T

he sporadic but deadly outbreaks of polio, measles and rubella in Java and Sumatra between 2005 and 2016 took Indonesia by storm because many thought that the childhood diseases, which could have been prevented by routine immunization, had long gone.

Immunization was made a national program during the Sukarno administration in 1956, and became a big success during the subsequent 32-year dictatorial rule of Soeharto, thanks largely to the World Health Organization’s (WHO) support. Among Soeharto’s legacy is the National Immunization Week campaign, during which children are vaccinated against diseases like polio, tetanus, measles, diphtheria, whooping cough, Hepatitis B and tuberculosis.

At a closer look, the provinces that saw the return of these epidemical yet preventable diseases were those with less than 80 percent coverage of the state-sponsored immunization program, the minimum standard set by health experts in order to achieve common immunity in a particular area.

Between 2005 and 2006, polio outbreaks began in the West Java regency of Sukabumi and quickly spread to neighboring Banten and Lampung, causing more than 300 cases of paralysis. In East Java, 41 children died in the wake of diphtheria outbreaks between 2009 and 2011. The disease has since sporadically plagued West Sumatra and neighboring Aceh.

Studies have shown that low vaccination coverage occurs in conservative and predominantly Muslim provinces, where resistance against the national program is high. There, people suspect that vaccines contain the haram (forbidden in Islam) elements of pork.

Further complicating the issue are highly active anti-vaccine activists who propagate their belief that vaccines only poison the human body, which they claim naturally produces immunity enzymes, or that immunization is part of a conspiracy to reduce the population. These “anti-vaxxers” are even more dangerous, because they make the best of the internet for their disinformation campaigns.

Last year, the national vaccination campaign received a boost when the Indonesian Ulema Council (MUI) issued a fatwa (religious edict) allowing Muslims to participate. The edict even makes immunization obligatory in the advent of life-threatening ailments.

Interestingly, although vaccination is obligatory, the government imposes no punitive measures against parents who refuse to have their children vaccinated, or against vexxers who exploit the loopholes.