As the bell was called recently in the elementary school, students were filled with classrooms, disturbed adults filled outdoors. It was a day of vaccination, but many parents in this village of North Sumatra did not want their children immunized with a new MRI. Some told the teacher that their children were at home without feeling well. The others were there to make sure that their children did not get a blow. They whispered the reason for the gnus: The vaccine "contains the elements of the pork". As the vaccination team left, only six of the 38 students were immunized.
Millions of Indonesian parents have thrown out the vaccine in recent months, after Islamic clerics proclaimed MR vaccine "haram, "or is prohibited under Islamic law because the components of pigs are used in its production. As a result, coverage of vaccines has dropped, alarming public health professionals who worry that the world's largest Muslim country can see new waves of goddesses and more miscarriages and damage to births is the result of a rubella infection during pregnancy.
Indonesia has long used a locally produced smallpox vaccine as part of a childhood vaccination scheme, but coverage has been uncertain, and until recently, the country had one of the world's largest burden of disease, according to the World Health Organization (VHO). Last year, as part of VHO's plans for the removal of smallpox and rubyol by 2020, Indonesia switched to a combined MR vaccine, produced by the Indian Institute of India in Mumbai. The Ministry of Health has launched an ambitious campaign to capture the target of 67 million children aged 9 months to 15 years. The first phase, 2017 on Java Island, was successful; of all six provinces reached the target of 95% coverage, and cases of goddesses and rubella fell by more than 90%.
But the decline in the rest of the country, originally scheduled for August and September this year, has encountered trouble. Immediately before it started, the Indonesian Council of the Ulama (MUI) of the island of Riau, a provincial Islamic body, expressed concern that the new MR vaccine was not certified as "halal" or lawful by the central MUI in Jakarta, the highest authority in such matters . The letter requested the disposal of vaccinations. The news spread rapidly across the country, encouraging distrust among parents.
In order to save the campaign, the health ministry lobbied central MUIs in August to issue fatwa – a decision in Islamic law – proclaiming a halal vaccine. Instead, the council declared MR vaccine haram, based on its ingredients and production process. Like many vaccines, it was made using several components of pig origin. Tripsin, an enzyme, helps in the separation of cells in which vaccine viruses grow from a glass vessel. Gelatin derived from pig skin serves as a stabilizer, protects vaccine viruses while they are dried in the freezer.
MUI tried not to block the vaccination campaign. It was concluded that parents can still have vaccinated children, given the need to protect public health. "Trusted experts explained the dangers that were not immunized," MUI said, a message reiterated at a public debate with Health Minister Nile Moeloekom on September 18th.
However, local priests and confused parents made their conclusions. Unlike the success on Java, coverage of children on other islands has so far reached only 68%, according to the Ministry of Health, which did not respond to the interview requests. In some regions it is far worse – only 8% in Aceh, for example, a province governed by sharia law.
A spokesman for the World Health Organization's office in Jakarta notes that Indonesia is not the only country in which trust in the vaccine is eroded and says the WHO remains optimistic about the campaign. Although the fatva "caused some confusion at the local level, in its directive it is clearly clear and eventually supports" vaccination, "the spokesman said in an e-mail. The WHO is co-operating with the Indonesian government, which has extended the catch-up campaign by December to expand its coverage.
Failure could be a major decline in public health. Fat can cause deafness, blindness, seizures, permanent brain damage, and even death; The vaccination coverage should be 95% in order to achieve the immunity of the herd, in which even those who are not vaccinated are protected. This threshold is about 80% for rubels. Lower levels may have a paradoxical effect: some women who have had a harmless infection early in their life, are now caught during pregnancy, increasing the risk of abortion or the birth of a baby with congenital rubella syndrome – whose symptoms include blindness, deafness, heart defects and mental disorders. "We can not play" with MR vaccine, says Elizabeth Jane Soepardi, an independent public health expert who until January was the Director of Disease Control and Quarantine at the Ministry of Health. A low vaccination rate "could mean boomerang for us," she says.
There is no ready alternative; MR vaccines have not been certified as halal anywhere. (The previous Indonesian vaccine against smallpox did not even have a halal certificate, which did not interfere with its use). Arifianto Apin, a Muslim pediatrician in Jakarta who advocates vaccination within an Indonesian pediatric society, says education can help. Clergy in many Muslim countries have concluded that gelatin in halal halides is because it has undergone hydrolysis, a chemical transformation that purifies it under an Islamic legal concept called " istihalah. In 2013, the Islamic Religious Council of Singapore declared the halal vaccine to rotavirus despite the use of trypsin; it was decided that the enzyme became pure dilution and addition of other pure compounds, which is known as istihlak. If Muslim parents learn about different legal attitudes within Islam, Apin says, "they will not hesitate to vaccinate their children."
If that does not happen, the only solution is to develop a halal vaccine as soon as possible, says Art Reingold, an epidemiologist at the University of California, Berkeley. Neni Nuraini, a leading scientist at Indonesia's state-owned vaccine company, Bio Farma in Bandung, notes that there are vaccine stabilizers, for example; the company plans to start examining bovine gelatin as a substitute. But development and clinical trials can last for 6 to 10 years, she says. "In the meantime, many will be sick and some may die of death that can be avoided," says Reingold.
However, VHO is apparent from religious debate and does not recommend the development of a halal vaccine. "The WHO works with regulatory authorities and manufacturers to ensure that vaccines have the highest standards of safety and efficacy," the spokesman said. "We do not evaluate vaccines by other criteria."