This article is part of our special report Fighting diseases: The challenges ahead.
SPECIAL REPORT: Indonesia is developing its own vaccines to fight infectious diseases because funds from the EU and other development agencies to its health sector are drying up. EURACTIV reports from Indonesia.
Indonesia has invested heavily in vaccine development through its state-owned pharmaceutical company, Bio Farma. The country suffers growing rates of many infectious diseases such as tuberculosis, malaria and HIV/AIDS.
The Southeastern Asian country benefited from EU development aid for its health sector from the 1980s to January 2014. Since then, it has stood on its own two feet when it comes to providing public healthcare for more than 200 million people across more than 6,000 islands and many rural areas. About 28 million Indonesians live below the poverty line and about 80 million could easily fall under it if they fell ill.
Rates of many preventable and treatable illnesses are high. It is estimated that 50,000 children under the age of five die every year from pneumonia and diarrhoea. Indonesia also has one of the highest rates of tuberculosis in the world.
The EU played a significant role in supporting the government of Indonesia and its civil society partners in combating HIV/AIDS, tuberculosis and malaria.
Indonesia has received $650 million from the Global Fund, to which the EU contributes, since 2003. Over the past ten years, the Commission has also committed over €83 million to Gavi, the Vaccines Alliance, from which Indonesia has benefited. In one year’s time, the support Indonesia gets for immunisation from Gavi will end.
But Indonesia is counting on Bio Farma, a 120-year-old state-owned institution, to be the answer to the country’s many challenges.
Bio Farma is a pharmaceutical company with 1,300 employees located in West Bandung, 100 kilometres from the capital, Jakarta. It produces all of the vaccines in Indonesia’s regular immunisation schedule and has developed the pentavalent vaccine, which protects against diphtheria-tetanus-pertussis, hepatitis B, and Hib (a cause for childhood meningitis and pneumonia) with only one injection.
Reducing the numbers of separate injections required minimises the number of health centre visits that must be made. The vaccine is the result of years of research and is now being rolled out all over the country.
Rahman Rustan, the company’s corporate secretary, told EURACTIV that Indonesia has a large population and a large number of diseases that are “dynamic”.
“We have to be able to anticipate the types of diseases of the future. We need to not only focus on the production, but also on the research into what challenges we will face.”
40% of Bio Farma’s vaccine production goes to the domestic market. 60% of the vaccines are distributed to, among others, UNICEF and the World Health Organisation (WHO). Bio Farma’s products have been exported to more than 133 countries.
It is owned by the government, but the management team is professional and independent. The responsibility for financial issues is given to financial experts.
“As a state-owned company,” Rustan said, “the main obligation of Bio Farma is to fulfill the needs of the government which is stated in the national immunisation programme. This is the main priority. When Bio Farma has excess capacity, our obligation is to distribute vaccines to other countries, especially countries that don’t have their own factories to produce vaccines,” he added.
Immunisation is one of the Ministry of Health’s top priorities, and Indonesia has seen significant gains due to investments in vaccines since it launched its national programme in 1997. For example, the country has been polio-free since 2006. In 2012, WHO and UNICEF estimated that 81% of children were fully immunised. But due to its large population, the remaining 19% makes Indonesia home to the third-highest number of unimmunised children.
Regional differences are profound in the country. For instance, provinces such as Papua and West Papua have coverage rates as low as 60%.
Immunisations are provided by health centres, clinics and hospitals. At the community level, more than 50,000 village midwives supervise around 260,000 posyandu to provide routine immunisation. A posyandu is an integrated village health post, which serves as first line of care for many Indonesians.
Among other things, they register births, weigh babies, maintain growth charts and immunisations. Like other health services, immunisation programming is decentralised in Indonesia, with district governments taking responsibility for their programme, and the central government being responsible for producing vaccines, developing guidelines, undertaking quality control and completing monitoring and evaluation.
All vaccines that form part of the regular immunisation program in Indonesia are manufactured locally by companies that have met WHO standards, and are financed by the Indonesian government.
In order to keep being successful, Rustan said that Bio Farma would need to maintain a close collaboration with other pharmaceutical companies such as Sanofi and GlaxoSmithKline. This collaboration is especially needed for many new vaccines, which are still under development, and require new technology, he said.