The dangers of "Values" Imperialism: how 2 opposing solutions can be both correct in their rightful place
Dear Editors
I would like to comment on Lloyd-Sherlock et al's rapid response (ref 1) in which it appears to assert that Indonesia's approach to COVID-19 nation wide vaccination programs reflects another form of injustice, in what they termed "vaccine ageism" which will be evident in other similarly low and middle-income countries (LMICs).
Apparently the plans to prioritise COVID-19 vaccines (of which 140 million doses are firm orders for Sinovac Biotech's CoronaVax vaccine) to those aged between 18 and 59, incurred significant displeasure with the authors who consider this as evidence of " a long, problematic tradition of infantilising “grandpa and grandma” and of justifying discrimination on the basis of false claims that people aged 60 or more are by definition unproductive and younger adults universally productive".
I will not want to discuss if this assertion is indeed true or not, but I ask fellow readers to consider the following:
Much of SInovac's vaccine trial involves volunteers under 60 years and the efficacy of their vaccine above this age cut is largely unknown as Lloyd-Sherlock et al acknowledged.
In Indonesia a country of 267 million, some 9% are of 60 years and older with average life expectancy of 71 years; UK of 66 million has 16% who are at least 60 years old with average life expectancy of 81+.
A significant proportion of older persons in UK are socially and financially independent, whereas in Indonesia there are far more older people who are socially and financially reliant on their children than not. The economic impact of unrestricted travel in vaccinated people of working age therefore has far more direct impact on their older relatives dependent on their support.
UK boost multiple level of safety net including the universal healthcare system delivered by NHS (8-9% GDP), in which many are determined that the "free at point of care" service stays that way at any price, whereas in Indonesia the public healthcare system (3% GDP) strived to deliver affordable services in some form or other, but it is generally not considered in the same class as the NHS.
Hence when considering what is the "right" or "just" for the people in Indonesia as opposed to UK (or other OECD countries), it is important to remember the basic assumptions and available resources as well as outlook and shared values in the society.
Granted the Indonesian government's explanation to target younger people as they are of "productive age", and one can wonder if that is part of the government's "spin" or the brutal truth, the scientific basis to deliver these vaccine initially to these people is consistent with the fact that the SInovac trials did not have much clinical data on older persons, which therefore reflects the careful application of evidence-based medicine if this was the reason.
Furthermore there is no doubt that in a tropical country with huge population over many scattered islands with numerous small remote communities, Indonesia cannot afford alternative vaccines tested on older persons, some with difficult supply chain issues, others with expected strong competition by vaccine nationalism, and most are thought to be significantly more expensive than the Chinese vaccines in firm orders.
Commentators on the issue of vaccine distribution and availability in other countries should consider taking off their rose-tinted glasses and accept the possibilities that another country's solutions different from their own may still be correct in their own way according to their values. To shame other countries simply because their approach is not the same as UK, reeks of past imperialism, of which the British in their past has been known to use this difference in values as an excuse to start wars and invasions.
Rapid Response:
The dangers of "Values" Imperialism: how 2 opposing solutions can be both correct in their rightful place
Dear Editors
I would like to comment on Lloyd-Sherlock et al's rapid response (ref 1) in which it appears to assert that Indonesia's approach to COVID-19 nation wide vaccination programs reflects another form of injustice, in what they termed "vaccine ageism" which will be evident in other similarly low and middle-income countries (LMICs).
Apparently the plans to prioritise COVID-19 vaccines (of which 140 million doses are firm orders for Sinovac Biotech's CoronaVax vaccine) to those aged between 18 and 59, incurred significant displeasure with the authors who consider this as evidence of " a long, problematic tradition of infantilising “grandpa and grandma” and of justifying discrimination on the basis of false claims that people aged 60 or more are by definition unproductive and younger adults universally productive".
I will not want to discuss if this assertion is indeed true or not, but I ask fellow readers to consider the following:
Much of SInovac's vaccine trial involves volunteers under 60 years and the efficacy of their vaccine above this age cut is largely unknown as Lloyd-Sherlock et al acknowledged.
In Indonesia a country of 267 million, some 9% are of 60 years and older with average life expectancy of 71 years; UK of 66 million has 16% who are at least 60 years old with average life expectancy of 81+.
A significant proportion of older persons in UK are socially and financially independent, whereas in Indonesia there are far more older people who are socially and financially reliant on their children than not. The economic impact of unrestricted travel in vaccinated people of working age therefore has far more direct impact on their older relatives dependent on their support.
UK boost multiple level of safety net including the universal healthcare system delivered by NHS (8-9% GDP), in which many are determined that the "free at point of care" service stays that way at any price, whereas in Indonesia the public healthcare system (3% GDP) strived to deliver affordable services in some form or other, but it is generally not considered in the same class as the NHS.
Hence when considering what is the "right" or "just" for the people in Indonesia as opposed to UK (or other OECD countries), it is important to remember the basic assumptions and available resources as well as outlook and shared values in the society.
Granted the Indonesian government's explanation to target younger people as they are of "productive age", and one can wonder if that is part of the government's "spin" or the brutal truth, the scientific basis to deliver these vaccine initially to these people is consistent with the fact that the SInovac trials did not have much clinical data on older persons, which therefore reflects the careful application of evidence-based medicine if this was the reason.
Furthermore there is no doubt that in a tropical country with huge population over many scattered islands with numerous small remote communities, Indonesia cannot afford alternative vaccines tested on older persons, some with difficult supply chain issues, others with expected strong competition by vaccine nationalism, and most are thought to be significantly more expensive than the Chinese vaccines in firm orders.
Commentators on the issue of vaccine distribution and availability in other countries should consider taking off their rose-tinted glasses and accept the possibilities that another country's solutions different from their own may still be correct in their own way according to their values. To shame other countries simply because their approach is not the same as UK, reeks of past imperialism, of which the British in their past has been known to use this difference in values as an excuse to start wars and invasions.
Reference
1. https://www.bmj.com/content/371/bmj.m4735/rr-0
Competing interests: No competing interests