Halal concerns drive vaccine hesitancy as Indonesia fights measles outbreak

A measles outbreak on Madura Island has persisted for nine months, challenging health officials and stressing regional hospitals as they try to halt a spread that has infected more than 2,600 children and claimed 20 lives this year. In Sumenep, the latest push to immunize children comes as authorities contend with hesitancy tied to concerns that some vaccines use stabilizers derived from pigs, a matter of faith for many in the predominantly Muslim region.

Three health care workers rode motorbikes into Sumenep, carrying doses of measles vaccine and a list of children who needed them. With blue medical boxes in hand, they went from house to house administering the life-saving shots. The mobile outreach is part of the regional government’s latest efforts to curb the outbreak on Madura Island, which has persisted for the past nine months. More than 2,600 children have already been infected this year and 20 have died. The campaign began in August and includes distributing more than 78,000 vaccines through local clinics, delivering them directly to residents at their homes and bringing them to schools. The aim is to prevent future outbreaks, infections and deaths.

But the effort faces resistance rooted in halal concerns. Pork-derived gelatin is widely used as a stabilizer to ensure vaccines remain safe and effective during storage and transport, presenting a dilemma to religious communities that view pigs as ritually unclean. Many Islamic scholars say that vaccines with gelatin stabilizers can be used under religious law, as can other medical products with pig-derived ingredients, under certain conditions. Indonesian religious leaders ruled in 2018 that vaccines with pig gelatin are haram, or forbidden, but advised Muslims that they should be used until other shots are available “for the benefit of society,” said Ahmad Syamsuri, the head of Disease Control and Prevention at the Sumenep Health Office.

In Sumenep, many are reluctant to even discuss their religious concerns. Pujiati Wahyuni, a 31-year-old Muslim mother and nurse, knows parents who refuse the vaccines for their children on religious grounds, though she recently had her daughter receive the vaccine at an Islamic kindergarten in Pamolokan village. “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,” Wahyuni said. The regional government’s campaign targets the wider community, but officials concede they cannot compel reluctant parents. “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, the general secretary of Indonesian Ulema Council in Sumenep.

Indonesia, the world’s largest Muslim-majority nation, has reported previous measles outbreaks tied to gaps in vaccination coverage. In 2018, a major outbreak occurred in Papua, causing dozens of deaths. Because some vaccines have ingredients tied to pig products, the Indonesian Ulema Council said the measles-rubella vaccine produced by the Serum Institute of India contained an ingredient derived from pigs but allowed its use until a halal alternative was available. The Serum Institute declined to comment to The Associated Press on the matter. Globally, the World Health Organization says 84% of children received the first dose of measles vaccine last year, and 76% had received two doses. But experts say measles vaccination rates need to reach 95% to prevent outbreaks. WHO noted that 60 countries reported big measles outbreaks last year.

Measles vaccination rates in Indonesia fell below the country’s targets in 2023. In 2023, measles-rubella vaccinations reached 86.6% of the target, and in 2024, the number fell to 82.3%. From May to July — the peak of the outbreak in Sumenep — isolation rooms at regional hospitals were full as staff treated more than a hundred measles cases daily. At an Islamic kindergarten in Pamolokan village, the head of the community health center met the students’ mothers before vaccines were administered and urged them to protect their children by reducing the spread of measles in Indonesia. Despite her hesitation over the vaccine’s ingredients, Ayu Resa Etika, a 28-year-old from Kebunan village, finally allowed her 2-year-old son to get his delayed second dose after seeing many local children hospitalized with measles. “There is a little doubt because it is not halal. But despite all that, this is for the sake of the child’s health,” Etika said. “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.”

Health officials say the vaccine push will continue alongside dialogue with religious leaders and communities, in hopes of reducing hesitancy while protecting children from a disease that remains dangerous even as the world seeks broader immunization coverage. The outbreak in Sumenep underscores the challenge of balancing faith-based concerns with public health imperatives in Indonesia, a nation that has long battled measles outbreaks amid uneven vaccination uptake.