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Why Indonesia is losing the COVID fight while neighbours crush the virus

So why has Indonesia recorded so many cases, so many more deaths and conducted so few tests?

What have countries such as Vietnam, Cambodia, Myanmar and even the Philippines (the second hardest hit country in south-east Asia by a considerable distance) got right to control the spread of the virus?

Jeremy Lim, an Associate Professor in the school of public health at the National University of Singapore, says some south-east Asian nations have had to “cut their coat according to the cloth they have, and some national don’t have a lot of cloth”.

He argues that some countries (Vietnam, with just 1361 cases, is a good example) “have been very creative and resourceful in making limited assets go a long way”.

“And if you look at two of the wealthiest countries in the world, the US and the UK, they have not done particularly well despite the immense resources from governments and individuals that they can mobilise,” he says.

But containing the virus is resource-intensive, while widespread testing costs money and “some countries just don’t have enough”.

“So if we look at the region, Philippines Health and the BPJS [Indonesia’s health system] have had many financial challenges for some time”.

It’s not just about the relative sizes of each country’s population though Indonesia, with 270 million (including 140 million on the densely packed main island of Java) is by far the most populous.

Will it work? Indonesian President Joko Widodo, centre, on Tuesday at the site of phase three clinical trial for the SinoVac vaccine.

Will it work? Indonesian President Joko Widodo, centre, on Tuesday at the site of phase three clinical trial for the SinoVac vaccine.

In its most recent weekly report on the COVID-19 situation in Indonesia, the World Health Organisation (delicately) spelled out some of the challenges the country is facing.

In reporting on the daily numbers, the WHO noted that “reporting of laboratory-confirmed results may take up to one week” and therefore “caution” must be exercised around daily totals.

In the most recent full week, the case incidence of COVID-19 per 100,000 population in Indonesia was 13.5 – the highest case incidence rate since the first case was reported on March 2.

Similarly, every province of Java recorded increases in cases per 100,000 people and, the situation report noted, only five of the country’s 34 provinces met the WHO’s minimum standard of a test per 1000 people.

Most importantly, the WHO noted: “there remains a gap between the number of suspected cases and the number of people tested. It is crucial to improve laboratory capacity and ensure adequate supplies to test all suspected cases”.

It’s obvious that Indonesia hasn’t been able to test widely enough.

In addition to this, contact tracing has been inadequate (the government belatedly hired more contact tracers only in November) and the density of Java, combined with the lack of financial reserves the central government can call on (Indonesia’s stimulus measures have been relatively modest) have all combined to exacerbate a difficult situation during the global pandemic.

Professor Wiku Adisasmito, the head of Indonesia’s expert team on its national coronavirus taskforce, on Thursday played down the spike in cases past 8000 and blamed provincial governments for inadequate or slow reporting.

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“One of the reasons [for the significant increase] is that the system has not worked optimally to accommodate the reports and data validation from provinces in real time…local governments that still have data discrepancies, please report to the central government immediately,” he said.

“Today it exceeded 8000 cases. This is the highest number and we cannot tolerate it.”

But there are few signs that testing rates, which have been inching up to around 40,000 people per day, are about to increase dramatically.

President Joko has adopted a vaccine-first strategy (though some allies of the president and epidemiologists have warned against this) but the roll-out of the Chinese vaccines Indonesia has signed up for have been delayed until early next year.

Meanwhile, Indonesia’s economy has been battered and a quick exit from recession is unlikely.

But Lim, from the NUS in Singapore, also highlights the awful calculus that the national government in Indonesia has had to use while trying to stop the spread of the virus.

“Staying home is a privilege of the wealthy and of wealthier governments. If countries don’t have the resources to do that, telling people to stay home and starve to death is not a realistic option.”

And it’s in that context that Indonesia’s battle to contain coronavirus, for all its shortcomings, must also be seen.

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