Beyond health regulations: Lessons from vaccine acceptance and the prevention of the COVID-19 pandemic

Abstract

Vaccine acceptance is a critical issue to study because it provides a means of measuring a nation’s success in handling the COVID-19 pandemic, particularly in nations where vaccine hesitancy has historically been common. This article seeks to explore the non-medical reasons for public acceptance of vaccines. More specifically, it asks: why has Indonesia, a Muslim-majority nation with elevated levels of resistance to the government’s COVID-19 mitigation policies, ultimately implemented vaccine mandates? This article relies on qualitative research, using a case study as well as in-depth interviews with one hundred randomly selected respondents. It shows that public acceptance was driven not by health considerations, but by coercive regulations. Three factors drove public acceptance: proof of vaccination was legally required to access public facilities; proof of vaccination was legally required to access public transportation systems; and proof of vaccination was legally required to access government assistance. Facing such regulations, the public had no choice but to comply with vaccine mandates, as only then could they access public facilities, travel, and access government assistance. This study concludes that coercive vaccination policies, though repressive, have been effective means of ensuring public compliance and reducing the spread of COVID-19. This study provides the government with considerations for formulating more effective policies for pandemic mitigation.

Keywords:

• public acceptance
• vaccinations
• COVID-19 pandemic
• health regulations
• state policy

1. Introduction

Despite high levels of vaccine hesitancy (Hanifah et al., 2021; Pronyk et al., 2019; Yufika et al., 2020), public participation in vaccination programs has increased (Faturohman et al., 2021a). As of 24 March 2022, some 71% of Indonesians have been vaccinated (our world in data, 24 March 2022). Although several wealthier nations have higher vaccination rates—99% in the United Arab Emirates and 92% in Singapore—Indonesia’s rates are still higher than nations such as India (our world in data, 24 March 2022). These figures are particularly impressive given the country’s high levels of vaccine hesitancy, which have been driven by rampant misinformation (Nasir et al., 2021), public distrust in the benefits and safety of the vaccines (Khadafi et al., 2022), and issues regarding the religious permissibility of the vaccines (Abdul Aziz et al., 2021; Nedjai & Ouinez, 2021). This contraction should be explored to provide insight into the best means of overcoming pandemics such as COVID-19.

Studies of vaccines and vaccination in Indonesia have generally focused on public resistance to vaccination policies (Nicolas, 2021). Studies of vaccine acceptance are still sparse, and most consider only the role of misinformation and education in resistance (Phillips et al., 2021; Rahman, 2021). Few academics have considered the public’s increased willingness to accept vaccination as a means of bolstering their immune systems and preventing the spread of viruses (Faturohman et al., 2021b). It is necessary to consider the perspectives of subjects when examining the public’s willingness to be vaccinated even in the face of heavy cross-sectoral resistance (Sangaji et al., 2021)

Our research focuses on the issue of the success of the Indonesian government’s policy to increase public participation in receiving the COVID-19 vaccine by reaching 71%, while there is resistance to vaccination that is so strong. This article seeks to explore the non-medical reasons for public acceptance of vaccines. Why has Indonesia, a Muslim-majority nation with elevated levels of resistance to the government’s COVID-19 mitigation policies, ultimately implemented vaccine mandates? This article shows that public acceptance was driven not by health considerations, but by coercive administrative regulations. Facing such administrative regulations, the public had no choice but to comply with vaccine mandates, as only then could they access public facilities, travel, and access government assistance. This study concludes that a coercive administrative policy approach is an effective way to gain public compliance with regulations that are crucial to reducing the transmission rate of COVID-19.

This article departs from the argument that individuals’ decision to be vaccinated is driven not only by health factors but also by other considerations—even though, as already shown elsewhere, knowledge of vaccines and their efficacy correlates positively with individuals’ willingness to be vaccinated. Here, acceptance is explored not at the individual level, but at the social level, with particular forces that drive social and cultural spaces. In other words, acceptance of vaccines is driven in part by collective reasoning and motivations.

2. Literature review

2.1. Social acceptance

Vaccine acceptance and pandemic mitigation are important not only for individuals but also for protecting society’s vulnerable citizens and ensuring collective survival (Brouwers & Van der Zeijst, 2021; Dauby, 2021). Globally, 68.6% of people have received at least one dose of a COVID-19 vaccine (ourworldindata, 6 December 2022). However, there are variations in global vaccine acceptance. Vaccine acceptance rates were highest among adults in Ecuador (97%), Malaysia (94.3%), and Indonesia (93.3%), and lowest amongst adults in Lebanon (21.0%). Limiting the discussion to healthcare workers (HCWs), acceptance rates were high in China (86.20%) and Italy (91.50%), but low in the Democratic Republic of Congo (27.70%) (Shakeel et al., 2022)

As shown by Hawlader et al. (2022), several factors affect vaccine acceptance. These include gender (men tend to be more accepting of vaccines), perception of future risks, fear of complications, perceived immunity, and perceived effectiveness of vaccines. A study by Kantarcioglu et al. (2021) found that 95.7% of 230 respondents were willing to receive booster shots to bolster their immune systems. People’s perceptions towards health and disease prevention also played a key role, with many considering spirituality to be a way to maintain health and deal with disease. Other common contextual factors such as religious beliefs, perceptions of pharmaceutical companies, and socio-cultural-economic conditions were also crucial for vaccine acceptance (Harapan et al., 2020; Sidarta et al., 2022).

2.2. Vaccination policies

During pandemics, vaccination policies have commonly been used to stop the spread of disease (Choi et al., 2021). Vaccines’ effectiveness can be seen in their ability to reduce the transmissibility of diseases and mitigate their potential effects. In the case of COVID-19, several vaccines have been developed by companies such as BioNTech/Pfizer, Moderna, Sinovac, and AstraZeneca (Solomon et al., 2021). As such a broad range of vaccines is available, many have doubted their safety and efficacy; consequently, hesitancy rates have been high (Patterson et al., 2022). In such cases, vaccines’ risks are perceived as outweighing their potential benefits—even though these vaccines have been proven to be effective in preventing the most serious symptoms of COVID-19 (Mofijur et al., 2020). Many countries have implemented vaccination policies to prevent the spread of COVID-19 and created massive clinics to expedite the process. For example, Grenoble Alpes University Hospital can vaccinate 5,000 people every day (Roseline et al., 2022).

Almost all countries have implemented vaccination policies, using different vaccines: to improve public immunity (Tabynov et al., 2022). Coercive approaches have broadly been used to ensure public participation, as such approaches were deemed necessary to accelerate the creation of herd immunity and increase the number of vaccinated health workers (Bradfield & Giubilini, 2021). As a result, 75–90% of the population are vaccinated and transmission levels are low enough that members of the public are protected (Anderson et al., 2020). Among the most common vaccination programs have been vaccine passports, wherein proof of vaccination has been required to access public facilities and transportation systems (Shin et al., 2021). Countries around the world, including Germany, the United Kingdom, and the United States, have required travelers to prove their vaccination status before entering the country (Voo et al., 2021). This has been fundamental in reducing the risk of international transmission (Chen et al., 2021). Airlines have supported such programs by ensuring that their staff are vaccinated and limiting travelers’ ability to fly.

In Indonesia, the government set vaccine obligations that could not be justified as human rights violations. Communities were also obligated to concern themselves with public health, as per Article 9, paragraph 1, of Law No. 36 of 2009 (Pawestri & Wahyuliana, 2021). Political pressure was thus used to compel Indonesians to be vaccinated. However, this has had negative consequences—acceptance rates have not been optimal, and public perceptions of vaccines have generally been negative (Limaye et al., 2021). In legal studies, social acceptance is closely correlated with the concept of obeisance, with is informed by such factors as relevance, clarity, socialization, coercive power, sanctions, enforcement, and moral/normative content (Roy, 2021).

2.3. COVID-19 pandemic

The COVID-19 pandemic, which has spread rapidly around the world, has proven deadly. Tabatabaeizadeh (2021) and Charlotte (2020) have shown that COVID-19 is transmitted primarily through direct contact with afflicted patients and their bodily fluids (particularly saliva). These high transmission rates have been exacerbated by the high mutability of the virus; since COVID-19 was first detected in Wuhan, China, in December 2020, there are many subvariants of COVID-19—including the gamma variant, beta variant, delta variant, and omicron variant—have been detected in countries such as the United Kingdom, South Africa, Brazil, and India (Yang et al., 2020). Each new mutation has resulted in an uptick in COVID-19 patients, particularly amongst the unvaccinated (Agosto et al., 2021; McGuire, 2021; Xiang et al., 2022). The rapid transmission and high mutability of COVID-19 have underscored the importance of responding quickly and seriously to the pandemic (Banerjee et al., 2022).

Various countries have made efforts to control the spread of COVID-19, often through policies that restrict public mobility and limit social interactions (Meyer et al., 2021). Such lockdown policies have been perceived as effective means of slowing the spread of COVID-19, particularly given China’s successful use of similar policies. In China, where the virus was first detected, 309 cities were reporting 0 cases of COVID-19 by 13 April 2020; only 34 cities were still reporting cases (Qian & Jiang, 2020). At the individual level, governments have intervened by implementing new health protocols (such as mask mandates) and limiting social interactions to curb the spread of the virus (Al-Ramahi et al., 2021; Betsch et al., 2020; Howard et al., 2020). It may be said that government pandemic—mitigation policies have sought not only to safeguard the economy but also to promote public health and well-being.

Since COVID-19 was first detected in Wuhan, China, in December 2019, the country has made a significant journey in overcoming this pandemic. The Chinese government quickly imposed a crackdown, including a wide-ranging lockdown of Wuhan and Hubei province, which was the initial epicenter of the outbreak. In April 2020, about four months after the outbreak first appeared, China reported that 309 cities across the country had recorded zero new cases of COVID-19. These statistics reflect the success of disease control efforts in most cities in the country. However, at the same time, 34 cities are still reporting active cases of COVID-19, indicating that challenges in breaking the chain of the spread of the virus still exist. China has run a massive contact tracing program, carried out mass testing and imposed isolation measures to control the pandemic. In addition, as of September 2021, China has shipped more than 2 billion doses of COVID-19 vaccines to countries around the world, playing an important role in global efforts to end this pandemic. Nonetheless, China is still struggling to cope with the new variant and keep the COVID-19 situation under control while continuing to take proactive steps in dealing with this pandemic.

3. Method

This research was conducted in Pekalongan, a city in Central Java, which is known as a “city of santri” due to the public’s high level of religiosity. This city is also known as a “city of batik” because it contains one of Indonesia’s largest batik industries (Rismawati et al., 2015). Pekalongan is home to a dynamic society, one that enjoys both economic prosperity and public piety, and this provides an important context for understanding the public’s acceptance of vaccination policies. It provides insight into the broader social and cultural context of Indonesia, a country whose Muslim-majority population is invigorated by a strong social, economic, and political spirit.

This study is qualitative, using a case study approach to obtain a deeper understanding of vaccine acceptance amongst the public. Several cases are used to present the rationales and motivations that drive vaccine acceptance. Data encompassed the social practices and reasonings for these practices, as well as respondents’ participation in vaccination programs, motivations, and rationales. Respondents’ socio-cultural situation was used to further contextualize their acceptance of vaccines.

For this research, data were first collected through a review of secondary data. In-depth interviews were subsequently conducted and surveys were distributed. The researchers traveled to public facilities to observe the daily activities of the sample population, as well as the vaccination programs implemented by local and regional government institutions, village governments, military/police agencies, universities, and even schools. In-depth interviews were conducted with informants of professional backgrounds, thus providing the researchers with information on their backgrounds as well as the factors underpinning their decision to be vaccinated. Interviews were also conducted with individuals involved in the planning and implementation of mass vaccination programs. All of these data were subsequently used for analysis.

During data collection, interview guidelines were developed and questionnaires were distributed. Questionnaires sought to collect information on respondents, vaccine access and receipt, and motivations. Interview guidelines, meanwhile, provided thematic guidance for discussion with informants and collecting information on vaccine policies and acceptance.

Data were collected through a survey of one hundred randomly selected respondents. Information collected included profiles of respondents themselves, their reasons for being vaccinated, the vaccination process, and the types of vaccines accessed. Disaggregated by gender, respondents consisted of fifty-three men and forty-seven women. Disaggregated by employment, respondents consisted of fifty-one farmers, fishers, and private-sector employees; twenty-six police/military/civil servants; and twenty-three students. Disaggregated by age, nineteen respondents were between the ages of 15 and 25; twenty-two were between the ages of 26 and 35; thirty-five were between the ages of 31 and 45; and twenty-four were older than 45 (Table 1).

Table 1. Respondents

Aspect	Category	Total
Gender	Male	53
	Female	47
Profession	Farmer/Fisherman	51
	Police/Military/Civil Service	26
	Student	23
Age (in years)	15–25	19
	26–35	22
	31–45	35
	>46	24
Motivation	Access to public facilities	43
	Access to transportation services	29
	Access to public services	28

Data were analyzed using the processes outlined by Miles et al. (2018), namely reduction, display, and verification. During data reduction, data were classified based on their theme and goal. Collected data were classified based on their themes, which included access to public spaces, transportation facilities, and government assistance. Data were subsequently codified based on the research question and disaggregated by informant gender, profession, age, place of vaccination, vaccinating party, and motivation for vaccination. Information was displayed through tables, illustrations, and quotes. Finally, data were verified by establishing links between data to establish its internal coherence. Further verification was conducted by placing data within its socio-cultural context.

4. Results

The COVID-19 vaccination program was developed through Law No. 2 of 2020 regarding the Passage of a Government Regulation in Place of Law No. 1 of 2020 regarding State Budgets and Financial Systems to Handle the Corona Virus Disease 2019 (COVID-19) Pandemic, better known as the COVID-19 law. To ensure the success of this program, the government involved a range of actors in mass-vaccination programs. These included not only government actors such as the military, police, local/national agencies, and state-owned enterprises, but also private-sector actors such as schools, universities, pesantren, and companies.

Targeted by these vaccination programs were Indonesians of all ages, from small children (starting at the age of six) to senior citizens. According to Minister of Health Budi Gunadi Sadikin, Indonesia sought to vaccinate 166.65 million people. According to Our World in Data, Indonesia had distributed 283,554,361 COVID-19 vaccine doses as of 4 January 2022. Consequently, Indonesia has had one of the world’s largest vaccine distribution programs (Menpan.go.id, 10 January 2022).

Vaccination drives were conducted not only at the national level but also at the local level, as seen in the case of Pekalongan, Central Java. By 13 June 2022, 253,840 residents had been vaccinated; this represented 90% of the government’s target (Radarsemarang.jawapos.com, 13 June 2022). This cannot be separated from the government’s ongoing efforts to conduct vaccination drives throughout the region.

Three policies drove the public’s decision to be vaccinated: the requirement to provide proof of vaccination to access public facilities; the requirement to provide proof of vaccination to access public transportation systems; and the requirement to provide proof of vaccination to access government assistance. These will be discussed in detail below:

4.1. Proof of vaccination as a legal requirement to access public facilities

Vaccination programs have been designed to realize herd immunity and minimize the dangers of COVID-19. At the same time, however, vaccination also has a social function: proof of vaccination was required to access public facilities such as malls and entertainment venues. As stated by Coordinating Minister of Maritime Affairs and Investment Luhut Binsar Pandjaitan, “the requirements for accessing public facilities will be made more stringent; only those who have received two doses may participate in public activities. So those millions of you in Java and Bali who have not received both doses, you should immediately get vaccinated” (Suryahadi et al., 2021, January 16).

Proof of vaccination was provided through an official application, called Peduli Lindungi, and used to access public facilities such as supermarkets, traditional markets, pharmacies, street vendors, salons/boutiques, laundromats, repair facilities, restaurants, malls, cafés, places of worship, and public health facilities.

The importance of access to public facilities was highlighted by several informants:

“I decided to get vaccinated because, if I didn’t have proof of vaccination, I would not be able to visit the Borobudur Mall with my family, eat at KFC, or accompany my children at a PlayKids Center.” (Informant A, age 34):

“I decided to get vaccinated not because of health considerations, as Insha’Allah my immune system will stay strong, but because I wouldn’t be able to hang out with my friends at the movies if I didn’t have proof of vaccination”. (Informant B, age 20)

“To be honest, I was afraid of getting the shot, but I wouldn’t be able to study at school or see my friends and teachers if I didn’t get vaccinated. I was tired of studying online, so I took part in my school’s vaccination program”. (Informant C, age 17)

“I decided to get vaccinated so that I’d have proof of vaccination. All I had to do was download my proof of vaccination through the Peduli Lindungi app. By showing this proof of vaccination to the security guard at the mall or cinema, I was allowed to enter and have fun with my friends”. (Informant I, age 20)

“On the weekend, I normally take my family to a tourist destination of sorts. Before, it was free; we didn’t have to do anything except buy tickets. Now, if we go to a tourist attraction, we need to show proof of vaccination. So, I was forced to get vaccinated, even though I’m afraid of needles”. (Informant J, age 37)

Based on the statements of these informants, it may be ascertained that they were vaccinated not for health reasons, but for the pragmatic reason of fulfilling their basic needs and accessing entertainment venues. Vaccine certificates did not simply confirm their participation in public policies; they were “skeleton keys” that opened the door to public facilities and entertainment venues during the COVID-19 pandemic (Robinson et al., 2021).

Per applicable law, proof of vaccination in figure 1 has provided the public with a means of entering public places and continuing their everyday lives. The public, rather than understand vaccines as being provided to safeguard public health, has viewed vaccination as the only available means of realizing their personal goals. In other words, personal factors were their prime considerations when deciding to be vaccinated. Individual members of the public sought to obtain proof of vaccination, as only then could they access entertainment venues and other facilities. There was no desire to contribute to public welfare.

Figure 1. Proof of vaccination required to access public facilities.

4.2. Proof of vaccination as a requirement for travel

As human beings are social creatures, mobility is crucial; only through mobility can everyday needs be fulfilled. However, since the beginning of the COVID-19 pandemic, the government has implemented social distancing and stay-at-home policies to limit the spread of the virus. Consequently, individuals and groups have had difficulty participating in activities outside the home. The commencement of vaccination programs marked a new era, as the vaccines enabled the public to regain its mobility and return to a semblance of normalcy.

Mobility encompasses all forms of travel, including land, air, and sea. Each of these requires proof of vaccination to access, as stipulated by several regulations. One of these is Circular No. 88 of 2021 regarding the Guidelines for Domestic Travel by Air during the COVID-19 pandemic. This policy stipulates that all persons traveling to or from Java/Bali must fulfill certain criteria. First, all travelers are required to provide proof of vaccination (a minimum of one dose). Second, all travelers must show a negative RT/PCR test, taken a maximum of 72 hours before departure (Kominfo.go.id, 2021).

These regulations and the mobility restrictions they entailed were recognized by informants. As they elucidated:

“I needed proof of vaccination because I work at the state court in Jambi, and I travel home to Pekalongan by plane—and then by train—at least once a month. As such, before I could travel, I needed proof of vaccination as well as a negative antigen test. Only then could I travel back and forth … although it was quite burdensome, what else could I do? I needed to see my family”. (Informant D, age 51)

“I got vaccinated because I needed to travel by train, to send my batik to Tanah Abang Market. If I didn’t have proof of vaccination, I’d never be able to earn an income for my family”. (Informant E, age 39)

“With proof of vaccination, I was greatly facilitated, because I was able to work. If I didn’t have proof of vaccination, I’d never be able to travel to my workplace in Semarang”. (Informant F, age 25)

“Me and my family, we were forced to get vaccinated. My wife comes from Jakarta, and so to visit with my in-laws, we had to travel by train and show proof of vaccination”. (Informant, K, age 47)

“I got vaccinated at work, at my campus. My home is outside the city, and I often travel there by train because it is more practical. When I enter the carriage, I have to show my ticket, identity card, and also my proof of vaccination. If I can’t, I can’t go home or go to campus”. (Informant L, age 52)

“I got vaccinated not because I was afraid of COVID-19, but to make things easier when traveling. My job requires me to travel between cities a lot, especially now that we have projects in Jakarta and Surabaya”. (Informant M, age 43)

These statements indicate that many members of the public have been vaccinated solely to safeguard their mobility and ensure their continued ability to travel. They have used vaccine certificates as passports, complementing the other documents that they require to travel. Without their certificates, they would be unable to conduct their everyday activities (See figure 2).

Figure 2. Proof of vaccination required to travel.

4.3. Proof of vaccination as a requirement for accessing government services

Public service is inexorably intertwined with public access to government institutions. As proof of vaccination has become necessary to enter government offices, it has thus become a prerequisite for accessing public services such as public assistance as well as issuing documents such as driver’s licenses and land deeds. Per Presidential Regulation No. 14 of 2021, members of the public must provide proof of vaccination before accessing any assistance that is supported by a national, provincial, or regional budget. Proof of vaccination is also required to access administrative services and enter other government institutions. In Pekalongan, this requirement is also regulated through Circular of the Mayor of Pekalongan No. 443/0027, which requires all residents to provide proof of vaccination before accessing public services in Pekalongan (Safuan, 3 November 2021).

This policy has been strictly enforced by government institutions, as attested by several informants:

“To be honest, I was terrified of being vaccinated, because one of my neighbors died after being vaccinated. In the end, I decided to participate in a village-level program, as I could no longer access the PKH program—even though I needed it to ensure that my family’s needs are fulfilled”. (Informant G, age 46)

“I had an unpleasant experience when I was handling my child’s birth certificate. When I went to the civil registrar, I wasn’t allowed to enter the office or access any services. In the end, I was forced to get vaccinated at the Bendan Clinic. Only after I showed proof of vaccination did anyone serve me”. (Informant H, age 35)

“I am old and afraid of needles, but I needed proof of vaccination to receive food and cooking supplies from the village government. As such, I had to get vaccinated at the village hall; if I didn’t, I’d be removed from the list of beneficiaries, even though my family sorely needed that assistance, especially during the pandemic”. (Informant N, age 63)

“When I went to the health program for assistance, it turned out that they required me to be vaccinated and have proof of vaccination. In the end, I got vaccinated at the Pekalongan Police Office. The vaccine? If I’m not mistaken, it was Moderna”. (Informant O, age 29)

“My driver’s license was expired, and only after I went to renew it did I learn that I needed to show proof of vaccination. In the end, I was vaccinated at the clinic. If I didn’t have proof of vaccination, my license would not be renewed”. (Informant P, age 41)

The information conveyed by informants confirms that vaccine certificates have been used as prerequisites for receiving service (see Figure 3). Without a certificate, they would not legally be able to access government services and social assistance programs. Members of the public were thus motivated by their personal concerns, rather than health matters, and only complied with public policy to advance their interests.

Figure 3. Proof of vaccination required to access public services.

Drawing from the above regulations and experiences, it may be concluded that informants were driven to comply with vaccine mandates not by health concerns, but by coercive regulations that limited their ability to realize their personal interests.

5. Discussion

This study has found that public acceptance of vaccination has been driven not by matters of health (Kassaw & Shumye, 2021; Wong et al., 2021) or survival (Brophy-Williams et al., 2021; Kampmann & Jack, 2021; Lernout et al., 2014), but by the pragmatic desire to adapt to new conditions (Denham et al., 2019; Gilliland et al., 2020). This is evidenced by three points. First, proof of vaccination was required to access public facilities and entertainment venues (Varade, 2020). Second, proof of vaccination was required to travel, either domestically or internationally, by land, air, or sea (Sharun et al., 2021). Third, proof of vaccination was required to access public services (Rochdiana et al., 2023).

This study has shown that obeisance and compliance with vaccine mandates have been driven not by knowledge of vaccines’ health benefits and awareness of the need to create herd immunity (Frederiksen et al., 2020), but as a pragmatic response to coercive regulations that were passed to mitigate the COVID-19 pandemic. These results differ from those of previous studies, which suggest that public acceptance of vaccines is driven primarily by public perceptions of vaccine efficacy and safety, as well as concerns regarding the COVID-19 pandemic (Dodd et al., 2022; Mitchell, 2021). According to informants (see Table 1), they felt compelled to be vaccinated, not because they feared COVID-19, but because government policies required them to show proof of vaccination to access public programs and social activities (The Lancet Microbe & The Lancet Microbe, 2021). Vaccine certificates were perceived as necessary to survive the COVID-19 pandemic (Fargnoli et al., 2021), access public facilities, travel, and access public services. Within the Indonesian context, vaccine acceptance has been driven more by administrative requirements than by health concerns. Administrative restrictions have been used by the government to increase vaccination rates (Anwar, 2019).

Ultimately, the policies that require citizens to show proof of vaccination have left the public with no other choice. Such policies are characteristic of repressive law (Nonet & Selznick, 2017), which sets strict sanctions for violators. In other words, vaccine mandates have been used primarily for social control (Barkan, 2018; Treviño, 2019), socioeconomic (Datta & Mete, 2022) and social engineering (Matnuh, 2017). Vaccine mandates, implemented with the support of law enforcement and the military, have been used to control public behavior and ensure public obeisance (Gandara, 2020; Hikmawati, 2020). From a democratic perspective, coercive programs that compel specific decisions are undesirable, especially as vaccination was voluntary in many other democracies (Popescu Ljungholm & Popescu, 2021). Nonetheless, this coercion provided Indonesia with a means of increasing public awareness of the COVID-19 pandemic and the importance of vaccination.

Where these mandates are violated, sanctions may be severe. Violators may receive warnings, experience delays, or even be denied access to social and administrative services. Some have been fined or even imprisoned (Maroni et al., 2021), as allowed by Paragraph 13A and Paragraph 14A of Presidential Regulation No. 14, 2021. Vaccine mandates have been used for social engineering, as they have ensured that all members of the Indonesian public adhere to the government’s grand design for handling the COVID-19 pandemic, writ, improving public awareness of COVID-19 as threatening the health of all Indonesians as well as the continued existence and sovereignty of the Indonesian nation. This policy succeeded because it was implemented strategically and followed a set plan.

This investigation shows that coercive regulations have been determinant factors in the success of vaccine mandates. Public compliance with these mandates has only occurred due to a self-centered understanding of the law and its implications. Members of the public have complied with a massive, systemic, and structured effort to compel them to act in a certain manner, recognizing that failure to do so would be detrimental to their interests. They have been forced to comply, even though they have not shared the same interests as the government. The government has understood its vaccine mandates as primarily a health issue (Dubé et al., 2014), while the public has perceived vaccination as necessary to continue a semblance of normalcy during the COVID-19 pandemic (Vanderpool et al., 2020).

From these cases, it may be concluded that efforts to control the spread of COVID-19 cannot be limited to the socialization of vaccines and their benefits. Only through coercion will the public be willing to contribute to pandemic mitigation programs. Coercive and even repressive policies are determinant in Indonesia. This condition differs from that in South Korea, where COVID-19 was combatted through digital technology, efficient healthcare management, and civil partnerships (Lee et al., 2020). In Indonesia, such civil partnerships were not utilized to combat the COVID-19 pandemic.

This study has provided a new perspective on public acceptance of the vaccine mandates implemented to curb the spread of COVID-19 by showing that the success of vaccine programs relies heavily on concerns that have nothing to do with health, i.e., the pragmatic need to maintain normalcy. In the Indonesian context, public health education—intended to improve public knowledge and awareness of the need to combat COVID-19—was limited.

6. Conclusion

This study has found that public compliance with vaccine mandates is driven not by an awareness of vaccines and their health benefits, but by repressive regulations. Without proof of vaccination, members of the public are unable to access public facilities, transport, or government services, and thus they have no choice but to comply with vaccine mandates. The ability to live in a semblance of normalcy, thus, depends on their decision to be vaccinated.

This study has contributed to an understanding of the policies implemented to control the spread of COVID-19. It thus offers insight that can guide the government’s emergency responses in the future, i.e., coercive and even repressive regulations are most effective when they involve administrative sanctions rather than the threat of violence or imprisonment. Empirically, this study has shown the need to expand public understanding using cases from societies with diverse socio-cultural backgrounds. Conceptually, this study of vaccine acceptance has taken an outsider’s perspective to understand vaccine acceptance. A subjective perspective is thus necessary to reveal society’s empiric experiences with and acceptance of vaccination. Practically, public experiences with vaccination may provide guidance for designing policies for responding to pandemics and other emergencies in a particular socio-cultural context.

This study is limited to a limited number of respondents in a single city, and thus it cannot provide a comprehensive examination of public response to vaccine mandates. Areas with diverse socio-cultural contexts must be considered, as these aspects influence public responses to government policies. Future studies should also use larger sample populations, as this will enable them to better map, contextualize, and understand the arguments in support of and opposition to government policies.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the State Islamic University (UIN) KH Abdurrahman Wahid, Pekalongan.