Reaching the margins: examining equity in Indonesia's COVID-19 vaccination strategy

The COVID-19 pandemic profoundly affected health, social and economic systems worldwide. In less than a year, COVID-19 vaccines were developed and distributed. However, global and national distribution efforts faced significant challenges in ensuring equitable access, particularly for vulnerable populations. Despite WHO guidelines for national vaccine allocation, governments encountered difficulties in vaccine allocation and prioritisation. While Indonesia's COVID-19 primary dose coverage surpassed 70%, disparities persisted both across and within provinces as well as among different population groups. Discussion about the definition of vulnerable population and who should be prioritised remains critical to preparing for future pandemics. This paper argues for the establishment of clear guidelines for national governments on the allocation of vaccines, enabling timely action in future pandemics to prevent avoidable deaths and disabilities. Robust governance and data also remain a key area to improve. Drawing on Indonesia's experience with COVID-19, this paper offers recommendations for vaccine allocation during a respiratory pathogen pandemic.