in the distribution of the Sinovac vaccine which must be stored at minus two-eight degree Celsius, the health ministry is exploring ways to collaborate with the private sector. It has also launched a public campaign to reach out to the citizens skeptical of the Covid vaccine.
Since his appointment as the health minister last December, Budi Gunadi Sadikin has his work cut out for him to handle a myriad of Covid-19 related-matters with vaccination at the top of his agenda. Two days after the vaccination program for 1.4 million health care workers kicked off on January 14, a total of 16,629 medical workers have already had their vaccine shots.
Amid various glitches it faces in shipping the vaccine to the regions, the health ministry targets to vaccinate 3 million people in January. “We could miss the target. We’re running into logistic problems as the vaccine needs a cold chain storage,” said Budi during a special interview with Tempo at his South Jakarta official residence last Friday, January 15.
He explained that the distribution of the first batch of 1.2 million doses to various regions was hampered by storage constraints. Cold storage facilities in some regions are already filled with other vaccines leaving little room for the Sinovac product. The government is currently seeking partnership with the private sector to tackle this problem. “(The stockpile) will get bigger and bigger and could peak at 25 million doses a month,” said the deputy state-owned enterprises minister for the period 2019-2020.
During the interview, Budi also talked about government’s initiatives for the vaccination program, from lobbying vaccine producers to approaching vaccine-wary public. An additional session of the interview was carried out via a video conference.
Has the vaccination program met the target so far?
We haven’t set a daily target yet. We target to vaccine 3 million in January.
Is it according to the timeline?
We could miss (the target) in logistics.
What are the problems?
In logistics preparedness, as the vaccine needs cold chain storage. It turned out we need far bigger capacity. We are recalculating as we go.
Not all health offices have adequate cold storage facilities?
They all have quite large facilities but they are being used to stock other vaccines. The pandemic has slowed down other vaccination programs and as a result, vaccines are still there in the facilities filling up the space. Generally, vaccines need to be kept at two to eight degree Celsius.
Is it true that the health ministry is working with Unilever which owns cold storage facilities down to the retail level?
We’re exploring all venues to overcome the problem quickly including seeking cooperation with private companies with strong supply chains, particularly cold supply chains.
How worrying is this cold chain logistics issue?
Cold chain logistics is highly critical in making vaccination programs successful. That’s why we went all out to make sure that storage was ready. There are always hurdles for sure but this is not a small hurdle. We didn’t predict it since we’ve never received so much so fast. We’ve tried to prepare everything but we were pushed for time. I checked as soon as I came on board on December 23 and found that not everything was as ideal as we wanted.
Could you give us examples of the problems, and what will be the solutions?
The shipment of the first 1.2 million doses was not completed in two days as targeted. There wasn’t enough storage space as the facilities still filled with other vaccines or reagents. So, the reagents were moved to make space for the vaccine. It happened in several provinces. Now the problems with the distribution to regencies and cities have been solved.
How many community health centers (Puskesmas) and other health care facilities have not received the vaccine due to the lack of storage facilities? Is it also a problem?
Yes, it is. Puskesmas during the Suharto era was orderly complete with logistics facilities. But since the regional autonomy, there’s no more national standardization. It completely depends on the regional heads with their own standards to manage the Puskesmas. Consequently, the cold chain facilities built in the past are no longer in the same condition. That’s what makes this already massive and widespread vaccination program even more challenging.
Under the circumstances, how will other vaccines such as those from AstraZeneca and GAVI be stored?
That’s what we’re currently trying to work out. From the shipment of 1.2 million doses, we already know there are problems. Perhaps the private sector that have cold chain logistics could assist us. Several large companies have the capacity. Since this is for the sake of the country, we all should work it out together.
Health Minister Budi Gunadi Sadikin during a meeting with the House of Representatives’ Commission IX, discussing Covid-19 vaccine availability and the implementation of the vaccination program, at the Parliament Building, Senayan, Jakarta, January 13. Antara/Rivan Awal Lingga
Which regions are in critical conditions?
The places where hold-ups occurred were Aceh, North and South Sumatra, Jakarta and two regions in Sulawesi. The storage facilities were full of other vaccines or goods.
Has the problem been resolved?
The first batch has already been distributed but we all know that it was a small batch. It will become bigger and bigger and could peak at 25 million doses per month. That is a challenge.
The Indonesian Chamber of Commerce and Industry has called on the government to open access for independent vaccines for the business world to expedite even vaccine distribution. Is it feasible?
The government is providing the vaccine for free. It means one can’t choose the type (of vaccine), the timing or the place of vaccination since it’s up to the state. If others want freedom of choice, as long as they don’t create crowds and negative narratives, that option is open for discussion. But the initiative shouldn’t end up creating a perception that the rich have the priority or the free vaccine could be sold. For sure, it is still a plan and not decided yet.
Is there a great chance for that option?
I cannot answer that because it hasn’t been discussed in depth. The House of Representatives (DPR) has also asked the same question. As far as I’m concerned, I’m open for all kinds of options provided we can vaccinate as many people as possible, as fast as possible, and as cheaply as possible. But right now, we’re still busy with the cold chain issue and vaccinating health care workers.
So, is it true that there are many companies asking for independent vaccination?
Yes, for their employees. Their intention is good.
Can they buy the vaccines on their own?
It has to be regulated. We don’t want them to buy the wrong vaccines or at the wrong prices.
It means they would need permit from the health ministry?
Yes, they do.
Is the wave of vaccine rejection still causing concern?
We were still concerned about rejection in the first week. Initially, not all health care workers wanted to be vaccinated. But thank God it’s not that bad now. People began to have faith after the President had his vaccine shot, you see. Many experts also began to promote it.
Is it true that some health care personnel refused the Sinovac vaccine on the ground of poor quality?
Yes, it is. Not everyone has the same preference, right? Based on the WHO (World Health Organization) standard, the efficacy should be above 51 percent. It set the standard after conducting thousands of vaccination programs. Secondly, it was approved by the Food and Drug Monitoring Agency (BPOM). It means it has met the safety and efficacy standards.
As regards vaccine rejection in the regions, what is the process of the government’s initiative to involve influencers such as Raffi Ahmad?
In essence, the government wants us to reach out to and encourage people to take part in the program. That’s why the President was chosen as an influencer figure. If he shows his confidence in the vaccine’s safety, more people will feel safe to be vaccinated. We also chose other figures representing respective segments.
Did you need the President’s approval for the selection?
It was discussed within the subordinate team.
How huge is the impact of vaccine rejection openly voiced by public figures such as DPR member Ribka Tjiptaning?
I asked around five to 10 people. It didn’t sway their opinions.
Surveys in the regions where Jokowi lost during the presidential elections show vaccine rejection among the people. What is the government’s strategy to respond to this?
Vaccination is a highly scientific matter. It’s absurd if it is used as a political commodity. It shouldn’t be. Many see it as a shield to protect themselves. Actually, the main purpose of the Covid vaccination is not for self-protection, but to create herd immunity to stop the pandemic. That needs to be straightened out. Why it has to be done to 70 percent of the population? So that the virus can no longer spread. That’s why WHO has set up GAVI to provide free vaccination access to the global population.
As regards the ongoing discourse of mandating vaccination, can it cause even more objections against vaccination?
We have to convince the public by explaining that vaccination will only work if the 70 percent of the population is vaccinated to achieve herd immunity. I personally feel that a good communication is far better than no communication at all or coercion. We also have to explain that this is a huge collective responsibility. It’s not about individual protection.
Many criticize that you seemed to be preoccupied with vaccination instead of intervention to reduce Covid transmission. What is your response?
It’s just a matter of priority. If I’m asked, ‘Pak, why don’t you take care of this or that?’ well, I’m not an angel. I’ve been in this position for only three weeks, excluding the holidays. I’ve been working just one and a half week, to be precise. If I’m asked to handle testing and tracing at the upstream and downstream, I simply can’t. Besides vaccination, I also have to manage hospitals. On the second day after taking office, I invited them. They said (infection) would explode in the second and third weeks because of the holidays. Bad luck, right? I chose to save those in front of my eyes rather than talk about strategy, planning and let people die as we talk.
Hospital capacity is improving after you appealed to private hospitals for more room capacity, isn’t it?
It wasn’t an appeal. I issued a circular letter to all hospitals to add more rooms. The capacity has since increased.
Adding rooms perhaps is easy, but what about the preparedness of health care professionals?
Every hospital is facing manpower shortage. I just learned that there are 10,000 nursing graduates unable to work because they need the registration card (STR) from the national nursing association to work. I issued a letter to ease the rule during the pandemic. We now have over 1,000 more nurses ready to work. So, if I can’t fulfill the expectations of everyone, well, I apologize. There are pressing issues that need to be prioritized.
Regarding the procurement of AstraZeneca’s vaccine, what are the latest developments? Is it true that there are renegotiations because the government at first was not willing to make the US$250-million down payment?
AstraZeneca has signed a sale contract with the Bio Farma about two weeks ago.
What is the impact of the delayed contract? Has the price gone up?
The price hasn’t changed. Nor the quota. Only the shipment was delayed. The vaccine is patented by the Oxford University. It is the cheapest vaccine we’ve bought except the free one.
I’m not allowed to disclose it because we have a confidentiality clause.
How many doses will Indonesia receive?
First, 50 million doses with an option for another 50 million.
AstraZeneca allows other countries such as Thailand and India, for example, to manufacture its vaccine. Why didn’t Indonesia pursue the manufacturing right for it but chose the Sinovac vaccine instead?
Because we are not familiar with their technology. Our factories are old and usually only two out of four have the vaccine manufacturing facilities. The oldest technology uses weakened or deactivated viruses. That’s the one Bio Farma uses. Sinovac and Sinopharm are also on the same platform. They both use the recombinant protein technology. Bio Farma can also do that. Other vaccines that use this platform are the Red-and-White and Novavax. The third and more modern vector technology is used by Cansino and AstraZeneca. The fourth which uses the nucleic acid, either DNA (deoxyribonucleic acid) or RNA (ribonucleic acid), is the most modern technology. It is a complete genetic engineering technology. We don’t have any factory that has this technology.
Some say that we were late in getting the vaccines from Europe and the United States so we turned to Sinovac. Is it true?
Actually, we sought the Sinovac vaccine very early on, you know. Bio Farma perhaps got it in March or April. Only two companies approached Indonesia, AstraZeneca and Sinovac. The rest refused to do that. And we chose Sinovac because they were willing to transfer the technology so we can manufacture the vaccine here. I think we were not late. On the contrary, we were quick. As soon as we inked the deal with Sinovac, others came in because Indonesia is a huge market.
Several people have died in some countries after getting Pfizer’s vaccine. What is your view?
Actually, there should be an independent monitoring commission in each country. We have an AEFI (adverse events following immunization) plan here in Indonesia. In case of death, whether it’s due to vaccine, stabbing, traffic accident or food allergy, it must be investigated. It’s too premature to make conclusions. But many say that the higher the efficacy, the stronger the vaccine is.
Strong in what sense?
It can cause hypersensitivity reaction.
The interim report from the phase III clinical trial of the Sinovac vaccine in Bandung only took efficacy data of 540 out of a total 1,600 volunteers. Is it sufficient?
It is still an interim report. Usually the final report is conclusive. Just like Pfizer, Moderna and AstraZeneca. None of them has completed yet. I leave it to the BPOM as the regulator because I don’t know the rules.
Are other vaccines also awaiting clearance from the BPOM?
Yes. It’s just that the clinical trials of the other vaccines were not done in Indonesia so the BPOM will use the reliance mechanism based on the approvals of the respective drug regulators of the countries where they conducted clinical trials.
Pfizer has asked for legal indemnity in case of problems with their vaccine. What is the government’s stance?
Perhaps there will be a tripartite agreement between Bio Farma, Pfizer, and the government. As a whole, it’s between Pfizer and Bio Farma albeit a few areas which will involve the government. That’s the current plan.
In case of AEFI, who will bear the cost of compensation in case of adverse affects from the vaccines? Will it be the government?
Actually, the AEFI is for other existing vaccines. According to the current mechanism, it is distributed via the Health Care and Social Security (BPJS) for JKN (National Health Insurance) members. For non-JKN citizens, we are preparing a presidential decree so it will be borne by the government. But (the cases) must go through the AEFI validation process. There are regional and national committees to ascertain that the effects are indeed caused by vaccines.
BUDI GUNADI SADIKIN
Place and Date of Birth: Bogor, May 6, 1964
Education: Bachelor of Science in Physics, Bandung Institute of Technology (1988)
Career: Minister of Health (since December 23, 2020), Deputy Minister of State-Owned Enterprises (2019-2020), Chief Executive Officer, PT Indonesia Asahan Aluminum (2017-2019), Special Staffer to SOEs Minister (2016-2017), CEO, Bank Mandiri (2013-2016), Director of Micro and Retail Banking, Bank Mandiri (2006-2013), Executive Vice President, Head of Consumer Banking, Bank Danamon and Director, Adira Quantum Multi Finance (2004-2006), Director of Consumer and Commercial Banking, ABN AMRO Bank for Indonesia and Malaysia (1999-2004)