Upholding Herd Immunity through Local Wisdom Empowerment

in Aceh
Theme: Empowering Local Wisdom towards Human Wellness
Sub-Theme: Society (Health)

As one of tropical countries, Indonesians are often the target of tropical

diseases, most of which are present as infectious diseases. On the basis of
consideration, individual immunity needs to be prepared by immunization, as one
of strategies to prevent infection, particularly vaccine-preventable diseases.
Immunization is the front line to prevent infectious diseases.
Unfortunately, the Ministry of Health of Republic of Indonesia (Kemenkes RI)
shows that around 1.7 million children have not received immunization status,
updated from 2014 to 2016. This plunges many uninfected people to death caused
by diseases that can actually be prevented, especially through immunization. For
instance, measles has the potential to become an epidemic if the immunization
coverage is low. When a person has measles, 90% of people who interact with
measles sufferers can get infected if they are not immune or have not been
immunized against measles.3 One of regions in Indonesia who has a tremendous
number of refusal is Aceh.
Immunity is formed through immunization or has been infected by
certain infections before. The fact also shows that people who refuse to be
immunized will be very susceptible to similar diseases and become spread
agents to other healthy people or people who have not been immunized. This
understanding has fueled the government's enthusiasm to campaign for
immunization as a fundamental effort in preventing disease. The more people are
vaccinated, the fewer people are infected with the infection, which is what is
called the concept of herd immunity. This concept is different for each disease
depending on basic reproductive number (R0); (R = reproductive number; R0 is
the average number of infection cases that can occur from one infection). For
example, for R0 measles are 12 to 18 and R0 pertussis is 12 to 17 (as mentiones in
Figure 1), of which the two diseases have the highest basic reproduction number
(Ro). The average threshold of herd immunity that must be achieved for both is
96%, which shows that measles has the potential to spread to 12-18 people, while
pertussis can spread to 12-17 people.4,17

Figure 1. Relationship between R0 and threshold level needed for herd immunity
The progress of a nation must also consider the great opportunities in
terms of the country's demographics. According to the Central Bureau of Statistics
(Badan Pusat Statistik; BPS), Indonesia will enjoy an era of demographic bonus in
2020-2035, which means that the population of productive age is at the highest
value in history, reaching 64 percent of the total population of Indonesia,
amounting to 297 million. This large amount of course must be prepared to be
able to move the nation's development wheels. A developing nation certainly
cannot be separated from a healthy nation and thus can make a productive age to
develop Indonesia.
The low number of immunity coverage is influenced by certain groups
of society who do refusal on immunization. At present, immunization creates a
polemic and is opposed by community groups acting on behalf of the anti-vaccine
movement. This happens in certain countries including Indonesia, moreover in
Aceh. Although the anti-vaccine movement is promoted by a handful of people,
this movement must be anticipated immediately, due to its expansion can be
carried out and provoke others to participate in encouraging immunization (Pelčić
et al., 2016).
Various factors that cause refusal of immunization including, (1) weak
enforcement of immunization laws so that they cannot be fully implemented in the
community and (2) the public does not know yet regarding the benefits of law
enforcement. Certain efforts must be done so that the implementation of the
immunization program for children can be well received by all communities
including, for example, the legal structure must be addressed, the existence of
more contextual public policies with real conditions in the field, the social norms
must be applied, and law will be being socialized (Rusharyati, 2017),
The social norms, as the closest part of the community’s life is closely
related to the local wisdom existed in the community itself.
Local wisdom in Aceh

1. MUI collaborates with religious leaders to spread the priority of vaccines to

achieve herd immunity,
2. The importance of upholding religious values such as attempting a healthy
body and avoiding disease as a form of gratitude for the health that has been
given, and
3. Communicating the lesson through the local language, to conduct relations that
are full of kinship, impressing the acceptance of culture to run with the nowadays’
condition especially in achieving health.

Immunization is one step that supports several points of the Sustainable

Development Goals (SDGs) simultaneously. Immunization can help reduce
poverty by increasing the number of healthy productive age communities,
equivalent to an investment of US $ 43 per expenditure of US $ 1, which means
supporting the point one SDGs namely ‘No poverty’. Point 2, namely ‘Zero
hunger’, immunization accompanied by good nutrition can form a healthier family
which is in line with expected outcomes with this point. Of course, immunization
is also in line with point 3 or ‘Good health and well-being’ because immunization
has saved 2-3 million lives and many more have avoided diseases that can be
prevented by immunization. In the other sides, this means the more productive
ages, the more potential a country can increase its economic growth, as the goal of
the 8th SDGs point, ‘Decent work and economic growth’. The health of the
community also supports the teaching and learning process, ensuring the health
and cognitive growth of children or anyone who is immunized, which means it is
in line with the 4th point, namely ‘Quality education’. More broadly,
immunization is even in line with the 5th point of the SDGs, ‘Gender equality’,
because immunization in young women can reduce or prevent 90% of cases of
human papillomavirus (HPV). Some SDGs points that can be realized
synergistically with immunization, require the government and the community to
be aware and have a high willingness to support the optimization of immunization
for the sake of nation’s development.18