Sharia law in Aceh puts kids at risk due to vaccine stigma

Campaign to put a lid on measles, rubella hits a wall as Muslim parents in Indonesian region fear 'haram' inoculation
Sharia law in Aceh puts kids at risk due to vaccine stigma

Rita Yana's third daughter, 7-year-old Shafa, is deaf and suffers from heart disease. She also has a cataract on her right eye. Yana, who lives in Banda Aceh, the capital of Indonesia's Aceh province, was struck with fever and itchy rashes when she was five weeks' pregnant due to the rubella virus. (Photo supplied by Rita Yana)

Husnul Faina was born a month prematurely, weighing 2 kilograms. At just 10 months she had her lenses replaced due to cataracts and still suffers, at the age of three, from deafness, heart disease, and stunted growth.

"When I was pregnant, a pediatrician suggested I take a blood test to see if I was infected by one of the TORCH infections," her mother, Husna, told ucanews.com. "They showed I had rubella."

TORCH stands for toxoplasmosis (which can lead to blindness if not treated), other (syphilis, varicella-zoster and parvovirus), rubella, cytomegalovirus and herpes.

Husna recalls being covered in rashes when she was three months' pregnant.

"I thought it was an allergy at first, but within two days they'd all disappeared," she said.

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Rita Yana's 7-year-old daughter also suffers from symptoms of congenital rubella. "In my fifth week of pregnancy, I got a bad fever and itchy rashes," said the mother of four.

Both women hail from Aceh province in the northern part of Indonesia's Sumatra Island, where this year's nationwide measles-rubella immunization program hit its lowest level.

The province, which has implemented strict Sharia law since 2001, is one of 28 provinces outside Java Island that has become a chief focus of the second phase of the program.

The government's aim was to vaccinate 32 million children aged between nine months and 15 years within the months of August and September.

The Indonesian Ministry of Health has set a target of 95 percent immunization coverage based on the success of the first phase of the campaign, which was conducted in six provinces on Java Island last year.

That saw 35 million children, or 98 percent of the target, receive vaccinations to keep a horde of dangerous diseases at bay so they could lead healthy lives.

The ministry has undertaken the program to cut the endemic chains of measles-rubella transmission, with the goal of eliminating this totally by 2020.

Data from the ministry shows that from 2010 until 2015, the nation recorded 23,164 cases of measles and 30,463 cases of rubella.

The United Nations Children's Fund recorded 8,516 cases of measles-rubella in 2016 and another 6,318 in 2017. 

A few months ago in Batanghari district of Jambi province a baby died shortly after being born because the mother had contracted rubella.

"This year's immunization coverage rate remains far from our expectation," said Anung Sugihantono, director general of the ministry's disease control and prevention department.

As of Sept. 16, the mean coverage rate was just 47.37 percent. In Aceh, however, only 7.01 percent of 1.54 million targeted children have been vaccinated.

Riau and West Sumatra provinces had the second and third-worst rates at 22.52 percent and 24.25 percent, respectively.

"Some of the challenges we face include geographical hurdles and limited human resources. In some regions, a fatwa issued by the Indonesian Ulema Council [MUI] is a significant factor working against us," said Sugihantono.

The fatwa, which was issued on Aug. 20, states that the measles-rubella vaccine produced by the Serum Institute of India (SII) is considered haram (forbidden) as it contains biological material derived from pigs due to the way it is produced.

However, the religious edict allows for use of the vaccination until a better surrogate is found. Doctors are reportedly now working on an acceptable, or halal, version.

Yet the stigma against breaking religious taboos means many parents in this predominantly Islamic region that was battered by the 2004 tsunami are reluctant to have their children vaccinated.

Nova Iriansyah, the acting governor of Aceh, even decided to put the program on ice until the local Ulema Consultation Council decides whether the current vaccine is acceptable.

Asrorun Niam Sholeh, secretary of the MUI commission that handles fatwas, said the fatwa in this instance should be considered a guideline and each case treated on its own merit.

But Yanuar Nugroho, deputy to the presidential chief of staff, recently told reporters that it was hampering the campaign and could lead to more children suffering or even dying.

"The potential for failure is huge if we don't meet our target," he said.

 

Right to immunization

A child with measles or rubella can spread it to more than a dozen others easily just by coughing or sneezing. The fast rate of transmission, children's vulnerable immune systems, and the fact they mingle so much at school makes them especially high risk.

According to Soedjatmiko, secretary of the immunization task force at the Indonesian Paediatric Society, the program has proved very effective in preventing outbreaks of measles and rubella.

It is buttressed by a program that sees children receive regular jabs when they are 9 months old, 2 years old, and when they enter elementary school.

"The vaccine produced by the SII has been shown to be safe and effective safe. It is recommended by the World Health Organization (WHO) and is already being used in 141 countries," Soedjatmiko said.

"Children and parents both have a basic right to be immunized in accordance with the 2014 Law on Child Protection and the 2009 Law on Health," he added.

On Sept. 15, President Joko Widodo publicly endorsed the program and stressed how it important it was to safeguard younger generations.

Now Husna and Yana are praying the administrators in Aceh revoke their temporary ban on the use of the vaccination so their younger kids won't suffer.

"This vaccine is very important," Yana said. "It's time to stamp out transmission before other young kids go through all that pain."

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