Progress in Disaster Science 6 (2020) 100091

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Progress in Disaster Science

journal homepage: www.elsevier.com/locate/pdisas

Invited ViewPoint

Review and analysis of current responses to COVID-19 in Indonesia: Period

of January to March 2020☆
⁎
Riyanti Djalante a,b, , Jonatan Lassa c, Davin Setiamarga b,d, Aruminingsih Sudjatma e, Mochamad Indrawan f,
Budi Haryanto g,h, Choirul Mahfud i, Muhammad Sabaruddin Sinapoy j, Susanti Djalante k,l, Irina Rafliana m,n,
Lalu Adi Gunawan o, Gusti Ayu Ketut Surtiari p, Henny Warsilah p
a
United Nations University - Institute for the Advanced Study for Sustainability (UNU-IAS), Japan
b
Ikatan Ilmuwan Indonesia Internasional (I4), Japan
c
Humanitarian, Emergency and Disaster Management Studies, Charles Darwin University, Australia
d
Department of Applied Chemistry and Biochemistry, National Institute of Technology, Wakayama College (Wakayama KOSEN), Japan
e
Ministry of National Development Planning (Kementerian PPN/Bappenas), Indonesia
f
Research Centre for Climate Change, University of Indonesia, Indonesia
g
Faculty of Public Health, Research Centre for Climate Change, University of Indonesia, Indonesia
h
Science-adviser to the Indonesian Task Force for COVID-19 Rapid Response, Indonesia
i
Institut Teknologi Sepuluh Nopember (ITS), Indonesia
j
Faculty of Law, Universitas Halu Oleo (UHO), Indonesia
k
Tokyo Metropolitan University, Japan
l
Faculty of Engineering, Universitas Halu Oleo (UHO), Indonesia
m
Indonesia Institute of Science (LIPI), Indonesia
n
German Institute for Development (DIE), Germany
o
Regional Development Planning Board, The Government of West Nusa Tenggara Province, Indonesia
p
Indonesia Institute of Sciences (LIPI), Indonesia

A R T I C L E I N F O A B S T R A C T

Article history: The world is under pressure from the novel COVID-19 pandemic. Indonesia is the fourth most populous country in the
Received 27 March 2020 world and predicted to be affected significantly over a longer time period. Our paper aims to provide detailed reporting
Accepted 1 April 2020 and analyses of the present rapid responses to COVID-19, between January and March 2020, in Indonesia. We partic-
Available online 4 April 2020
ularly highlight responses taken by the governments, non-government organisations and the community. We outline
gaps and limitations in the responses, based on our rapid analysis of media contents, from government speeches and
Keywords:
COVID-19
reports, social and mass media platforms. We present five recommendations toward more rapid, effective, and compre-
Indonesia hensive responses.
Governance © 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license
Health (http://creativecommons.org/licenses/by/4.0/).
Pandemic
Epidemic
Resilience

1. Introduction pandemic on March 11, 2020 [1]. The scale of the impacts is unprece-
dented, and studies have suggested that it might take more than a decade
The world is currently impacted by the novel coronavirus disease for the world to recover, societally and economically [2] and might signif-
(COVID-19). The World Health Organisation (WHO) coordinates the global icantly compromise the progress of Sustainable Development Agenda
efforts to manage the impacts and it declared COVID-19 as a global (SDGs) 2030. On March 27th, the G20 countries pledged $5 trillion to de-
fend the global economy against COVID-19 [3], while the United Nations
☆ Final version is to be available in Progress in Disaster Science on 12 April 2020, pre-proof is (UN) launched the Global Humanitarian Response Plan for COVID-19 [2].
available online on 4 April 2020, 100091 https://www.sciencedirect.com/science/article/pii/ The pandemic started in the city of Wuhan, Hubei province, China and
S2590061720300284. has brought many new challenges to public health in various countries. The
⁎ Corresponding author at: United Nations University-Institute for the Advanced Study for
Sustainability (UNU-IAS), Japan.
world has experienced global public health crises in the last 20 years caused
E-mail addresses: djalante@unu.edu, (R. Djalante), jonatan.lassa@cdu.edu.au, (J. Lassa), by novel virus infections, such as HIV, Influenza A virus subtype H1N1, In-
davin@wakayama-nct.ac.jp. (D. Setiamarga). fluenza A virus subtype H5N1, SARS-CoV1, MERS-CoV, and Ebola.

http://dx.doi.org/10.1016/j.pdisas.2020.100091
2590-0617/© 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.
0/).
R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

However, the epidemiological novelty of COVID-19, which caused by a 2. Key COVID-19 health-emergency impacts and early responses
strain of coronavirus (the SARS-CoV2), revealed our lack of preparedness
given its sudden and rapid spread that caught many governments around This section reports on key responses in Indonesia. We first discuss the
the world unprepared. existing institutional framework on responding to health emergencies. We
On March 26th, WHO issued six prioritised strategies, to be undertaken then focus on the early and rapid detection and diagnosis of infections.
by governments to cope with the pandemic. The strategies were as follow:
Expand, train and deploy health-care workers; Implement systems to find 2.1. Overview of key impacts and timeline
suspected cases; Ramp up production of tests and increase availability;
Identify facilities that can be transformed into coronavirus health centres; The initial zero case reported by Indonesia prior to the Global Pandemic
Develop plans to quarantine cases; and Refocus government measures on declaration by the WHO, is questionable by many (e.g. [8]). During this pe-
suppressing the virus [1]. Lowering and delaying the epidemic peak is im- riod, despite reports of increasing numbers of infection from all countries
portant. Uncontrolled measures will lead to the rapid increase in the num- surrounding Indonesia at that time, Indonesia did not issue any form of
ber of cases, reach the peak earlier and require more capacity of healthcare travel restrictions and specific quarantines of travellers coming in/coming
systems to respond, while stringent control measures implemented early back to Indonesia, even from severely hit countries such as China. On Jan-
will help to lower the number of cases, delay reaching the peak and need uary 27, 2020, Indonesia issued a travel restriction from Hubei province,
considerably lower capacity of the healthcare systems [4]. which was at that time, the epicentre of global COVID-19, while at the
Indonesia is the fourth most populous country in the world, and thus is same time evacuated 238 Indonesians from Wuhan. After the initial and
predicted to suffer greatly and over a longer time period, when compared to subsequent reports of infections, Indonesia started to realize the direness
other less-populous countries [5]. When the novel coronavirus SARS-CoV2 of the situation, and has since issued various policies and actions to tackle
hit China most severely during the months of December 2019–February COVID-19, including appointing 100 domestic general hospitals as Referral
2020, Indonesia reported no case of infection at all. Only on March 2, Hospitals (Rumah Sakit Rujukan) on March 3, 2020. To cope with the ever-
2020, President Joko Widodo reported the first confirmed two cases of increasing number of COVID-19 patients, the number of Referral Hospitals
COVID-19 infection in Indonesia. As of April 2, the country has reached was increased to 227 on March 18, 2020. However, despite such efforts, the
1790 confirmed cases, 113 new cases, with 170 number of deaths, and number of victims keeps increasing rapidly. The Ministry of Health of Indo-
112 number of recoveries [6,7]. nesia provides live data on COVID-19 impacts in Indonesia [6]. A coordi-
This paper is one of the first policy-response-focused academic publica- nated information for covid-19 coordination is presented on this newly
tions aimed at providing a brief reporting, analysis and evaluation of cur- established website of https://www.covid19.go.id/. Fig. 1 shows the
rent rapid responses to COVID-19 in Indonesia. To allow for rapid front page. To date, there are 20 dedicated websites by the provincial
publication and dissemination of information, this paper does not intend governments.
to provide an exhaustive list of the responses, but it aims to capture current Data transparency in the early response has been criticised by several
government-led responses in the middle of the crisis. This paper can be mainstream media. At least since 11 March 2020, the public had started
viewed as ‘real-time evaluation’ as it provides insights and lessons for all to critically demand data transparency toward the government, which
stakeholders to improve and adjust existing policy options mainly at na- such plea emerged in digital news media [10,11] of which during the
tional level from April 2020 till the end of the crisis. There are three objec- time there were already 27 cases reported. The lack of data transparency
tives of this paper. First, to highlight key response strategies and actions in might have caused the underreporting of the actual number of cases, or,
responding to COVID-19 emergencies in Indonesia. Second, to analyse the the dissemination of probably the actual number of cases detected, but
gaps and opportunities in these responses. Third, to put forward recommen- not the number of actual infections, which could be undetected because
dations toward rapid, comprehensive and more systematic approaches in of, for example, the lack of proper diagnoses. Such misinformation could se-
the short- and longer-term. verely impede the government's future responses. This indicated the possi-
The methodology includes rapid analysis based on media content anal- bility that such efforts were not enough.
ysis including governments speeches and reports as well as observation of
various social media platforms available from January to March 2020. 2.2. Early and rapid detection and diagnosis of infections
We especially targeted online media contents from the website of www.
covid-19.go.id, mass media as well as participant observations in social Presently, RT-PCR (reverse transcription polymerase chain reaction) is
media platforms (e.g. Facebook postings from governments and relevant the only acknowledged method to rapidly and accurately detect COVID-
stakeholders). This paper is interdisciplinary in nature, with authors com- 19 infection in humans [12,45]. First, the enzyme reverse transcriptase is
ing from various disciplines. This is a collaborative work following calls used to change the RNA, which is the genetic material of SARS-CoV2,
of co-authorships by the first author on March 26th, 2020. All authors are from nasopharyngeal swab samples, to DNA (the reverse transcription
Indonesian scholars and experienced practitioners, with broad expertise step). Next, using specific primers, a section of the synthesized DNA origi-
on health/public health, basic biology, disaster governance, law, engineer- nated from the virus was amplified using the polymerase chain reaction
ing, public policy, environmental science, culture and community advo- (PCR) method. Only swab samples containing both human and virus RNA
cacy, and risk communication. We aim to have a balanced analysis will show positive results.
between those from natural and social scientists, focussing our analysis on Earlier mass media reports in Indonesia during the onset and peak of ep-
the policy-relevant responses. Some authors are involved in response activ- idemics in Wuhan, China, suggested that there was zero infection in the
ities or providing government advice, both nationally and locally. country. This happened for a few months, even when various reports had
The structure of the paper is as follows. Section 1 provides context, ra- shown that Indonesia's neighbouring countries had reported at least one in-
tionale and aim of the paper. It briefly presents COVID-19 impacts to date fection. The lack of rapid scientific surveys deployed by the government to
(as of 31 March 2020). We present our report on the key health strategies make swift decisions and actions has caused many pseudo-scientific “expla-
taken by the National government in Section 2. We further analyse the nations” for the cause spreading in Indonesia, as seen in the mass and social
role of different organisations in Section 3. We review the roles of key min- media, ranging from racial superiority to religious and paranormal reasons
istries at the national level, responses at the provincial and local govern- (e.g. [13]). However, later reports strongly indicated that zero case was sci-
ment level, along with roles of other major organisations and those at the entifically improbable, for example as suggested by Harvard University [8]
community level (Section 4). This is complemented with our analysis of and later severely criticised by the Indonesian Minister of Health [14]. Var-
these responses, focussing on the gaps and limitations. Finally, in Section ious international mass media and foreign bodies outside Indonesia even
5, we outline the recommendations for improving current responses, became very stringent and went as far as questioning the abilities of Indone-
grouped into health-related and wider recommendations. sian scientists and medical practitioners, as well as the presence of enough

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R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

Fig. 1. Front page of INDONESIAN GOVERNMENT'S COVID-19 website.

(Source: [9]).

technical facilities and skills to detect and diagnose the disease. Further in- useful if carefully used. For example, the test could be conducted as the
vestigations reported that many of the suspected COVID-19 persons were first line of rapid public diagnoses, to select those who must take the
only diagnosed clinically and not tested using the PCR method, including more expensive and elaborate, but more accurate, PCR test. Only those
Indonesians evacuated from Wuhan. This could be one of the reasons for tested positive by RDT must be required to do PCR test. Meanwhile, those
the (most likely incorrect) report of zero infections, during the initial period tested negative, must take the test multiple times, up to at least three
of this global pandemic. At present, through extensive coordination among times, after an interval of 5 to 7 days, considering the incubation period
different institutions, Indonesia has started to do PCR analyses on suspected of the virus. Also, because the result of this test will be very useful not
citizens. However, when compared to other countries such as Japan, Korea, only for global COVID-19 countermeasures, and for the private sectors pro-
and China, the number is not enough to reflect the most likely actual pres- ducing the test kits, Indonesia must negotiate her position so that she will
ent condition of infection in Indonesia. also benefit from using the RDT kits.
On March 19, 2020, President Joko Widodo announced that Indonesia
will conduct massive testing by conducting rapid detection tests on the cit- 2.3. Issuance of Guidelines for Medical Rapid Response and Public Health As-
izens [15]. This test will use recently developed testing kits, which are pects of COVID-19
based on serology [16]. Results will be out in 10–30 min, which is much
faster than the PCR test (about 1–8 h, depending on the method). Further In late March 2020, the Indonesian Task Force for COVID-19 (Gugus
news from the mass media suggested that the Indonesian government has Tugas Percepatan Penanganan COVID-19) issued the Guidelines for Medical
ordered 500,000 testing kits from China. The mass media have reported Rapid Response and Public Health Aspects of COVID-19 in Indonesia. The
the results of the first batch of tests conducted in Jakarta: 121 positive, guide targets the medical force and general public in terms of informing
and 10,338 negatives [16,17]. The problem is, although testing kits have the means to mitigate the impacts and death rates. Information includes
been developed and even sold by various companies, none of the kits protocols for rapid tests using RDT, lab testing, patient handling, and out-
have passed clinical testing, without any clinical assessment on the actual reach/communications means. The protocols for rapid testing and lab test-
specificity and sensitivity. Some reports have indicated that other ing recognize three levels of risks: without symptoms (asymptomatic),
coronaviruses, or even dengue, might give false positive results. Moreover, person under surveillance (ODP/Orang Dalam Pemantauan), and patient
unlike the PCR test, which targeted the presence of actual genetic materials under surveillance (PDP/Pasien Dalam Pengawasan). The test involves isola-
of SARS-CoV2 in samples, immunoreaction-based testing targets the pres- tion of the suspected person, rapid testing, and ultimately, when required,
ence of antibodies in the bodies of patients. The antibodies for SARS- PCR.
CoV2 are known to be present from 5 to 14 days after symptoms appear, Indonesian Public Health Association (IAKMI) also regularly issued key
which means the antibody-antigen-based test cannot detect any infection recommendations for the Task Force that in general supported government
prior to symptoms appearance, and thus might give false negative results. measures and advocated for evidence-based policy. In one instance circular
Meanwhile, the test might also detect antibodies presence on recovering (20 March 2020) IAKMI encouraged the government to strengthen the role
or cured patients, and thus giving another false positive result. Indonesians of the primary health care system and facilitate community-based re-
shouldn't be used as guinea pigs, giving these pharmaceutical companies sponses of COVID-19 including education and surveillance. Recommenda-
free nation-wide clinical trials. Therefore, such data must be handled very tions were also made by Indonesia's Association of Specialist Doctors for
carefully, since a recent report by the Business Insider suggested that such Clinical Pathology and Medical Lab (PDS PatKLIm). For instance, they is-
rapid tests using serology-based RDT are only 30% accurate [16]. sued cautions on possible caveats in interpreting the results of serology-
Indonesia needs to quickly and ambitiously collect information in order based RDT tests for COVID-19 and suggested that negative results must
to obtain the big picture of present nation-wide COVID-19 distributions. be repeatedly tested by the same method over time, and positive results
This information will be important when deciding actual policies. There- retested by PCR [16]. These emphasize that rapid tests should be viewed
fore, immunoreaction-based rapid detection kits (RDT) can actually be mainly to implement broader surveillance and epidemiological studies, in

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R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

order to understand the breadth of COVID-19 infection in Indonesia (PDS The President Directive has major points of calling for rapid and active
PatKLIm, circular 19 March 2020). strategies related to budget reallocation, ensuring food security, strengthen-
ing health sector through basic health services and national insurance
3. National governments' responses scheme (BPJS) for COVID-19 patients, changes teaching delivery and can-
cellation of national exam of schools, strengthening local governments
This section presents key responses by different governmental organisa- and local economy, reduction of taxes for selected commodities, implemen-
tions. We start with analysing regulatory and institutional frameworks for tation of various economic and fiscal strategies for ensuring those affected
health emergency responses in Indonesia. We then discuss the formation receive certain compensations [9]. Some of these policy directions have
of the Indonesian Special task force for COVID-19, a very important step been followed up at ministerial levels as can be seen in the rest of this sec-
in the response. tion. Both central and local governments are working together with related
stakeholders to execute the President's directives as mentioned above. It is
3.1. Regulatory and institutional responses by national government however unclear whether we can say that the recommendations have been
implemented since they have been only issued 2 weeks ago.
Most countries are caught unprepared to the speed and scale of impacts However, such Directive (Inpres 4/2020) was not strong enough to cre-
from the COVID-19. Several national regulations have been produced by ate national scale imperatives to rapidly end the spread of COVID19. There-
the government at different levels from the president to ministerial levels fore, pressures have been made by many stakeholders. And finally, after
during January–March 2020. Table 1 (ordered chronologically) summa- long overdue, the President of Indonesia issued one decree and two funda-
rises the rules and regulations produced to guide national and local re- mental regulations on the last day of March 2020 as this article goes to
sponse in Indonesia. The table shows that most of the regulations were print. These regulations include: First, Regulation on National budgeting
issued after 13 March when the President established the Task Force. The policy and the stability of budgeting system for Covid-19 pandemic disaster
head of National Disaster Management Agency (BNPB) was appointed as and/or Managing threats for national economy and/or the stabilisation of
the commander. Prior to this Decree, national level response had been min- budgeting system; Second, A declaration of community health emergency
imal as indicated by only two sectoral regulations were issued. First was the situation for Covid-19; Third, Big scale social restriction for accelerating
Health Ministry declaration of Novel 2019-nCov as a disease that outlines COVID-19 eradication (Table 1).
potential transform of COVID-19 into an outbreak and what can be done
on 4 February 2019. Second, a national declaration of the specific emer- 3.2. Indonesian Task Force for COVID-19 Rapid Response
gency situation of COVID-19 by the head of BNPB on 28 February 2020.
One of the most important one is the President's Directives 4/2020 A coordinated response is extremely important. The first significant reg-
(Instruksi Presiden Nomor 4/2020) specifically instructing for refocusing of ulation is the formation of the Task Force for Rapid Response to COVID-19
development activities, reallocation of government budget, and procure- (Gugus Tugas Percepatan Penanganan COVID-19) on 13 March 2020. This
ment of goods and services for rapid and accelerated response to COVID- suggests that despite gaps in top leadership as it took more than 10 days
19 (Refocussing Kegiatan, Realokasi Anggaran, Serta Pengadaan Barang dan after the first confirmed cases in early March 2020, the establishment of
Jasa dalam rangka Percepatan Penanganan Corona Virus Disease 2019) (see the Task Force provides better inter-agency coordination and response
President Directive (Inpres) 4/2020 from Table 1). mechanisms. This task force is led by the head of BNPB, General Doni

Table 1
List of regulations created from February to March 2020.
(Source: authors, compiled from different sources).
Date Issuing agency Title of regulation Reference

4 February Ministry of Health Declaration of Novel 2019-nCov as Disease that can cause plague and its response measures Decision of MoH No:
2020 HK.01.07/MENKES/104/2020
28 BNPB (National disaster Declaration of Special Emergency Situation of COVID-19 Epidemic Disaster in Indonesia Decision of Head of BNPB
February management agency) 9A/2020
2020
13 March President of Indonesia Task Force for Rapid Response to COVID-19 Presidential Decree (Keppres)
9/2020
14 March Ministry of Finance Distribution of Special Grant Allocation for Infrastructure in Health Sector and Grants for Health Decision of MoF 6/KM.7/2020
2020 Operation for COVID-19 response
16 March Ministry of Health Network of COVID-19 Laboratories Decision of MoH HK.
2020 01.07/MENKES/182/2020
16 March Ministry of Finance Distribution and the use of Shared income grant, fiscal allocation, general allocation grant, special MoF Regulation No:
2020 allocation grant and regional incentives for 2020 fiscal response to COVID-19 19/PMK.07/2020
19 March National Police (POLRI) Prohibition of mass gathering or group activity both in public and local environments. Kapolri Mandate No.
2020 MAK/2/III/2020
20 March President of Indonesia Revision of Keppres on Task Force for Rapid Response to COVID-19 Presidential Decree (Keppres)
2020 9/2020
20 March President of Indonesia Refocussing of activities, fiscal allocation and procurement of goods and services for the acceleration President Instruction (Inpres
2020 of COVID-19 response. 4/2020)
21 March Ministry of Finance Tax incentives for Compulsory Tax Holders affected by COVID-19 MoF Regulation No:
2020 23/PMK.03/2020
23 March Ministry of Communication and Acceleration of socialisation of COVID19 Prevention at Provincial and District/City levels. Circulated letter SE 2/2020
2020 Information
24 March Village, Regional Disadvantage Village Response for COVID-19 and Cash for work in Villages Circulated Letter SE 8/2020
2020 and Transmigration Minister
31 March President of Indonesia National Budgeting Policy and the Stability of Budgeting System for COVID-19 Pandemic Disaster Government Regulation in
2020 and/or Managing Threats for National Economy and/or the Stability Budgeting System Lieu of Law No 1/2020
31 March President of Indonesia Declaration of Community Health Emergency Situation for COVID-19 President Decree No 11/2020
2020
31 March President of Indonesia Big Scale Social Restriction for Accelerating COVID-19 Eradication Government Regulation No
2020 21/2020

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R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

Monardo. Mr. Achmad Yurianto is the task force spokesman, who is also Rp. 1 million per month. Second, there is provision for Minimum business
both a medical doctor and the current Health Ministry's Disease Control protection measures - including a big push for the banking to relax pay-
and Prevention Director-General. ments from certain business groups that are too risky to be removed from
supply chains [20–24]. The spread of the COVID-19 virus has the greatest
3.3. National Disaster Management Office (BNPB) impact on the financial and investment business sector including the most
affected one such as Aviation, tourism, hotel, restaurant, shipping and
Managing an epidemic is not a natural mandate of BNPB. However, transportation. Third, through the so-called counter-cycle policy, the gov-
given the presidential preference and decision, the Head of BPBP has ernment decided to relax fiscal policy, namely by widening the 2020
been tasked as the Chief of the Task Force (see Section 3.2). Overall, we State Budget deficit to around 2.5% of GDP from originally planned at
are not able to provide an evaluation of BNPB given the lack of time for ob- 1.76% of GDP. Widening the deficit means that there will be added
servation. However, it is worth noting that in addition to their key roles in spending.
the Task Force, the National Disaster Management Agency (BNPB) has been The President of Indonesia recently highlighted the ‘agenda to fight the
tasked to collaborate with Ministry of Health to disseminate the informa- two wars’, namely the war against COVID-19 and the prevention of eco-
tion of Covid-19 through different media platforms including SMS blasts; nomic crisis. The Bank of Indonesia (BI) has a vital role to play in ensuring
Established a rapid response team; Provide logistics, materials, and health policy measures to anticipate the impact of the coronavirus on the financial
facilities; Conduct surveillance for new potential cases of Covid-19; And market, and to mitigate macro-economic impacts. Key policies to stabilize
Collaborate with the Indonesia National Armed Forces, Indonesia National the financial market due to the coronavirus has been introduced: BI will
Police, and Ministry of Health. BNPB is equipped with approximately 176 continue to monitor developments in financial markets and the economy,
officials who will join the existing team of Pusat Pengendalian Operasi including the impact of the corona virus and continue to strengthen the pol-
Penanganan Bencana/the Center for Disaster Management Operation. icy mix and coordination with the Government and relevant authorities, to
maintain economic stability, encourage economic growth momentum, and
3.4. Ministry of Health accelerate structural reforms [20–24].

Complacency has plagued the ministry from being proactive and able to 3.6. Enforcement: military and police forces
lead the pandemic at national levels. Despite being heavily criticised for
being reluctant by the informed public and academics from within and out- As a democratic country, using the military and police forces is not a
side the country, the Ministry of Health has been one of the first ministerial popular option. However, the Indonesian National Armed Forces (TNI;
level agencies to formally respond to COVID-19 since 4 February 2020. Tentara Nasional Indonesia) participation in the war against COVID-19 is
Elsewhere in Indonesia, the health system capacity has been under ca- necessary. We are not able to assess their effectiveness exhaustively and
pacity to cope with the pandemic at the moment. The legacy of the National fairly here, but we can briefly highlight their involvements. For example,
Committee for Avian Influenza Control and Pandemic Influenza Prepared- the use of military assets and personals is essential in this response where
ness [18] could not be seen in the present crisis. Such lack of preparedness military aircrafts have been used to help with the logistical response at
can be seen throughout the six building blocks of the health system ranging times where no civilian system can provide such support. TNI has been in-
from health service delivery, workforce, information system, access to es- volved in the preparation of emergency hospitals in some locations from
sential medicines, health system financing and leadership and governance. Wisma Atlet (Jakarta), Natuna, Pulau Sebaru, Pulau Galang Pangdam.
Therefore, starting from 4 February, there was no clear indication of accel- Therefore, their roles in this non-traditional war have been essential. Inter-
eration response to COVID-19 until first confirmed cases. estingly, we also observed an emerging paradigm of non-traditional view of
At the moment, despite criticisms for being not agile enough, the MoH security forces, in social media and mainstream media during the last few
has been playing critical roles as the national spokesperson of the weeks. In this view, frontline medical workers including doctors and nurses
COVID19. Starting from February till 31 March 2020, at least 6777 tests have been viewed as ‘armies’, combatting in the war against COVID-19.
had been conducted for covid-19 suspects out of which 1677 have been Since enforcement to ensure social distance and other mitigation measures
confirmed positive. Until the First half of March 2020, there were only are in place, we also observed that the role of the police has been critical in
1100 tests carried out and 117 were confirmed positive. While starting enforcing mitigation measures. The Head of the Police (Kapolri) issued a
from 16 March 2020, there are at least 5600 tests were done with 1560 Mandate Letter (No. MAK/2/III/2020) on 19 March 2020 to prohibit
were confirmed positive. Overall the testing has been very slow as the gov- mass gatherings or group activities both in public and private
ernment has been quite passive in conducting diagnostic testing. Health in- environments.
frastructure, especially health laboratories in Indonesia has been identified
by one of the weakest problems in Indonesia health system [18]. The spread 3.7. Ministry of village, development of disadvantaged regions, and
of COVID-19 has revealed these health infrastructure gaps. For example at transmigration
present, the Indonesian MoH has designated only 48 laboratories across In-
donesia to do COVID-19 diagnostics (www.litbang.kemkes.go.id). One of the most vulnerable groups are people in remote and disadvan-
taged regions in Indonesia where the health system and access to health ser-
3.5. Ministry of Finance and Central Bank of Indonesia (Bank of Indonesia) vice remains limited. The good news is that in the last five years, the central
government has created a nation-wide incentive for village development
The Ministry of Finance, headed by former World Bank's managing di- through the Village Development Fund (ADD). At the moment, as
rector, Sri Mulyani Indrawati has made four major decisions namely tax-in- instructed by the president and responded directly by the Ministry of Vil-
centives policy, labour protection, rescheduling of loan repayment from lage, Regional Disadvantage and Transmigration, is to allow village govern-
small and medium enterprises (SMEs) and reallocation of fiscal policy at ments (ca. 80,000) to shift existing funds for cash for work. Therefore, this
local government levels [19]. While new policies have been issued in the is subject to future studies and investigations on how village governments
last week of March 2020, at this point of time, there is limited information can truly help COVID-19 affected communities by using the funding from
on both the implementation of both financial and monetary responses from ADD.
the Ministry of Finance. However, we provide some overview of the poli-
cies and their promises for future reference. 4. Broader societal responses
First, Decision to expand labour insurance (BPJS Tenaga Kerja) to cover
COVID-19 related job losses. This policy is a form of protection for workers In this section, we review roles and responses, focussing on that of reli-
via 3-months cash transfers program where an affected worker is entitled to gious and socio-economic organisations, as well as communities. We

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acknowledge that there are many other groups that have contributed to the the internet [20–24]. PGI also calls on all churches to form posts to deal
responses such as those from international, non-government organisations, with the corona virus outbreak. A case of the Synod Assembly Council of
civil-society groups but not discussed in this paper. Western Indonesian Churches (GPIB) on 26 February 29, 2020, had four
participants tested positive for coronavirus. PGI prepared volunteers to
4.1. Religious culture and tradition: source of strength or vulnerability? clean the house of worship by spraying it with disinfectant liquid [20–24].
Majelis Buddhayana Indonesia and the Indonesian Buddhist Tzu Chi
While religions provide comfort and sense of security throughout the Foundation have been instrumental in post-disaster response in Indonesia
history of human civilisation, their roles in pandemics can be both produc- including COVID-19 response. The Foundation in collaboration with the In-
tive and counterproductive at the same time. As a religious country, Indone- donesian Chamber of Commerce (Kadin) have been able to fundraise US$
sia has experienced both good and inconvenient experiences in regard to 31.25 million (IDR 500 billion); They have distributed items such as insula-
religious views of COVID-19. Human fellowship characterised by tion clothing, masks, goggles, gloves, as well as ventilators for the Ministry
routinised human contacts and gatherings around their house of prayers of Health along with several hospitals nationwide.
has been the key features of religious tradition from Abrahamic religions
(Islam and Christian) as well as Hindu and Buddhism as well as countless
of faith-based traditions in Indonesia. Their fellowship has been a source 4.2. Travel and tourism agencies
of dense social capitals that shape their worldview and source of inspiration
and wisdom not only in today's pandemic but also in the past. COVID-19 The drops in tourist arrivals during late February and March 2020 have
brings new imperatives of social-cultural change by default. Therefore, made the tourism industry one of the first and hardest hit businesses sectors
when COVID-19 hit the world, the agenda for social distancing and isola- [29]. The Indonesian Hotel and Restaurant Association (PHRI) reported a
tion have been seen as an attack on the culture and tradition that lasted loss of about US $ 1.5 billion due to the corona virus outbreak since January
for some millennium. 2020. The Indonesian Travel Agent Association (Astindo) reported that
Despite their unique adherents and to some degree counter-productive since February 2020, there was relatively no income for the travel agent in-
response in times of epidemic, religions should be seen as a solution and dustry. The loss experienced by the travel industry in the form of 80% of po-
not a problem. We provide a brief overview of potential religions for coun- tential passenger cancellations is likely to continue to grow in the future.
tering COVID-19 pandemics. We have observed some (if not all) religious Nationwide, Indonesian business sectors including tourism have limited
public gatherings in March 2020 amid COVID-19 that later led to the spread business continuity plans and management (BCPM).
of COVID-19. From the perspective of disaster governance, where manag- Lack of business preparedness has long been an overdue issue but barely
ing risk beyond government centric paradigm [25], religious organisations addressed by both the sector and the government. At the moment, there is
must be seen as governing power that can be equally powerful as govern- no clarity on how to help this sector to survive and recovery after COVID-19
ments given the capacity of their institutions, resources and members. due to other competing priorities from the government. Tax incentives by
As the country with the highest number of Muslims in the world, the the government could help but long-term recovery of the sector needs seri-
government of Indonesia cannot ignore the religious factors and roles in ous thinking.
handling the spread of COVID-19 [26]. Three largest Islamic organisations
such as MUI, Nahdlatul Ulama, and Muhammadiyah have developed their
governing structure in a state-like structure, consisting of multi-level insti- 4.3. Digital and media thrives under COVID-19
tutions from national to village levels.
Governments do not have all the resources to mass-campaign COVID-19 Digital platforms such as Gojek, Tokopedia, Bukalapak, Halodoc, and
mitigation alone. In fact, the Government must rely on these organisations Ruangguru have provided facilities and support in working from home,
to use their resources (schools, health facilities, volunteers and clerics) and learning from home and praying or worshiping at home according to
structures to conduct rapid promotion and education on COVID-19. their respective fields of service [30]. Gojek and Halodoc have provided fa-
Indonesian Ulema Council (MUI) has real potential power to shape nar- cilities for monitoring and checking health from home. While Bukalapak,
ratives that help Islamic communities in Indonesia to follow certain safety Tokopedia, Gojek and Grab open opportunities to work from home,
‘dakwah’ (imperatives). In times of perils where ‘social-distancing’ has Ruangguru which facilitates the learning process from home.
been promoted and sounded like an act against the traditions, MUI has Mainstream media has been at the front to correct the government's
been trying to introduce new imperatives aimed to mitigate COVID-19 slow response since January till today [31]. Recently, On March 24,
from spreading. The MUI Fatwa Commission has issued Fatwa No. 14 of 2020, the first content was published with the hashtag #AmanDiRumah,
2020. The fatwa explained the implementation of worship in the COVID- as well as the launch of the hashtag #MediaLawanCovid19 [32]. This con-
19 pandemic situation with the aim of safety and preventing the spread tent is created in multiplatform which will be broadcast simultaneously
of the disease among Muslims [27]. MUI further forbids actions that on Tuesday morning on various television channels, radio, newspapers,
cause panic or cause public harm, such as buying up and hoarding basic ne- cyber media and social media. With this awareness, it is expected that the
cessities including protection masks. The MUI fatwa also states that people rate of spread of the Corona virus can be inhibited. With this pattern, it is
who have been exposed to SARS-CoV2 must isolate themselves so that s/he hoped that the available educational publication material can multiply
won't infect others. Those who have been exposed to the virus can replace and be utilized by all national and local media.
Friday Prayers with Zuhr prayer at their respective residences. For the man- Initiatives to share information and educate the public against COVID-
agement of corpses exposed to COVID-19, the MUI stipulates that bathing 19 were carried out by journalists and the media industry. The objective
and caving must be in accordance with medical protocols and carried out of such a media movement is to spread a variety of educational content
by competent authorities with due regards to the provisions of the Shari'a. on a massive scale in an effort to combat the spread of the Corona virus
Meanwhile, burials need to follow the standard procedures [27]. in Indonesia. This initiative was attended by more than 50 national and re-
Muhammadiyah formed COVID-19 Command Center and allocated hospi- gional media from various platforms, namely television, radio, print media,
tals [28]. Muhammadiyah has transformed itself to be one of the most cyber media and social media in Indonesia [32]. This initiative arose spon-
agile promoters of health-based and hospital-based emergency response. taneously from the media and was independent, without affiliation and
MDMC has been instrumental in the disaster response system in Indonesia. funded by any party. That way, journalistic work can still run as it should,
Such institutions provide clinical services to COVID-19 patients in their by continuing to uphold the principle of independence. Through this
hospitals. networked work, it is hoped that various important messages in the fight
The Indonesian Council of Churches (PGI) proactively called congre- against the spread of the Corona virus can be spread widely and reach all
gants not to come to churches on Sunday worships and did services through levels of society quickly.

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R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

4.4. Community responses though not only physical and mental health, but also in its economy, phys-
ical and social infrastructure as well as those of nature and the
The three most frequent changes in public behaviour are staying at environments.
home, washing hands more, and applied social distancing [33]. While
some communities are more mindful of the risks than others, communities' 5.1. Strengthen health-responses as outlined by WHO, with initial consideration
responses should be seen as key to end this pandemic. They should be seen of long-term zoonotic risks and One Health approach
as a part of solutions and not the problem. In the earlier phase of the out-
break, it seemed obvious that the Government's scepticism and hesitance, As the WHO [1] outlined, there are six priority strategies for countries to
or even denial of the potential pandemic occurring in Indonesia, had direct implement: Expand, train and deploy health-care workers; Implement sys-
impacts and drifted communities away from favourable risk perceptions to- tems to find suspected cases; Ramp up production of tests and increase
ward the pandemic. This is coupled by relatively low awareness and drills availability; Identify facilities that can be transformed into coronavirus
on pandemics, although a number of socializations had already been facil- health centres; Develop plans to quarantine cases; and Refocus government
itated for example by the Ministry of Health in the past. on suppressing the virus. Specifically, for Indonesia, we underline these fol-
People's perception of COVID-19 risk might be low despite complex and lowing recommendations:
rapid flow of information in the last since January 2020. It took time for the
general public to process information on COVID-19 and take serious action 1. Active tracing to close contacted patients and do massive rapid tests +
to protect themselves. In the earlier phase of the pandemic, scientific or socializing for staying at home and physical distancing as well for
non-indigenous terminologies (e.g. Corona, Covid-19, the confusion of them. Identifying and mapping every single infected person with close
the differences between outbreak, epidemic and pandemic, etc) were contacts will be helpful for contact tracing and mass rapid test.
used in introducing the risk, hence created distance on how such pandemic 2. Coordinating, collaborating, and utilizing all of PCR laboratories (re-
can affect one's life. Later on, simplified technical terms related to COVID- search institutes, universities, hospitals, clinics, local government) to
19 were introduced into local language as initiated by some academics support PCR-based diagnoses. More attention must also put on health in-
and experts. English terminologies such as “social distancing” have been lit- frastructure development including health laboratory development in
erally adopted by governments and the general public. all provinces.
Slow progression of information and the disclosures of suspects or pa- 3. Rapid detection tests (RDT) using kits based on antibody detections are
tients with positive diagnosis also created a lack of senses of emergency and known to be far less accurate than the PCR-based tests. Therefore, such
perceived risk. This indicated how the government response had in fact con- tests must be conducted very thoughtfully, and the results must be han-
tributed in shaping community's risk perception. The very low perceptions of dled with care. For example, multiple tests up to at least three times must
risk, at least in the early phase also shaped unfavourable responses, which be conducted for those tested negatives, while PCR tests must be done
later on created immense problems for the government when deciding on those tested positive. However, because of the rapidity, obtained
whether or not extreme measures should be taken to contain the virus spread. data can be used as a ballpark in order to get a broad view about the
When school is closed nationwide, some families decide to go for mass family range and scope of COVID-19 spread. Preferably whenever possible,
holiday and to go back to their hometown. In this sense, the context evolved rapid PCR methods using the most current techniques (e.g. microfluidic
in a vicious cyclical way that hinder appropriate responses both by the gov- RT-PCR), which is much faster (ca. 45 min until result) than the conven-
ernment and communities. Although later on, also due to extremely high ex- tional methods (3–8 h), should be adopted, rather than the serology-
posure of the narratives in all types of media, the COVID-19, pandemic, and based RDT.
Corona, also terms such as WFH (work from home) as the relatively contem- 4. Increase the number of referral hospitals adequately and equip such hos-
porary terminologies had slowly entered the public acceptance as the new pitals for treatment properly. This includes to properly set up treatment
norm. These are shown in the attitude of communities to follow the self-iso- facilities (e.g. respirators, isolation chambers), diagnostics facilities (e.g.
lation or stay at home advice. The government is still adopting a position of PCR machines, diagnostics kits), medicine and pharmaceuticals, man-
holding off from nationwide lockdown. agement, medical doctors, specialists, nurses, health volunteers, and
Nevertheless, the self-isolation process is also a new norm, of which has safety and protection equipment for frontline practitioners (e.g. safety
almost never been a reflection of Indonesian general and sub-cultures, goggles, protection masks, hazardous materials suits).
which is different from Japan for example. These are multiplied with num- 5. Incentive and disincentive. Incentive should be given to those who vol-
bers of informal workers, and types of professions that simply do not allow untarily report their symptoms to hotline/referral hospitals. Disincen-
a person to work from home to earn their living. We have seen social media tive must be implemented to those who are still available out there
postings where some communities in Indonesia provided food for their in- without any relevant reason.
fected neighbour in house isolation. Community self-screening for outsiders 6. Mass spraying of disinfectant on the road, house, park, schools should be
and health checks have also been conducted, for example, in some commu- reconsidered since it may have little or no effect and may harm the inha-
nities in Lombok Island as many migrant workers returned back from Ma- lation of the people.
laysia and other countries. However, the limitation of technical 7. Develop proper health infrastructure including a proper government
knowledge and tools impedes the effectiveness of the initiatives. health laboratory system, which might include, not limited to, resources
Public misinformation and lack of communication among government of private diagnostic labs, research institutes, and universities, in all
levels triggered a misleading interpretation through instant social media provinces, to allow local COVID-19 testing without delays. We suggest
tools e.g. WA, Facebook etc. (herbal medication can beat viruses quickly that the MoH and DoHs at local levels should be more aggressive to ex-
which brings to skyrocketing prices in particular commodities such as garlic, pand the coverage of the whole six building blocks of the health system.
onions, ginger). Even more, some quick guidelines on how to make instant 8. Furthermore, in the long term, COVID-19 reveals the need to main-
hand sanitizer and disinfectant are publicly spread in the community. Some stream the One-Health approach where animal and human health devel-
activities to prevent the proliferation of viruses such as sunbathing have opment should be integrated in order to achieve SDGs. Current
been implemented routinely by some communities and government entities. approach that separates both health systems has proven not effective
as revealed by COVID-19. The COVID-19 case has yet to be tied with
5. Recommendations for health and broader systems' resilience Indonesia's elephant in the room, namely rampant wildlife trade at mul-
tiple scales. For example, domestic wildlife markets especially in Java
Resilience is the key to enable rapid, successful, sustained coordinated (e.g. [35]) are ongoing, as are animals as source of drugs including tra-
approach and responses toward COVID-19 and future crises and emergen- ditional Chinese medicines business in Sumatra, and bushmeat con-
cies (see e.g. [34]). It is about the resilience of nations, communities, sumption, including endangered bats in North Sulawesi. There are

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R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

delicate issues, because it is a matter of traditional food and part of the 5.4. Utilise science-based multi-disciplinary decision making/advisory, supported
culture. Allowing all these to continue without reserve goes contrary by big data/open science/citizen data, ensure transparency and strategic crisis
to the safety principles against the wildlife to human infections (zoono- and risk communication, and involve social influencers, especially to encourage
ses) [36]. Systems need to be built to ensure safety (e.g. by testing for general public to undertake self-isolation and health precautions
known pathogens) to prevent novel zoonotic pandemics [37].
We note that the COVID-19 task force has included scientists and
recognised science-based, data-driven advisory and decision making. The
5.2. Proactive, no-regret approach save life, strengthen disasters - humanitarian role science advisory has been notable in helping the governments to re-
coordination and decision-making capacity for sub-national governments during spond. This important progress needs continuity. Multi-disciplinary advice
crisis and emergency situation by health/public health researchers and practitioners, social scientists,
economists, legal experts, modellers will lead to better understanding of
This pandemic proves a difficult time for rapid large-scale decision mak- the contexts and potential impacts. Big data, artificial intelligence, open-sci-
ing for all governments worldwide. Presidential, nation-wide decisions are ence and citizen-data can accelerate current responses. Countries such as
changing minute-by-minute. Leaders are faced with criticisms when decid- Singapore, South Korea, and China have attributed their aggressive moni-
ing on whether to impose nation-wide lockdowns for example. This study toring through the use of these technologies.
shows that lockdowns have already saved thousands of lives [38]. Adaptive Governments at different levels can prepare and manage their crisis and
risk governance is about coping with complexity, uncertainty and ambigu- risk communication strategy by anticipating not only information overload
ity [39,46]. in social media but create a system where both pro and anti-government
The country should strengthen its disasters-humanitarian coordination hoaxes can be minimised. Transparency is key to managing pandemic as
to manage the pandemic and broader emergencies, across and between it provides a condition where infected persons can be quickly identified
levels, but also regionally within the ASEAN [40]. Indonesia has great expe- and treated accordingly in a timely fashion. Central and local government
riences managing disasters with coordinated approach by the government, must develop an integrated strategy of crisis and risk communication strat-
UN-OCHA in Indonesia or ASEAN through the AHA Center have been coor- egy [44] that allow people to be informed to minimise any irrational behav-
dinated effectively [41,47]. Moreover, Indonesia still needs to be ready iours such as ‘panic’ buying at local markets. It is also important to build the
should an earthquake or floods occur including their potential occurrence capacity of high-level officials at local level governments (provincial and
amid COVID-19. districts) on decision making and crisis communication during crises situa-
Djalante et al. [40] showed that focuses were mainly made at the tions. A good start has been made with provinces developing their own da-
national government response, with limited and varied focus on tabases and websites sharing monitoring data for each the provincial
cross sectors and cross government levels. It is important to mandate jurisdiction.
local governments to urgently form their own special task force It is commendable that social media has played a good part, e.g. advo-
(Gugus Tugas Percepatan Penanganan Covid-19 Tingkat Provinsi dan cating economic solidarity (increasing neighbourhood spending for infor-
Kabupaten/Kota) to accelerate responses and to achieve coordinated mal workers). Interesting short videos raising awareness for self-isolation
and coherent responses, involving key government offices and agen- were made by members of the public, including by Najwa Shihab (re-
cies, especially health, and communications and information. Sub-na- nowned news anchor) and Nadiem Makarim (Minister of Education).
tional governments also need to start proactive tracing and mass rapid More recently the awareness videos were made in local languages (Java-
tests for suspected persons. Some even decided to close entrance to nese, Sundanese and Sasaknese). However, many times also the social
their areas. media has been invaded by dangerous hoaxes e.g. promoting chloroquine
as a reliable drug to fight COVID-19, or alcohol-based hand sanitizer (and
not soap) as the most effective prevention. The government has developed
5.3. Strengthen the resilience of the economy a hoax buster http://www.covid10.go.id/hoaks, albeit with limited
amounts of information. Civil society such as Anti Hoax society group
Resilience is about the ability to absorb impacts, reorganise, learn, (Masyarakat anti fitnah) is also developing their own hoax buster such as
adapt, and transform [42]. It is about having the capacity to sustain https://turnbackhoax.id/.
development from expected and surprising change and diverse devel-
opment pathways development [42]. Country and business leaders are
moving urgently to protect their nations and organisations. Immedi- 5.5. Promote inclusive and community-based approach for community health re-
ate action is critical, but we also need to embrace broader sustainabil- silience and preparedness
ity of all of society. On March 31, the UN launched a new plan to deal
with the potential socio-economic impacts of the COVID-19 pan- Community-based responses may help to reduce pressure on local gov-
demic, calling on everyone to “act together to lessen the blow to peo- ernments to provide relief responses. The government also needs to ensure
ple” [2]. Three global measures were outlined: (1) Global stimulus an inclusive approach, considering vulnerable groups include people with
package to the amount of double-digit percentage points of the world's disability. The UN Secretary-General launched the Global Humanitarian
GDP, focussing on developing countries; (2) regional mobilisation to Response Plan, which explicitly includes persons with disabilities. In his re-
consider impacts, monetary coordination, fiscal and social measures, marks during the launch, the Secretary-General highlighted the situation of
with involvement from private and financial sector,; (3) National sol- persons with disabilities in relation to the response, as well as planning for
idarity needs to prioritize social cohesion and provide fiscal stimulus the future [2]. Organisation such as Arbeiter-Samariter-Bund (ASB) have
for the most vulnerable along with support to small- and medium- long advocated for such an inclusive approach.
sized enterprises, decent work and education. This is extremely rele- In conclusion, this paper has presented recent responses to COVID-
vant for Indonesia. The economy needs to have the capacity to absorb 19 in Indonesia. Most importantly, we outlined key health-related
the impact and focus on the most vulnerable people. Millions of jobs strategies and roles of different agencies in the responses. We
will be lost, with global assessment from the International Labour Or- complemented this with our analysis on the gaps and limitations in
ganization (ILO), five to 25 million jobs will be eradicated, and the the current strategies. We put forward recommendations to improve
world will lose $860 billion to $3.4 trillion in labour income [43]. the efficiency of the responses. We coupled them with wider consider-
Health and unemployment insurance and social protection are neces- ations on how the current COVID-19 responses be used as a window of
sary, to also support business (large, medium, small scales) to prevent opportunities to strengthen the state of health, and place Indonesia in
job losses. the path for healthy people and the planet.

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R. Djalante et al. Progress in Disaster Science 6 (2020) 100091

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