In the heart of Sumenep, a city on Indonesia’s Madura Island, three health care workers revved their motorbikes and set out with a mission that’s become both urgent and fraught: delivering life-saving measles vaccines to children. Their journey, winding through narrow lanes and bustling neighborhoods, is emblematic of a larger struggle playing out across Indonesia—the world’s most populous Muslim-majority nation—as it battles a persistent measles outbreak that has already claimed the lives of 20 children and infected more than 2,600 in 2025 alone, according to the Associated Press.
The outbreak, which has gripped Madura Island for nine months as of late September 2025, has forced local authorities to ramp up vaccination efforts. Beginning in August, the regional government launched an ambitious campaign to distribute over 78,000 vaccine doses, bringing them directly to clinics, homes, and even schools in hopes of reaching every vulnerable child. But the campaign faces a formidable obstacle: widespread concerns among the predominantly Muslim population about whether the vaccines are halal, or permissible under Islamic law.
The root of the dilemma lies in the composition of some measles vaccines, which use a stabilizer derived from pigs—an animal considered ritually unclean in Islam. Pork-derived gelatin is a common ingredient in vaccines to ensure their safety and efficacy during storage and transport. Yet its presence has sparked religious hesitation in communities where adherence to halal principles is deeply woven into daily life.
Many Islamic scholars have weighed in, offering nuanced guidance. While the Indonesian Ulema Council, the nation’s highest clerical body, ruled in 2018 that vaccines containing pig gelatin are haram (forbidden), they also advised that such vaccines could be used “for the benefit of society” until halal alternatives become available. Ahmad Syamsuri, head of Disease Control and Prevention at the Sumenep Health Office, told the Associated Press that this guidance was meant to strike a balance between religious observance and public health needs. “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,” said Ayu Resa Etika, a 28-year-old mother from Kebunan village, who ultimately decided to have her 2-year-old son vaccinated despite her doubts about the vaccine’s halal status.
Still, the religious concerns have proven stubborn. Pujiati Wahyuni, a 31-year-old nurse and mother, described an atmosphere of quiet reluctance among some parents. “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 explained. The hesitancy is not always voiced openly, but its impact is clear: vaccination rates across Indonesia have slipped below the levels needed to prevent outbreaks.
According to data from Indonesia’s Ministry of Health, measles-rubella vaccination coverage fell to 86.6% of the target in 2023 and dropped further to 82.3% in 2024. Experts warn that to effectively halt measles outbreaks, at least 95% of children must receive two doses of the vaccine. The World Health Organization notes that, globally, only 76% of children received both doses last year, with 60 countries reporting significant measles outbreaks—a sobering reminder that this is not just an Indonesian problem, but a global one.
The consequences of lagging vaccination rates have been starkly visible in Sumenep. From May to July 2025, the peak of the outbreak, hospital isolation rooms were filled to capacity as staff treated more than a hundred measles cases each day. At an Islamic kindergarten in Pamolokan village, health workers met with mothers before administering vaccines, urging them to protect their children and stem the spread of the disease. The sense of urgency was palpable, as was the underlying tension between faith and medicine.
Musthafa, general secretary of the Indonesian Ulema Council in Sumenep, voiced the hopes of many in the community. “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,” he said, reflecting a widespread desire for a solution that aligns with both religious values and public health imperatives.
Indonesia’s struggle with measles is not new. The country has experienced previous outbreaks, often triggered by gaps in vaccination coverage. In 2018, a particularly severe outbreak in the eastern province of Papua led to dozens of deaths. At that time, the Indonesian Ulema Council acknowledged that the measles-rubella vaccine, produced by the Serum Institute of India, contained a pig-derived ingredient but allowed its temporary use until a halal alternative could be found. The Serum Institute did not respond to requests for comment, according to the Associated Press.
The current crisis on Madura Island has reignited calls for the development and distribution of halal-certified vaccines—a demand that resonates not just in Indonesia, but in other Muslim-majority countries facing similar dilemmas. In the meantime, health workers continue their rounds, navigating both logistical challenges and the delicate terrain of religious belief. Their efforts are bolstered by local government initiatives, which have made vaccines available in a variety of settings to maximize accessibility.
Yet, as the experience of Ayu Resa Etika and other parents shows, the decision to vaccinate is often a deeply personal one, shaped by fears for children’s health as much as by religious conviction. “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, capturing the difficult calculus faced by many families.
As Indonesia grapples with this measles outbreak, the interplay of faith, science, and public health policy remains at center stage. The hope among health officials and religious leaders alike is that, through dialogue and innovation, a path can be found that honors both the spiritual and physical well-being of the nation’s children. For now, the motorbikes keep rolling, the blue medical boxes are unpacked at doorsteps, and the fight against measles continues—one hesitant conversation, and one vaccine, at a time.
