One Health: Healthcare Transformations in Indonesia

So far, 74% (174 million people) of the target population in Indonesia has been fully vaccinated against Covid, and 29% has received a booster. As Indonesia transitions from an emergency into a routine healthcare situation, it is committed to remoulding its healthcare system, with a 6-fold focus covering primary healthcare services, referral services, healthcare system resilience, financing, human resources and technology.

Indonesia is among the fastest-growing countries in the ASEAN region. In 2021, the Indonesian pharmaceutical market size stood at $8.6 billion, whereas the medical devices market was worth $3.6, according to GlobalData. Revenue from the OTC pharmaceutical market, specifically, is expected to cross $2.2 billion in 2023, with a CAGR of 6.12% from 2023-2027; 17.9% of this revenue is forecasted to come from online sales. Even the digital health market looks promising, at $2.38 billion in 2023 with a CAGR of 13.66% till 2027.

Many developments have gripped healthcare and pharma over the past couple of years. In a terrible turn of events last year, over 200 children in Indonesia lost their lives due to the consumption of cough syrups contaminated with ethylene glycol and diethylene glycol. While families of the children are suing the country’s health ministry and drugs regulator, the country’s police claimed that a local trader of industrial-grade chemicals sold them as pharmaceutical-grade. The licences of the pharma companies concerned have been suspended and the supplier charged for forged ingredient labels, but regulation of drug quality remains a concern.

In spite of such challenges, Indonesia’s dreams of becoming not just a regional but a global vaccine hub are inching closer to reality. Indonesia contributes nearly 70% of the world’s polio vaccine supply; state-owned Bio Farma even secured a UNICEF purchase order for 2022 and 2023. The largest vaccine manufacturer in Southeast Asia is also set to become a regional mRNA vaccine hub as a beneficiary of the WHO’s tech transfer programme.

Late last year, Indonesia launched its first domestically-produced Covid vaccine IndoVac. With close to 80% local ingredients, IndoVac was a milestone in local vaccine manufacturing for the country, which had then imported all 400 million doses of its Covid vaccine. Unlike many other vaccines around the world, IndoVac is not an mRNA vaccine, but that is precisely what makes it suitable for deployment in LMICS. It has no cold storage requirements, a lower production cost, and is patent-free. And Indonesia’s plans include supplying not only its own citizens but also African countries.

In December 2022, state-owned Bio Farma made a deal with Merck to manufacture its HPV vaccine, which is already in use in Indonesia, where cervical cancer is the second most common type of cancer affecting women. The country intends to administer the shot to 1.4 million girls this year. Further, Indonesia’s Etana Biotechnologies reached a tech transfer agreement with China’s Suzhou Abogen to develop homegrown mRNA vaccines.

Additionally, Indonesia has been selected by CEPI to participate in its manufacturing network to have vaccine stocks ready around the world in preparation for another pandemic. Indonesia is also set to benefit from a deal that the Medicines Patent Pool signed with Novartis, allowing selected manufacturers to produce and supply generics of its leukaemia drug Nilotinib (sold by Novartis under the brand name Tasigna) in LMICs.

October 2022 was an especially action-packed month for Indonesia, having signed 8 bilateral agreements with other G20 countries on health transformation: with South Korea on expanding hospital medical services and collaborating with Korean pharma; with South Africa on genomic and mRNA sequencing; a $5 million grant from Saudi Arabia for meningitis medicines and vaccines for Hajj and Umrah travellers; and $10 million for TB control from UAE. Agreements were also inked with Spain, Germany, the Netherlands, the US and Brazil, with support ranging from vaccines and infectious disease surveillance to R&D, training and hospital cooperation.

Not one to be left behind in the health tourism sector, Indonesia is working to build its first purpose-fit SEZ in the Sanur area of the Bali province. Over 2 million Indonesian citizens travelled abroad to seek health services worth $6 billion in 2019. The number of tourists visiting Bali is projected to rise by almost 25% from 2020 to 2024. Medical tourism in Southeast Asia is expected to grow 18% in the same time frame. Indonesia hopes to capitalise on this growth, attracting people, both local and international, to its own health infrastructure at the Sanur SEZ.

Indonesia’s healthcare transformation plans have another integral element: SATUSEHAT, or One Health, a digital platform to integrate all healthcare data from hospitals, clinics, community health centres, labs and pharmacies. Hoping to achieve greater speed, efficiency and transparency, 370 hospitals and 2893 community health centres in Java and Bali are already ready for integration. Startups like Halodoc and Alodokter are also contributing to the digital healthcare movement, connecting patients to healthcare providers, insurance and pharmacies online.

Indonesia’s high disease burden poses a challenge, but the country is taking concrete steps to tackle it. With over 1000 dengue deaths and 125,888 cases of dengue hemorrhagic fever (DHF) in 2022, Indonesia suffers a disproportionately high burden of dengue fever – one of the highest in the world and about half of the South East Asian regional burden. In 2022, the Indonesia National Agency for Drug and Food Control became the first anywhere in the world to approve Qdenga, Takeda’s dengue vaccine, for its 6-45-year-old population, irrespective of prior exposure to dengue.

There are also other situations that stand to threaten health security in the archipelago nation. In 2021, Indonesia had the third highest leprosy prevalence in the world, though cases may have gone undetected and underreported due to Covid. In 2019, NCDs – stroke, ischemic heart disease, diabetes and cirrhosis – were the leading causes of death, followed by TB. In 2021, Indonesia witnessed a tuberculosis caseload of 969,000 (9% of the global total) with 150,000 deaths; in December 2022, the World Bank approved a $300 million loan to the government to enhance its TB response.

Despite its share of challenges, Indonesia’s health transformation efforts reveal just how ambitious it is – in manufacturing, digital health and medical tourism. The country used its 2022 G20 presidency to feature global health architecture high on its list of priorities. The country’s primary pharmaceutical manufacturer, the state-owned Bio Farma, produces 14 types of vaccines which are imported to 150 countries. It has a capacity of over 3 billion and even holds the mRNA knowledge shared through the WHO. As it remains open to global innovation, tech and collaboration, Indonesia has a big role to play in pharmaceutical self-sufficiency in the Southeast Asian region.

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