Medical Trust in Indonesia

"We are in crisis right now."
"This is a medical emergency and we have to overcome this."
Dr. Aman Bhakti Pulungan, head, Pediatrician Association, Jakarta, Indonesia

"Fake vaccines arose because there was a scarcity of vaccine a few years ago that led hospitals and clinics to look for imported vaccines."
"Also because the middle class demanded imported vaccines rather than locally made."
Jane Soepardi, director of surveillance, health quarantine and epidemiology, Indonesian Health Ministry

"I was shocked and very disappointed when the hospital management asked me, along with about 300 other parents to bring our children for revaccination, because the vaccine that is injected into our children turned out to be fake."
"How could this happen?"
"We need a medical checkup, not only an explanation. We need concrete compensation."
Danang Susilo, father of 14-month-old

"The attitude of the Indonesian people, especially the middle class, is that they look at the building and the facility and they say: 'This is the best hospital'."
"But nobody knows if it really is a good hospital or not because there is no quality control, no quality assurance done by the government."
Dr. Kartono Mohammad, (former) head, Indonesia Medical Association

An Indonesian health official prepares a vaccine injection during a revaccination program for children who were earlier given fake vaccines, at a community health center in Jakarta, Indonesia on Monday, July 18, 2016. (AP / Achmad Ibrahim)

Dr. Mohammad points to federal regulations in place theoretically alongside the reality of lax, if not absent enforcement where the vaccine scandal, as far as he is concerned is symptomatic of more larger-reaching problems. Monitoring and enforcement of regulations to ensure the administration of safe vaccines can be assured, is simply absent. And this is the largest component of failed responsibility by the government to the safety of the country's most vulnerable, its children.

Vials identified by their labelling as vaccines have been increasingly discovered to be carrying nothing but saline solution sometimes mixed with antibiotics that have been found to be used at 37 hospitals and clinics located in nine cities throughout the country, according to revelations by Indonesia's Food and Drug Agency. Investigations have resulted in 23 people being arrested, among them three doctors.

When a nation of over 250 million people discovers that something as elemental as protecting their infants from diseases whose efficacy and reliability is generally taken for granted in a well-regulated and operated health system, has failed the test of trust, the response will be guaranteed outrage. Indonesian president Joko Widodo paid a personal visit to a clinic where several hundred children were scheduled for revaccination.

There, he appealed to parents and the public at large for patience while his government investigates further the "extraordinary crime" that has been uncovered of false vaccines, which have been a problem, as it has been revealed, as far back as 2003. Dr. Pulungan, as head of the country's pediatrician society has attested that to his knowledge no children are known to have died resulting from their unprotected status against diseases they were supposed to be vaccinated against.

Some, he agrees, may have become ill and the cause obviously not fully understood. Inoculations routinely used are those for measles, whooping cough, hepatitis and diphtheria. And their matched vaccines were labelled as imported brands. Dr. Pulungan understands that only one percent of vaccines used nationwide have been imported. A mob of raging parents appeared on television haranguing a doctor, punching and spitting on him at an eastern Jakarta hospital.

Members of Indonesian parliament have been approached by angry parents demanding action on the urgent file. The Health Ministry estimated that five thousand children from among 4.8 million who were immunized in the current year, were recipients of the fake vaccines. According to the director of surveillance with the ministry, the fake vaccines contained no harmful ingredients, though the possibility of infections resulting was possible, related to unsafe processing in their production.

The endemic corruption, overcrowding in hospitals and a severe shortage of doctors are conditions not conducive to trust by the population in the health care system. Those Indonesians who have money to spare seek treatment often in neighbouring Singapore or Malaysia. While parents are beside themselves with concern over the well-being of their children, it seems that the government had prior knowledge it failed to act upon.

Women wait for information about the alleged use of fake vaccines on their children at a hospital in East Jakarta, Indonesia   Antara Foto/Sigid Kurniawan/via Reuters

In 2013, a report from GlaxoSmithKline about counterfeit vaccines bearing their logo and guarantee was received by the Indonesian Food and Drug Agency. The person behind the scheme was apprehended and fined a grand sum total of under $100. And then in 2014 and 2015 other problems surfaced. In 2016, PT Sanofi-Aventis Indonesia, a subsidiary of the French Sanofi, informed Indonesian national police that fake vaccines were surfacing with its product labels affixed.

Hospital workers (R) collect information from parents who believe their children may have received fake vaccines at a hospital in East Jakarta, Indonesia  Antara Foto/Sigid Kurniawan/ via Reuters