The one-sentence letter didn’t say much. The coronavirus vaccine was “manufactured free of porcine materials,” Sinovac, the Chinese vaccine maker, wrote to Indonesia’s state-owned vaccine manufacturer in July.
While the letter was promising, Indonesian clerics needed more details. A vaccine laced with the smallest amount of pork DNA could dissuade some followers of Islam from inoculation in Indonesia, the country with the world’s largest Muslim population. Sinovac took months to provide more information, which came only this week.
The Chinese company’s delayed response has been yet another challenge in Indonesia’s already fragile vaccine rollout. With the highest number of coronavirus infections in Southeast Asia, the country is eager to drum up support for its goal of inoculating 181.5 million adults within 15 months. But looming questions about the safety of the Sinovac vaccine and whether it is halal, or allowed under Islam, are complicating the government’s efforts.
“There shouldn’t be any concern about whether this vaccine is halal or not halal,” said President Joko Widodo. “We are in an emergency situation because of the Covid pandemic.”
Indonesia has recorded nearly 800,000 infections and more than 23,000 deaths, staggering numbers in a region where virus cases have remained relatively low. Inoculations are set to begin with health workers, soldiers and police officers in the coming weeks, once health authorities are satisfied that the Sinovac vaccine is safe and effective.
Mr. Joko said he would go first to show there was nothing to fear.
The vaccine must also undergo a separate approval process by the Ulema Council, an influential group of Muslim clerics that decides which products are halal in Indonesia.
Islamic authorities in other countries where Muslims make up a sizable share of the population, including Malaysia and the United Arab Emirates, have already ruled that coronavirus vaccines are permissible, even if they contain pork gelatin, which is used to stabilize many inoculations.
Last month, the Vatican released a statement declaring coronavirus vaccines “morally acceptable” for Catholics who might be opposed to a vaccine developed with stem cells from fetuses aborted decades ago.
Indonesians are still waiting for religious leaders to weigh in.
“In pharmaceutical products, halal is one of the important elements after the safety, efficacy and quality of the vaccine itself,” said Bambang Heriyanto, a spokesman for Bio Farma, Indonesia’s state-owned vaccine manufacturer.
The Ulema Council is expected to issue a decree, or fatwa, authorizing the use of the Sinovac vaccine in the coming weeks, but the nature of its findings could affect how widely it is accepted in Indonesia, especially among the country’s many conservative Muslims.
During a measles outbreak in 2018, the government, backed by the World Health Organization, undertook an ambitious vaccination program, but the only vaccine available in sufficient quantities contained pig products.
After analyzing the measles vaccine, the Ulema Council declared it haram, or forbidden under Islam, but said its use was allowed because the outbreak was an emergency.
In some parts of the country, however, local Muslim leaders opposed using a haram vaccine. The program fell well short of its 95 percent target and ended with nearly 10 million children unvaccinated. Only 72 percent of the target group was vaccinated.
On billboards above the busy streets of Jakarta, the capital, a woman wearing a face mask and head scarf can be seen flexing her arm as images of the coronavirus float nearby. Thousands of such billboards and banners have been erected along high-traffic roadways across the country. The message: Vaccines protect you.
To encourage widespread vaccinations, some regional governments have also passed new laws allowing for the punishment of people who refuse to get inoculated against the coronavirus.
With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:
- If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
- When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
- If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
- Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
- Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
“The government will ensure that the vaccine is safe and effective, has minimal side effects and is, of course, halal,” said Wiku Adisasmito, spokesman for the national Covid-19 task force. “Regional governments will have the authority to make people obey and participate in the vaccination program so that herd immunity can be achieved easily.”
With a population of 270 million, Indonesia hopes to achieve herd immunity by vaccinating roughly two-thirds of the population in just over a year. President Joko said Tuesday that he hoped it could be done even more quickly.
Indonesia has ordered vaccines from several companies, but plans to rely mostly on Sinovac, which has already delivered three million doses. It is the only vaccine to have arrived in the country so far.
Bio Farma plans to manufacture 122.5 million additional doses using raw materials provided by Sinovac.
Like other countries, Indonesia is eagerly awaiting data from Stage 3 trials so that its Food and Drug Control Agency can evaluate the safety of Sinovac’s inoculation. Months ago, China began administering the Sinovac vaccine and one made by a second company, Sinopharm, even though human trials were not completed.
Sinovac is expected to release the findings of its late-stage trials soon, with approval by the Chinese government to follow. But China has rarely been forthcoming about its vaccine data and has a history of producing faulty vaccines and tainted food products. In 2018, a scandal erupted over substandard doses of a vaccine for diphtheria, tetanus and whooping cough, and over fabricated data for a rabies vaccine.
In Indonesia, a nationwide survey conducted in September by the health ministry, the World Health Organization and Unicef found that health issues were of even greater concern than whether a coronavirus vaccine was halal.
Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia, called on China to release scientific data from the inoculations so that Indonesia could evaluate the vaccines’ safety and effectiveness.
“Transparency is one of the biggest challenges for China, especially with their vaccines,” he said. “This is a crucial time for China to show the world how they have improved the quality of their vaccines.”
The Ulema Council said it had asked Sinovac repeatedly for documentation on the materials in the vaccine in order to make its determination. It is prepared to announce its ruling after Indonesia determines that the vaccine is safe and effective.
At the Global Halal Center near Jakarta, the council operates laboratories in biotechnology, physics, chemistry and microbiology that it has recently used to test Sinovac’s vaccine for pig products.
Its labs can test 500,000 product samples a year, said Muti Arintawati, director of the council’s Food, Drug and Cosmetics Analysis Agency. The council, founded in 1975 by representatives of major Islamic groups, has the authority to certify whether products and medications meet Islamic standards in Indonesia. Companies pay from $180 to $780 for the certification.
Major Islamic groups such as Nahdlatul Ulama and Muhammadiyah, which together have some 140 million members, will join the effort to encourage the vaccine’s acceptance once it has been deemed safe and a fatwa has been issued.
“We will give an explanation from the Islamic law perspective so that people are willing to be vaccinated,” said Ahmad Ishomuddin, Nahdlatul Ulama’s supreme leader. “I think only a small number of people will reject it because protecting life is a major purpose of religion.”
Dera Menra Sijabat and Muktita Suhartono contributed reporting.