Indonesia’s researchers consider options for eventual Covid-19 immunity certification

JAKARTA, Jun 24, 2020, The Jakarta Post. With a COVID-19 vaccine still months or even years away, countries are seeking ways to accommodate millions of stir-crazy people eager to usher in a “new normal.” Indonesia is no exception. Researchers are pooling suggestions about how to create a proof of immunity to exempt people from physical restrictions and allow them to return to work, school and daily life, The Jakarta Post reported.

However, many experts are worried about jumping the gun on an issue that is very likely dependent on the accessibility of vaccines.

Djarot Andaru, a health law researcher from the University of Indonesia, suggested that the government could create its own version of the international vaccination certificate issued by the World Health Organization (WHO) for people who eventually received a COVID-19 vaccination.

Travelers have long used a WHO-issued certification called the “Yellow Card” to enter certain countries where they may face increased individual health risks. Djarot suggested using a similar document for domestic travel to specific places.

“This may function as an identity card and a prerequisite for entering [offices and government buildings] and can be applied when traveling to certain areas or areas with crowded places,” he said, comparing it to the Ebola vaccine certificates issued in several African countries during outbreaks in 2013 and 2014.

The certification could distinguish between those who had and had not been vaccinated, Djarot said, especially as many countries, including Indonesia, were already transitioning to a new normal. However, he said the government had to ensure there were sufficient vaccine supplies before the certificate was issued.

Different regions in Indonesia have begun transitioning out of large-scale social restrictions (PSBB) imposed to curb the spread of the virus, despite the lack of evidence that transmission rates have plateaued. The central government is also keen to jump-start the economy to avoid sliding into a recession.

As of Monday, Indonesia had recorded 46,845 confirmed cases of COVID-19 and 2,500 deaths.

Eijkman Institute for Molecular Biology director Amin Soebandrio suggested that Indonesia could use a WHO international certification for COVID-19, which could be particularly useful for Indonesians traveling abroad.

But he also warned that an eventual vaccination would not guarantee that an individual was fully protected from the disease. Amin urged people to get regularly checked and follow physical distancing measures even after being vaccinated.

A 2016 Health Ministry regulation on international vaccination certification serves as a legal guideline for the provision of certificates for those who wish to travel to countries that require specific vaccinations, such as Saudi Arabia, which requires haj and umrah (minor haj) pilgrims to be vaccinated for meningitis.

The government has not yet declared a certification procedure for COVID-19 vaccination.

“This isn’t the first time we have managed vaccines, as all haj and umrah pilgrims must be vaccinated. That is to say [COVID-19 vaccine] management isn’t something we are worried about at the moment,” said national COVID-19 task force spokesman Achmad Yurianto last Thursday.

“We are resolute in our priority to find a vaccine first.”

There are still no proven vaccines or antiviral drugs to treat COVID-19, with most patients only receiving palliative care. The World Health Organization (WHO) has listed 139 vaccines under development worldwide as of June 16, with 11 undergoing clinical trials.

In Indonesia, the government has established a consortium to develop a vaccine, involving state-owned pharmaceutical company PT Bio Farma and the Eijkman Institute, which sequenced the complete genome of Indonesian coronavirus samples in early May, as part of the initial stage of vaccine development.

Some governments, including those of Chile, Germany, Italy, the United Kingdom and the United States, have suggested that the detection of antibodies for SARS-CoV-2, the virus that causes COVID-19, could be used as the basis for an “immunity passport” or “risk-free certificate”, which would certify that an individual had been infected and was therefore purportedly immune to the virus.

However, the WHO wrote in a brief in April that there was “no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection”.

“People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risk of continued transmission,” the WHO wrote.

An article in The Lancet medical journal noted that immunity passports posed “considerable scientific, practical, equitable and legal challenges” in their implementation. The author advised countries to build up established public health practices of testing, contact tracing, quarantine and isolation until a COVID-19 vaccine was accessible.

Bio Farma’s R&D project integration manager Neni Nurainy has said that the government should stockpile sufficient vaccine doses before attempting to introduce any immunity certificate, so as to avoid friction between different economic classes, with the rich having more access to vaccination than the poor.

Neni suggested the use of existing vaccination records from health facilities, surveillance data and regular COVID-19 testing to distinguish between patients that had and had not been vaccinated.

“If we later have enough vaccines, it will be good for everyone to have the same rights [to vaccination],” she said.