Intended for healthcare professionals

Letters Covid-19: Equitable global access to vaccines

Ageism in Indonesia’s national covid-19 vaccination programme

BMJ 2021; 372 doi: (Published 02 February 2021) Cite this as: BMJ 2021;372:n299
  1. Peter Lloyd-Sherlock, professor1,
  2. Paramita Muljono, postdoctoral researcher1,
  3. Shah Ebrahim, honorary professor of public health2
  1. 1University of East Anglia, Norwich NR4 7HT, UK
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  1. p.lloyd-sherlock{at}

Concern about vaccine nationalism is well founded,1 but it has overshadowed another form of injustice: vaccine ageism.

In many low and middle income countries (LMICs) Sinovac is currently the main covid-19 vaccine. Initial Sinovac trials in China were only conducted on adults aged under 60.2 Because of a lack of published evidence, the government of Indonesia has decided to exclude people aged 60 and over from its initial vaccine rollout.3

Further trials of Sinovac for older people have since begun in countries such as Brazil,4 yet ongoing Sinovac trials in Indonesia continue to exclude older people. In 2020 clinical trial leader, Kusnandi Rusmil, said, “Why do we target people of a productive age? Because these people can work hard, so the country will not have a deficit.”5 This justification follows an established tradition of using inaccurate generalisations about older people’s “public value” to justify ageist discrimination.6

Not all candidate covid-19 vaccine trials have excluded older people. Nevertheless, there is a long and problematic history of excluding older people from trials of vaccines or treatments for conditions that affect them greatly.7 Media reports suggest that Sinovac may be effective for older people, but at a lower level than for other ages.8 Related findings are, however, yet to be published.

In Indonesia, the official position remains that older people will only be included either when age specific Sinovac data are published or new vaccines become available.9 In the meantime, exclusion of older people from vaccination will exacerbate pressure on hospitals and increase avoidable deaths. Indonesia is not a unique case: Peru has given its military, private security guards and election workers higher priority than older adults.10

For now, nationalist self-interest means LMICs are at the back of the global vaccine queue; and vaccine ageism means older people are at the back of the queue in some LMICs.


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