An Anti-Expertise, Anti-Science Attitude is Undermining Indonesia’s Pandemic Response
Thediplomat.com – On July 29, Luhut Binsar Pandjaitan, Indonesia’s Coordinating Maritime and Investment Minister, made a comment that many would view as stating the obvious: “Now we understand that tracing is important in handling COVID-19,” he said to journalists during his visit to a medical oxygen supply facility in East Jakarta.
Given that Luhut is in charge of the emergency restrictions designed to fight the pandemic, many Indonesians interpreted his remark as evidence that the government has been very late in understanding the importance of tracing, although the country’s epidemiologists and other public health experts have been communicating its importance since the beginning of the pandemic. Indeed, it is incomprehensible that the government has only just now realized the importance of tracing those infected with COVID-19.
Luhut made another startling statement on August 9, claiming that the government would exclude the death rate from the indicators of its pandemic response, citing “errors in the data entry that caused distortion in the judgment.”
That decision is contrary to the World Health Organization’s guidance that mortality should be one of the primary indicators for assessing pandemic responses. Amid the inevitable outcry from experts, the government later clarified that the decision was only a temporary measure while it made efforts to clean up the data.
Both of these comments pointed to the fact that the Indonesian government has largely disregarded the advice of experts during the pandemic, resulting in systemic failures in its response to COVID-19. For example, senior officials were downplaying experts’ warnings about the seriousness of the virus as early as January 2020, leading the government to underestimate its dangers and respond belatedly to the spread of the virus.
This denial is best exemplified by the former Health Minister Terawan Agus Putranto. Consider his response when journalists asked for his comment about a study by researchers at Harvard University’s T.H. Chan School of Public Health, which concluded that the coronavirus could have arrived in Indonesia in February 2020. He discredited the study by challenging the researchers to come to Indonesia to prove their study.
Even after the virus was confirmed to be in Indonesia, Terawan underestimated it by saying that “the flu was more dangerous” because of its higher death rate. His continued underestimation of the pandemic, his arrogant, anti-science attitude, and his alleged incompetence in handling the pandemic, led to him being replaced as minister in December 2020.
Terawan’s anti-science orientation should have come as no surprise. The military doctor had a decorated career, having served as head of the Indonesian Army (TNI-AD)’s main hospital. But he had also courted controversy for formulating a quack “brainwash” therapy for stroke patients – a method roundly criticized by the medical community. It involved a technique called digital subtraction angiography (DSA), which doctors argued as not a therapy for healing patients, but only a tool for diagnosing the disease. The Indonesian Medical Association (IDI) dismissed him for violating the medical code of ethics and not cooperating when IDI summoned him over the matter.
But being replaced as minister was not the end for Terawan, and he quickly returned to spotlight with a new project to develop a dendritic cell-based COVID-19 vaccine called the “Nusantara vaccine,” Dendritic cells are those responsible for the initiation of adaptive immune responses. Terawan’s project has been conducted with an “autologous” method, which in this case involves isolating a patient’s dendritic cells, treating it, then injecting it back to the same patient. This personalized and exclusive approach is contrary to the goal of developing a vaccine that can be used by as many people as possible to achieve herd immunity in the population.
At first, the Indonesian Food and Drug Authority (BPOM) did not authorize the vaccine to proceed to Phase II trials, after finding problems during the previous phase of the trials. Nevertheless, the vaccine found support from military figures and politicians, who pressured BPOM to allow its trials to continue. Ultimately, in April of this year, BPOM agreed to an MoU that the vaccine development would continue, but it would not receive distribution authorization from BPOM. It became a research on dendritic cells under the supervision of the Health Ministry.
Terawan is far from being the only government figure who undermined the authority of experts during the pandemic. Other military figures and politicians, as well as government agencies, have also raced to develop so-called COVID-19 “cures,” far exceeding their official roles and mandates.
One of the cures endorsed by several government figures is ivermectin, the antiparasitic drug whose usefulness for treating COVID-19 lacks credible scientific evidence. In June, some cabinet members even claimed that BPOM had authorized the use of ivermectin to treat the virus. BPOM soon clarified that its authorization of ivermectin was as an anthelmintic (drugs used to treat worms and parasites), not as a COVID-19 drug.
In July 2021, BPOM shut down the factory of an ivermectin manufacturer after finding several violations. Nevertheless, the media soon reported that the company was suspected of having lobbied several government officials, including officials in the Defense Ministry and the State Palace, to approve the use of ivermectin as a COVID-19 drug. A local NGO also found links between members of political parties and public officials with the ivermectin manufacturer. Ultimately, BPOM agreed to authorize clinical trials of ivermectin as a COVID-19 drug.
Another example is the combination of drugs that has been pushed by the Indonesian State Intelligence Agency (BIN) and TNI-AD as a treatment for COVID-19. In August 2020, BPOM said that the drugs’ clinical trials had not followed proper procedures, and declined to authorize their use. Nevertheless, in July 2021, it was revealed that the research has continued, combining several existing drugs into one.
Of course, the above is not an exhaustive list of the various examples of the Indonesian government’s disregard of public health experts, nor its support for pandemic mitigation measures that are not recommended by experts in the field. However, it is still a worrying phenomenon that needs to be resolved if Indonesia is to contain the current severe outbreak of COVID-19.
It is easy to list the evidence of the Indonesian government’s anti-expertise and anti-science attitude to the COVID-19 pandemic. It is more difficult to discuss the reason why such sentiments are so widespread . One probable reason is that due to the various failures of its pandemic response, the Indonesian government is desperate for an easy way out of a hopeless situation. Hence, many factions in the government have tried to build gratifying fantasies of magical cures for the disease, while denying the unpleasant fact that there is no shortcut out of it. Political elites want to be able to claim credit for these “cures,” while businesses hope to reap benefits from them.
The Indonesian government must cease its anti-expertise sentiment – especially during the current serious outbreaks of COVID-19 – and listen more closely to the advice of experts in shaping its pandemic response. Experts do sometimes fail, and are not always in the best position to decide on difficult political trade-offs, but other experts can recognize each other’s errors and provide advice to correct and rectify their failures. Meanwhile, anti-expertise sentiment only makes us resistant to learning important lessons that are needed to improve our pandemic response.
This article is previously published in thediplomat.com August 26, 2021