Sumenep, Indonesia: In the streets of Sumenep on Madura Island, three healthcare workers on motorbikes deliver life-saving doses of the measles vaccine directly to children’s homes. Carrying blue medical boxes and lists of names, they have been going house to house to tackle a nine‑month outbreak that has infected more than 2,600 children and claimed 20 lives this year.

But amid urgent public health efforts, resistance persists. Religious concerns over whether some vaccines meet Islam’s halal requirements are slowing the fight against the disease.

Religious concerns and vaccine ingredients

The reluctance stems from the use of pork‑derived gelatin, a common stabiliser in vaccines that ensures they remain safe and effective during storage and transport. For many Muslims, pig‑based products are considered ritually unclean. While numerous Islamic scholars allow such vaccines under certain circumstances, the Indonesian Ulema Council ruled in 2018 that vaccines containing pig gelatin are haram, or forbidden. However, the council advised their use until halal alternatives are available “for the benefit of society,” according to Ahmad Syamsuri, head of Disease Control and Prevention at the Sumenep Health Office.

In Sumenep, some parents hesitate to even speak about these religious concerns. Pujiati Wahyuni, a 31‑year‑old Muslim mother and nurse, said, “Yes, there are some. Islam is a big religion. Maybe some Muslim people just do not want to get vaccinated, and it is not just now, but since they were born.” She added that she recently had her own daughter vaccinated at an Islamic kindergarten in Pamolokan village.

Government campaign to boost vaccination

Since August, the regional government has rolled out a campaign to contain the outbreak. More than 78,000 measles vaccines have been distributed through local clinics, home visits, and schools. The aim is to prevent further infections and fatalities.

Despite the outreach, officials cannot compel reluctant parents to vaccinate their children. “We have high hopes for Muslims in Indonesia, who are the ones consuming it. Let us ask the government, in this case the Health Office and the Ministry of Health, to find a halal vaccine,” said Musthafa, general secretary of the Indonesian Ulema Council in Sumenep.

History of Measles outbreaks and hesitancy

Indonesia, the world’s largest Muslim-majority nation, has faced recurring measles outbreaks, often linked to gaps in vaccination coverage. In 2018, Papua province experienced a major outbreak that caused dozens of deaths. The Indonesian Ulema Council then permitted the use of the measles‑rubella vaccine produced by the Serum Institute of India, despite its pig‑derived ingredients, until a halal alternative became available.

Vaccination rates and challenges

According to the World Health Organization (WHO), global measles vaccination coverage needs to reach 95% to prevent outbreaks. Last year, only 84% of children worldwide received the first dose, and 76% received two doses. Indonesia’s figures fell short of national targets, with measles‑rubella vaccinations reaching 86.6% in 2023 and dropping to 82.3% in 2024.

From May to July, hospitals in Sumenep were overwhelmed, with isolation wards filled and over a hundred cases treated daily during the outbreak’s peak.

Personal decisions amid uncertainty

At an Islamic kindergarten in Pamolokan village, a health centre leader urged mothers to protect their children. Despite hesitation, some parents agreed to vaccinate. Ayu Resa Etika, 28, from Kebunan village, said, “There is a little doubt because it is not halal. But despite all that, this is for the sake of the child’s health. The effects are quite extraordinary; it can cause death. I am afraid that if my son is not vaccinated against measles, that is the risk. So it’s OK, as long as the effects are good.”

(With inputs from AP)