Vaccination: Right or Obligation?

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The acceleration of vaccination has become a strategic step for the international community amid the threat of Covid-19. This step is carried out quickly and evenly to most of the population. The hope is that herd immunity will be formed, which will prevent the spread of Covid-19.

So, should vaccination be a right or an obligation?

The issue became an exciting and interesting discussion in the discussion on Vaccination: Rights or Obligations?: that organized by the Institute for Democracy and Social Welfare (INDEKS) and the Friedrich Naumann Foundation (FNF) Indonesia and supported by the Ministry of Law and Human Rights (Kemenkumham) of the Republic of Indonesia on Monday (30/8/2021).

The Director of Cooperation at the Indonesian Ministry of Law and Human Rights, Hajerati, said that the state requires the public to vaccinate against COVID-19 to contain the outbreak, which does not violate human rights. Instead, the policy is an effort by the Government of Indonesia to fulfil the human rights of its citizens, namely the right to life and the right to health.

"The European Court of Human Rights (ECHR) in Strasbourg, France on Thursday, April 28, 2021, decided that the state policy that requires vaccination is not a violation of human rights," said Hajerati as a resource person at Session I of this discussion.

Hajerati said that the Indonesian government had provided free Covid-19 vaccinations for Indonesian citizens without any conditions. The policy is based on the Minister of Health Regulation Number 23 of 2021. Hajerati views this free vaccination policy as a manifestation of the government's efforts to fulfil Human Rights (HAM) related to health and guarantee the right to life as mandated in Article 9 of Law no. 39 of 1999 on Human Rights.

According to Hajerati, citizens have the right to refuse and accept all relief measures given to them related to health. Her statement is based on Article 56 of Law No. 36 of 2009 concerning Health.

"The right to refuse does not apply to people with diseases that can quickly spread to the wider community," said Hajerati, citing article 56, paragraph 2 of the Law on Health.

In contrast to Hajerati, Nanang Sunandar (Director of the Index) said that requiring vaccinations to the community was not the right step. The reason is that various efforts to prevent the spread of Covid-19 must still pay attention to the position of citizens as the rights holders. In this case, they ensure that all prevention efforts are minimally impacted, reducing or losing citizens' rights. If forced, all forms of rights restrictions, especially if they apply massively, require regulation at the legal level.

Nanang continued, one of the basic principles that are the origin of all rights is the autonomy of the individual body. This principle will first make the individual the highest authority over the integrity of his body so that any intervention on a person's body must be carried out with the consent of the owner of the body.

"The application of this principle in the context of handling Covid-19 places vaccination as a citizen's right whose implementation is voluntary rather than mandatory. It means that the decision to undergo vaccination or not is an individual decision that must be respected," Nanang explained in Session II of the discussion.

Acceleration of Vaccination to Create Herd Immunity and Welfare

Hajerati admits that the number of people who have been vaccinated is still far from the target to create herd immunity. "The government's target is to reach 208,265,720 people who are vaccinated in April 2022. Meanwhile, as of August 26, only 35 million people have been vaccinated against dose II," said Hajerati.

Currently, the Government faces various challenges to achieve this target. One of the challenges is that many people refuse to be vaccinated—both those who do not want to be vaccinated because they are exposed to hoaxes or other reasons.

For the sake of accelerating vaccination, the Government of Indonesia has brought in several vaccine brands and made them free for the public. According to an internal medicine doctor who is also an influencer, Jeff Aloys Gunawan, all types of vaccines effectively prevent infection with the coronavirus, including the Delta variant. For this reason, he hopes that the public will take advantage of the vaccines provided by the government.

“We should be grateful that vaccines are available in Indonesia, and we can use them easily and for free. In India, you have to pay for the vaccine, around 160,000 for a single injection,” said Jeff when he participated in Session I of the discussion.

According to him, many people choose the type of vaccine with various considerations, even waiting for the type of vaccine, which is limited in number or not yet available, because they want to get the best covid-19 kind of vaccine.

"There's no need to be picky or do 'vaccine shopping', which in the end doesn't get vaccinated." This Siloam Hospital doctor regretted.

Jeff continued, all Covid-19 vaccines in Indonesia have met WHO standards because their effectiveness is above 50%. Sinovac has 65.9% protection, Moderna 94%, Pfizer 95%, AstraZeneca 92%, Cansino 68%.

For this reason, all vaccines available in Indonesia are good because they meet the standards of the World Health Organization (WHO). Jeff also hopes that people will not hesitate to vaccinate with any vaccine.

"Choose an available vaccine—no need to wait for certain types of vaccines because all of them are already above 50%. Don't get caught up in those percentages. Those percentages don't indicate which vaccines are better and which ones are not," advised Jeff.

Jeff continued, the percentage is the result of a complex process and is determined in many aspects. In addition, said Jeff, there have been no studies that show a comparison of one vaccine with another, which is better.

The World Health Organization (WHO) categorizes the COVID-19 vaccine as a global public good. To that end, vaccines must make a significant contribution to the equitable protection and promotion of the well-being of all people around the world. It was conveyed by Diah Saminarsih, one of the speakers for this discussion in Session I.

"We should not allow vaccines to increase injustice and inequality," said the Senior Advisor on Gender and Youth Affairs to the Director-General of the WHO.

Diah continued, the existence of a covid-19 vaccine must be based on the principles of welfare, equal respect, global justice, national justice, mutual benefit, and legitimacy.

Based on this, WHO, through the COVAX Facility platform, ensures fair distribution of the COVID-19 vaccine. WHO, through COVAX Facility, ensures that all countries that are members of the WHO receives a supply of COVID-19 vaccine at least 20% of the total population of their citizens. Diah said Indonesia became one of the heads of this COVAX Facility.

Diah further explained that vaccination alone is not enough to bring a country out of the pandemic. Vaccination must be balanced with supporting measures.

“Vaccinations are very important. If you want to get out of the pandemic, the vaccine must be pursued and accelerated, plus it must not be lax in carrying out 3T, testing, tracing, and treatment," Diah advised.

In addition, public awareness is also needed by diligently washing hands, avoiding crowds, reducing mobility, wearing masks, and maintaining distance.

The Covid-19 pandemic impacts the health of the Indonesian people and has an impact on the community's economy. Both formal and informal business actors are affected. For this reason, Herman Heizer (Management of the Indonesian Young Entrepreneurs Association, HIPMI) hopes that all parties, the government, the general public, and business actors, united to get out of this pandemic.

“We must do whatever it takes to end this pandemic. One of the important things to be done is accelerating massive vaccination to create herd immunity,” said Herman in the discussion.

Herman said HIPMI was involved in accelerating vaccination to the community in several areas. It provides a place for vaccination and provides incentives for necessities to the community so that they are willing to be vaccinated.

Acceleration of Vaccination Needs to Involve the Private Sector

Nanang Sunandar assessed that to encourage the acceleration of vaccination; it is necessary to involve the private sector to participate actively. "More non-governmental organizations are involved in the vaccine procurement process and the vaccination process, thus providing space for those who are willing and able to carry out paid self-vaccination," said Nanang in this discussion.

Nanang said that the vaccine economy could not only accelerate vaccination. But it can also be an answer to the problem of a pandemic that threatens public health and the community's economy.

"The vaccine economy is an effort where the implementation of vaccination is not only to answer public health problems but also can grow a health industry that can grow the economy," said Nanang.

In line with Nanang, Andree Surianta (Researcher at the Center for Indonesian Policy Studies, CIPS) believes that private sector involvement is needed to accelerate vaccination. Moreover, 35% of the people are willing to be vaccinated for a fee.

"Based on a survey in November 2020, 65% of respondents want vaccines, and 35% of them are willing to pay. In the end, the vaccine is free for all,” said Andree in the discussion.

Andree continued, the Government of Indonesia is currently cooperating with the private sector to accelerate vaccination. Namely, through the Mutual Cooperation Vaccination (VGR). But unfortunately, this VGR invites polemics.

“In May 2021, 22,736 companies registered more than 10 million people. 57% are companies in Jakarta. But at that time, it became a polemic; such as the price is not transparent and quite high, registration is not easy, and the stock is not clear," explained Andree.

In the end, Andree continued, the VGR program had only consumed about one million doses as of August 25. This VPR polemic then led to a proposal to open an individual paid vaccination room, leading to a debate. Andree regretted why the issue of paid vaccination became a polemic and triggered controversy.

“Thailand, India and Pakistan are allowing private hospitals to provide paid COVID-19 vaccines. Some countries make COVID-19 vaccines for tourism packages, such as America, the UAE, the Maldives," said Andree.

However, Andree recognized that for now, the paid vaccination program faces two challenges. First, the limited supply of global vaccines, while national vaccine production can only be carried out in 2022. Second, distribution issues such as vaccines are perishable. If you want to implement a paid vaccination program, said Andree, make sure the supply is available.