The Control of Population Mobility since the Early Pandemic Era to the End of 2021: Lessons from Indonesia

COVID-19 in Indonesia at a glance

COVID-19 came suddenly at the beginning of 2020, even though the mystery of it had already been recognized since the end of 2019. The deathly plague that suddenly occurred started with a mortality case by the virus that at the beginning was not recognized, let alone anticipated. After three months since the first incidence of the disease, the number of cases all over the world had increased drastically. Panicking happened because at the beginning the world did not know what was going on. The mortality cases occurred everywhere, bringing up humanity crisis, crisis in the health service, and even developed to become a political crisis. All of the world then made efforts to prevent and control the spread of the virus which was later known as SARS-CoV-2. The WHO even immediately formed an expert team to pioneer the effort to make vaccines. At the end of 2020, vaccine technology was discovered. Then the world started to conduct mass vaccination.

The first case of COVID-19 in Indonesia was detected in March 2020. At the onset, the government did not quickly have any policies on the incidents that started to draw the attention of the world at the beginning of 2020. From the interview with Terawan Agus Putranto (the Minister of Health from 23 October 2019 to 23 December 2020) who was the representative of the government policy at that time, there was an impression of a late response and underestimation of COVID-19 issues. The Minister of Health at that time even stated that COVID-19 could be fought with prayers,⁷ herbal drinks⁸ and that COVID-19 was not even more harmful than the diphtheria disease, which Indonesia was already used to dealing with.⁹ Even the minister asserted that the mask was only used by sick people, not healthy people.¹⁰

Public pressure made the government become more serious. When the pandemic was declared by the WHO, there was no option for many countries in the world not to adopt the strategy applied by the People’s Republic of China. At that time it was only China that had the experience to directly deal with the patients attacked with the virus SARS-CoV-2. The experimentation of China which was later written into a guideline document was used by the Ministry of Health of the Republic of Indonesia to then take countermeasures of COVID-19 in Indonesia.

The Response of the Indonesian Government and Mobility Control

PSBB period (March 2020-January 2021)

The government employed Law No. 4 of 1984 on contagious disease plague and the Law No. 6 of 2018 on health quarantine to decide the forms of the Large-Scale Social Restrictions (PSBB). PSBB was implemented based on the Indonesian Government Regulation No. 21 of 2020, governing population mobility including at least: a. temporary closing of schools and workplaces; b. restriction on religious activities; and/or c. restriction of activities in public places and facilities. That was the first time the term “lock-down” experiencing integration into the public life in Indonesia.

The rules on PSBB provided authority to every government at the provincial level to apply population mobility control. The application of PSBB was proposed to the Minister of Health by the region that would like to apply PSBB.

Besides applying PSBB, in March 2020, the government also made the coordination of cross sectors by forming a task force unit named Gugus Tugas Percepatan Penanganan Corona Virus Disease 2019 (COVID-19) (Task Force for Handling Acceleration of COVID-19) through the Presidential Decision No. 7 of 2020. The task force is accountable directly to the President, and it is given a big task to increase national resistance in health; to accelerate handling of COVID-19 through synergy among the ministries/agencies and the regional governments; to anticipate COVID-19 spreading; to increase the synergy of operational policy making; and to increase readiness and ability to prevent, detect, and respond toward COVID-19 (Article 3). Hierarchically, the regional governments were also requested to form the task force in each region by making coordination with the task force in the central government. With the presence of the task force, the effort to control COVID-19 is no longer a health problem being addressed through the cooperation of cross sectors from the central area to regions.

PSBB, with the support of the task force, was then applied in Indonesia. Within only a week, starting from Jakarta, followed by several towns and other regencies, as well as provinces in Indonesia, PSBB was implemented. Every 14 days, which was referred to as the incubation period known at that time, the application of PSBB could be terminated or prolonged. In reality, the implementation of PSBB was kept on being prolonged, particularly in Java and Bali Islands up to January 2021.

The decision on the PSBB application certainly directly affected population mobility. At the onset of the decision, all sectors were stopped, except the essential ones. Schools, houses of worship, offices, and trading centers stopped operating. The relaxation of restrictions was slowly introduced in June 2020 where offices, houses of worship, and recreation facilities were allowed to be opened with the capacity of 50 per cent. Meanwhile, the education sector was not opened at all.

PPKM (since January 2021)

The evaluation on PSBB implementation caused the government to issue the policy on PPKM (Community Activity Restriction Implementation) which started in January 2021 and has been effective up to now. What is different is that the PPKM policy is applied to control the area in accordance with the condition of the area. Previously, PSBB was assessed simultaneously all over Indonesia. PPKM was measured and observed based on the number of cases and deaths in an area. Based on the number, the central government announced the status of an area to be then assigned to take measures ideally expected. Consequently, because an area might have a certain level, namely level 1 (the lowest) to level 4 (the highest), the treatment of a level will be different from that of another level. Even in areas within the same province, the level status of PPKM in an area can be different from that in another area.

At the beginning of January 2021, the government only applied PPKM in seven provinces. However, the additional cases in the first six months in 2021 caused the government to announce the PPKM application nationally. Along with that, there was a big change that was also influential, namely the level of vaccination. At the beginning of 2021, the government encouraged the increase of vaccination. The government issued the regulations in connection with vaccination, which, among others, provided a priority to certain groups and made mobility arrangement based on the received vaccination. Until the middle of 2021, the new full vaccination scope reached only 5 per cent, but at the end of 2021, this scope reached 40 per cent (https://ourworldindata.org/covid-vaccinations).

The profile of those vaccination numbers might correlate with the decrease of COVID-19 cases in Indonesia, added with the population mobility restrictions that are still happening. After the cases reached the peak in the middle of 2021, approaching the end of the year, almost all regions only applied the level 1 PPKM.

Different from PSBB, in the PPKM period, gradually the government started to loosen the community activities. One of the things that is different is the education activity which started to be opened slowly, even though it only happened in several areas. The government allowed education activities to be carried out offline by first conducting trials to observe the COVID-19 spreading. The economic sector which was at first limited now becomes more opened.

Implications

No governments anywhere, including the Indonesian government, in a short time could make so many rules in dealing with COVID-19. From the period of 2020 to the end of 2021, the mobility control policy making was conducted by 12 government agencies jointly to carry out the provisions. Even though the Indonesian COVID 19 task force was just established and due to the pandemic, it has had the most number of policies issued to control the mobility of the population. The main position belongs to the Ministry of Internal Affairs that indeed has direct authority to regional government heads.

Mobility arrangement is the domain of the government responsibility. In the PSBB period, the arrangement of population mobility control only included 12 activities (see material and methods number 1-12), while during the implementation of PPKM, carrying out isolation and having the vaccine record card as parts of the requirements to travel for the citizens were added.

Mobility arrangement is an important policy that has been produced by many countries with all of its design variety.^11–14 In Indonesia, the authority of the Indonesian COVID-19 Task Force has been proven to be very dominant during the COVID-19 pandemic in Indonesia, although it was just newly established. In the period of PSBB, it was seen that the policies issued by the government were very dominated by movement restrictions. This is certainly closely connected with the early pandemic paradigm that humans are virus carriers whose movements must be limited and if possible, their movements have to be stopped. Therefore, this mobility control was mostly directed by the Task Force and the Ministry of Health, as done in other countries at the beginning of the pandemic.¹⁵

Understanding from its experience in controlling the pandemic, Indonesia prioritized the regulations for population mobility. When the level of PPKM increased, the community’s mobility was restricted or delayed; when the level decreased, the community could freely travel anywhere. When PPKM supported mass vaccination,¹⁶ people together in large groups went to get vaccination as it became a requirement for travelling.

This mobility control model was adopted by an institution that manages COVID-19 control. In the period of PPKM, the agencies that played an important role were the Task Force, the Ministry of Internal Affairs, as well as the Ministry of Health. These three institutions used the vaccine record card, integrated it into the application of PeduliLindungi to control the mobility of population. This application was made mandatory for everyone, to be shown in all important areas, especially the departure/arrival gates. It contained a history of vaccinations, as well as a history of exposure to COVID-19.

Previously, during PSBB, where mass vactination was not available, mobility control only used the COVID-19 test results. Therefore, COVID-19 vaccination was not only considered as the mass prevention measure of the disease but also required the presence of technology such as the PeduliLindungi app that facilitated vaccination history record, as well as made the population mobility control more easier.

It is important to note that the government of Indonesia has played a vital role in disease control. For the last two years, the celebration of Eid al-Fitr and Christmas as well as New Year was cancelled. Mobility restriction was in place very strictly. There were even circular letters issued by various government agencies to prohibit the government employees from making movements either by taking a leave, having a holiday, or going back to their hometown.

Recommendations

Indonesia’s initiatives give us insight that the decision to issue mobility control policies is still very effective in controlling highly contagious diseases, such as COVID-19. However, this policy must be accompanied by detailed adjustments in order to have an effective impact at practical level. Controlling a pandemic does not have to be just a total lockdown, but every government must create continuously evolving policies and make sure the implementation is carried out well.

Thus, it is highly recommended that public health stakeholders must continue to be involved with the government to formulate policies for what emergency situations are faced with, the most possible solutions, the impact on policies, and then to reconstruct or modify them if necessary. It is clear that the method applied by the government of Indonesia considers the health aspect, even though at the same time the government also considers other aspects, including economic, social, and educational aspects.

It is also very important to consider that the design of these policies must take into account the culture of the society. In Indonesia, mobility control decisions are heavily influenced by mass movement of people, patterns of people’s occupations, and social dynamics. The government regulates each of those matters in great detail. This certainly becomes an important lesson for the government anywhere, which will influence all life aspects of the society.

It should also be emphasised that in order to anticipate future pandemics or diseases, the government has to be assertive, although it does not have to be authoritarian. From Indonesia’s experience in controlling pandemics it is clearly evident that centralized power, with the support of laws, does not make the government liable to hold an authoritarian character as considered been in the past, but it proved effective in controlling pandemics.

This policy was effective in terms of reducing the number of cases, as the impact of this mobility restriction has never been investigated before. This paper only discusses the policies implemented by the government but the psychosocial and mental health impacts of people who experience mobility control are still unknown. Mobility restriction due to the pandemic in the two crucial phases aforementioned have inevitably impacted people’s mental health. This paper also does not discuss local policies that probably have been in practice independently by the community, as an additional effort beyond the instructions of the central government.