Epidemiologist weighs in on Indonesia’s decision to acquire Sinovac vaccine despite unknown levels of efficacy

JAKARTA, INDONESIA — As many as 1.2 million doses of Sinovac COVID-19 vaccines arrived in Indonesia on 6 December, with millions more expected to land in January next year.

Indonesia ordered 128 million doses of Sinovac vaccines, data from Duke Global Health Innovation revealed.

Other countries that have purchased Sinovac vaccines include Brazil, Turkey, Chile, and Bangladesh.

Vaccine manufacturers such as Pfizer, Novavax, AstraZeneca, and Moderna are competing to produce their best vaccines to tackle the spread of the virus, which has infected more than 70 million people and claimed the lives of 1.5 million people globally.

The availability of vaccines gives some hope that the pandemic can be contained. However, questions linger about the efficacy of those COVID-19 vaccines, side effects, and how people can get access to COVID-19 vaccination.

Sinovac vaccines compared to other similar vaccines

Pandu Riono, an epidemiologist at the University of Indonesia, questioned the government’s decision to buy Sinovac vaccines even though those vaccines’ efficacy is not known yet.

“In January, we will know the result of the phase 3 trial in March or April. In January, there will be partial analysis. I am surprised that Indonesia conducted the phase III trial with only 1,620 samples,” Dr Pandu told TOC, adding that the final step of the clinical trial should ideally involve at least 30,000 samples like the trials of Moderna and AstraZeneca.

The expert added that Sinovac produces vaccines from the deactivated virus, considered to be the conventional method in formulating vaccines.

Moderna and Pfizer, on the other hand, use messenger arena or mRNA to stimulate the body’s immune system that creates antibodies without using actual bits of the virus.

At the same time, Oxford AstraZeneca develops COVID-19 protection from adenovirus that incorporates COVID-19 genetical fragments into the body.

The essential ingredients of those vaccines will determine the latter’s efficacy.

Moderna reported that its efficacy hits 94.5 per cent in the Phase 3 trials while that of Pfizer hit 90 per cent. The technology used by Pfizer and Moderna brings optimism despite some doubts and questions.

“There were a lot of people who were sceptical that an mRNA vaccine would work. Scientifically, it makes sense, but there’s no mRNA vaccine out there that has been approved yet,” Dr Carlos del Rio, executive associate dean of the Emory University School of Medicine in Atlanta, told NBC.

Biofarma — the Indonesia pharmaceutical firm that conducts clinical trials of Sinovac vaccine — clarified the news report which claimed that Sinovac’s vaccine efficacy hit 97 per cent, saying that the claim is not valid.

Pandu explained that while 97 per cent of the subjects who underwent the vaccination tests had their antibodies formed, it does not mean that that the efficacy of the Sinovac vaccine itself has reached 97 per cent.

“There is no guarantee that those antibodies will give protective effects. What we must know whether the level of the antibodies can prevent the infection, we are not sure,” he added.

Even Sinovac on 8 December stated that it had yet to receive the result of the Phase 3 trial. The Brasil Butantan Institute is expected to publish data of the final clinical trial in Brazil on 15 December.

If Indonesians have yet to know about the efficacy of the Sinovac vaccine, and the Food and Drugs Supervisory Agency (BPOM) has yet to issue a vaccination permit based for emergency use, there will be another problem.

“BPOM will be under pressure, meaning that it has yet to receive complete information, but those vaccines are already here. And the numbers of new daily cases hit more than 5,000,” he explained.

Who should get vaccinated first?

People aged 18-59 will be prioritised for COVID-19 vaccination, according to Indonesia’s Health Ministry.

Director-General of Disease Prevention and Control at the ministry Dr Ahmad Yurianto explained that vaccines will be given to those aged 18-59 without any underlying disease according to the Phase 3 clinical trial.

However, research and clinical trials of vaccines are going on, meaning one day there will be vaccines suitable for the elderly with underlying disease and minors, Health Minister Dr Terawan Agus Putranto said.

Indonesia’s Spokesperson for COVID-19 Mitigation Prof Wiku Adisasmito said in September that people aged 19-45 accounted for 55 per cent of the country’s COVID-19 cases due to their mobility.

Dr Pandu said that if the majority of the population gets vaccinated, they can protect those who have yet to get vaccinated.

Free vaccines for all?

Nadia Tarmizi, a government spokeswoman for COVID-19 vaccination, said that medical workers and public service workers will receive free vaccination as well as those who are economically impoverished.

Dr Pandu opined that the government should make sure all Indonesians get equal access to COVID-19 vaccines.

“The government must protect its people even though there are several priorities,” he stressed.

“During the pandemic, there must be an effort to make people can get equal access to the vaccine. Whether the government finances for vaccination or subsidy,” the epidemiologist added.

Strengthening the country’s Universal Health Coverage, thus, is essential, said Dr Pandu.

“Theoretically, all Indonesians are members of Health Care and Social Security Network (BPJS), so there will be subsidies for low-income Indonesians,” he told TOC as he wrapped up the interview.

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