A WIDE-RANGING EXAMINATION: INDONESIA AND JAPAN'S BILATERAL VACCINE DIPLOMACY THROUGH THE INSTITUTIONALISM THEORY

During the global pandemic COVID-19, Japan-Indonesia cooperation begins to involve the health sector and grows stronger. Acknowledging that there is a connection between past history and the bilateral cooperation relations between Indonesia and Japan, the purpose of this study is to cast light on the relations between the two countries, which have been expanding for many years, particularly in the healthcare sector. Through the institutionalism lens, this essay aims to unveil the relations between Japan-Indonesia cooperation during pre and post-COVID-19 involving the use of the institutional body in establishing a coordinating system to facilitate the attainment of prospective benefits from cooperation; this increases the likelihood of a successful outcome. The bilateral cooperation between the Indonesia-Japan demonstrated that collective challenges, such as pandemics, can also be resolved through active collaboration.


INTRODUCTION
Indonesia and Japan have a long history of cooperation in a variety of sectors.Notably as strategic partners in various economic sectors.Diplomacy regarding healthcare between the two nations took place on a greater scale in the wake of the COVID-19 pandemic.At the start of the pandemic, Indonesia was ill-prepared, lacking sufficient quality equipment and facilities to handle the pandemic.It was widely reported that the country lacked healthcare equipment, including vaccines and healthcare attire, to name a few.In addition, Indonesia's laws regarding how the country should operate in a pandemic are quite outdated and have not been put into practice for decades.Indonesia's initial response was to acquire as many resources as they could, and thus cooperation on a bilateral and multilateral level was promoted in order to fulfill the need for health protection.
Japan and Indonesia's cooperation dates back to after World War Two.After the Japanese surrender and their subsequent withdrawal from Southeast Asia, Japan initiated a "cultural rebranding".Prior to WW2 Japanese culture was militaristic in nature.Post WW2 Japan was faced with many economic and diplomatic challenges, which came about from their aggressive behavior during the war.Due to the Allied powers viewing Japan as a military aggressor, Japan's international image soured along with its economic prosperity as Japanese products were not received well internationally.To combat this, Japan began to push what they call Kawaii, or cute culture.Things like anime, manga, and video games became more widespread, and their rising popularity spared Japan from being viewed as a military aggressor.After its international image improved, Japan sought to redeem itself for its wartime actions by engaging in extensive cooperation and diplomacy with previously occupied countries.Indonesia was just one of those countries.
Japan was the largest donor country in Indonesia during the COVID-19 pandemic.According to the JICA Report, Japanese associations with Indonesian development have been going on for six decades and are still continuing to this day.Indonesia also acts as the biggest Japan ODA recipient; in fact, about 90% of Japan's ODA was allocated to Indonesia to upgrade its infrastructure, which it counts as a fund donation (Pires de Campos, R. & Kawai, S. (2022).Japan's ODA to Developing Countries in the Health Sector: Overall Trend and Future Prospects).The strategic partnership between Indonesia and Japan during the pandemic successfully addressed health diplomacy's importance in strengthening and widening mutualistic bilateral cooperation as well as looking into new prospects for further practical collaboration in a variety of fields.

RESEARCH METHODS
To shell the Indonesia-Japan cooperation, the researchers purpose to employ qualitative methods in examining the bilateral relations.To answer the research question, the researchers endeavor secondary data in the form of news outlets, reports, and journals that are accessible on the internet.In addition to the extant bilateral relations, the researcher employs an institutionalism perspective to explain the cooperative relationship between the two countries.Liberal institutionalism, also known as institutionalism, is a theory that posits the possibility of international cooperation between governments, emphasizing its potential to be enduring and effective in reducing competition and conflict.Institutionalism highlights state cooperation with the aim to reach mutually beneficial outcomes, harmonization of actions among states, and manage anarchy by reducing uncertainty by generating information through institutions.
According to Keohane and Martin (1995), institutions play a crucial role in establishing a coordinating system that facilitates cooperation and increases the likelihood of achieving mutually beneficial outcomes.In the context of healthcare cooperation between Indonesia and Japan, institutions can be understood as a set of norms and rules that have been established to facilitate and govern the collaboration between the two countries.These institutional mechanisms serve as the foundation for the cooperative efforts at the institutional level.One notable example of such an institutional mechanism is the Japan International Cooperation Agency (JICA), which has been dedicated to improving Indonesia's healthcare system since the 1970s.Japan and Indonesia's healthcare cooperation also increased over the Covid-19 pandemic as Japan has continually supported Indonesia up until the present day (Jica, n.d.).
By providing a structured framework for collaboration, the institutional framework for healthcare cooperation between Japan and Indonesia promotes mutual trust, facilitates information exchange, and supports joint problem-solving initiatives.This institutional setup also ensures that the cooperation between the two countries is of a long-term nature, allowing for sustained engagement and the maximization of benefits for both parties involved.
By changing the nature of contacts from one-time engagements to iterative and ongoing processes, the institutional framework further improves collaboration.The lengthy partnership between Japan and Indonesia through JICA, where continuing dialogues and engagements take place, going beyond specific projects or initiatives, is an example of this iterative nature.
The healthcare cooperation between Japan and Indonesia is characterized by a structured and systematic approach through the establishment and observance of institutional norms and rules, which not only fosters cooperation but also provides a platform for addressing challenges and achieving shared goals in a manner that is sustainable.

RESULTS AND DISCUSSION
State's Bilateral Cooperation in the Healthcare Sector during COVID-19 a. Japan-Indonesia Cooperation During the Covid-19 Outbreak Since the meeting between Indonesian President Joko Widodo (Jokowi) and Japanese Prime Minister Yoshihide Suga on October 12, 2020, Japan has been an important partner in assisting Indonesia in dealing with the effects of the pandemic This was accomplished with the help of a vaccination collaboration and a $473 million loan.(Japan to Loan $473 Million to n.d.).
During the height of the pandemic, the success of the vaccine partnership between the Indonesian government and other countries was critical to Indonesia's survival.They found that the mortality rate and the number of hospital patients dropped significantly with the number of people who received vaccinations.Vaccination was a criterion that was used to restrict the number of individuals who needed to be hospitalized, as well as to address shortages of resources and healthcare professionals.Vaccination was used to prevent the spread of disease.The Ministry of Health also claimed that the severe COVID-19 cases were caused by a lack of vaccination and that the number of health professionals affected by COVID-19 who required hospitalization reduced drastically, going from 18% to only 3.3 percent.Both countries have discussed establishing a future ASEAN Center for Public Health Emergencies and Emerging Diseases to boost regional health governance in preparation for future pandemics.
Indonesia is also one of Japan's biggest economic partners, with Japan being the third largest foreign investor in Indonesia.Denso, Sagami, Panasonic, Mitsubishi Chemical, and Toyota are just some of the Japanese companies that have expanded their operations or moved their headquarters to Indonesia.Furthermore, Japan's Prime Minister has expressed his support for the ASEAN Outlook on the Indo-Pacific initiative, which aims to expand Indonesia's bilateral relations and improve areas such as the maritime, climate, and low-carbon sectors through concrete and inclusive development cooperation.Indonesia has also requested that Japan participate in the Sovereign Wealth Fund and address issues regarding import licenses for Indonesian agricultural, forestry, and fishery products.
Indonesia emphasized the need to maintain the spirit of collaboration between the two countries, particularly in light of the increasing competition among the world's major powers.(Japan and Indonesia Agree to Strengthen Multilateral Cooperation in 2020).

b. Vaccine Diplomacy
Japan is well-known as one of Indonesia's key economic partners in trade and investment.As time goes by, the strategic partnership between Indonesia and Japan continues to develop in the economic and healthcare fields.The partnership exhibited tangible cooperation between the two nations during the covid-19 pandemic.It cannot be denied that the diplomatic relations between countries have developed reaching the soft power aspect, such as health security.One of the methods to reach health security through bilateral health diplomacy is in the form of vaccine diplomacy.Vaccine diplomacy refers to all aspects of international health diplomacy that are dependent on the use or dissemination of vaccines (Hotez, 2014).The objective of Indonesia's vaccine diplomacy is to obtain access to immunizations for the protection of national health (Setiawan et al., 2022).In the meantime, Japan's objective as a vaccine producer is to undertake a diplomatic vaccine as an instrument of foreign policy and humanitarian aid (Setiawan et al., 2022).Japan had conducted vaccine diplomacy with Indonesia in the form of dosesharing bilateral collaboration with the goal of assisting Indonesia's economic development.It is vital for countries to work hand in hand on vaccine development in order to preserve citizens.The two nations' cooperation is also aligned with global health goals, which is strengthening global health cooperation.
The dose-sharing cooperation is the result of intensive communication between the Indonesia Ministry of Foreign Affairs Retno L.P. Marsudi and the Japan Ministry of Foreign Affairs Motegi Toshimitsu on several occasions, such as the G20 Foreign Ministers Meeting and the United Nations General Assembly in New York (Kementerian Luar Negeri, 2021).Other than that, the Indonesian Ministry of Foreign Affairs and the Japanese Embassy in Jakarta had signed an exchange of letters as a coordinated international effort to combat the COVID-19 outbreak.Japan provided 4.15 million doses of an AstraZeneca vaccine to Indonesia in 2021(Bhwana, 2022).Also, as of January 19, 2022, Indonesia had received a total of 2,722,930 doses (Bhwana, 2022).
Indonesia-Japan strategic partnership in dose-sharing bilateral cooperation certainly helps the acceleration of Indonesia's economic growth.On the other hand, it has been demonstrated that Indonesia-Japan cooperation is portrayed as a strategic partner in combating pandemics and implementing immunization programs.c.Improving the Vaccine Cold Chain After the coronavirus impacted many lives and the health of children all across the world, UNICEF surely took part in mitigating COVID-19's impact when it comes to the education sector, but moreover strengthening the vaccine cold chain.Japan themselves extended their fund for UNICEF for a total of $6.9 million USD to help Indonesia in this part.They gave a generous amount of grant to Indonesia to help support the emergency aid for improving the vaccine cold chain.The grants are also used to purchase equipment, storage facilities, and transportation to support the distribution of COVID-19 vaccines across the country.Of course, they generously granted this support under the circumstances of how COVID-19 itself really impacted the stability of the global economy-Indonesia for example, was impacted heavily by the pandemic since they are a developing country that does not have the same level of advanced healthcare technology.Therefore, Japan as a developed nation aided the shortage of healthcare and economic sectors in Indonesia as a kind gesture to further develop cooperation between the two nations.
The Japanese Ambassador for Indonesia-Kanasugi Kenji, stated that "Japan is currently working closely with Indonesia to help boost its health system and gain economic recovery, through principles of human security.".UNICEF so far has made an initiative to work with local authorities to help the children to return to school in hopes to continue their education.Other than that, UNICEF intends to distribute and install vaccine cold chain equipment for district vaccination that will speed the recovery itself.A recent assessment has also been made regarding the cold chain system in Indonesia which has been reported that the administration of more than 335 million doses of vaccines will make a significant impact on the supply chain.Therefore, UNICEF and Japan are helping Indonesia to achieve that; to help Indonesia regain its health system back with these goals and also achieve economic recovery from the instability that was caused by the COVID-19 outbreak.
d. Japan's Loan and Funding for Covid-19 Handling in Indonesia Throughout the COVID-19 outbreak, Indonesia has received a kind amount of help from Japan.The Director General of the Labor Inspection and Occupational Safety and Health Department of the Ministry of Manpower, Haiyani Rumondang, emphasizes how important and critical it is to ensure the safety of workplaces for businesses and workers, which has become a priority throughout the pandemic outbreak.The spread of the COVID-19 itself has threatened many lives and also taken away job opportunities from many people; a total of 2.6 million workers lost their jobs, and 24 million workers suffered from wage cuts due to the pandemic.
This sudden and significant change was due to the atrocious spread of COVID-19 which eventually needed to be handled as soon as possible.The Indonesian government ended up receiving a total of 7.14 trillion rupiahs in loans and grants from the Japanese government to be used in handling the COVID-19 cases and victims in Indonesia who have been affected by the outbreak.The Embassy of Japan in Jakarta wrote a statement that stated how "the loan is to be used as an emergency fund for aiding the people affected by COVID-19, revamping the healthcare system, and medical equipment."The loan itself is part of the partnership between the Japanese and Indonesian governments, an effort made to help stabilize the economic and social sectors during the pandemic.Kenji Kanasugi, the Ambassador of Japan to Indonesia also stated that ensuring the safety of workers and the sustainability of businesses is key to achieving economic recovery and job security for the well-being of the people.

Mechanization of International Organizations;
The alternation from G to P a. Examining International Organizations as an Arena for Indonesia and Japan's Bilateral Cooperation Aligned with the institutionalism perspective, international organizations can serve as a collaborative partner and an arena for the state to address its interest in conjunction with the mutual interest of the cooperating states.The COVID-19 pandemic appears to be a manifestation of the effects of globalization, in which increasing interdependence between sectors and actors has led to the emergence of health issues as a focal point and arena of international cooperation (Kurniawati & Madu, 2022).Considering the difficulty of states conducting physical bilateral discussions due to COVID-19, the staging of the multilateral summit has become an important diplomatic tool to open up dialogues between Japan and Indonesia.In the case of Japan-Indonesia cooperation, international organizations function as a forum to open up and strengthen the state actors' dialogue as well as facilitate cooperation.
International forums can be used as a communication medium more practically.The state may pursue its interest in a global organization while also pursuing bilateral cooperation through private meetings.For instance, during the G20 Foreign Ministers Meeting and the UN General Assembly meeting in New York, Indonesia, Japan's Foreign Affairs Minister arranged a small gathering to examine the dose-sharing cooperation (Kementerian Luar Negeri, 2021).Nevertheless, Indonesia-Japan cooperation is not only taking place during the pandemic.Through the help and collaboration of UNICEF, Indonesia-Japan relations extended to post-pandemic recovery, focusing on assisting vulnerable children by providing essential needs and services (UNICEF, 2022).Furthermore, the bilateral cooperation between Indonesia and Japan, known as JICA, also proves and reflects the friendship that is continuously growing between the two countries (Kementerian Luar Negeri, 2021).Under the direction of the World Health Organization (WHO) via the COVID-19 Vaccines Global Access (COVAX) Facility, Japan has made significant contributions by disbursing funds to support the capacity building of medical experts and by donating coronavirus vaccines by means of JICA (Panda, 2022).Indonesia was one of the recipients of Japanese vaccines, receiving a total of 6.88 million doses (Panda, 2022).
In this regard, international organizations are essential for establishing and sustaining international relations.As exemplified by the Indonesia-Japan relationship, international organizations are necessary to maintain bilateral cooperation between nations, particularly when circumstances preclude bilateral relations.The presence of international organizations is urgently required as a facilitator to facilitate regulations on the distribution of rights pertaining to humanity, namely the distribution of vaccines, as previously described.
b. Linking the Government (G) to Government (G) to Business (B) to Business (B) to People (P) to People (P)

People to People
The Japan-Indonesia healthcare diplomacy initiative has improved healthcare in both countries through the exchange of professionals, researchers, and students.This aligns with the concept of epistemic communities, where Japanese and Indonesian experts share norms and values (Keohane & Martin, 1995).They form a dedicated community committed to enhancing healthcare and promoting cooperation.By transcending borders, this initiative fosters enduring relationships, trust, and knowledge sharing.It cultivates sustainable cooperation and advancements in healthcare delivery.The people-to-people dimension, exemplified by initiatives like Japan-Indonesia healthcare diplomacy, adds a human touch to institutional interactions, fostering solidarity.In conclusion, this initiative demonstrates the transformative power of people-to-people exchanges in improving healthcare, benefiting both Japan and Indonesia.

Business to Business
Through the healthcare diplomacy initiative, Indonesian and Japanese healthcare companies have formed partnerships and collaborations, exemplifying transnational private governance.These alliances contribute to the development of shared norms and practices within the healthcare sector.Transnational private governance entails the influence of non-state actors in shaping global norms and standards through collaborative interactions (Bäckstrand & Kuyper, 2020).These business-to-business relationships foster knowledge exchange, innovation, and the dissemination of best practices.By transcending national boundaries, they promote the harmonization of healthcare approaches and enhance the quality of services provided.The involvement of private entities in shaping healthcare norms highlights the importance of cross-border cooperation and private-sector engagement in addressing global health challenges.Thus, these partnerships serve as influential drivers of positive change in the healthcare landscape, benefiting both Indonesia and Japan.

Government to Government
The Indonesian and Japanese governments have actively endorsed Healthcare Diplomacy through formal agreements and partnerships.This aligns with the concept of international regimes, which pertains to the impact of established rules, norms, and procedures on state interactions and behavior in specific domains (Keohane & Martin, 1995).The Japan-Indonesia healthcare diplomacy initiative operates within the framework of a broader international regime for cooperation.By engaging in this regime, both governments demonstrate their commitment to fostering collaboration and harmonizing healthcare policies.This formal support facilitates the exchange of knowledge, resources, and best practices between the two nations, leading to improved healthcare systems and outcomes.The establishment of formal partnerships between governments strengthens diplomatic ties and underscores the importance of governmental involvement in addressing healthcare challenges.Through government-to-government cooperation, Indonesia and Japan contribute to the advancement of global healthcare governance and pave the way for future collaborative endeavors.

Post COVID-19 Indonesia-Japan Healthcare Partnership
Cooperation between Indonesia and Japan dates back to before diplomatic relations were established.The exchange of human resources and deepening mutual understanding, which has developed over time, are significant advantages for both countries.It is believed that Indonesia and Japan will continue to collaborate as joint partners for decades to come.
Japan views Indonesia as an important partner with great potential because it is one of the most dominant countries among the G20 member countries.Indonesia also has a particularly strategic geographical location, as it is located between the Indian and Pacific Oceans, both of which are vital shipping channels for Japan.Indonesia has an abundant source of materials.Statistics show that the demographic strength of Indonesia's younger generation, which is currently more dominant, is one of the factors that can ensure the country's future progress.This is in contrast to Japan, which has a larger elderly population.
According to Hiroki Sasaki, the Japanese Embassy's Labour Attache, there are an estimated 340,000 special skilled job vacancies in Japan, but only about 130,000 of them are filled.As a result, a foreign workforce is becoming increasingly important.More than 16,000 Indonesians were employed under this scheme as of December 2022.Indonesian vocational schools have begun catering to students seeking to fill vacant job positions in Japan.The most sought-after form of employment in Japan is primarily caring for the growing elderly, with Japan having the world's largest senior population ratio, with 29.1% of the population being over 65 years old.
The Indonesian Ministry of Industry (Kemenperin) continues to contribute to efforts to boost the country's health sector, particularly through encouraging the development of the pharmaceutical and medical device industries (Farmalkes or Kefarmasian dan Alat Kesehatan).According to the Making Indonesia 4.0 strategy, the Farmalkes industries are two of the seven sectors that would receive development priorities.The seven sectors are: food and beverage, automotive, chemical, textiles and textile products, electronics, pharmaceuticals, and medical devices.The implementation of the Indonesia-Japan Pharmaceutical and Medical Device Business Forum, which took place on October 5-7, 2022, in Osaka, Japan, was done to speed up efforts to expand the pharmaceutical business.
Once Japan and Indonesia had officially declared the end of the pandemic within their own borders it did not mark the decline of their healthcare diplomacy.Rather, cooperation between the two nations would continue at a greater scale than ever before.The pandemic highlighted the importance of a mutually beneficial agreement between Indonesia and Japan and how such an agreement would reduce the risks and impacts of another pandemic should it occur.
One noteworthy effort in the healthcare cooperation between Indonesia and Japan is the Indonesia-Japan Pharmaceutical and Medical Device Business Forum which took place in Osaka between 5 October and 7 October 2022.The business forum was an initiative by the Indonesian embassy in Japan, supported by the Indonesian ministries of health and industry as well as the Indonesian Chamber of Commerce, in cooperation with several Japanese pharmaceutical companies and the Japanese Government.The purpose of which was to discuss Indonesia-Japan healthcare cooperation following the COVID-19 pandemic.The forum resulted in a cooperation commitment signed by GPFI with Japanese partners to open up opportunities for cooperation in the fields of research and development as well as co-production.

Medical Devices Distribution and Research
The Covid-19 pandemic has caused the world to endure a number of challenges during the last three years.While Indonesia was struggling, Japan has been a significant help in the health sector.Indonesia is currently working on a midterm national plan for health and medical care, and it can be said that the health sector is well prepared for reform and transformation, this time again by collaborating with Japan.
The Indonesia-Japan Pharmaceutical and Medical Devices Business Forum, held on October 6, 2022, marked a significant milestone in the collaboration between key stakeholders in the healthcare industry.The forum was jointly organized by the Ministry of Health, the Republic of Indonesia Consulate General in Osaka, and the Indonesian Embassy in Tokyo, in close coordination with various entities including the Indonesian Embassy in Tokyo, the Indonesian Consulate General in Osaka, the KADIN Indonesia-Japan Bilateral Committee, the Ministry of Industry, IIPC Tokyo, ITPC Osaka, METI Kansai, FPMAJ, and JETRO, all of whom played instrumental roles in ensuring the success of the event.
The primary objective of this collaboration was to bolster and strengthen the health sector in Indonesia, with a specific focus on facilitating the expansion of the pharmaceutical industry and the medical device business.Recognizing the importance of advancing healthcare, the partnership also emphasized its commitment to supporting the six pillars of the National Health Transformation Program, which included initiatives such as the genomic approach (BGSi) and the national digital portal (SatuSehat).
Kunta Wibawa Dasa Nugraha, the secretary general of the Ministry of Health, highlighted the key goals of this collaboration.The primary aim was to enhance both primary and secondary healthcare services by harnessing the potential of advanced biotechnology.By focusing on the mastery of viral vectors, nucleic acid-based technology, and recombinant proteins, the collaboration aimed to develop vaccines and medications that would cater specifically to the healthcare needs of the Indonesian population.As a direct outcome of this partnership, various essential commodities in the healthcare industry were expected to be produced.Examples of such products included erythropoietin, insulin, monoclonal antibodies, and plasma derivative products.The collaboration aimed to strengthen domestic capabilities in the pharmaceutical industry, with six out of ten active pharmaceutical ingredients (APIs) being developed domestically by the Ministry of Health.
Through the Indonesia-Japan Pharmaceutical and Medical Devices Business Forum, stakeholders in both countries came together to forge stronger ties and lay the foundation for future collaborations in the healthcare sector.By leveraging each other's expertise, resources, and technological advancements, both Indonesia and Japan aimed to address pressing healthcare challenges and improve the overall well-being of their respective populations.

CONCLUSION
In conclusion, the Japan-Indonesia cooperation in the healthcare sector has become stronger and more significant during the global pandemic COVID-19.The long history of bilateral relations between the two countries, coupled with the institutional framework established through organizations like the Japan International Cooperation Agency (JICA), has facilitated successful collaboration.The cooperation between Indonesia and Japan in response to the pandemic has included various aspects such as vaccine diplomacy, improving the vaccine cold chain, and financial support.
Japan has played a crucial role in assisting Indonesia during the pandemic, providing financial aid, vaccine doses, and support for improving healthcare infrastructure.The partnership between the two countries has not only addressed immediate challenges but also aimed at long-term collaboration and preparedness for future health emergencies.The use of international organizations, such as the G20 Foreign Ministers Meeting and the United Nations General Assembly, has provided platforms for dialogue and coordination between Indonesia and Japan.
The Japan-Indonesia cooperation during the COVID-19 outbreak highlights the significance of collective efforts in addressing global health challenges.Through active collaboration and mutual support, both countries have demonstrated the potential for resolving common problems and achieving shared goals.The strong bilateral cooperation in the healthcare sector serves as a testament to the enduring and effective nature of institutionalized collaboration between nations.