Grandmother Maria Irene Pusporini has barely left her home in Jakarta since coronavirus first spread to Indonesia almost a year ago.
While still sprightly and active, the 80-year old knows she is in the age group most likely to die from the virus.
“I am old, so I am super careful,” she said.
“If I have to leave the house and go outside my front yard I always wear a mask.”
When she heard that Indonesia was rolling out a COVID-19 vaccine, she wanted to sign up. But Ibu Pusporini’s age has made her ineligible.
“I want to get vaccinated but the vaccine for old people hasn’t yet arrived,” she said.
It’s estimated that people over the age of 60 make up around 15 per cent of deaths from COVID-19 in Indonesia, where the death toll has now reached 29,000 and total cases have passed 1 million.
Yet unlike other countries that are prioritising the elderly for vaccination — such as the United States and the UK — Indonesia is actively excluding anyone aged 60 or over — for now at least — as it rolls out its mass immunisation program.
Instead, ordinary Indonesians aged 18 to 59 will receive higher priority for the Chinese-made Sinovac vaccine, once doctors, nurses and other frontline responders — including police and even taxi drivers — receive their first dose of the vaccine.
Why have older citizens been ruled out for jabs currently?
Elderly citizens including Ibu Pusporini will have to wait weeks or months for their first jab.
Professor Amin Soebandrio, a member of the Indonesian Government’s COVID-19 taskforce, said there were good reasons why younger people should be vaccinated first.
“The Government saw that people of working age were more likely to be infected,” he said this week at a conference on public health.
“This group is susceptible to carrying the virus [and] if they’re not immunised they will transmit the virus.
“After being exposed and infected, they will bring it home.”
Epidemiologist Pandu Riono at the University of Indonesia said by excluding the elderly from its immunisation program, the Government was putting the economy ahead of lives.
“The real motive is to fix the economy, instead of fixing the pandemic or its impact on the elderly,” he said.
“Everyone knows that most people who die from COVID-19 are in a specific age range, over 50. So age is a very dominant factor.”
But the BBC reported the country’s Health Minister, Budi Gunadi Sadikin, said he didn’t “want people to think this is about just the economy” and that “this is about protecting people”.
In Indonesia, elderly people are more likely to live at home in extended families, rather than in aged care facilities as many do in the west.
As a result, Professor Soebandrio said older people would also be protected if working-age Indonesians could no longer transmit the virus.
“Those who are productive, who have to leave the house every day, are made immune,” he said.
“So, they protect themselves and also protect their families. That’s the idea.”
More testing still being done on vaccine safety for elderly
Indonesia’s Government has also said it needs to delay vaccinations for the elderly because of safety reasons.
Health authorities said there was a lack of research into how the Sinovac vaccine, known as CoronaVac, would affect older people.
Indonesia was one of several countries that carried out clinical trials on the vaccine for the Chinese company, with results showing that CoronaVac was about 65 per cent effective.
But not one of the 1,640 volunteers was over the age of 60.
The Government said it needed to wait for data from similar trials overseas that specifically included older people. Until then, it argued it was yet to be proven whether it was safe for elderly people.
“If the analysis [from those trials] shows that the Sinovac vaccine is safe for the elderly, then an emergency permit will be issued,” Penny Lukito, who is the head of Indonesia’s food and drug authority BPOM, said.
“If it is there, of course it can be given to the elderly.”
It comes as Germany’s vaccine committee said in a draft recommendation that another vaccine, AstraZeneca‘s, should only be given to people aged between 18 and 64, citing a lack of data.
The drugmaker denied that its COVID-19 vaccine was not very effective for people over 65.
What do the epidemiologists think?
But epidemiologist Dr I Gusti Ngurah Mahardika, at Bali’s Udayana University, believed the Sinovac vaccine — by its very nature — is safe to administer to older people.
“Sinovac is an inactive vaccine,” he said.
“An inactive vaccine is safe to be administered to people who are above the age of 59.”
CoronaVac works by using dead or inactivated particles of the virus to prime the body’s response to COVID-19, without posing any risk of it causing disease.
The same approach has been used in other successful vaccines, including measles, polio and rabies.
“Sinovac uses an inactive virus, a traditional approach that has been used for years, for decades,” he said.
“We’ve been using the same approach in vaccines for children and adults, and there’s no dangerous reaction.
“I am certain that this vaccine is a traditional vaccine and safe for old people.”
Nevertheless, Dr Mahardika supported the Government’s decision to wait for more data on the Sinovac vaccine’s efficacy in older people.
But he and other epidemiologists said the Government should carry out another clinical trial to gauge its use in Indonesia.
“The safest way to continue with vaccinating the elderly is to accelerate a trial in the elderly as well,” Dr Panji Hadisoemarto, from Padjajaran University in Bandung, said.
“Indonesia needs to work faster to establish its efficacy and safety and use it on this group, to reduce their illness and mortality.
“Because some would say people in Brazil and Turkey are not Indonesian. It would be helpful to have our own data.”
They are not expected to be delivered in-country until possibly April.
Dr Hadisoemarto said it could be months — or even next year — before some elderly people are finally inoculated against COVID-19 given the limited number of vaccines and the need for two doses.
“That’s why we need to have this trial expanded, to include the elderly as soon as possible,” he said.
Until then, Ibu Pusporini said she has no choice but to stay home to avoid getting COVID-19.
“It’s the most potent virus,” she said.
“In the old days there were a lot of viruses but none of them is like this one.”