In August, Indonesia top Muslim clerical body, the Indonesian Ulama Council (MUI), issued a religious decree declaring that the measles-rubella (MR) vaccine is ‘haram’ – forbidden under Islamic law – because several of its components are derived from pigs.   

Now, public health officials are beginning to observe the dangerous consequences of this declaration. According to a report in Science magazine, millions of parents have already opted out of MR vaccines for their children.

However, the full picture is a bit convoluted.

Compared to other nations, Indonesia has had continually high rates of measles and rubella for many years. Consequently, the nation has been a priority target for vaccine coverage-boosting campaigns led by the World Health Organization (WHO), whose worldwide initiative to eradicate the two preventable diseases by 2020 was initiated in 2012. As part of this program’s strategic plan, the Indonesian Ministry of Health began a catch-up program aimed at immunizing 67 million children between the ages of 9 months and 15 years in 2017. To do this efficiently, the agency switched from the locally produced measles vaccine that had been used for many years to a combined MR vaccine manufactured in India.

When the program first began, it looked as though the country’s religious leaders were onboard. In August 2017, the MUI issued a decree – called a fatwa – that stated the MR immunizations are permittable but not mandatory (‘mubah’) in order to prevent disease. The clerics even went so far as to say immunizations are obligatory in cases where a non-vaccinated person could cause harm to others by spreading an illness with potentially permanent effects.  

With the religious seal of approval in hand, the first wave of vaccinations, focused on the island of Java, went swimmingly. The journal Science notes that all six Java provinces achieved the 95 percent coverage goal, and that measles and rubella incidence dropped more than 90 percent shortly thereafter.

But when health officials began implementing the program in the Riau Islands within Indonesia, local MUI clerics slammed the brakes, claiming that the vaccine had not been granted ‘halal’ status (meaning ‘lawful’, with subtle variations from ‘mubah’ that are up for interpretation) by the central MUI in Jakarta. After reviewing the information, the main MUI clerics decided that the MR vaccine was unlawful under Islamic law due to its pig-derived ingredients and elements of the production process that use pig-derived ingredients.

Though this sounds like a 180-degree shift in policy, it must be noted that immediately below these declarations, the clerics wrote:

“The use of the MR Vaccine product from the Serum Institute of India (SII), at present, is permissible because of:
a) There is a condition of compulsion (declared syar'iyyah).
b) There are no halal and sacred MR vaccines yet.
c) There is information from competent and trusted experts about the dangers caused by not being immunized and the absence of halal vaccines.”

They then recommended that the government prioritize the creation of a halal vaccine, and note that once this option is available, the permissibility loophole for the existing vaccine will be closed.

Yet despite the clear language in the fatwa itself and direct public messages made by the MUI endorsing the vaccine program, local religious leaders and parents have been interpreting the message differently. It is estimated that the coverage achieved on other islands has ranged from an alarmingly low 8 percent in the conservative Aceh province to about 68 percent elsewhere.

WHO and Indonesian Health ministry officials are continuing to push the vaccination program, optimistic that the MUI’s supportive stance can be made clear – a crucial effort considering that halal vaccines could not enter the market for at least 6 to 10 years, pending safety and efficacy trials.

[H/T: Science]