Ageism in Indonesia’s national covid-19 vaccination programme

<p>Concern about vaccine nationalism is well founded,<a href="https://www.bmj.com/content/372/bmj.n299#ref-1" target="_blank">1</a> but it has overshadowed another form of injustice: vaccine ageism.</p> <p>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.<a href="https://www.bmj.com/content/372/bmj.n299#ref-2" target="_blank">2</a>  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.<a href="https://www.bmj.com/content/372/bmj.n299#ref-3" target="_blank">3</a></p> <p>Further trials of Sinovac for older people have since begun in countries such as Brazil,<a href="https://www.bmj.com/content/372/bmj.n299#ref-4" target="_blank">4</a>  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.”<a href="https://www.bmj.com/content/372/bmj.n299#ref-5" target="_blank">5</a>  This justification follows an established tradition of using inaccurate  generalisations about older people’s “public value” to justify ageist  discrimination.<a href="https://www.bmj.com/content/372/bmj.n299#ref-6" target="_blank">6</a></p> <p>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.<a href="https://www.bmj.com/content/372/bmj.n299#ref-7" target="_blank">7</a> Media reports suggest that Sinovac may be effective for older people, but at a lower level than for other ages.<a href="https://www.bmj.com/content/372/bmj.n299#ref-8" target="_blank">8</a> Related findings are, however, yet to be published.</p> <p>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.<a href="https://www.bmj.com/content/372/bmj.n299#ref-9" target="_blank">9</a>  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.<a href="https://www.bmj.com/content/372/bmj.n299#ref-10" target="_blank">10</a></p> <p>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.</p>