One of the biggest infrastructure projects in Southeast Asia is unfolding at the edge of the rainforest on eastern Borneo: the construction of a new Indonesian capital. Ibu Kota Nusantara (IKN), as it’s called, will replace Jakarta, which is overcrowded and sinking at an alarming rate, making it increasingly flood-prone. Already, some 17,000 hectares of pulpwood plantations and mangroves have been cleared, and buildings are rising. The first occupants are expected to arrive in a few years.
They may, however, be moving into harm’s way. The province of East Kalimantan, where IKN is located, is a hot spot for vector-borne diseases such as malaria. It may also host a relatively rare form of malaria caused by the parasite Plasmodium knowlesi. As deadly as the better known P. falciparium, it thrives in degraded forest areas and is on the rise in Southeast Asia. Without more research and control measures, moving at least 1 million people from malaria-free Jakarta to the new capital “will be naïve,” says epidemiologist Henry Surendra of Monash University, Indonesia, the first author on a December 2024 commentary in Nature Communications about IKN’s public health risks.
IKN is the legacy of former President Joko Widodo, who wanted a new capital at the center of the giant archipelago to help develop the eastern part of the country and offset the dominance of Jakarta and the rest of Java. “We need equitable development that is not Java-centric,” Widodo said. But critics say he appears to have picked the location because a business tycoon who has long supported Widodo’s political career owns land concessions in the area. And the project has been surrounded by controversy from the start.
In 2022, the Indonesian parliament approved the plan in less than 2 months, with little public consultation. There’s not much democratic oversight of the powerful agency managing planning and construction, which some say has appropriated Indigenous lands on dubious legal grounds. “So many processes were circumvented,” says Deden Rukmana, a professor of city planning and urban design at the University of Texas at Arlington. Environmentalists question promises about the sustainability of the “smart forest city,” as Widodo has called it, and have asked for environmental impact assessments. “We are really demanding transparency,” says Anggi Prayoga of Forest Watch Indonesia.
The risk of malaria and other infectious diseases is a newer concern. Although 85% of Indonesia’s population lives in malaria-free zones—and the government hopes to eliminate the disease by 2030—the country still has more than 400,000 cases a year. Most are in Indonesian New Guinea, but East Kalimantan is another endemic zone, with less than one-quarter of the population of Indonesian Borneo but about 85% of its malaria cases. More than half of those are in Penajam Paser Utara, one of the two districts IKN will straddle.
A 2020 assessment of IKN by the National Planning and Development Agency highlighted the risks, citing data including the abundance of disease-carrying mosquitoes. At least two construction workers caught malaria in 2022 while at the site, according to the Ministry of Health. Last year, 54 cases were reported there, but the ministry claimed the patients were infected elsewhere. Although the construction authority has taken some control measures, such as handing out mosquito nets to workers, it’s not well-equipped for the job, says Mirza Buana, a legal scholar at Lambung Mangkurat University in SouthKalimantan: “It has all the authorities but no capabilities.” The agency has shifted most of the tasks—such as vector control and screening workers entering or leaving IKN—to district health officials, who have struggled to keep up.
Surendra is particularly worried about the potential spread of P. knowlesi, a parasite first discovered in the 1930s. It emerged as a public health threat in the early 2000s, in areas in the Malaysian part of Borneo where forests were cleared for oil palm plantations. It has since been identified in many Southeast Asian countries.
P. knowlesi primarily infects long-tailed macaques, highly adaptable monkeys that thrive at the forest edge, and is spread by forest-dwelling Anopheles mosquitoes that occasionally bite humans as well. People working in or near the forest, including hunters and loggers, are at the highest risk. Because it has an animal reservoir, the disease is impossible to eliminate completely. Mosquitoes don’t transmit P. knowlesi between people—or very poorly—but some scientists worry that could change.
Studies have confirmed that several Anopheles species that transmit P. knowlesi live in East Kalimantan, and one lab-confirmed infection has occurred in IKN. But Surendra says others may have gone undetected because of the lack of molecular testing. The disease may also have been misdiagnosed, says Ibrahim Said, a biologist at the State Institute for Islamic Studies, because under a microscope, P. knowlesi can resemble P. falciparium and P. malariae, yet another malaria parasite found in Indonesia.
By creating puddles and other standing water reservoirs, massive construction could also lead to a surge of Aedes mosquitoes, which can transmit a host of diseases, including dengue—of which IKN had 650 cases last year—Zika, and chikungunya. “We don’t have data on most of those diseases now,” Surendra says, “but absence does not mean nonexistence.” His team is planning to collect blood samples from people in IKN and surrounding areas, looking for antibodies that could signal a past infection.
In their commentary, Surendra and his colleagues argue for more research to assess the risks, especially of P. knowlesi, and for strengthening environmental monitoring and disease surveillance. Surendra sees opportunity in the relocation as well. It may force Indonesia to take malaria elimination more seriously, he says, and help alleviate long-neglected health disparities between western and eastern Indonesia. Rukmana adds that building a megacity in malaria-prone areas “is very possible,” with careful planning. Without it, “the public will become the victim.”
