Coronavirus Disease 2019 (COVID-19) World Health

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Coronavirus Disease 2019 (COVID-19) World Health CoronavirusCoronavirus Disease Disease 2019 2019 (COVID (COVID-19) -19) World Health OrganizationOrganization Situation Report - 52 Situation Report - 7 Indonesia Indonesia

21 AprilData 2021 as of 07 May 2020

HIGHLIGHTS

• As of 21 April, the Government of Indonesia reported 1 620 569 (5720 new) confirmed cases of COVID-19, 44 007 (230 new) deaths and 1 475 456 recovered cases from 510 districts across all 34 provinces.1

• WHO continues to provide technical assistance to the Government of Indonesia for the continuity of essential health services. Highlights of the Routine Immunization Programme are available on pages 19 to 24.

• On 16 April, WHO convened the sixth meeting in 2021 of key development partners to discuss and coordinate COVID-19 response activities among partners in Indonesia (page 24).

Fig. 1. Geographic distribution of cumulative number of confirmed COVID-19 cases in Indonesia across the provinces reported from 15 to 21 April 2021. Source of data

Disclaimer: The number of cases reported daily is not equivalent to the number of persons who contracted COVID-19 on that day; reporting of laboratory-confirmed results may take up to one week from the time of testing.

1 https://covid19.go.id/peta-sebaran-covid19 1 WHO Indonesia Situation Report - 52 who.int/indonesia GENERAL UPDATES • During a virtual discussion with the Indonesian Medical Association on 18 April, the Minister of Health reported that there was a decline in the daily COVID-19 vaccination rate in the country since the beginning of the second week of April; the Minister stated that the vaccination rate decreased from 500 000 injections per day to 200 000 to 300 000 injections per day. Among others, this was due to the limited availability of vaccine stock. However, with the additional allocation of COVID-19 vaccines from the COVAX Facility that is estimated to arrive in Indonesia in May, the Minister was optimistic that the Ministry of Health (MoH) will be able to increase the daily vaccination rate in the country to 750 000 per day by May or June.2

• The Government of Indonesia extended the implementation of the micro-scale restrictions on community activities (pemberlakuan pembatasan kegiatan masyarakat (PPKM)) from 20 April to 3 May, adding West Sumatra, Jambi, Bangka Belitung Islands, Lampung and West Kalimantan to the list of provinces to implement PPKM.3 On 16 April, the National COVID-19 Task Force spokesperson stated that more than 14 000 COVID-19 handling posts have been built in 323 districts of 31 provinces to support the implementation of the micro-scale PPKM at the village and sub-district levels.4

• On 13 April, the Head of the Disease Prevention and Control of DKI Jakarta Provincial Health Office (PHO) stated that residents who accompany two older people to vaccination sites to receive COVID-19 vaccine can get vaccinated without prior registration, even if they are not included in the priority group of the current vaccination rollout. The province is using this strategy as one of the efforts to boost vaccination coverage among older people. On 12 April, the DKI Jakarta Governor stated that the province plans to vaccinate 95% of the targeted older people before the Eid.5

2 https://nasional.kompas.com/read/2021/04/18/14584121/menkes-vaksinasi-covid-19-turun-selama-ramadhan- jadi-200000-300000-suntikan?page=all#page2 3 https://www.kompas.com/tren/read/2021/04/20/162900365/daftar-25-provinsi-yang-berlakukan-ppkm-mikro- mulai-20-april-2021?page=all 4 https://en.antaranews.com/news/172638/indonesia-has-14093-posts-to-support-micro-scale-activity-restriction 5 https://megapolitan.kompas.com/read/2021/04/13/15151291/warga-jakarta-yang-bawa-2-lansia-untuk- vaksinasi-bisa-ikut-disuntik?page=all 2 WHO Indonesia Situation Report - 52 who.int/indonesia SURVEILLANCE

• On 21 April, 5720 new and 1 620 569 cumulative confirmed COVID-19 cases were reported nationwide (Fig. 2). The average for the last seven days from 15 to 21 April was 5341 cases per day, compared to 5117 cases per day reported in the previous week.

16000 1800000

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Daily number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases

Fig. 2. Daily and cumulative number of cases reported in Indonesia, as of 21 April 2021. Source of data

Disclaimer: The number of cases reported daily is not the number of persons who contracted COVID-19 on that day and might be influenced by the number of people tested on that day (see Fig. 17); reporting of laboratory-confirmed results may take up to one week from the time of testing. Therefore, caution must be taken in interpreting this figure and the epidemiological curve for further analysis, either at the national or subnational level.

3 WHO Indonesia Situation Report - 52 who.int/indonesia • During the week of 12 to 18 April, the provinces of East Nusa Tenggara, Riau Islands, Maluku, West Kalimantan and Lampung experienced an increase in the number of weekly cases of more than 50% compared to the previous week (Fig. 3). It is critical to investigate reasons for the increase in the new confirmed cases to guide decisions on response activities and inform the adjustment of public health and social measures (PHSM).

East Nusa Tenggara Riau Islands Maluku West Kalimantan Lampung North Kalimantan Bangka Belitung Islands West Java Aceh Central Java West Papua Central Sulawesi Riau North Sulawesi Jambi West Nusa Tenggara West Sulawesi Gorontalo West Sumatra South Sumatra Bengkulu DKI Jakarta Central Kalimantan East Kalimantan DI Yogyakarta East Java North Maluku Banten Bali North Sumatra Southeast Sulawesi South Kalimantan South Sulawesi Papua -100% -50% 0% 50% 100% 150% 200% Percentage change of weekly number of confirmed cases

Fig. 3. Percentage change of weekly number of confirmed cases by province during 12 to 18 April 2021 compared to the previous week. Source of data

Disclaimer: The number of weekly confirmed cases is calculated taking into consideration the daily number of reported cases. It is important to conduct further investigation if there is a substantial change in new cases, especially in provinces with a change of 50% or more. Other factors, such as testing and contact tracing, may help elucidate the reasons behind substantial changes. Additional indicators, including case incidence and mortality, should be considered to guide adjustment of PHSM.

4 WH O Indonesia Situation Report - 52 who.int/indonesia

• During the week of 12 to 18 April, the incidence6 of COVID-19 in Indonesia was 13.2 per 100 000 population, compared to 13.1 per 100 000 in the previous week (Fig. 4).

CT2 (20 - <50) 25

15 Case Case incidence CT1 (<20) 10

11/05 - 17/05 - 11/05 09/08 - 03/08 01/11 - 26/10 24/01 - 18/01 18/04 - 12/04 13/04 - 13/04 19/04 - 27/04 03/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 28/09 04/10 - 12/10 18/10 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 21/12 27/12 - 04/01 10/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 15/03 21/03 - 29/03 04/04 Fig. 4. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period reported in Indonesia from 13 April 2020 (when Indonesia first reported community transmission in the country) to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

Disclaimer: There are seven categories for transmission classification: (1) no (active) cases; (2) imported/sporadic cases; (3) cluster of cases; (4) community transmission 1 (CT1); (5) community transmission 2 (CT2); (6) community transmission 3 (CT3); and (7) community transmission 4 (CT4). Caution should be exercised when interpreting this indicator due to limitations listed in the WHO interim guidance. Other limitations include data incompleteness and data quality issues reported by MoH. Other epidemiological indicators also need to be evaluated to decide on the level of community transmission. This disclaimer applies to indicators at national (Fig. 4) and subnational levels (Figs. 5 to 11).

6 Weekly incidence of COVID-19 is calculated as the number of new cases per 100 000 population per week averaged over a two-week period. Source of population data 5 WHO Indonesia Situation Report - 52 who.int/indonesia

• During the week of 12 to 18 April, the incidence of COVID-19 per 100 000 population was 59.4 in DKI Jakarta, which corresponds to community transmission level 3 (Fig. 5). Based on WHO interim guidance, community transmission level 3 means that there is a high risk of COVID-19 infection for the general population and that a high number of locally acquired, widely dispersed cases was detected in the past 14 days.

DKI Jakarta Bangka Belitung Islands DI Yogyakarta South Kalimantan East Kalimantan Bali Banten Central Kalimantan Riau North Kalimantan West Papua West Sumatra Riau Islands West Java Bengkulu Central Java Central Sulawesi Papua South Sulawesi West Kalimantan Jambi South Sumatra Gorontalo East Nusa Tenggara East Java Lampung West Nusa Tenggara North Sumatra Aceh Maluku North Sulawesi North Maluku West Sulawesi Southeast Sulawesi

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Weekly case incidence

CT 1 (<20) CT 2 (20-<50) CT 3 (50 - <150) CT 4 (150+)

Fig. 5. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period by province in Indonesia during 12 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

6 WHO Indonesia Situation Report - 52 who.int/indonesia • The weekly incidence of COVID-19 increased in West Java, Central Java and DI Yogyakarta during the week of 12 to 18 April compared to the previous week (Fig. 6 to 11).

DKI Jakarta 240

200 CT4 (150+)

160

120 CT3 (50 - <150)

Case Case incidence 80

40 CT2 (20 - <50) CT1 (<20)

15/03 - 21/03 - 15/03 13/04 - 13/04 19/04 - 27/04 03/05 - 11/05 17/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 03/08 09/08 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 28/09 04/10 - 12/10 18/10 - 26/10 01/11 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 21/12 27/12 - 04/01 10/01 - 18/01 24/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 29/03 04/04 - 12/04 18/04 Fig. 6. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in DKI Jakarta, from 13 April 2020 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

West Java 45 CT 2 (20 - <50) 40 35

30 25 20

Case Case incidence 15 10 CT 1 (<20) 5

13/04 - 13/04 19/04 - 27/04 03/05 - 11/05 17/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 03/08 09/08 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 28/09 04/10 - 12/10 18/10 - 26/10 01/11 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 21/12 27/12 - 04/01 10/01 - 18/01 24/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 15/03 21/03 - 29/03 04/04 - 12/04 18/04 Fig. 7. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in West Java, from 13 April 2020 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

7 WHO Indonesia Situation Report - 52 who.int/indonesiaFig. 6. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in West Java, from 13 April 2020 to 24 January 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence.

Central Java 40 35 CT 2 (20 - <50) 30 25 20

15 Case Case incidence 10 CT 1 (<20) 5

28/09 - 04/10 - 28/09 27/12 - 21/12 21/03 - 15/03 13/04 - 13/04 19/04 - 27/04 03/05 - 11/05 17/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 03/08 09/08 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 12/10 18/10 - 26/10 01/11 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 04/01 10/01 - 18/01 24/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 29/03 04/04 - 12/04 18/04

Fig. 8. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in Central Java, from 13 April 2020 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

DI Yogyakarta 70 CT 3 (50 - <150) 60

40 CT 2 (20 - <50) 30

Case Case incidence 20

10 CT 1 (<20)

13/04 - 13/04 19/04 - 27/04 03/05 - 11/05 17/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 03/08 09/08 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 28/09 04/10 - 12/10 18/10 - 26/10 01/11 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 21/12 27/12 - 04/01 10/01 - 18/01 24/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 15/03 21/03 - 29/03 04/04 - 12/04 18/04 Fig . 9. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in DI Yogyakarta, from 13 April 2020 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

8 WHO Indonesia Situation Report - 52 who.int/indonesia

East Java 20 18 16 14 12 10 CT 1 (<20) 8

Case Case incidence 6 4 2

Fig. 10. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in East Java, from 13 April 2020 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

Banten

30 CT 2 (20 - <50)

Case Case incidence CT 1 (<20) 10

13/04 - 13/04 19/04 - 27/04 03/05 - 11/05 17/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 03/08 09/08 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 28/09 04/10 - 12/10 18/10 - 26/10 01/11 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 21/12 27/12 - 04/01 10/01 - 18/01 24/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 15/03 21/03 - 29/03 04/04 - 12/04 18/04 Fig. 11. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period in Banten, from 13 April 2020 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

9 WHO Indonesia Situation Report - 52 who.int/indonesia

• Nationwide test positivity proportion increased sharply after 23 November and reached a peak of 30.5% in mid-February. Subsequently, the positivity proportion declined and stood at 11.5% on 18 April (Fig. 12). However, the percentage of positive samples can be interpreted reliably only with comprehensive surveillance and testing in the order of one person tested per 1000 population per week. This minimum case detection benchmark was achieved in DKI Jakarta and DI Yogyakarta for the last three weeks, but none of these provinces had a test positivity of less than 5% (Fig. 13).

40%

35%

CT 4 (20%+) 30%

25%

20% CT 3 (5% - <20%)

15% Positivity Positivity proportion(%)

10%

5% CT 2 (2% - <5%) CT 1 (<2%)

0% 1-May 1-Jun 1-Jul 1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr

Fig. 12. Test positivity proportion averaged over a two-week period at the national level in Indonesia, as of 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data Disclaimer: Caution should be exercised when interpreting this indicator due to limitations listed in the WHO interim guidance. Other epidemiological indicators also need to be evaluated to determine the level of community transmission.

10 WHO Indonesia Situation Report - 52 who.int/indonesia 8.00 55.0% 50.0% 7.00 45.0% 6.00 40.0% 5.00 35.0% 30.0% 4.00 25.0% 3.00 20.0% 2.00 15.0%

10.0% Positivity proportion(%) 1.00

5.0% People People tested/1000 population/week - 0.0% 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Indonesia DKI West Central DI Yogyakarta East Banten Jakarta Java Java Java

People tested/1000 population/week Test positivity proportion 8.00 55.0% 50.0% 7.00 45.0% 6.00 40.0% 5.00 35.0% 30.0% 4.00 25.0% 3.00 20.0% 2.00 15.0%

10.0% Positivity proportion(%) 1.00 5.0%

People People tested/1000 population/week - 0.0% 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Indonesia West East West Riau Central South Southeast Sumatra Kalimantan Papua Kalimantan Sumatra Sulawesi

People tested/1000 population/week Test positivity proportion

Fig. 13. Test positivity proportion and people tested per 1000 population per week at the national level and in select provinces.

Week 1: 29/03/21 to 04/01/21; Week 2: 05/04/21 to 11/04/21; Week 3: 12/04/21 to 18/04/21 Benchmark: one person tested per 1000 population per week Threshold test positivity proportion: <5% Source of data: Indonesia, DKI Jakarta, West Java, Central Java, DI Yogyakarta, East Java, Banten, West Sumatra, East Kalimantan, West Papua, Riau, Central Kalimantan, South Sumatra, Southeast Sulawesi

Note: Due to a limitation in data, other provinces could not be evaluated. For surveillance purposes, test positivity proportion is calculated as the number of confirmed cases divided by the number of people tested for diagnosis.

11 WHO Indonesia Situation Report - 52 who.int/indonesia

• During the week of 12 to 18 April, Banten had the highest weekly number of confirmed COVID-19 deaths per 100 000 population, followed by East Kalimantan, Bali, DI Yogyakarta and Bangka Belitung Islands (Fig. 14).

Banten East Kalimantan Bali DI Yogyakarta Bangka Belitung Islands South Kalimantan Riau Central Kalimantan DKI Jakarta North Kalimantan East Java West Papua West Sumatra Central Java Gorontalo South Sumatra West Java Central Sulawesi Riau Islands Bengkulu Maluku West Sulawesi Lampung East Nusa Tenggara North Sumatra Aceh West Nusa Tenggara Papua North Sulawesi South Sulawesi Jambi Southeast Sulawesi West Kalimantan North Maluku 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 Weekly number of confirmed COVID-19 deaths per 100 000 population

CT 1 (<1) CT 2 (1 - <2) CT 3 (2 - <5) CT 4 (5+)

Fig. 14. Number of confirmed COVID-19 deaths per 100 000 population per week averaged over a two-week period by province in Indonesia during 12 to 18 April 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

Disclaimer: Based on data availability, only confirmed COVID-19 deaths have been included. As per WHO definition, however, death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case is a COVID-19-related death, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g. trauma); there should be no period of complete recovery between the illness and death. 12 WHO Indonesia Situation Report - 52 who.int/indonesia

• During the week of 12 to 18 April, the number of confirmed COVID-19 deaths was 0.37 per 100 000 population7, compared to 0.39 per 100 000 in the previous week (Fig. 15).

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13/04 - 13/04 19/04 - 27/04 03/05 - 11/05 17/05 - 25/05 31/05 - 08/06 14/06 - 22/06 28/06 - 06/07 12/07 - 20/07 26/07 - 03/08 09/08 - 17/08 23/08 - 31/08 06/09 - 14/09 20/09 - 28/09 04/10 - 12/10 18/10 - 26/10 01/11 - 09/11 15/11 - 23/11 29/11 - 07/12 13/12 - 21/12 27/12 - 04/01 10/01 - 18/01 24/01 - 01/02 07/02 - 15/02 21/02 - 01/03 07/03 - 15/03 21/03 - 29/03 04/04 - 12/04 18/04 Fig. 15. Number of confirmed COVID-19 deaths per 100 000 population per week averaged over a two-week period in Indonesia, as of 18 April 2021. Source of data

Disclaimer: Based on data availability, only confirmed COVID-19 deaths have been included. As per WHO definition, however, death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case is a COVID-19-related death, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g. trauma); there should be no period of complete recovery between the illness and death. Evaluation of the level of community transmission could not be conducted due to data limitations.

• During the week of 12 to 18 April, the total number of weekly confirmed COVID-19 deaths in DKI Jakarta was 86, compared to 90 in the previous week (Fig. 16).

7 Weekly mortality of COVID-19 is calculated as the number of COVID-19 deaths per 100 000 population per week averaged over a two-week period. Source of population data 13 WHO Indonesia Situation Report - 52 who.int/indonesia DKI Jakarta 350

300 19 19 deaths - 250

200

150

100

Weekly Weekly number confirmed of COVID

16/03 - 22/0316/03- 03/0527/04- 02/0308/03- 30/0305/04- 13/0419/04- 11/0517/05- 25/0531/05- 08/0614/06- 22/0628/06- 06/0712/07- 20/0726/07- 03/0809/08- 17/0823/08- 31/0806/09- 14/0920/09- 28/0904/10- 12/1018/10- 26/1001/11- 09/1115/11- 23/1129/11- 07/1213/12- 21/1227/12- 04/0110/01- 18/0124/01- 01/0207/02- 15/0221/02- 01/0307/03- 15/0321/03- 29/0304/04- 12/0418/04-

Fig. 16. Weekly number of confirmed COVID-19 deaths in DKI Jakarta, as of 18 April 2021.Source of data,

Disclaimer: The data are provisional. There may be a discrepancy in the number of deaths in confirmed COVID-19 cases between national and provincial data sources.

HEALTH OPERATIONS

• As reported on 21 April, the daily number of people tested for COVID-19 was 47 048 and the cumulative number of people tested was 9 412 427 (Fig. 17).

14 WHO Indonesia Situation Report - 52 who.int/indonesia 80000 10000000 70000 8000000 60000 50000 6000000 40000 30000 4000000 20000 Daily numberDaily 2000000

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10-May 26-May Daily number of people tested Cumulative number of people tested

Fig. 17. Daily and cumulative number of people tested for COVID-19 in Indonesia, as of 21 April 2021. Source of data

• As of 21 April, the proportion of people recovered among the total confirmed COVID-19 cases was 91.0% and there were 101 106 active cases (Fig. 18).

200000 100.0

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Number 40.0 50000 (%) Percentage 20.0

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12-Nov 27-Nov

12-Mar 27-Mar

16-May 31-May

Active cases Recovery percentage

Fig. 18. Number of active cases of COVID-19 and recovery percentage in Indonesia, as of 21 April 2021. Source of data

15 WHO Indonesia Situation Report - 52 who.int/indonesia

• The reported number of confirmed COVID-19 cases hospitalized in DKI Jakarta reached a peak of 9888 hospitalized cases on 12 February. The number of hospitalized cases has since decreased to 3611 on 18 April (Fig. 19).

12000 19 19 - 10000

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Number of confirmed COVID ofconfirmed Number

8-Jan

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19-Dec 29-Dec

11-Aug 21-Aug 31-Aug

19-Nov 29-Nov

19-Mar 29-Mar

Fig. 19. Number of confirmed COVID-19 cases hospitalized in DKI Jakarta from 1 August 2020 to 18 April 2021. Source of data

Disclaimer: Data from Wisma Atlet are not included.

RISK COMMUNICATION

• WHO is regularly translating and sharing important health messages on its website and social media platforms – Twitter and Instagram – and has recently published:

Infographics: - Religious celebration

16 WHO Indonesia Situation Report - 52 who.int/indonesia

Fig. 20. WHO infographics on Religious celebration, April 2021

VACCINATION

• As of 19 April, 17 024 955 vaccine doses have been administered in the national COVID-19 vaccination campaign; 10 972 343 people have received the first dose and 6 052 612 people have received the second dose (Fig. 21).

18000000 16000000 14000000 12000000 10000000 8000000 6000000 4000000 Number vaccinated 2000000

1-Apr 4-Apr 7-Apr

3-Feb 6-Feb 9-Feb

2-Mar 5-Mar 8-Mar

28-Jan 22-Jan 25-Jan 31-Jan

10-Apr 13-Apr 16-Apr 19-Apr

12-Feb 15-Feb 18-Feb 21-Feb 24-Feb 27-Feb

29-Mar 11-Mar 14-Mar 17-Mar 20-Mar 23-Mar 26-Mar

Cumulative 1st dose vaccination Cumulative 2nd dose vaccination

Fig. 21. Cumulative number of vaccine doses administered in Indonesia, from 22 January to 19 April 2021. Source of data

Disclaimer: COVID-19 vaccination started on 13 January. Published data from MoH is available starting from 22 January.

17 WH O Indonesia Situation Report - 52 who.int/indonesia

• As of 19 April, the number of health workers who have received the second dose of the COVID-19 vaccine (fully vaccinated) was 1 325 963 (90.3% of the target population of 1 468 764). The number of essential public service workers who have received the first dose of the vaccine was 7 267 647 (41.9% of the targeted 17 327 167); 3 724 381 (21.5% of the target population) have received the second dose of the vaccine. The number of older people who have received the first dose of the vaccine was 2 237 282 (10.4% of the targeted 21 553 118); 1 002 268 (4.7% of the targeted population) have received the second dose (Fig. 22).

Essential public service 7267647 workers 3724381

1466675 Health workers 1325963

2237282 Older people 1st dose 1002268 2nd dose

0 1000000 2000000 3000000 4000000 5000000 6000000 7000000 8000000

Number of people who have received COVID-19 vaccine

Fig. 22. Cumulative number of people who have received COVID-19 vaccine in Indonesia, as of 19 April 2021. Source of data

Disclaimer: COVID-19 vaccination started with health workers on 13 January. The second stage of COVID-19 vaccination started on 17 February, targeting essential public service workers and older people (above 60 years old). Published data from MoH is available starting from 22 January.

• As of 18 April, Bali had the highest coverage of the first dose vaccination administered to health workers, essential public service workers and older people amongst all provinces, followed by DKI Jakarta, DI Yogyakarta, Riau Islands and East Java. As of the same day, DKI Jakarta had the highest coverage of the second dose vaccination administered to the same priority target groups, followed by DI Yogyakarta, Bali, East Java and North Sulawesi (Fig. 23).

18 WHO Indonesia Situation Report - 52 who.int/indonesia 100% 90% 80% 70% 60% 50% 40% 30% 20%

Vaccinationcoverage 10%

Bali

Riau

Aceh

Jambi

Papua

Banten

Maluku

EastJava

Lampung

Bengkulu

West Java West

Gorontalo

Riau Island Riau

DKI Jakarta DKI

West Papua West

Central Java Central

DI Yogyakarta DI

NorthMaluku

West Sulawesi West

Bangka Belitug Bangka

South Sulawesi South

NorthSulawesi

West SumateraWest

EastKalimantan

South Sumatera South

NorthSumatera

Central Sulawesi Central

West Kalimantan West

South Kalimantan South

NorthKalimantan

Central Kalimantan Central

SoutheastSulawesi

East Nusa Tenggara EastNusa West NusaTenggara West

1st dose 2nd dose

Fig. 23. COVID-19 vaccination coverage of health workers, essential public service workers and older people by province in Indonesia, as of 18 April 2021. Source of data

CONTINUITY OF ESSENTIAL HEALTH SERVICES

WHO is supporting MoH with the programme analysis of various essential health services to maintain their continuity during the pandemic. Highlights of previous Routine Immunization (RI) programme analyses can be found in WHO Situation Report 13 (pages 18 to 21) and Situation Report 20 (pages 19 to 23). Updates from the programme are presented below:

• The COVID-19 pandemic has impacted the RI programme in the country, resulting in vaccination coverage under 95% of the target (children under 2 years of age) for commonly used vaccines in the programme; the highest coverage in 2020 was bivalent oral poliovirus vaccine dose 2 (Polio 2) with 89.5% and the lowest was inactivated poliovirus vaccine (IPV) with 36.8% coverage (Fig. 24). Compared to 2019, there was a 5.9% to 11.4% reduction in the coverage of RI in 2020, except for IPV which decreased by 52.2%; this decrease was due to prolonged vaccine stock out from the fourth quarter of 2019 until mid-2020. Although vaccine stock was restored in August 2020, health centres continued to have difficulties to conduct catch-up vaccination to reach the 2020 target.

19 WHO Indonesia Situation Report - 52 who.int/indonesia 5000000 4000000 3000000 2000000

1000000 Number vaccinated Number 0 BCG Polio 1 Polio 2 Polio 3 Polio 4 HB0 DPT-Hb-DPT-Hb-DPT-Hb- IPV MCV1 MCV2 DPT-Hb- Hib 1 Hib 2 Hib 3 Hib 4 2019 2020

Fig . 24. Routine immunization coverage from January to December 2019 compared to 2020. Source: Ministry of Health Routine Immunization Monthly Bulletin, 6 April 2021. BCG=Bacill us Calmette-Guerin; HB=hepatitis B; DPT=diphtheria-pertussis-tetanus; HiB=haemophilus influenza type b; IPV=inactivated polio virus; MCV=measles-containing virus

• Disparity in subnational performance of routine immunization activities is reflected in the geographic distribution of diphtheria-tetanus-pertussis vaccine dose 3 (DPT3) coverage (Fig. 25). A total of 208 districts reported vaccination coverage of DPT3 below 80%. The number of unvaccinated children was 642 786 and that of partially vaccinated children was 4 078 719. This resulted in an increased risk of a diphtheria outbreak, particularly in high density urban areas. It is advised to extend the data mapping to the lowest administrative level to identify and prioritize villages with the largest proportion of unvaccinated and partially vaccinated children.

20 WHO Indonesia Situation Report - 52 who.int/indonesia

Fig. 25. Geographic distribution of diphtheria-tetanus-pertussis vaccine dose 3 (DPT3) coverage by province (top) and district (bottom) in Indonesia in 2020. Source: Ministry of Health Routine Immunization Monthly Bulletin, 6 April 2021

• A decreasing trend of RI for the second year of life is indicated by the 8% reduction in measles-containing vaccine dose 2 (MCV2) coverage from 73% in 2019 to 65% in 2020 (Fig. 26). Following the national measles-rubella (MR) vaccination campaign that was conducted in 2017-2018, the number of measles and rubella cases reported subsequently dropped. This trend may continue throughout 2021. However, the lower number of suspected MR cases reported in 2020 likely does not reflect the real situation in the communities due to the impact of the COVID-19 pandemic on the surveillance system.

21 WHO Indonesia Situation Report - 52 who.int/indonesia 99.3 97.8 94.7 95.2 9000 93.6 92.3 93 92 92.3 100

8000 7753 85.6 90

7000 72.7 80 67.6 64.5 70 6000 62.8 56.0 5125 60 5000 4664 4523 50 4000 3412

Numberofcases 40 30.8 3000 27.9 2449

30 RoutineCoverage (%) 2241 1808 1684 2000 1565 20 1175 906 920 1000 747742 639710 429 312 10 151 0 0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Measles cases Rubella cases Routine Coverage MCV1 Routine Coverage MCV2

Fig . 26. Number of measles and rubella cases and measles-containing vaccine dose 1 and 2 (MCV1 and MCV2) coverage in Indonesia from 2011 to 2020. MCV1 and MCV2 include vaccination

against rubella. Source: Ministry of Health Expanded Programme on Immunization (EPI) and Vaccine Preventable Diseases (VPD) Surveillance Report, 6 April 2021.

• Together with key immunization partners, WHO is supporting MoH to resume to pre-pandemic performance while conducting catch-up vaccination for unvaccinated and partially vaccinated children from 2020 target. Some of the activities are highlighted below:

i. Rollout of virtual training on RI for health workers to improve confidence and commitment in providing RI service during the pandemic. The training was conducted using a Learning Management System, in collaboration with Balai Besar Pelatihan Kesehatan (BBPK) Ciloto, a centre for health training.

ii. Finalizing the ‘Routine Immunization Operational Guidance for Health Workers’. This document includes defaulter tracking and catch-up vaccination that is in line with WHO guidance on catch-up vaccination.

iii. Updating the supportive supervision tool and developing an online reporting system to improve feedback and quality of service delivery.

22 WHO Indonesia Situation Report - 52 who.int/indonesia iv. Completion of Measuring Behavioural Social Driver (BeSD) Study on RI in Aceh and West Sumatra. The result of the study showed that immunization coverage in these two provinces can be improved by addressing caregiver motivation,family support, public awareness of and satisfaction with vaccination services, including routine immunization, among other factors.

• World Immunization Week 2021 will be celebrated from 24 to 30 April to promote the use of vaccines to protect people of all ages against vaccine-preventable diseases (VPD). With the theme of ‘Vaccines bring us closer’, World Immunization Week 2021 will urge greater engagement around immunization globally to promote the importance of vaccination in bringing people together and improving the health and wellbeing of everyone, everywhere throughout life. In collaboration with WHO and other key immunization partners, MoH is preparing several activities to celebrate the Wold Immunization Week 2021, including webinars, bloggers’ workshops as well as development and dissemination of information, education and communication (IEC) materials.

Fig. 27. A rollout of school-based immunization service for second and fourth grade students of SDN 235 Cege elementary school in Bone District of South Sulawesi Province. Credit: Puskesmas

Sumaling/Andi Erni

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Fig. 28. Immunization services in South Sorong District of West Papua Province during the

COVID-19 pandemic. Credit: Puskesmas Seremuk

PARTNER COORDINATION

• On 16 April, WHO convened the sixth meeting of key development partners in 2021 to discuss and coordinate COVID-19 response activities among partners in Indonesia. The meeting was attended by partners, including the Asian Development Bank (ADB), British Embassy, European Union (EU), Japan International Cooperation Agency (JICA), United Nations Children’s Fund (UNICEF), United States Agency for International Development (USAID), and World Bank. WHO presented COVID-19 updates in the country, discussed the latest epidemiological situation at national and subnational levels, and explained the key WHO interventions to support the national pandemic response. Several key points of discussion among partners included mortality and hospitalization data in Indonesia, and updates on the shipment of COVID-19 vaccines allocated from the COVAX Facility and overall support to the national vaccination campaign.

24 WHO Indonesia Situation Report - 52 who.int/indonesia • The overall funding request for WHO operations and technical assistance is US$ 46 million (US$ 27 million for response and US$ 19 million for recovery phase), based on estimated needs as of April 2021 (Fig. 29).

Fig. 29 WHO funding situation for COVID-19 response, April 2021.

Data presented in this situation report have been taken from publicly available data from the MoH (https://infeksiemerging.kemkes.go.id/), COVID-19 Mitigation and National Economic Recovery Team (KPCPEN) (http://covid19.go.id) and provincial websites. There may be differences in national and provincial data depending on the source used. All data are provisional and subject to change.

25 WHO Indonesia Situation Report - 52 who.int/indonesia RECENT AND UPCOMING WHO RESOURCE MATERIALS

Table 1: Title and details of recent WHO resource materials Source: https://www.who.int/ Title Details Statement on the The seventh meeting of the Emergency Committee convened seventh meeting of by the WHO Director-General under the International Health the International Regulations (2005) (IHR) regarding COVID-19 took place on Health Regulations 15 April 2021. The Emergency Committee concurred that the (2005) Emergency COVID-19 pandemic remains a public health emergency of Committee regarding international concern (PHEIC) and offered advice to the the COVID-19 Director-General. pandemic, 19 April 2021

Disability This document presents considerations and actions for considerations for governments, health service providers delivering vaccinations, COVID-19 disability service providers, residential institutions and vaccination: WHO long-term care facilities, communities and other stakeholders and UNICEF policy to ensure equity in access to vaccination against COVID-19 for brief, 19 April 2021 persons with disabilities.

Asthma and People with asthma (PWA) generally are considered at higher COVID-19: scientific risk from respiratory infections. At the outset of the COVID-19 brief, 19 April 2021 pandemic, PWA were widely assumed to be at increased risk from COVID-19. A rapid systematic review was set out to assess the available peer-reviewed literature regarding whether PWA are at increased risk of infection with the virus that causes COVID-19, and/or of experiencing complications or death.

Episode 34 of WHO Chief Scientist Dr Soumya Swaminathan discusses Science in 5, WHO’s about vaccines, variants and mass gatherings in the context of series of the COVID-19 pandemic. conversations in science, 16 April 2021

Why are there extra This job aid provides an explanation for the difference between doses of vaccine in the number of doses stated on the vaccine label and the true the vaccine vial? number of doses that can be withdrawn in a multi-dose vial. (COVID-19 job aid),16 April 2021

26 WHO Indonesia Situation Report - 52 who.int/indonesia WHO COVID-19 This fourth version of WHO COVID-19 Essential Supplies essential supplies Forecasting Tool (ESFT) provides governments, partners and forecasting tool other stakeholders with a choice among several (COVID-ESFT), epidemiological methods for forecasting COVID-19 cases to 14 April 2021 estimate potential requirements for essential supplies, including through integration with Imperial College’s Susceptible-Exposed-Infectious-Removed (SEIR) model.

COVID-19 and This document identifies important ethical considerations and mandatory caveats that should be explicitly evaluated and discussed vaccination: Ethical through ethical analysis by governments and/or institutional considerations and policy-makers who may be considering mandates for caveats (policy brief), COVID-19 vaccination as a way to increase vaccination rates 13 April 2021 and achieve public health goals.

27 WHO Indonesia Situation Report - 52 who.int/indonesia A SNAPSHOT OF WHO COURSES AND INFORMATION MATERIAL

Online WHO COVID-19 courses: • COVID-19 vaccination training for health workers • Standard precautions: Environmental cleaning and disinfection • Management of COVID-19 in long-term care facilities • Operational planning guidelines and COVID-19 • Clinical management of severe acute respiratory infections • Health and safety briefing for respiratory diseases – eProtect

WHO guidance: • Reducing public health risks associated with the sale of live wild animals of mammalian species in traditional food markets (interim guidance) • Safe Ramadan practices in the context of COVID-19 (interim guidance) • Data for action: achieving high uptake of COVID-19 vaccines (interim guidance)

Infographics: • Contact tracing • COVID-19 new variants • COVID-19 vaccines and vaccination • The truth about COVID-19 vaccines • Quarantine and self-monitoring • COVID-19 tests

Questions and answers: • COVID-19: Vaccines • COVID-19: Vaccine research and development • COVID-19: Vaccine access and allocation • How are vaccines developed?

Videos: • Science in 5: Evolution of the SARS-CoV-2 virus • Time to abide (1-10) • Hand sanitizer routine • COVID-19 virus variants

For more information please feel free to contact: [email protected] WHO Indonesia Reports

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