COVID-19 cases are skyrocketing in Indonesia. Can a new Minister of Health make a difference? | Science

ScienceCOVID-19 reports are supported by the Pulitzer Center and the Heising-Simons Foundation.

A new face at the head of Indonesia’s health ministry has raised hopes among scientists that the country could take a more scientific approach to its increasingly desperate fight against COVID-19. In a cabinet reshuffle on December 22, 2020, Indonesian President Joko Widodo appointed Budi Gunadi Sadikin, a graduate in nuclear physics, as Minister of Health. He succeeded Terawan Agus Putranto, a military doctor known to have developed a controversial and unproven therapy for stroke. His slow and covert handling of the pandemic has been widely viewed as a failure.

Sadikin, who has been working on the pandemic since March 2020 at the State Enterprise Ministry, “seems to understand the problem very well,” Zubairi Djoerban, head of the Indonesian Medical Association’s COVID-19 task force, wrote on Twitter after to have met Sadikin. January 11. Indonesia lags behind in testing and data collection, and faces the mammoth task of immunizing its population of 270 million people. “Hopefully a scientific approach will light our way,” tweeted Ines Atmosukarto, an Indonesian molecular biologist who runs Lipotek, a biotech start-up in Canberra, Australia.

The official toll from the pandemic in Indonesia is relatively low: the COVID-19 task force reported only 850,000 cases and 25,000 deaths, a per capita death toll less than a tenth of that in the United States. But the situation on the ground tells a different story. Hospitals in Java, the country’s most populous island, are on the brink of collapse; some treat patients in hallway chairs instead of beds. Families drive from hospital to hospital with patients, trying to find one who will accept them. Infections are ‘out of control’, says epidemiologist Henry Surendra of the Eijkman-Oxford clinical research unit. (Surendra says he’s speaking in a personal capacity, not on behalf of the research unit.)

Part of the discrepancy stems from Indonesia’s very low test rates. The country currently performs around 0.12 tests per 1,000 people per day, compared to 3.9 in the United States and 8.1 in the United Kingdom, according to Our World in Data. Some regions have intentionally kept the number of tests low to avoid highlighting their infection rates, says Septian Hartono, a medical physicist at Duke-NUS Medical School in Singapore and a volunteer at KawalCOVID19, a collaborative platform that analyzes data from Indonesian coronavirus independently.

Without the right data, it is very difficult for the government to develop the right policy.

Hartono also found numerous discrepancies between the data reported by the provincial and national governments. On January 10, for example, the national government reported 58% fewer deaths than the total reported by Indonesian provinces. At the same time, detailed demographic and clinical information on patients has not been obtained from the health ministry, Surendra says. “Without the right data, it’s very difficult for the government to produce the right policy,” says Hartono.

Hartono believes Sadikin “really wants to fix this problem, but he’s still in firefighting mode,” trying to reduce the number of cases. Sadikin took over at the start of the vacation, when local and international tourists flocked to Bali and mobility in Java was quite high. Sadikin imposed stricter lockdowns on the two islands and issued a travel ban for foreigners effective January 1. But daily infections have increased by 30% to 40%, according to data from the Ministry of Health. Sadikin has called on hospitals to increase the number of beds for COVID-19 patients and allowed 10,000 unemployed nurses to work temporarily in hospitals.

One of Sadikin’s main priorities will be vaccination. On January 11, the Indonesian Food and Drug Surveillance Agency (BPOM) issued an emergency use authorization for CoronaVac, produced by Chinese manufacturer Sinovac Biotech; 2 days later, Widodo rolled up his sleeve for his first dose. Indonesia was the first country outside of China to approve CoronaVac, and the decision is based on preliminary data.

A Phase III trial in the city of Bandung, West Java, showed the vaccine to be 65.3% effective, according to BPOM – well below the rates of over 90% seen in RNA vaccines messenger manufactured by Western companies, but well above the 50% Threshold recommended by the World Health Organization for widespread use of a vaccine. With just 1,600 participants, however, the trial was much smaller than most, and it only registered 25 infections. Researchers in Turkey reported in December that CoronaVac was 91.5% effective, based on another relatively small trial. A week ago, a team leading a much larger study in Brazil announced an effectiveness of 78%, but on Wednesday they said based on stricter criteria, the effectiveness was only 50%.

CoronaVac cleared another big hurdle: On January 11, the Indonesian Ulema Council issued a fatwa declaring the vaccine halal, or permitted under Islamic law. Many vaccines contain pork gelatin as a stabilizer, and in 2018 a new measles and rubella vaccine was declared haram, or banned, in Indonesia for this reason. It’s not clear if CoronaVac also contains elements of porcine origin, but Muslim scholars have decided the injections are halal anyway because the pandemic is an emergency. Sadikin called on religious leaders from Muhammadiyah and Nahdlatul Ulama, the country’s two largest Islamic organizations, to support the new vaccine, and both have since said it is mandatory for every Muslim to be vaccinated.

Indonesia has ordered 125 million doses of CoronaVac. So far, 1.2 million have been distributed; An additional 15 million doses arrived in Jakarta in bulk, to be processed by Bio Farma, Indonesia’s only vaccine manufacturing company. Sadikin says he has obtained an additional 300 million doses of COVID-19 vaccine from Pfizer, AstraZeneca and through the COVID-19 Global Vaccine Access Mechanism, a global mechanism for equitable vaccine distribution.

Detecting the spread of mutant variants of SARS-CoV-2 like the one that has emerged in the UK is another priority for Sadikin. Only 194 complete viral genomes from the country have been published in GISAID, an international virus genome database, suggesting that more transmissible or dangerous variants could easily go unnoticed. On January 9, Sadikin signed a memorandum of understanding with Bambang Brodjonegoro, Minister of Research and Technology, aimed at increasing these figures and strengthening collaboration between Indonesian universities. “I realize that we have to build a defense system against this virus,” Sadikin said at a press conference.