TEMPO.CO, Jakarta - The recent low measles and rubella (MR) vaccination coverage rate has set the alarm bells ringing. The immunization program rolled out by the health ministry during the period August-September 2018 outside Java has only managed to cover 49 percent of the 32 million children targeted.
This is truly a worrying trend. Even 75percent coverage can still result in 142,000 cases with almost 2,000 deaths. This abysmal result has the potential to bring about measles outbreaks across the country.
In severe cases, the measles virus can cause pneumonia, encephalitis, acute diarrhea and ear infection that can lead to deafness. The disease is also frighteningly contagious; a study says that one infected child can transmit it to 20 others.
Meanwhile, rubella a.k.a the German measles can cause blindness, deafness, heart abnormalities, brain damage, autism and diabetes mellitus. The initial symptoms of the disease are fever, rash, nausea, red eyes and swelling of the lymph nodes behind the ears. In pregnant women, it can cause severe fetal defects in the eyes, heart, ears and brains.
In 2015, World Health Organization listed Indonesia as one of 10 countries with the highest measles incidence in the world. The ministry of health recorded between 5,000 to 8,000 cases of measles and rubella during the period 2014-2018 with three-quarters of them being children under 15.
The cause of the low MR vaccination coverage actually did not come as a surprise. Many consider the MR vaccine to be ‘haram’ (unlawful) given the pancreatic enzymes from pigs used in making the vaccine. The resistance comes not only from the public but also from clerics and even regional heads with Aceh’s acting governor Nova Iriansyah and Balikpapan deputy-mayor Rizal Effendi ordering to delay the implementation of the program in their regions on legal grounds. As the majority of the population is Muslim, it’s not surprising that the halal-haram (halal = allowable) issue became a hot potato.
The opponents argue that the Indonesian Ulama Council (MUI)’s edict No.4 regarding immunization issued in 2016 declares the use of vaccines made from ‘impure’ elements as haram. MUI later called on the MR vaccine producer to apply for the halal certificate which the producer could have obtained much earlier. The health ministry’s delay in approaching the MUI to relax the regulation is quite regrettable. Using common sense and consideration for public health and the compelling conditions, the use of the vaccine categorized as haram could have been justified sooner without much ado.
Another sad factor is our bureaucrats’ abysmal knowledge of the laws. Law No. 33/2014 regarding halal product guarantees producers—in this case, Serum Institute of India—the right to apply for halal certificates. However, having based in a predominantly Hindu country, Serum Institute certainly did not feel the urgency to get a halal certificate, much less from the MUI.
Only later, did it come to light that the distributor, the state firm Bio Farma in this matter, can in fact, apply for the certificate. But, to issue the certificate, the MUI must first examine the content—the data that must be obtained from the company. To cut the story short, the MUI eventually revised the law changing the status of the vaccine from haram to mubah (permissible).
The health ministry’s slow response in this issue has serious consequences. Instead of using the new edict to convince the public about the importance of vaccination, some regional heads delay the program due to lingering doubts. The ministry is now scurrying to promote the MR vaccine’s new status through the help of clerics and public figures.
The health ministry must work hand in hand with religious and public figures to meet the vaccination target. They must work hard not only to expel the public’s doubts but also to ensure that vaccines are distributed to all corners of the country.
The government, meanwhile, should not hesitate to use the child protection law against rebelling parents, slapping them with criminal sanctions for neglecting their children’s health.
At the same time, the government’s opposition should immediately stop politicizing the issue including inciting the public to reject vaccination. We should discard outdated religious views in this matter. Instead of being embroiled in the polemic surrounding the halal-mubah status of the MR vaccine, they should ponder upon the more vital question: how to protect our future generation from the deadly virus.