Ageism in Indonesia’s national covid-19 vaccination programme

Concern about vaccine nationalism is well founded,1 but it has overshadowed another form of injustice: vaccine ageism.

In  many low and middle income countries (LMICs) Sinovac is currently the  main covid-19 vaccine. Initial Sinovac trials in China were only  conducted on adults aged under 60.2  Because of a lack of published evidence, the government of Indonesia  has decided to exclude people aged 60 and over from its initial vaccine  rollout.3

Further trials of Sinovac for older people have since begun in countries such as Brazil,4  yet ongoing Sinovac trials in Indonesia continue to exclude older  people. In 2020 clinical trial leader, Kusnandi Rusmil, said, “Why do we  target people of a productive age? Because these people can work hard,  so the country will not have a deficit.”5  This justification follows an established tradition of using inaccurate  generalisations about older people’s “public value” to justify ageist  discrimination.6

Not  all candidate covid-19 vaccine trials have excluded older people.  Nevertheless, there is a long and problematic history of excluding older  people from trials of vaccines or treatments for conditions that affect  them greatly.7 Media reports suggest that Sinovac may be effective for older people, but at a lower level than for other ages.8 Related findings are, however, yet to be published.

In  Indonesia, the official position remains that older people will only be  included either when age specific Sinovac data are published or new  vaccines become available.9  In the meantime, exclusion of older people from vaccination will  exacerbate pressure on hospitals and increase avoidable deaths.  Indonesia is not a unique case: Peru has given its military, private  security guards and election workers higher priority than older adults.10

For  now, nationalist self-interest means LMICs are at the back of the  global vaccine queue; and vaccine ageism means older people are at the  back of the queue in some LMICs.