Parties, Patronage and COVID-19 Vaccination Distribution in Indonesia.

• Author: Sari, Lila

During the height of the COVID-19 pandemic in Indonesia, which saw almost 140,000 deaths by late 2021, (1) a remarkable phenomenon occurred: political parties stepped forward to take a prominent role in the public campaign to vaccinate the population. All of the major parties obtained vaccine doses, which they distributed to members of the public, often in well-publicized mass events with party colours and symbols on display, and at which party leaders gave rousing speeches. Although the government did not release data on this programme, media reports suggest that between March and September 2021, eight parties each distributed roughly 200,000 doses. Though the scale and speed of the COVID-19 vaccination campaign stretched health system resources in most countries, it was very rare for governments to reach beyond existing systems of healthcare provision to deliver doses of vaccines, and when they did so they tended to turn to organizations such as the military.

This article examines party involvement in Indonesia's vaccine rollout. We ask three sets of questions. First, what roles did the parties play in the vaccine rollout, how did they gain access to the vaccines, and how did these patterns vary across parties and regions? Second, we also explore the motivations behind the politicians' involvement in the vaccine distribution effort; looking at both health and political factors. Lastly, we explore the potential effects and implications of this approach to vaccine delivery.

To answer these questions, we employed in-depth interviews, direct observations, and monitoring of online media to assess the COVID-19 vaccination programmes run by parties and politicians in four provinces (Jakarta, Central Java, East Nusa Tenggara, and South Sulawesi) between May and October 2021. Due to COVID-19 travel restrictions, direct observations were only possible in South Sulawesi (where Haryanto and Andi Ali Armunanto reside) and Central Java, with the help of a research assistant. We also interviewed 16 local politicians, health bureaucrats, and local experts via telephone or WhatsApp. (2) With parties and politicians widely publicizing their vaccination campaigns, we combed through their social media accounts and websites, as well as media reports. (3) Doing so provided us with evidence of how politicians promoted and presented these events, and with examples of complaints from health workers and other public officials about them. Additionally, we used these sources to compile counts of vaccination doses distributed by politicians (as the government did not release official data on these campaigns). (4)

We propose that these party-led vaccination campaigns are an extension of the pattern of patronage politics that has come to dominate Indonesian politics in the last two decades. (5) Numerous studies in other countries have explored how healthcare and welfare services can be used for partisan advantage and to gain support for ruling parties or politicians. (6) There are also many examples of patronage politics disrupting orderly delivery of assistance during emergency situations. (7) In Indonesia, while elected politicians have dabbled in clientelistic delivery of healthcare services, for example by offering ambulances or other specialized healthcare assistance to constituents at election times, or by facilitating constituents' access to health services more generally, (8) most scholarly attention to the politics of healthcare has focused on politicians' programmatic behaviour, i.e. their efforts to improve healthcare system quality and impartial access at both the national and local level. (9) Our study addresses the most extensive--and blatant--example of clientelistic intervention in healthcare services yet identified in Indonesia.

Specifically, with regard to our first set of guiding questions about the nature of and variation in these party campaigns, we find that party approaches to vaccine delivery varied significantly based on their relationship with state institutions across regions. Parties were most active in vaccine delivery in areas where they had strong local bases of support and access to local government. Politicians' manipulation of the vaccination campaign took place within the context of well-documented weaknesses of local state institutions in managing the COVID-19 pandemic. (10) Our findings suggest that party politicians with strong informal connections within local governments were able to more easily access vaccines and public health officials to aid party campaigns.

Regarding our second set of questions, concerning the motivations behind this phenomenon, we argue that while it is clear that the Indonesian government was eager to speed up the rollout, there is little evidence that involving parties helped to realize this goal. Parties mostly engaged in the programme when they were able to--to use their preferred euphemism--"borrow" (pinjam) vaccines from government programmes and draw in public health workers to administer the injections. In other words, party-led campaigns mostly consisted of diverting vaccines and staff from existing programmes, rather than expanding their reach. For this reason, we contend that the party-led vaccinations should be viewed as an extension of patronage politics. They were a way for parties and politicians, in the context of the intense competition that characterizes Indonesian democracy, to demonstrate their utility to supporters, and to supplement established forms of patronage distribution which are usually much more expensive for individual politicians and often have limited impact.

Third, with regards to the effects of these party-executed vaccination programmes, we find that while they might in a general sense be viewed as helping to achieve the government's vaccination targets, the appropriation of state resources involved was heavily guided by calculation of political benefit, leading to the skewing of, and disruptions to, delivery. At the regional level, parties tended to deliver vaccines in areas where they had the most support, rather than in areas prioritized by the national vaccination plan. At the individual level, party-led vaccination programmes mostly targeted and prioritized party constituents and supporters, rather than distributing the vaccine based on assessments of medical need. Having the right political connections enabled individuals to get vaccinated before those who lacked such ties. Moreover, the fact that the party programmes typically utilized public healthcare workers caused disruption to the delivery of regular healthcare services in public facilities, as various of our informants indicated.

Our article contributes to the literature on how clientelistic politics can affect the delivery of basic services, including healthcare, providing an example of its extension to a highly critical area of pandemic response. It also extends the existing literature on patronage politics in Indonesia by providing an analysis of a relatively high level of party coordination in clientelistic delivery. Existing literature on patronage politics in Indonesia has highlighted that clientelistic distribution typically occurs through a highly personalized and fragmented mode in the country, largely due to Indonesia's electoral system and its emphasis on a personal vote. It has also explained how this context tends to undermine coordination and sharing of resources among party politicians when targeting voters with benefits. (11) In contrast, this article shows that parties can and do play an important role in clientelistic delivery, especially when it comes to "hijacking" national programmes where a degree of coordination is required in order that benefits be diverted for political use. Our findings thus add to the existing literature on patronage politics in Indonesia by drawing attention to the potential role that parties can play in the coordination of clientelistic delivery, adding to the arguments of scholars who have suggested that Indonesian parties are more coherent and effective than they sometimes seem.

The article first provides an overview of the Indonesian national vaccination programme and explains how parties gained access to, and delivered, vaccinations. We then illustrate these party campaigns by exploring the efforts of four major parties and discuss the key distinctions between their respective approaches, considering how their access to decision-making authority in national and local governments affected their campaigns. After that, we delve more deeply into the motives behind the campaigns, examining the parties' claims that their efforts were an attempt to help the government cope with a health crisis. We evaluate the evidence for these claims and suggest that the campaigns should be seen as an exercise in patronage politics, involving a form of policy hijacking and a combination of personalized and party-level coordination. Finally, we discuss the implications of our findings for the Indonesian polity and its capacity for service delivery.

The COVID-19 Vaccination System in Indonesia

Indonesia's response to the COVID-19 pandemic has been subject to extensive analysis, much of it focusing on the government's hesitancy to impose lockdowns and the inefficiencies in the early stages of the response. (12) However, comparatively little has been written about the politics of the country's vaccine rollout. As in many other countries, the challenge of delivering the vaccine was particularly severe from June to September 2021, when the emergence of the Delta variant meant that, for a period, Indonesia was experiencing the highest daily caseload in the world, with high fatalities, reaching over 2,000 deaths per day in July. (13) At that time, Indonesia had already begun to distribute vaccines, but the scale of the crisis prompted President Joko Widodo (Jokowi) to double the national COVID-19 vaccination target to two million persons per...