Childhood immunisations dip in Covid-era Indonesia
THE Covid-19 pandemic has led to backsliding in Indonesia’s childhood immunisation efforts, with the government prioritising its pandemic response and fears over virus transmissions deterring parents from bringing their children to healthcare facilities.
Naditya Fitriani, a 27-year-old office worker in Bogor, West Java, said her 2-year-old son had missed two of his scheduled immunisations during the pandemic.
“My son missed his PCV [pneumococcal conjugate] vaccine [for bacterial meningitis] in January this year because he contracted Covid-19,” she said.
“And six month later, in June, he missed the second dose of his varicella vaccine [for chickenpox] because I was too afraid to bring him to the hospital to get the shot. At the time, Indonesia was experiencing a huge spike in Covid-19 cases and many hospitals were overwhelmed with patients.”
In Klaten, Central Java, 28-year-old Anitasari said her 6-month-old son had fallen two months behind his polio immunisation schedule because the clinic she frequently visited had run out of vaccine stocks.
“Even if the vaccines were still available, it was very hard to book vaccination appointments in the clinic as it was busy dealing with Covid-19 patients,” she said.
A 2017 Health Ministerial Regulation on immunisation stipulates that children below 1 year must be given basic vaccines, including against hepatitis B, polio, tuberculosis, diphtheria, pertussis, tetanus, measles, pneumonia and meningococcal disease (bacterial meningitis).
Data from the health ministry, however, showed that only half of the 401 cities and regencies across the archipelago were able to reach the targeted coverage rate of 80 per cent for the full course of basic childhood vaccines last year, when the pandemic began. In 2019, around 70 per cent of all cities and regencies were able to meet this target.
Last year, vaccinations were particularly low for measles-rubella (MR) and tetanus-diphtheria (TD), with their average national coverage rates standing at 40 and 45 per cent, respectively. Vaccine rates must reach 95 per cent of the target population to achieve herd immunity from the diseases.
The major decline in the country’s childhood vaccination reflects a global trend. In July, the World Health Organisation reported that 23 million children across the world had missed out on basic vaccines through routine immunisation services in 2020. This is about 3.7 million higher than in 2019.
The report suggested that Southeast Asian and Eastern Mediterranean regions had been the most affected by the disruption, with Indonesia placing third among countries with the greatest increase in children not receiving the first dose of the diphtheria-tetanus-pertussis vaccine.
Health ministry spokeswoman Widyawati said that aside from fears over the coronavirus, the main reason for the lag was because health workers were focusing on pandemic control, especially as there have generally been more Covid-19 cases this year compared to last year.
“The pandemic has also forced many Posyandu [integrated health services posts] to temporarily suspend their [childhood immunisation] services,” she said.
The Posyandu is a vital part of the public health system as it offers free primary immunisations for infants and children.
Fuelling the immunisation problem, the government is also experiencing a disruption in its basic childhood vaccine supply due to a lack of funding and poor vaccine management. In August, several regions reported a shortage of these vaccines, with local authorities saying that stocks for certain shots had been empty for months.
Cissy Kartasasmita of the Indonesian Paediatric Society (Idai) said that disruption in routine immunisation has exposed children – who account for 30 per cent of the country’s population – to deadly, vaccine-preventable diseases (VPD).
“The drop in primary childhood vaccination could lead to VPD outbreaks, especially measles and polio, which are very contagious,” Cissy said.
Widyawati said there had been no reports of a VPD outbreak so far, as children’s mobility remains low and most schools are still closed under public activity restrictions (PPKM).
“However, this might also be caused by poor surveillance on VPDs because we’re still focusing on Covid-19 surveillance at the moment,” she said.
She added that the government was trying to ramp up routine childhood vaccinations by organising “catch-up immunisation programmes” for children who missed their shots and allin-one vaccination programmes so that children could get more than one basic vaccine simultaneously.
The ministry has issued a set of technical guidelines on childhood immunisations during the pandemic, which includes a requirement for parents to make an appointment before visiting health facilities. Health workers are also required to keep records of children whose immunisations have been delayed and ensure that they receive their vaccines.