Why you should care
Because this religious edict will have huge health ramifications.
For the 225 million Muslims who call Indonesia’s 17,500 islands home, the supreme authority on religious affairs is the Indonesian Ulama Council, or the MUI. So when the central MUI issued a fatwa last August backing up a regional council’s decision that the measles and rubella (MR) vaccine was considered haram, or forbidden, many conservative families across the archipelago refused to vaccinate.
The reason was that the innoculation contained elements derived from pigs, and the fatwa — a ruling on a point of Islamic law — earned the dubious accolade of being the first known in the world to be issued against a vaccine.
The central MUI, chaired until recently by the incumbent president’s new running mate Ma’ruf Amin, later walked back its condemnation. It said that the prohibited porcine elements were superseded by the risk to public health, and that parents should inoculate their children despite the haram label. But the damage had already been done. Especially in one province: geographically isolated Aceh, the only state in Indonesia permitted to enforce Sharia law.
In Aceh, less than 8 percent of children have had the MR vaccine, compared to a 70 percent national average and a target rate of 95 percent.
“Trusted experts have explained the dangers posed by not being immunized,” MUI fatwa commission secretary Asrorun Ni’am said in September. However, the lack of communication between central and regional religious authorities and their communities has fueled the preexisting distrust of vaccines among parents in conservative communities.
Aceh is a semi-autonomous state on the northern end of the island of Sumatra, and its population of 5 million is 98 percent Muslim. According to Ministry of Health officials and local media, residents and religious leaders in Aceh are caught in a state of confusion where the news of the MUI’s original fatwa spread quickly and entrenched itself deeply in the minds of anxious parents. Efforts to clarify and bolster the floundering vaccination program have not carried the same weight.
That’s exacerbated by laws surrounding the age of consent for medical services, says Jeffry Acaba, who works with the Asia-Pacific health and social justice organization APCASO. “Despite international guidelines’ recommendation for parents to get their children aged 5 and below vaccinated for preventable diseases such as measles or rubella or influenza, it is still up to the parents whether their children can get vaccinated or not,” he explains. “The punitive aspect of Sharia also perpetuates such behaviors.”
The World Health Organization (WHO) reports that as a result of vaccination, measles deaths dropped by a staggering 80 percent globally between 2000 and 2017. It is estimated that the vaccine has saved 21.1 million lives around the world. But the disease saw a 50 percent increase in cases worldwide last year, spurred by a rise in anti-vaccine sentiment. According to the Ministry of Health, Indonesia saw 23,000 cases of measles and 30,000 cases of rubella between 2010 and 2015 alone. It has the third highest rate of measles of any country in the world, after India and the Philippines.
The joint effort between the Indonesian Ministry of Health and the WHO sought to vaccinate 67 million children below the age of 15 by the end of 2017. The initial effort on Indonesia’s most populous island of Java in 2017 was a massive success, reaching the 95 percent vaccination rate required for herd immunity — when a high enough proportion are vaccinated to stop the spread of the germ and protect those who can’t be vaccinated for health reasons. The remaining provinces have not had similar success. According to the WHO, nationwide vaccination rates are a dismal 66 percent, well below the 95 percent target. By comparison, nearby Malaysia and Singapore both have greater than 95 percent coverage with cooperation from their respective Islamic authorities.
In January, the Health Ministries’ official immunization drive outside Java ended after five months, having already been extended twice. Anung Sugihantono, director general of the ministry’s disease control and prevention programs, says the effort to vaccinate Indonesian children will continue despite the official end of the drive. “We are currently mapping out areas at risk of diseases that can be prevented through immunization,” Anung said in a statement on a ministry website. “We hope to achieve 95 percent immunization coverage in 2019.”
And what about Aceh? Acting on national recommendations, the ministry hopes that by including the currently optional MR vaccine in the basic vaccination program, they will be able to overcome the religious objections of parents in Aceh and elsewhere. But an active anti-vaccine movement, says vaccine researcher Harapan Harapan, is still spreading via social media, and “most of those who are against vaccines use religion to make their argument.”
No MR vaccine has been certified halal (permissible under Islamic law), including the locally made vaccine used in Indonesia prior to a WHO-recommended switch … which wasn’t met by the same objections from Muslim authorities. Indonesian company Bio Farma said last year that it’s working to produce a halal vaccine under the auspices of the MUI, but such a breakthrough could be as many as 20 years away. WHO spokesperson Fina Tams says they are continuing to offer support, but that they’ll continue to sidestep religious issues as the organization does not “assess vaccines on that criteria.”
Many other Islamic and Jewish authorities around the world have certified vaccines containing pig gelatin under a concept called istihalah in Islam, claiming that the hydrolysis process purifies the vaccines. While some ultra-Orthodox Jews and branches of fundamentalist Christianity oppose vaccines, no other major religious council has rejected them. Vaccination rates among ultra-Orthodox Jews are thought to be low, and New York City suburb Rockland County has recently seen a measles outbreak with cases concentrated among its Orthodox population, though no known authority has forbidden that community from vaccinating.
Meanwhile in Aceh, even after the fatwa was formally rescinded, the community is hardly immune from the consequences.