Religion and measles vaccination in Indonesia, 2007–2017

Abstract

Background: Some Muslim religious councils in Indonesia have ruled that the measles vaccine contains haram materials, and there is concern that vaccination coverage may decrease as a result. The aims of this study are to (1) evaluate changes in measles vaccination coverage between 2007 and 2017, and (2) compare vaccination coverage between Muslims and non-Muslims in Indonesia. Methods and materials: Three cross-sectional datasets of mothers of children 12–23 months old were used: The Demographic and Health Surveys from 2007, 2012, and 2017 in Indonesia. Participants were only asked about religion in 2007, and so 100 datasets of religion were imputed for 2012 and 2017, with the probability being Muslim calculated as the proportion of individuals who were Muslim in the participant's province as of 2007. In this multiple imputation analysis, Poisson regression models output prevalence differences (PD) and 95% confidence intervals (CI), adjusted for wealth index and age of the child in months. An interaction term between year and religion evaluated changes in vaccination over time by religion. Results: Across the three datasets, there were 10,524 children, of whom 78.9% were vaccinated against measles. Across 32 provinces, the unweighted prevalence of Islam in 2007 ranged from 8% in East Nusa Tenggara to 100% in South Sumatra, for a weighted average of 85.4%. In the main effects model, non-Muslims had 3.5% higher vaccination coverage (95% CI: 1.1%, 6.0%), and compared to 2007, vaccination coverage increased in 2012 (PD: 3.6%, 95% CI: 1.7%, 6.0%) and 2017 (PD: 4.6%, 95% CI: 2.6%, 6.5%). In the models with an interaction term between year and religion, the estimated vaccination coverage for children 12 months old in the highest wealth quintile was 79.3% (95% CI: 76.5%, 82.1%) in 2007 and 82.9% (80.1%, 85.8%) in 2017. In contrast, vaccination coverage increased more for non-Muslims from 81.4% (95% CI: 77.6%, 85.2%) in 2007 to 89.6% (85.0%, 94.3%) in 2017. Conclusion: Measles vaccination coverage has been increasing in non-Muslims, but not Muslims, in Indonesia. Because further proclamations about vaccine products were issued after 2017, future studies should continue to examine the relationship between religion and vaccine uptake in Indonesia.