On a humid September morning in Sumenep, a city on Indonesia’s Madura Island, three health workers zipped through narrow alleys on motorbikes. Their blue medical boxes—packed with measles vaccines—were heavy with urgency. Going door to door, they offered life-saving shots to children whose names filled a long list. Their mission was clear: halt a deadly measles outbreak that had already infected more than 2,600 children and claimed 20 young lives in 2025 alone, according to The Associated Press.
This wasn’t just a battle against a virus. It was also a contest with deeply held beliefs. In Sumenep and across Indonesia—the world’s largest Muslim-majority nation—concerns about the halal status of some vaccines have fueled hesitancy, complicating efforts to contain outbreaks. The crux of the matter? Pork-derived gelatin, commonly used as a stabilizer in vaccines, is viewed by many as ritually unclean and forbidden, or haram, under Islamic law.
“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, as reported by The Associated Press. The council had ruled back in 2018 that vaccines with pig gelatin were haram but advised their use until halal alternatives became available, prioritizing public health in the interim.
Still, the conflict between religious conviction and medical necessity has left its mark. Pujiati Wahyuni, a 31-year-old Muslim mother and nurse, knew parents who refused vaccines on religious grounds, even as she opted to have her own daughter vaccinated 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 told The Associated Press.
In August 2025, the regional government made a bold push, distributing more than 78,000 vaccine doses through clinics, schools, and direct home visits. Yet, even with these efforts, they couldn’t compel every reluctant parent. The dilemma was evident at the Islamic kindergarten, where the head of the community health center met with mothers before vaccines were administered, urging them to protect their children—and the wider community—from the ravages of measles.
For some, the threat of disease ultimately outweighed religious doubts. Ayu Resa Etika, a 28-year-old mother from Kebunan village, had hesitated to vaccinate her two-year-old son because of concerns about the vaccine’s ingredients. But after witnessing a surge in local hospitalizations, she relented. “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.”
The numbers tell a sobering story. Measles vaccination rates in Indonesia have declined, falling from 86.6% of the target in 2023 to just 82.3% in 2024, based on Ministry of Health data cited by The Associated Press. The World Health Organization warns that 95% coverage is needed to prevent outbreaks—far above Indonesia’s current rates. During the peak of the Sumenep outbreak from May to July 2025, isolation wards at regional hospitals overflowed, with staff treating over 100 measles cases daily.
Indonesia’s struggle is echoed in neighboring Pakistan, where a very different vaccine campaign is underway—but with strikingly similar obstacles. On September 15, 2025, Pakistan launched a national drive to vaccinate 13 million girls aged 9 to 14 against human papillomavirus (HPV), the virus responsible for most cases of cervical cancer. By September 26, about 9 million girls had received the vaccine—an impressive 70% of the campaign’s target, according to The Associated Press.
Yet, here too, rumors and mistrust have threatened progress. Health Minister Mustafa Kamal faced a wave of skepticism, much of it swirling online, that the vaccine could cause infertility or was part of a plot to reduce the Muslim population. To counteract the misinformation, Kamal made a bold move: he publicly vaccinated his own daughter on stage at an event in Karachi. “By the grace of God, administering the vaccine to my daughter publicly had a huge impact,” Kamal told The Associated Press. “From the fifth day of the campaign, refusal rates began dropping and acceptance climbed to 70–80% in some districts.”
But not all parents were convinced. “I have heard that the vaccination is being used to make women infertile and reduce the population of Muslims,” said Ali Sheikh, a mother of two in Karachi, echoing the widespread fears circulating on social media. For health workers like Shamim Anwar, the job has been grueling. “It is very difficult work. Many parents refuse because of rumors and hesitate to let us vaccinate their daughters,” Anwar said. “Sometimes we even face humiliation, but we tolerate it because we have to complete the vaccination target.”
The stakes are high. Cervical cancer is the third most common cancer among Pakistani women, claiming between 18,000 and 20,000 lives each year. Globally, it ranks fourth among women’s cancers. Authorities have set up vaccination centers and deployed teams to schools nationwide, offering the vaccine free of charge and reporting only minor side effects. The campaign slogan—“one jab will do the job”—underscores the hope that widespread vaccination can eliminate cervical cancer as a public health problem by 2030. Pakistan, now the 149th country to include the HPV vaccine in its immunization schedule, plans to expand coverage to additional regions by 2027.
Both Indonesia and Pakistan’s experiences reveal a common thread: the power of rumor and religious debate to shape public health outcomes. In Indonesia, the debate centers on halal standards; in Pakistan, on fears of infertility and foreign plots. In each case, health authorities have had to balance respect for religious beliefs and cultural anxieties with the urgent need to protect children’s lives.
Experts warn that, without near-universal vaccine coverage—whether for measles or HPV—outbreaks and needless deaths will persist. The World Health Organization notes that 60 countries reported major measles outbreaks in the past year alone. As misinformation spreads faster than ever on social media, the challenge for health workers grows ever more daunting.
Yet, amid the setbacks, there are glimmers of hope. Public demonstrations by officials, honest conversations at community meetings, and the sheer persistence of health workers are making a difference, one family at a time. The stories of hesitant parents who ultimately chose vaccination—sometimes with lingering doubts—show that trust can be built, even in the face of fear.
As Indonesia and Pakistan press forward, their efforts may well offer lessons for the rest of the world: that the path to public health is rarely straight, but with patience, respect, and determined outreach, even the toughest barriers can be overcome.
