Why vaccination program for indigenous people needs shot in arm
Residents of Ratenggaro Traditional Village in Southwest Sumba, East Nusa Tenggara (NTT), prepare to participate in a COVID-19 vaccination program on March 12, 2023. (ANTARA/Andi Firdaus/rst)
So far, the transition from the pandemic to the endemic phase has been on the right track, with the positive case indicators showing a controlled situation: the number of cases has been the lowest in the past four months, despite some fluctuations.
One indicator of the controlled pandemic situation has been the positivity rate recorded in the past two weeks. Even though it has risen by 1.34 percent to 1.87 percent, the figure has not yet exceeded the safe threshold of five percent.
The number of hospitalized cases has also remained below the 5-percent threshold even though the hospitalization rate has increased from 2.13 percent to 2.22 percent. The death rate has also reduced to less than 3 percent, although two to three deaths are still being recorded every two weeks.
The World Health Organization (WHO) has not declared the pandemic over. In Indonesia, the push to vaccinate at least 97 percent of the elderly population and vulnerable groups is still being hampered by geographical conditions, particularly in remote areas and islands.
Indonesia, as an archipelagic country, has a significant indigenous population. One of the areas where the indigenous population can be found is Sumba Island in East Nusa Tenggara (NTT), which was named the “Best Beautiful Island in the World” by Focus Germany magazine in 2018.
This achievement was also supported by a statistical report on the village’s potential the same year, which showed that 19.03 percent of tourism villages are concentrated in NTT. One of the best examples of the beauty of Sumba Island is Ratenggaro Traditional Village in Kodi Bangedo Sub-district, Southwest Sumba District.
However, three years into the pandemic, COVID-19 vaccines have yet to reach around 50 Ratenggaro natives, especially vulnerable groups such as the disabled and the elderly, who are currently facing the highest risk of death.
According to the Health Ministry’s COVID-19 vaccination dashboard, as of March 15, 2023, the coverage of complete vaccinations in NTT was 66.59 percent, with the first dose provided to 82.70 percent of the total target of 4.43 million people.
As tourist village residents, the indigenous peoples of eastern Indonesia fall into the vulnerable group category, requiring extra protection or booster doses.
However, only 19.90 percent of them have received the first booster dose and 0.44 percent the second booster out of the total target of vulnerable people in NTT, which comprises around 2.40 million people and more than 405 thousand elderly people.
Efforts to realize vaccination equality in remote areas are still running into obstacles in terms of difficulties in vaccine distribution and stigma surrounding vaccines, including their side effects.
The Australia-Indonesia Partnership for Health Resilience (AIHSP) has reported that one out of two elderly people in NTT has not yet received both doses of the primary vaccination, while nine out of ten elderly people in NTT have not received the first booster.
Head of the Ratenggaro Traditional Institution Donatus Jamabohe said that the local population’s motive for receiving the vaccination has been economic rather than health-related.
Various social supports, such as village funds, basic necessities, and cash social assistance that is from the post office can only be obtained by those who have been vaccinated. Generally, residents also need vaccines to travel across villages and islands for work or simply to attend family invitations and religious agendas.
Jamabohe said that the revocation of community activity restrictions (PPKM) at the end of last year has opened doors for 20–50 tourist arrivals in NTT on average.
"Even though none of our residents have ever contracted COVID-19 thanks to our ancestors and God, we still need to prepare for the worst through vaccination. There are a lot of residents who think without vaccination, they cannot receive the government’s assistance,” he added.
Challenge to expediting vaccinations
Recently, the AIHSP, in collaboration with Save the Children and Timor’s Circle of Imagine Society (CIS), held an inclusive vaccination drive at Ratenggaro traditional village.
No less than 400 residents of Ratenggaro and its surrounding areas lined up at the vaccination service desk. A team of vaccinators from Walla Ndimu Health Center (puskesmas) had to work in two batches until the afternoon to provide vaccination services to them.
Head of the Walla Ndimu Puskesmas Debora Kaka said that the vaccination booth proved effective in accelerating vaccination coverage among the indigenous people since they normally need to travel several kilometers to reach the puskesmas.
Inter-village bus transportation, which costs Rp50 thousand one way, is the alternative for those who do not have motorized vehicles. That means one person needs to shell out a minimum of Rp100 thousand to get vaccinated at the puskesmas.
Thus, some people are choosing to work and skipping vaccination.
Hoaxes regarding the side effects of vaccines are also hindering vaccination provision by the local health service. Some of the residents are afraid of dying of vaccine side effects.
News about business interests in the national vaccination program has also reached traditional villages in NTT. In fact, fake news regarding chips being implanted through vaccines has added to residents’ concerns.
Based on the observations of agencies collaborating in the vaccination program, one of the main challenges to accelerating the program, which has been implemented since October 2022, has been the strategy of balancing vaccine availability with residents' demand.
The Ministry of Health reported that the vaccine stock available in Southwest Sumba is currently around 800 doses, or less than a week’s worth of supply.
Since the COVID-19 vaccination is mandatory for receiving social assistance, residents in Southwest Sumba have begun taking an interest in getting vaccinated. So far, the number of first-dose recipients has reached 2,780, second-dose recipients 2,264, and third-dose recipients 2,244 out of a total target population of around 8 thousand people spread across 8 villages.
With the average vaccination rate reaching 400 doses in Southwest Sumba, the local community is looking forward to village-to-village vaccination services carried out by the health authority.
However, obstacles in the form of rainy weather to strong winds often impede the progress of the 8 local puskesmas vaccination workers tasked with providing the services.
Among those who enthusiastically took part in the vaccination program in Ratenggaro Village, there were those who were disappointed when they had to take the first dose again because they missed the maximum interval of 6 months.
Besides, some had to be turned away by officials because the Covovax vaccine they received earlier did not match the Pfizer vaccine regimen available that day.
Officers also noted that around 500 residents faced problems with identification numbers (NIK) and their vaccination data could not be registered on the Primary Care application. So their data had to be recorded manually, while waiting for the re-activation process from the conventional identity card (KTP) to the electronic KTP in the village.
Push for collaboration
President Widodo’s request for collaboration has elicited a good response from the Australian government in the form of an accelerated COVID-19 vaccination program for vulnerable groups in four districts of NTT, namely Sabu Raijua, Belu, Timor Tengah Selatan, and Southwest Sumba.
The support is being realized through AIHSP's role, in collaboration with CIS, which started in August 2022.
AIHSP NTT provincial coordinator Mei Tatengkeng said that the program aims to protect vulnerable groups from COVID-19 through vaccination and provide inclusive healthcare access.
The two humanitarian organizations have carried out 124 inclusive COVID-19 vaccinations in 35 villages in NTT and reached 9,897 residents, including 871 elderly people, 66 persons with disabilities, 9,052 members of pre-prosperous families, 778 people who live far from health service facilities, as well as other vulnerable groups.
The activities have been held through collaborations with civil society organizations, community-based organizations, organizations for people living with disabilities, and other local residents who are serving as partners in the work program.
Besides taking vaccination services closer to the residents, the program has also helped health center cadres reach vulnerable groups, such as the elderly and people living with disabilities, who cannot travel to health facilities.
The spirit of collaboration and push for equal healthcare access in the remote areas of Indonesia has not ended. Not a single citizen will be left behind even as the Indonesian government holds discussions with several countries that are ready to end the pandemic phase this year.
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Editor: Rahmad Nasution
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