Indonesia’s Halal Vaccine Diplomacy: A Qualitative Study

Indonesia’s Halal Vaccine Diplomacy: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Indonesia’s Halal Vaccine Diplomacy: A Qualitative Study Dewi Trisia Putri, Remco van de Pas, Wiku Bakti Bawono Adisasmito, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9409919/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Indonesia, as a major Muslim population worldwide, emerged as a significant initiator and player in Halal-certified vaccine production, highlighting its desire to be a key player in the production and distribution of Halal vaccines, thereby supporting the Islamic population worldwide through the Halal vaccine diplomacy strategy. This study aims to explore the role of key stakeholders in Indonesia in shaping perceptions towards policy and management processes involved in the development of Halal vaccines to position Indonesia as a global actor, specifically to establish the Halal vaccine hub. This study draws on the combined work of Kickbush and Labonté. This qualitative study, conducted in 2023, used semi-structured online Zoom interviews, maintaining recordings until the researcher reached data saturation. Stakeholders contributed essential themes that emerged through discussion and had the opportunity to enhance, modify, or clarify their perspectives. Moreover, we transcribed the interview verbatim and manually used Microsoft Word. We conducted a manual thematic analysis to analyze the transcriptions. Results We interviewed forty (40) consenting stakeholders, prominent actors in Indonesia’s Halal vaccine development and policy (government, religious institutions, academia/researchers, the pharmaceutical industry, the Muslim community, and international institutions). Three themes emerged from the interviews: 1) The objective of the Halal vaccine policy-Sovereignty, Health Security, Economy, Social Justice and Muslims’ Rights; 2) The challenges - Research and Development of Halal vaccines, Collaboration, Halal vaccine standardization and certification, Halal status versus emergency, Fatwa from Ulama and different religious schools, Leadership, Solid political will and Commitment; 3) The COVID-19 pandemic. Conclusions Halal vaccine diplomacy strategies are promising for equitable global health governance while simultaneously enhancing vaccine acceptance and access. The Halal vaccine policy implemented by Indonesia represents an important step in advancing health sovereignty and establishing Indonesia as a key and unique player, despite multifaceted challenges. The Halal vaccine policy not only safeguards Indonesia’s majority Muslim population but also fosters global health equity by ensuring the availability of healthcare services, protecting public health, promoting economic development, and preserving the principles of social justice and human rights. Halal Halal vaccine Halal vaccine diplomacy vaccine diplomacy global health diplomacy Indonesia health equity BACKGROUND Globally, immunization initiatives are increasingly met with resistance, also based on religious grounds. Freedman and Nichols( 1 ) hypothesized that various factors might contribute to declining immunization rates within specific religious communities, which include the marginalization and alienation experienced by the specific religious groups from the larger society, limited availability of social programs, deference to religious leaders' viewpoints, and concerns regarding the use of aborted fetal tissue cell lines or of porcine-based gelatine in vaccine production. In addition, currently, Halal considerations (see textbox 1) have become a significant concern within Islamic states or nations where the Muslim population constitutes a majority. Not to mention, with the transcending of national borders, the need for Halal vaccines has become a worldwide issue and has become an important theme in global health diplomacy among Islamic countries. The first meeting of the Organization of Islamic Cooperation (OIC) in November 2018, for instance, was dedicated to Halal production of medicines and vaccines. Furthermore, during this meeting, the heads of National Medicines Regulatory Authorities (NMRAs) formulated Halal requirements for medicines and vaccines, outlining them in an Action Plan to foster cooperation, achieve self-sufficiency in the production of Halal medicines and vaccines, and establish a basis for Halal certification. Textbox 1. Summarized the Concept of Halal and Haram Jallad( 2 ) summarized the concept of Halal and Haram as follows: The word Halal, as used by Arabs and Muslims, refers to anything that is considered permissible and lawful under religion, while Haram is what is forbidden and punishable according to Islamic law. The word Halal is derived from the verb Halla "to be or become lawful, legal, licit, legitimate, permissible, permitted, allowable, allowed, admissible, un-prohibited, unforbidden." In western countries, the term is usually used in the context of just Muslim food laws, especially where meat and poultry are concerned. In a Muslim's life, every aspect of life is regulated by Islamic law; therefore, the Halal-Haram dichotomy almost always applies to everything. Some Halal categories: milk (from cows, sheep, camels, and goats), honey, fish, plants which are not intoxicant, fresh or naturally frozen vegetables, fresh or dried fruits, legumes, nuts, and grains. Moreover, animals such as cows, sheep, goats, deer, moose, chickens, ducks, game birds, etc., are Halal, but they must be dabiHah (slaughtered according to Islamic Rites). In contrast to Halal, Haram refers to any forbidden pattern of behavior, speech, dress, conduct, and manner under Islamic law. It also includes what is unlawful to consume food or beverage. Some examples of Haram are meat from pork (ham, gammon, bacon), pork-based products and by-products (sausages), animals improperly slaughtered, or already dead before slaughtering, animals killed in the name of anyone other than Allah, and intoxicants. To sum up, al-Halal and al-Haram represent the Islamic laws that govern every aspect of a person's life (speech, behavior, dress, dietary, etc.), and everything Halal is rewarded by God while the Haram is punishable. Put simply, it is the Islamic dichotomy of rights and wrongs and dos and don'ts , Indonesia, an archipelago nation with a substantial Muslim population of over 242 million, which accounts for about 87% of the demographic majority of the Indonesian population and 11.7% of the world's total Muslim population( 3 ), has also become imperative to consider the religious ramifications of immunization initiatives. Around 2018, Indonesia faced a low coverage of the Measles-Rubella (MR) vaccination program in some regions due to the narrative that the MR vaccine is not Halal because it contains pork.( 4 , 5 ) Similarly, a study conducted by Harapan et al.( 6 ) on the acceptance of the Dengue vaccine in Aceh, Indonesia, revealed that the second most significant attribute sought by individuals was the adherence to the vaccine to Islamic dietary guidelines, commonly referred to as Halal (permitted) and the absence of any Haram (forbidden) substances as prescribed by the Qur'an. Further, the primary distinguishing feature of the Dengue vaccine, which could potentially enhance its acceptance among individuals in Aceh, Indonesia, is its compliance with Halal standards and its ability to offer comprehensive protection against dengue virus infection. Indonesia emerged as a pivotal advocate and initiator of Halal-certified vaccine production, and hosted the first OIC meeting, which highlighted the country's desire to be a key player in the global production and distribution of Halal vaccines, thereby supplying the Islamic population worldwide. An important international strategy associated with this kind of policy is known as vaccine diplomacy. The concepts of "health" and "vaccine" diplomacy were introduced by the World Health Organization (WHO) in late 2015 and refer to international collaborative efforts to provide the world's population with affordable, accessible medicines and vaccines. This paper examines the role of key stakeholders in Indonesia in shaping perceptions of the country's policies on the development and production of Halal vaccines for the global market. Based on interviews with these stakeholders, the paper will explore perspectives on Indonesia's efforts and assess whether and to what extent Indonesia is acting in line with the principles of vaccine diplomacy. The paper will also discuss the barriers that may prevent Indonesia from taking up its intended role as a significant international player in the production of acceptable vaccines. Vaccine Diplomacy The concept of diplomacy encompasses the skillful management of international relations through the establishment of alliances, treaties, and other agreements.( 7 ) The main goals of diplomacy are to prioritize the development of discussions that aim to identify common interests and uncover areas of dispute among the parties involved, guided by the nation's foreign policy. In addition, the position of health in foreign policy is the subject of a substantial body of literature that examines historical and contemporary contexts including the roles of drivers and actors involved.( 8 ) Many scholars acknowledge the crucial role of diplomacy in health-related foreign policy. Health and diplomacy are undergoing significant transformations. As a result, the growing influence of health in the political sphere requires diplomats and health specialists to possess exceptional negotiation skills, which are integral to navigating the complexities of a highly politicized setting.( 9 ) Furthermore, International Relations scholars have distinguished between foreign policy and diplomacy. Foreign policy encompasses a range of concepts, objectives, and attitudes that guide a nation's interactions with other states. Diplomacy, according to Evans and Newnham, as cited by Lee and Smith( 7 ), diplomacy is a crucial instrument for executing foreign policy objectives. The correlation between health and foreign policy stands as critical, complex, and challenging. Hence, crafting health policies demands the involvement of governments, international institutions, and non-governmental organizations. A study by Kickbusch( 9 ) examined how health has gained significant attention within the framework of foreign policy, with its integration into three key global agendas: security, economics, and social justice, all of which align with the objectives of the United Nations (UN). In addition, UN Secretary-General( 9 , 10 ) defined the fundamental goals of 21st-century foreign policy: achieving security, fostering economic prosperity, promoting development in impoverished nations, and safeguarding human dignity. Hence, it is crucial to emphasize the importance of fostering international health cooperation and integrating health considerations into foreign policy, which underpin Global Health Diplomacy (GHD). Moreover, Labonté and Gagnon( 11 ) classified GHD into six policy framings : security, development, global public goods, trade, human rights, and ethical/moral reasoning. Hence, each conceptual frame shapes how global health emerges as a foreign policy concern. Finally, vaccine diplomacy encompasses a range of dimensions within GHD, including prioritizing the development, manufacturing, and distribution of vaccines as crucial public health commodities. It is recognized for its potential as a humanitarian intervention in immunization initiatives, highlighting its capacity to address pressing health needs.( 12 ) Moreover, vaccine diplomacy pertains to a specific aspect of GHD, which promotes the use and dissemination of vaccines to achieve broader global health goals and cultivate mutual foreign policy interests.( 13 ) Indonesian context During 2007 and 2008, Indonesia exhibited a distinct and significant shift in its engagement with international vaccine diplomacy. Indonesia's former health minister caused international concern by refusing to share bird flu samples or report disease incidents, arguing that advanced and more prosperous countries and manufacturers should offer guarantees to access a vaccine publicly.(14, 15) The assurance provided underdeveloped countries with affordable vaccines generated from their respective samples, which have compelled Indonesia to assert its "viral sovereignty" regarding Avian influenza A (H5N1) and have played a role in the formation of a novel intergovernmental negotiation process, The Pandemic Influenza Preparedness (PIP) framework overseen by the WHO concerning virus and benefit-sharing. However, this process has not yet achieved a mutually agreeable resolution for years(14, 15). In 2025, WHO member states adopted a Pandemic Agreement ( 16 ). However, its annex on viral access and benefit sharing is still under (difficult) negotiations. Similarly, Asians express support for Indonesia's position on the claims mentioned above, showcasing a longstanding concern with inequitable and potentially exploitative regimes and practices.(15) Nowadays, Indonesia can assume a pivotal position in advancing the health agenda within developing nations, Southeast Asia, and the wider Asia-Pacific region. According to Hiebert( 17 ), Indonesia must effectively participate in a global multilateral platform alongside predominantly Muslim nations. The country would need to make significant investments in acquiring expertise and diplomatic skills. These investments are crucial for successfully advancing a multifaceted agenda at the global level. Indonesia sought to establish itself as a credible participant in international affairs and proactively assumed a more prominent position in health diplomacy. In December 2017, the OIC expressed its trust in P.T. Biofarma, a state-owned pharmaceutical company, as a leading manufacturer of vaccines and a recognized Center of Excellence in Vaccine Production and Biotechnology. Additionally, P.T. Biofarma, the leading vaccine producer in Southeast Asia, has a manufacturing capacity exceeding 2 billion doses annually and has successfully met demand for national and global vaccines through collaborations with the WHO and United Nations Children’s Fund (UNICEF).( 18 ) Moreover, Biofarma's vaccine products have been utilized by over 140 countries, particularly developing nations, with 50 of them being members of the OIC.( 18 ) Indonesia has implemented the Halal Product Assurance Act (HPAA) No. 33 of 2014 to ensure its citizens' access to Halal goods. HPAA mandates that all products and services distributed in Indonesia must comply with the Halal certification process, including biological products and vaccines. Moreover, Indonesia assumed the role of being a Global Halal Center, demonstrating its capabilities and serving as a pilot project to advance Halal-related issues globally.( 19 ) Therefore, establishing international cooperation plays a significant role in effectively addressing Halal matters at both national and global levels. Why this study was necessary? Given Indonesia's status as the largest Muslim nation, its track record of practicing health diplomacy, and its concerns regarding Halal issues, we sought to explore the perspectives and attitudes of major Indonesian stakeholders towards Halal vaccine diplomacy. Although many papers have discussed the significance of the relationship between health and foreign policy in GHD, it is rare to obtain perspectives on its implementation from the standpoint of developing countries, particularly those with Muslim-majority populations, such as in Indonesia. METHODS This research aims to explore Indonesian experts' attitudes toward the policy and management processes involved in developing Halal vaccines, to position Indonesia as a prominent global actor in Halal products, specifically to establish a Halal vaccine hub. The theoretical framework for this study is derived from the combined works of Kickbush( 9 ) and Labonté( 11 ) and serves as a guide for data collection and analysis. Hence, our primary research question is: Can implementing the Halal vaccine make a significant contribution to formulating national health policies and advancing diplomatic practices within Indonesia's GHD framework? Study Design This is a qualitative-exploratory study of Indonesian experts' views on policy and management processes for the development of Halal vaccines within Indonesia's health policy. It aims to position Indonesia as a leading global center for Halal products, particularly through the establishment of a Halal vaccine hub. It addresses security, economic, social justice, development, global public goods, trade, human rights, and ethical/moral reasoning. Study Setting We selected Indonesia as the study setting given its pivotal position at the intersection of global health, religion, and diplomacy. Moreover, as the largest Muslim-majority nation globally, Indonesia’s vaccine acceptance is greatly influenced by Halal assurance, making it an invaluable context for analyzing the incorporation of religious legitimacy into vaccine governance. In addition, Indonesia’s institutional capacity and international involvement further validate its selection as a study setting. The National Halal authorities and state-owned vaccine manufacturers have played significant parts in vaccine certification, production, and international collaboration, especially during the COVID-19 pandemic. Indonesia’s active engagement in multilateral and South-South health collaboration establishes it as a significant player in influencing Halal standards in global vaccine diplomacy. Participants We selected participants, which later we will call all as stakeholders, purposively and iteratively, using inclusion criteria from both local and international institutions operating within Indonesia. We contacted persons holding influential positions, decision-making roles, and policymaking positions related to Indonesia's Halal vaccine, including the government, religious institutions, academia/researchers, the pharmaceutical industry, the Muslim community, and international institutions. We identified stakeholders and, during the process, selected key informants using a snowball sampling technique. The snowballing approach involved recruiting stakeholders and requesting them to recommend actors who met the predetermined inclusion criteria and expressed potential interest in participating in the research. Additionally, key informants were individuals with relevant knowledge and expertise in Indonesia's Halal Vaccine sector. They were able to provide valuable insights into how the combined frameworks by Kickbusch( 9 ) and Labonté( 11 ) could portray Indonesian policymaking processes regarding Halal Vaccine policy related to GHD practice. Data Collection We conducted semi-structured interviews, guided by predetermined research questions on five topics around as follows: 1) role of Halal vaccines in GHD; 2) concept of Halal vaccine development; 3) aims of Halal vaccines policy and productions; 4) policy background of Halal vaccine; 5) diplomatic and governance challenges in Halal vaccine development; and all in all followed up with additional inquiries. Moreover, this study employed online interviews via Zoom, per the stakeholders' preferences, and recorded them digitally. Before starting the interview, the researcher adhered to informed consent procedures, including maintaining the anonymity of stakeholders. Interviewees provided both written and verbal consent to participate in the study. The process underwent incremental refinement through a series of interviews. Furthermore, during the interviews, it is necessary to deepen and refine questions to enhance their coherence. Before the interviews, we sent the inquiry topics guide to stakeholders via email Stakeholders contributed essential themes that emerged through discussion and had the opportunity to enhance, modify, or clarify their perspectives. The interviews were conducted from January to April 2023. The duration of the interview sessions ranged from 20 to 120 minutes. Analysis We recorded and transcribed the interviews verbatim, then manually used Microsoft Word for the transcription process. To analyze the interview transcriptions, we utilized a thematic analysis manually, which spanned the following stages: ( 1 ) generating initial codes, ( 2 ) searching for themes, ( 3 ) reviewing themes, ( 4 ) defining and naming themes, and ( 5 ) writing up.( 20 ) Furthermore, we extracted representative quotes for each theme from our raw data and translated the provided data from Bahasa Indonesia to English. We used Grammarly, an Artificial Intelligence (AI) writing assistant, to provide real-time checks for grammar, spelling, and punctuation. RESULTS Demographic findings We interviewed forty (40) consenting stakeholders, prominent actors in Indonesia's Halal vaccine development and policy, as presented in Table 1 . (Please place Table 1 under the subheading of Demographic findings) Table 1 Demographic stakeholders Groups* Stakeholder/level Position and role Government (N = 21) National Policy Makers (N = 12) Senior Officials The portfolio includes the policy formulation and development of Halal Vaccines. National Policy Makers (N = 2) Senior Staff Involved in the National COVID-19 Task Force, which encompasses the comprehensive management and response to the COVID-19 pandemic, including developing, distributing, and administering COVID-19 vaccinations. Other National Institutions (N = 5) Senior officials Involved in National Research and Development initiatives, explicitly focusing on the formulation and implementation of policies related to the development of Halal Vaccines Other National Institutions (N = 1) Senior Officials The portfolio includes the development of National Halal Products. Other National Institutions (N = 1) Senior officials Actively engaged with the National COVID-19 Task Force and the Merah Putih Vaccine Consortium Religious Institutions (N = 5) Islamic Scholars (N = 5) Senior Islamic Scholars Participated in the deliberations and discussion surrounding the issuance of a fatwa Academia/Researcher (N = 7) Lecturers/Researchers (N = 7) Senior National Lecturers/Researchers Two ( 2 ) actively engage in International GHD practices and Halal Vaccine issues. Pharmaceuticals Industry (N = 5) Public Sectors (N = 1) Senior Officials The portfolio includes Halal Vaccine Development and Vaccine Diplomacy. Private Sectors (N = 4) Senior Officials The portfolio includes the development of the Halal Vaccine and the Merah Putih Vaccines Consortium. Muslim Community (N = 1) National NGO for Muslim Consumers (N = 1) Senior Officials Engaged in the Judicial Review of the Halal Certification Status for COVID-19 Vaccines and conducted a Survey on the Demand for Halal Vaccines among Indonesia's Muslim Population. International Institutions (N = 1) International Health Institution-Regional Branch (N = 1) Senior Officials Engaging in the Formulation and Implementation of Policies for Vaccines. Three themes that emerged from the interviews: 1) The objective of the Halal vaccine policy, 2) The challenges, and 3) The COVID-19 pandemic. 1. The Objective of the Halal Vaccine Policy a. Sovereignty The theme of sovereignty is essential and adds value to Kickbush and Labonté's framework, as interview materials reveal that the implicit and explicit main objectives of Halal product policies, particularly regarding Halal vaccines, aim for Indonesia to achieve sovereignty, particularly in health resilience. Stakeholders agreed that Indonesia's key objective is to establish itself as a global hub for Halal production and services across various industries, including the health sector, specifically vaccinations. Furthermore, stakeholders noted that the Halal vaccines initiative aims to safeguard the Indonesian population by mitigating potential risks posed by the widespread importation of vaccines. Therefore, most stakeholders emphasized that Indonesia's regulation of Halal vaccines reflects the country's assertion of sovereignty, considering its status as a nation with a predominantly Muslim population. "…If the decision is to develop (Halal products) by ourselves, this is a decision with high nationalism values…(if) We do not make it, or (if) it is too late...In the end, if that happens, we buy Halal products from abroad, and the outcome for Indonesia is a setback to being a market-only. Of course, we do not want it to be like that." (K10, 2023) Furthermore, stakeholders noted that Indonesia's proficiency in developing Halal vaccines would be evident in its capacity to manufacture vaccines for both domestic and international markets. Halal vaccines underscore Indonesia's capacities, self-reliance, and resilience in health products, as demonstrated by its proactive efforts in formulating the Halal vaccine roadmap. Currently, stakeholders have stated that Indonesia is developing a Halal vaccine roadmap as a practical application of the HPAA and Presidential Decree (PD) No. 6 of 2023. The interviewees also added information that the Ministry of Health (MoH) is responsible for spearheading the development of a comprehensive plan and fostering partnerships with various organizations involved in addressing Halal vaccines. The stakeholders also agreed that Indonesia had taken a strategic step with the Halal vaccine roadmap to position itself as a global hub for the production and distribution of Halal vaccines. The stakeholders explained that the Halal vaccine regulation could constitute a trade barrier to the import of foreign vaccination products, particularly in Muslim countries such as Indonesia. Stakeholders noted that developed nations often adopt advanced technological standards to protect and safeguard their citizens, particularly in product requirements. Nevertheless, stakeholders predicted that countries like Indonesia and other developing nations with predominantly Muslim populations could leverage Halal product regulations to gain competitive trading advantages and establish unique prerequisites, such as Halal requirements. b. Health Security The stakeholders asserted that the provision of Halal vaccines is a governmental obligation to safeguard the Indonesian population by upholding health protection as outlined in Law No. 36 of 2009 on Health. Moreover, stakeholders emphasized that Islam is the predominant religion among Indonesians. It is worth noting that the HPAA mandates the adherence of medical pharmaceuticals, biological goods, and vaccines to the Halal certification system and serves to assure Muslim consumers. "There is no (Act of the Halal Product Assurance in other countries yet) ... Indonesia is the only country (in the world) that implements Halal (product) obligations…" (K17, 2023) Furthermore, stakeholders emphasized that establishing health security is crucial to achieving health resilience in Indonesia. They mentioned that the statistics showed a decline in immunization rates, which has had a detrimental impact on the nation's long-term health security. Hence, stakeholders agreed that providing Halal vaccines is pivotal in ensuring health security and resilience in Indonesia. The informants stated that addressing "vaccine pocket" concerns and mitigating vaccine hesitancy contribute to achieving health security. Moreover, informants noted that implementing a Halal vaccine policy aligns with the government's commitment to safeguarding the well-being of the majority of the population, which comprises over 80% of Muslims among the total population of nearly 300 million inhabitants. c. Economy Participants unanimously agreed that the use of Halal vaccines in Indonesia yields significant economic benefits. The lucrative benefits are primarily due to the vast market potential for Halal vaccines, given the growth of the Muslim community, which is currently the fastest-growing religious group globally. Consequently, stakeholders agreed that the target market for Halal vaccines extends beyond domestic boundaries, encompassing international markets as well. Therefore, the informants stated that the Indonesian government must seize this opportunity, even though the current emphasis is on prioritizing Halal vaccine manufacturing and meeting domestic demand. The stakeholders highlighted the presence of regulatory frameworks, including Undang-Undang (the National Law), Peraturan Pemerintah (Government's Regulations), and Peraturan Presiden (Presidential Decree), that pertain to the Halal vaccine. The experts mentioned that all existing regulations serve as the basis for endorsing and guaranteeing the Halal status of vaccines, thereby facilitating the potential for exporting them to other Muslim nations. Furthermore, most stakeholders agreed on the expansive nature of the prospective market for Halal products, including Halal vaccines. The stakeholders further emphasized that the potential market for Halal vaccinations in the home market accounts for approximately 80% of the total population, or approximately 200 million individuals. When considering international expansion, stakeholders emphasized the importance of focusing on specific target markets. In this case, one potential target market is the Muslim population in the European Union (EU), which comprises approximately 5% of the EU's total population. Experts also mentioned other potential markets, including the Middle East, Africa, Nigeria, and countries within the Association of Southeast Asian Nations (ASEAN), such as Malaysia and Brunei Darussalam. "...we are members of the OIC (Organization of Islamic Cooperation), that is why we have the advantage of this Halal vaccine. So, our market is indeed Muslim countries and OIC countries…" (K8, 2023) d. Social Justice: Muslims' rights Most stakeholders agreed that Halal vaccines uphold the rights of Muslim individuals, particularly within Indonesia, a nation characterized by its significant Muslim population. Furthermore, stakeholders noted that equity, particularly in healthcare accessibility, is a substantial concern. The informants mentioned that presently, Muslim populations face marginalization in their pursuit of vaccine rights on a global scale; consequently, the provision of Halal vaccines emerges as a potential solution to address this issue. Furthermore, the respondents also indicated that the HPAA does not impose a limitation on the entry of non-Halal products or non-Halal vaccines into the Indonesian market, provided that the manufacturers explicitly disclose the presence of non-Halal ingredients and affix a non-Halal label to their products. Therefore, experts considered that the non-Muslim community possesses the option and liberty to select vaccines based solely on their safety and efficacy considerations, and if affordable. The stakeholders recognized that vaccine availability is both vital and pressing. The informants stated that, based on lessons learned from the recent pandemic, wealthy nations, which serve as significant vaccine manufacturers, prioritize the distribution of vaccines to their own populations, a phenomenon commonly referred to as vaccine nationalism. Therefore, experts expressed that the availability of Halal vaccines confers a significant competitive benefit to nations with predominantly Muslim populations. Furthermore, stakeholders noted that developing countries lack the capacity to produce vaccines compared to affluent countries. Consequently, experts recognized that equitable access to diagnostic and therapeutic vaccines is lacking. The stakeholders underscored the importance of expanding manufacturing capabilities in therapeutic vaccines, diagnostics, and Halal health products as a vital component of the overall strategy. Stakeholders emphasized that the promotion of Halal vaccines is crucial, particularly in response to the needs of Muslim communities. The respondents noted that Halal Vaccines are particularly relevant in countries such as Indonesia, where demand for products that adhere to Halal standards is high. Furthermore, stakeholders said that the European market offers growth opportunities, driven by the growing size of the Muslim population and the corresponding demand for Halal products. Indonesia is well-positioned to tap into this expanding Halal product market. 2. The challenges a. Research and Development (R&D) of Halal Vaccines The stakeholders expressed concerns about the inadequacy of the laboratory environment for vaccine R&D, particularly its capacity to transition to large-scale vaccine manufacturing. Therefore, the respondents expressed that vaccination R&D results are primarily documented in academic articles and have limited practical application. The experts also noted that pharmaceutical companies, particularly those in the private sector, are hesitant to allocate their financial resources. These experts assumed that, from the business sector's perspective, the pharmaceutical industry currently perceives no substantial economic advantage in allocating funds to the exploration and development of vaccines within a Halal research center or a university's Halal research center. "The investment (of Halal vaccine for industrial partners) ...will it be break-even financially or not? Is this assumption accurate? (hahaha)." (A6, 2023) The respondents highlighted that P.T. Biofarma, a state-owned pharmaceutical company, occupies a prominent position in Halal vaccine R&D in Indonesia, having been designated as the Center of Excellence in Vaccines and Biotechnology for member nations of the OIC. Additionally, the stakeholders agreed that P.T. Biofarma remains a crucial player in this domain. In addition, stakeholders noted that P.T. Biofarma had gained recognition for its production and as a prominent supplier of vaccines from Indonesia to many nations, particularly those with predominantly Muslim populations. On the P.T. Biofarma website, we can easily access information about 152 countries that have used P.T. Biofarma products, including 52 Islamic states and OIC members. b. Collaboration Most stakeholders in this study agreed on the importance of collaboration among key institutions associated with Halal vaccines. Most stakeholders noted that collaboration remains disorganized and lacks continuity, initiated only in response to issues and lasting only briefly. The informants were also aware that the prevalence of divergent priority goals among stakeholders remains a significant obstacle that may impede the effectiveness of collaborative efforts. The stakeholders stated that collaboration exhibits a positive trajectory during times of crisis, reverting to its previous patterns after the crisis subsides. According to this research's findings, most stakeholders acknowledge that implementing Halal vaccine diplomacy is vital due to its potential benefits for both Indonesia and the global community. However, most experts also mentioned that it is crucial to recognize that there is presently no sustainable framework in operation that adequately coordinates the integration and marketing of Indonesian Halal vaccines in the global market, similar to the approach taken by India in promoting its vaccine Industry. Despite the foreign ministry's efforts to improve international cooperation on Halal vaccination, the current state of linked ministries, industries, legislation, and diplomatic practices remains fragmented. "…Yes, collaboration is easy to say in our country, but basically, it is the most difficult thing to do between government institutions, right? However, regarding routine communication, the Ministry of Foreign Affairs has regularly conducted meetings. (K15, 2023) The respondents noted that The Ministry of Foreign Affairs (MoFA) of Indonesia acknowledges that while they are aware of Indonesia's concerns regarding Halal vaccines, they currently lack detailed knowledge of the specific criteria requested by Indonesia as a consequence of the Lembaga Pengkajian Pangan Obat-Obatan dan Kosmetika Majelis Ulama Indonesia (LPPOM MUI)-a Private Halal Accreditation Institution, and the Indonesia Ulama Council (MUI), which are the technical bodies responsible for comprehending the Halal vaccine criteria applicable in Indonesia. "...(in practice) on how the Halal vaccine diplomacy we have handled previously is, precisely, how to obtain the vaccine itself. So we do not handle the Halal labeling…so, maybe about the (Halal criteria), the further information could be obtained from the Indonesia Ulama Council (MUI) " (K21, 2023) Furthermore, informants stated that it is noteworthy that the MoFA of Indonesia has not been included in or extended an invitation to participate in the formulation of the Halal vaccine roadmap under the purview of the MoH of Indonesia. The participant further elucidated that during 2021 and 2022, the Minister of Foreign Affairs of Indonesia expressed the prioritization of health diplomacy in the country. The stakeholders explained that the President of Indonesia and the Minister of Foreign Affairs had expressed Indonesia's readiness to serve as a regional hub for vaccine production, research, and manufacturing. However, stakeholders noted that their statements do not explicitly address the development of Halal vaccines. Furthermore, the informants explained that in October 2022, the WHO acknowledged Indonesia as a participant in the development of mRNA vaccines. The MoFA of Indonesia is prepared to advocate for the global dissemination of the Halal vaccine. However, the informants also stated that it is essential to acknowledge that there has been no dialogue yet between the MoH and the MoFA regarding the strategic plan for developing and distributing the Halal vaccine. The consensus among stakeholders suggests that incorporating Halal vaccine opportunities into both national health policies and international health diplomacy holds promise. The experts observed that the considerable demand for Halal vaccines within OIC member states drives opportunities, supported by the Non-Aligned Movement, especially from countries in Africa, Asia, and the Middle East. c. Halal Vaccine Standardization and Certification Some experts mentioned that standardizing Halal vaccines within the framework of issuing Halal certification is necessary. The experts stated that the international community has recognized and relied on Indonesia's Halal certification, particularly within OIC member states. The experts further explained that the United Arab Emirates Authority has recognized and accredited the Halal certification provided by the LPPOM-MUI (Indonesia's Ulama Council Certification Body). The stakeholders acknowledged that Indonesia is the only nation globally to have enacted the HPAA, a legislative measure that requires Halal certification for all products and services. The respondents noted that the implementation of the HPAA occurs in stages, depending on the classification of the respective products and services. The experts explained that the compulsory requirement for Halal certification concerning vaccines and biological goods will be implemented exclusively by 2039. Moreover, experts mentioned that the absence of a universally recognized Halal standard or certificate worldwide challenges Muslim countries' automatic acceptance and recognition of Halal vaccines. Therefore, informants explained that nations and Halal certification organizations must establish a mutual recognition agreement for their certificates. Furthermore, experts explained that in Indonesia, the Badan Penyelenggara Jaminan Produk Halal (BPJPH), or the Indonesian Body for Halal Products Assurance, an institution under the Ministry of Religious Affairs (MoRA), has officially said that no foreign Halal institutions or bodies have met the criteria and gone through the necessary assessment to be automatically accepted and mutually recognized in terms of Halal certification. Consequently, informants noted that Halal certification and registration apply universally to all imported products and services. The informants stated that Halal certification and registration are crucial elements in establishing trust in existing international Halal institutions and safeguarding Indonesia's domestic industry. d. Halal status versus health emergency The experts noted that maintaining the Halal status of vaccines poses challenges during health emergencies, as few Halal vaccines are available. Islamic scholars have agreed that non-Halal vaccines can save many lives during health crises. However, most stakeholders in this survey expressed a consensus regarding the pressing need to create Halal vaccines to ensure health security, particularly within the Muslim community. One of the stakeholders noted that the MoFA currently lacks a sufficient understanding of the compliance of Halal vaccines with the Indonesian HPAA. Moreover, stakeholders indicated that there is no definitive framework for promoting and pursuing globally recognized criteria for Halal vaccines during crises such as a pandemic, as the MoFA has limited involvement in the technical aspects of Halal vaccine certification. e. Fatwa from Ulama and different religious schools The Stakeholders were aware that Islamic schools exhibit subtle variations in their perspectives when evaluating the Halal status of certain products, particularly vaccines. Still, the experts explained that Islamic scholars agree that it is essential to recognize and respect different points of view, as long as any Fatwa (Islamic legal ruling) is based on sound and reliable Islamic knowledge and is issued by respected and trusted Islamic scholars to determine if something is Halal. One participant clarified that the validity of a Fatwa is not contingent on its acknowledgment or non-acknowledgment by a specific group of Islamic scholars, but instead on mutual respect among individuals and between nations. Moreover, stakeholders explained that adherents who share the same values and perspectives within specific Islamic schools (mazhab) would follow the Fatwa in question. Nonetheless, stakeholders stated that the variations in fatwas on the Halal status of vaccinations continue to pose difficulties for the Muslim community's pursuit of a universally recognized certification and standard. f. Leadership, solid political will, and commitment This study's findings reveal that most stakeholders believe Indonesia currently lacks strong leadership in developing Halal vaccines. Most stakeholders also emphasize that the lack of strong leadership in Halal vaccines stems from a fragmented strategy that lacks a unified approach, especially in international diplomacy. Stakeholders stressed that a state's political will and strong commitment are paramount for achieving success in Halal vaccine policy and diplomacy in Indonesia and the global environment. This study also found that stakeholders noted a substantial disparity between Indonesia's regulations and the implementation of Halal vaccines, from upstream (R&D) to downstream (industrial and marketing). The experts elaborated that Indonesia has implemented comprehensive regulatory measures for the production and distribution of Halal vaccines. However, a participant noted that Malaysia has successfully implemented a Halal vaccine policy, even without a Halal Assurance Act within its jurisdiction. "…Well, if we look at Malaysia, studies about Halal are more aggressive and progressive, and they speak in international forums, maybe because they can speak English much better than Indonesian people, more people attend meetings on Halal products as we search on the internet, for example, lectures about Halal products come from Malaysia, only a few from Indonesia. (A2, 2023) One participant underscored the significance of cultivating a sovereign spirit and courageous leadership as a strategic approach to achieving success in GHD, specifically in Halal vaccinations. Stakeholders mentioned that the Minister of Health must actively engage in diplomatic efforts and possess the necessary acumen within the WHO, as well as a steadfast commitment to political objectives. Nevertheless, stakeholders also emphasized that Indonesia could face significant challenges confronting formidable global powers, such as the prominent and established international pharmaceutical sector. "…It cannot be denied anymore; the majority are Muslim. So, products that enter Indonesia, including vaccines, must be Halal... Yes, it should be the minister of health (who takes action). The health minister must have the capacity for diplomacy at the WHO and engage in that diplomacy… As long as it is for the nation's benefit, the people, there is no need to be afraid. Moreover, the international community will admit that we are fighting for humanity. That we will also win the international world…" (K10,2023) Furthermore, stakeholders emphasized that effectively communicating the production of Halal products, specifically Halal vaccines originating in Indonesia, requires concerted efforts, diligence, and collaboration, along with time, effort, and resources from all relevant stakeholders. Nonetheless, the stakeholders agreed that attaining this goal is feasible given the desire and resolute political determination. 3. The COVID-19 pandemic Experts explained that the COVID-19 pandemic has catalyzed advances in Halal vaccination research in Indonesia. In addition, they shared information that Indonesia established the Merah Putih Vaccine National Consortium, which consists of two prominent research organizations, namely Eijkman and Lembaga Ilmu Pengetahuan Indonesia (LIPI) or Indonesian Institute of Sciences, together with five well-recognized universities in Indonesia: Universitas Airlangga (UNAIR), Universitas Indonesia (UI), Universitas Gajah Mada (UGM), Institut Teknologi Bandung (ITB), and Universitas Padjajaran (UNPAD). The informants further explained that all consortium members successfully conducted laboratory research. However, the informants added that only PT Biotis, in partnership with UNAIR, successfully developed and finalized the production of Halal COVID-19 vaccines. Furthermore, the respondents also expressed that the Merah Putih Vaccine National Consortium members lack initial partnerships with pharmaceutical companies, posing difficulties in achieving the necessary expansion for the ultimate vaccine formulation and production. One crucial aspect to consider, as the informants stated, is establishing partnerships, particularly with university alumni working in the pharmaceutical industry. The respondents mentioned that a reliable collaborator is paramount, as is the inclination to engage and contribute to the nation, particularly during a national emergency. In the present study, stakeholders stated that P.T. Biotis has demonstrated a proactive stance since its inception, showing a willingness to take on challenging endeavors, encounter setbacks, make advancements, conduct iterative evaluations, and ultimately achieve successful outcomes. Experts explained that P.T. Biotis' collaboration exemplifies the successful implementation of the Halal Vaccine Policy. P.T. Biotis and UNAIR, which involve the production of Halal vaccines along the whole supply chain. Furthermore, experts have proposed that the Hexahelix partnership aims to achieve success in developing a Halal vaccine. The experts added that the Hexahelix collaboration encompasses six key sectors: government, industry, academia, mass media, law and regulation, and community. Geopolitical strategy of vaccine development and deployment This study reveals that stakeholders assumed that China, Korea, and several nations in the Global South are more receptive to the Muslim community's requirements, criteria, and needs concerning Halal vaccines, in contrast to those in the Global North, such as the United States and Europe. The participant explained the comparative ease with which China's vaccine manufacturers grant access to data on COVID-19 vaccines, as well as their greater flexibility in meeting the standard needs of destination market countries, in contrast to the European and American vaccine industries. They asserted that this disparity is attributable to the Chinese government's policy of bolstering its domestic vaccine sector, which is relatively less developed than those in Europe and the United States. The respondents express concern that, during a health crisis such as the ongoing COVID-19 pandemic, countries, including Indonesia and other low- and middle-income countries (LMICs), must rely on vaccine donations through initiatives like the COVID-19 Vaccines Global Access (COVAX) facility. Several stakeholders highlighted that, in Indonesia, the Government is bound to accept vaccines from COVAX facilities without adhering to the HPAA, due to the urgent need to rapidly administer COVID-19 vaccines during the pandemic emergency, exacerbated by an inadequate supply to meet national demand. The stakeholders noted that the Indonesian government must decide whether to decline the vaccines or use them despite the associated expenses. "…Moderna had not registered (Halal certification) at that time. Not yet. Nevertheless, that is the COVAX Facility Program, right…. So, if it is through the COVAX Facility, it is up to Indonesia to accept it or not; that is it. Do you accept it or not? If you do (accept it), you must issue an Emergency Use of Authorization. However, there is no mandatory requirement for vaccine producers to register their products with the (Halal) certification institution.; if Indonesia is willing to accept vaccines (on COVAX facility schemes), there is no such condition…precisely Indonesia's position is more…more…yes (weak)." (I1, 2023) DISCUSSION This research examines the intricate aspects of Indonesia's Halal vaccine policy and its potential to significantly influence national health policies and enhance diplomatic practices within Indonesia's GHD framework, particularly in establishing the Halal vaccine hub. The study has applied Kickbusch's( 9 ) and Labonté's( 11 ) framework to capture the perspective of Indonesian experts regarding the Halal vaccine policy, specifically by exploring the policy frames of Halal vaccine diplomacy through the three emerged themes in the findings: 1). The objectives of the Halal vaccine policy (sovereignty, health security, economic, social justice: Muslims' rights), 2). The challenges, and 3) as explored in the COVID-19 pandemic, within the geopolitical ramifications Policy framework findings In the context of health security, as discussed in Labonté's( 11 ) framework, this study has recognized the importance stakeholders in Indonesia attach to implementing the Halal vaccine policy. They point out that the policy aims to safeguard public health by ensuring the availability of Halal vaccines and adherence to health standards. They add that it is imperative to prioritize health security to enhance health resilience in Indonesia, as many stakeholders are concerned that the adverse effects of a non-Halal vaccine could decline immunization rates, thereby affecting the nation's long-term resilience. Moreover, based on our stakeholders' analysis, Indonesia is the only nation globally that enforces mandatory Halal product regulations for legal certainty and prioritizes human security by mitigating the prevalence of 'Vaccine Pockets' resulting from non-Halal vaccines. The stakeholders also expressed that while Halal product regulations were not mandatory at first, due to the growing awareness and demand of Muslim consumers in Indonesia concerning the legality of Halal status of products, including vaccines, the Indonesian government has upgraded to mandate the Halal certification for all products and services circulating within the country as a legal requirement. The Halal certification measure aims to ensure legal certainty and firmly safeguard the well-being of citizens. Consequently, the Halal vaccine policy also bolsters Indonesia's national security and health resilience. Therefore, our stakeholders' experiences and views suggest that the government's current commitment to ensuring the community's safety, which covers more than 80% of the Muslim population, is well in line with Labonté's call for health security. The stakeholders also indicate that implementing the Halal vaccine policy in Indonesia offers significant economic benefits due to its vast market potential, particularly for Indonesia's majority Muslim population and the rapidly growing Muslim community globally. Hence, the target market for the Halal vaccine extends beyond domestic boundaries, encompassing international markets, as Indonesia aims to become the global hub for Halal products. Stakeholders emphasized that the Indonesian government must seize this opportunity to gain recognition as a significant global player in Halal products, despite prioritizing Halal vaccine manufacturing primarily to meet domestic demands. Regulatory frameworks serve as the basis for endorsing and guaranteeing the Halal status of vaccines, thereby facilitating the potential for exporting Halal vaccines to other Muslim nations. Moreover, stakeholders emphasized that focusing on specific target markets, such as the Muslim population within the EU, the Middle East, Africa, Nigeria, and ASEAN countries like Malaysia and Brunei Darussalam, is crucial for international expansion. The advantage of being a member of the OIC and having P.T. Biofarma, a longstanding, trusted pharmaceutical company, as a partner makes the market for Halal vaccines in Muslim and OIC countries much more achievable. Enhancing the distribution of the Halal vaccine through trade could improve health by fostering global market integration, economic growth, and positive health externalities, as elaborated in Labonté's framework.( 11 ) As the stakeholders imply, Indonesia is well on its way towards achieving this. Additionally, the stakeholders' perspectives on using the Halal vaccine policy as a trade barrier to balance current trade disparities, which skew benefits toward more economically and politically powerful countries, seem to align with Labonté's trade framework.( 11 ) Regulating Halal vaccines is crucial for enforcing protective trade barriers, ensuring that vaccines from high-income countries (HICs) and foreign pharmaceutical companies comply with the requirements of the Indonesian population. Consequently, LMICs like Indonesia have high confidence in their bargaining power. Stakeholders describe the development of the Halal vaccine policy as aligning with Labonté's human rights considerations( 11 ), where Indonesia's practices can reflect attempts to ensure equitable access to health services. In this study, most stakeholders agreed that the Halal vaccine policy is crucial for protecting the rights of Muslim individuals, especially in countries like Indonesia, which has a Muslim majority population. On the other hand, the HPAA is also inclusive, as it allows non-Halal products or vaccines to enter the Indonesian market, provided their components are explicitly disclosed and labeled. Hence, it will enable non-Muslims to have alternatives and choose vaccines based on safety and efficacy. Stakeholders emphasize that the Indonesian government must ensure routine vaccination programs in primary health care services and also ensure that P.T. Biofarma develops and produces Halal vaccines. Additionally, the Government will invest sufficient funds and ensure vaccine availability, allowing targeted communities to access the vaccines free of charge or at an affordable price. The issue of vaccine availability is also a pressing concern, as wealthy nations prioritize vaccine distribution for their citizen, particularly in global emergencies. Labonté( 11 ) argued that treating health as a global public good is a strong rationale for advancing GHD and that vaccines are crucial public health commodities. However, developing countries often lack the technological and regulatory capacity, as well as the financing, for vaccine production, resulting in limited equitable access to diagnostic and therapeutic vaccines. Hence, expanding manufacturing capabilities for Halal vaccine production is essential for a comprehensive strategy to fulfill Muslims' rights in Indonesia and globally. Sovereignty as a distinctive feature of Halal vaccine diplomacy. During the interviews, the stakeholders highlighted Indonesia's aspiration to establish itself as a major producer and distributor of Halal products, portraying the health sector as a hub for Halal vaccines. Stakeholders in Indonesia underscore the country's aspiration for national sovereignty and view Halal vaccine products as a manifestation of this sovereignty, given its predominantly Muslim population, and as a means to protect the population from risks associated with foreign vaccine imports. Stakeholders perceive Indonesia's commitment to prioritizing a Halal vaccine policy to assert state sovereignty, reflected in the enactment of the HPAA and its derivative legislation. Stakeholders viewed the drafting of the Halal vaccine roadmap as a strategic move by Indonesia to secure a competitive advantage and establish distinct requirements for Halal vaccines. Referring to developments in 2008, when Indonesia's Minister of Health officially proclaimed Indonesia's "Viral Sovereignty" regarding the Avian Influenza virus( 21 ), stakeholders praised Indonesia's longstanding history of implementing a policy framework that strongly emphasizes sovereignty, particularly in the area of vaccines. A phenomenon like this can be understood in light of an important aspect of sovereignty, as defined by Mayank and Saxena( 22 ). Moreover, the stakeholder examples also align with Colon's (2004) articulation, which states, '…sovereignty protects the right of people to determine their future, without manipulation or exploitation by outside nations.' Therefore, in line with stakeholders' positions, the Halal vaccine policy could be a constitutional obligation to ensure Indonesian citizens' access to Halal goods while advancing the nation's sovereignty. The Challenges In this study, the stakeholders we interviewed also identified challenges in implementing Halal vaccine R&D. These included an insufficient enabling environment for the availability of Halal laboratories, which hinders progress in Halal vaccine R&D. Additionally, pharmaceutical companies’ reluctance to engage in Halal vaccine research further complicates implementation. According to our stakeholders, the pharmaceutical industry, particularly the private sector, was hesitant to invest in Halal vaccine R&D, probably because there was no guarantee from the Indonesian government of purchasing their Halal products. Moreover, researchers and developers in the medical field in the Global South, as the stakeholders asserted, can access and develop novel vaccines that align with the specific health needs of their countries and regions without waiting for "charity" from the global community. The Global South must have control and authority over vaccine manufacturing technology and facilities, as well as the products they produce and the recipients they serve, they pointed out. This assertion is in line with what Torreele( 23 ) discusses when she claims that significant areas of disagreement persist between HICs and LMICs around issues such as R&D, intellectual property rights, technology transfer, and access (to pathogen) and Benefit Sharing (ABS), which historical economic power imbalances influence all these matters. According to stakeholders, discussions among Indonesian researchers on intellectual property rights are rare. Researchers in Indonesia perceive intellectual property rights as an additional benefit, as they already receive a salary and place greater value on the inner satisfaction derived from the potential societal impact of their research. Researchers in Indonesia face obstacles in applying their research findings to industry due to the high costs of intellectual property rights. Our analysis indicates that Indonesian researchers prioritize the novelty of vaccine types over attaining Halal status when considering the relationship between intellectual property rights and Halal vaccine products. The absence of globally acknowledged Halal standards, the necessity for mutual recognition agreements, and the complications encountered during emergencies hinder standardization and certification. The stakeholders shared an overview of the differing opinions expressed by the Muslim population in Indonesia and many Islamic nations in the Middle East, like Saudi Arabia, concerning the Halal status of vaccines. Various Muslim communities in Saudi Arabia adopt the opinion that, due to the medical benefits of vaccines and their role in emergencies aimed at preserving human lives, the Halal status of vaccines is not a significant factor in their utilization. In contrast to other nations, stakeholders stated that Indonesia is implementing more rigorous Halal-accepted methods and standards in determining Halal vaccine status. Stakeholders emphasized that MUI’s approach aims to ensure meticulous adherence to Halal and Haram rules for products and services; they added that several Muslims in Indonesia maintain that any product consumed or processed by the human body must adhere to Halal standards, including health products such as vaccines. Lastly, concerns about insufficient leadership highlight the significance of political commitment, as global diplomacy on the Halal Vaccine lacks clear statements at the Presidential level. It impedes the achievement of establishing a prominent international presence in Halal Vaccine Diplomacy. Lessons learned during the COVID-19 Pandemic This paper critically analyzes the Halal vaccine policy implemented in Indonesia, with particular emphasis on its application during the COVID-19 pandemic. Stakeholders explained that the Indonesian government established the Merah Putih Vaccine National Consortium, comprising a collective of universities, to address the lack of national vaccine resilience and autonomy during the COVID-19 pandemic. This consortium has now achieved the effective development and finalization of the COVID-19 Halal vaccine products, namely Inavac. Nevertheless, difficulties in forming relationships with pharmaceutical corporations impeded the expansion of vaccine R&D. In addition, P.T. Biotis demonstrated proactive collaboration with UNAIR by implementing the proposed Hexahelix partnership to attain favorable results in launching and administering the Inavac vaccine in Indonesia. The study further examines the geopolitical implications of vaccine development during the COVID-19 pandemic, highlighting the increased receptiveness of China, Korea, and South Asian states to accommodate the Indonesian Muslim community's Halal vaccine requirements by producing them in accordance with Indonesian Halal standards. Moreover, stakeholders explained that, due to insufficient vaccine availability, Indonesia had to obtain vaccines from COVAX facilities without complying with the HPAA. Hence, the stakeholders stated that the Indonesian government faced a predicament regarding using vaccines from COVAX facilities due to the absence of their Halal certification. The case study highlights the complexities and challenges of developing and deploying the Halal vaccine within the context of Halal vaccine diplomacy and the urgency of responding to a health crisis such as the COVID-19 pandemic. It also sheds light on geopolitical considerations and disparities in vaccine access across regions. Moreover, we found that Indonesia has ample opportunity to develop Halal vaccines through Halal vaccine diplomacy among ASEAN countries and through South-South cooperation, as Indonesia has robust Halal product regulations, not to mention P.T. Biofarma, a pharmaceutical company recognized by the WHO and trusted by most Muslim countries globally. We observed that our study has strengths in obtaining diverse perspectives from stakeholders, including the government, religious institutions, academia/researchers, the pharmaceutical industry, the Muslim community, and international institutions. A total of 40 stakeholders, with various levels and roles, is adequate to obtain saturated data. This study significantly contributes to Halal vaccine diplomacy, especially for countries globally with needs and concerns for Halal vaccines. However, like other studies, our research also has limitations: most key informants were from Indonesian national institutions, with only one from an international institution; hence, the global perspectives need further elaboration. Moreover, in this study, we did not incorporate the other religious communities acknowledged by the Indonesian government (Christians, Catholics, Hindus, Buddhists, and Confucians); thus, the different religious perspectives on vaccination policy require further elaboration. CONCLUSIONS Overall, in the face of multifaceted health issues, the interviews with our stakeholders suggest that Halal vaccine diplomacy strategies are promising for more equitable global health governance while simultaneously enhancing acceptance and access. Vaccine diplomacy efforts, such as those taken on by Indonesia, certainly deserve attention. The Halal vaccine policy implemented by Indonesia signifies an important step in advancing health sovereignty, establishing Indonesia as a key and unique player in Halal vaccine diplomacy, and fostering global health equity by ensuring equitable and proportionate availability of healthcare services while also paralleling with existing literature framework such as protecting public health through solid health security measures, promote economic development, and preserve principles of social justice and human rights. The study also highlights the complex relationship between geopolitical factors and the vaccine development process. Indonesia's efforts to manage the complexity of Halal vaccine diplomacy amid worldwide health emergencies underscore the importance of promoting international cooperation and addressing inequalities in vaccine availability. The Halal vaccine policy exemplifies Indonesia's dedication to safeguarding its Muslim population as well. In addition, the research emphasizes the importance of collaborative endeavors, strong, proficient Leadership, and strategic decision-making led by the MoH. Hence, Indonesia would do well to finalize the sustainable Halal vaccine roadmap as a vital contribution to formulating Indonesia’s health policy, particularly to become the Halal vaccine hub, while advancing diplomatic practices, including the MoFA as a crucial and strategic collaborator for Halal vaccine diplomacy. Although the study has limitations, the results provide valuable insights into the complexities of Halal vaccine diplomacy in Indonesia and its implications for foreign policy. These findings underscore the need for further research and international cooperation to address emerging health issues effectively. Lastly, the findings of this research offer valuable insights for policymakers and stakeholders who encounter the complexities and potential benefits of engaging in Halal vaccine diplomacy. Abbreviations OIC Organization of Islamic Cooperation NMRAs National Medicines Regulatory Authorities MR Measles-Rubella WHO World Health Organization UN United Nations GHD Global Health Diplomacy PIP Pandemic Influenza Preparedness UNICEF United Nations Children’s Fund HPAA Halal Products Assurance Act PD Presidential Decree MoH Ministry of Health EU European Union ASEAN Association of Southeast Asian Nations R&D Research and Development MoFA Ministry of Foreign Affairs LPPOM MUI Lembaga Pengkajian Pangan Obat-Obatan dan Kosmetika Majelis Ulama Indonesia, or Private Halal Accreditation Institution, or Indonesia’s Ulama Council Certification Body MUI Indonesia Ulama Council, or Majelis Ulama Indonesia BPJPH Badan Penyelenggara Jaminan Produk Halal, or The Indonesian Body for Halal Products Assurance MoRA Ministry of Religious Affairs LIPI Lembaga Ilmu Pengetahuan Indonesia, or The Indonesian Institute of Sciences UNAIR Universitas Airlangga UI Universitas Indonesia UGM Universitas Gajah Mada ITB Institut Teknologi Bandung UNPAD Universitas Padjajaran LMICs Low-and Middle-Income Countries COVAX The COVID-19 Vaccines Global Access HICs High Income Countries ABS Access and Benefit Sharing Declarations Ethics approval and consent to participate The Ethics Committee from The Faculty of Public Health, University of Indonesia, granted ethical approval for this study (Approval number: Ket-499/UN2.F10.D11/PPM.00.02/2022). Before the interviews, we informed the stakeholders about the study's inquiry topics and obtained both written and verbal consent. We assured the confidentiality of stakeholders’ responses, and they retained the right to withdraw from the study at any time without consequences. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to confidentiality/anonymity for the participants/stakeholders but are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests Funding Indonesia Endowment Fund for Education or Lembaga Pengelola Dana Pendidikan (LPDP) (Ref: S-1072/LPDP.4/2019 and LOG-427/LPDP/LPDP.3/2023), supported this study. The funders had no role in conceptualization, study design, data collection, data analysis, decision to publish, or preparation of the manuscript. However, monitoring all stages of the study is necessary to ensure the study process is approved. Authors’ contributions DTP, AK, and RP: designed the study and played a significant role. DTP: conducted interviews, data collection, and data coding, drafted the manuscript, integrating qualitative insights, analyzing data, and critically interpreting findings. AK: guided content structure and ensured academic rigor in the research process. RP: contributed to revisions, reviewed the manuscript for intellectual content, and formatted the article for publication standards. AK and RP: supervised the study, contributed to the critical interpretation of findings, and reviewed the manuscript for coherence and accuracy. WBA: revise and review the pre-final manuscript. All authors read and approved of the final manuscript. Acknowledgements The authors would like to express their gratitude to all the individuals who helped conduct this study, as follows: Wahyu Septiono from Faculty of Public Health, University of Indonesia, and Fury Maulina from Faculty of Medicine, University of Malikussaleh, Indonesia for their insightful feedback, comments, and support on conducting and writing an academic paper on the qualitative research in Indonesia; Widya A Munggaran from Coordinating Ministry for Human Development and Cultural Affairs, Indonesia for her helpful and valuable access to stakeholders in Indonesia, and lastly my research team member Finishia Desela, Frea Petra Maheswari, and Rizki Ahmad Nugraha, for their commitment and dedication to scheduling and technical support when conducting online interviews for data collection, with different time zone from the Netherlands and Indonesia. Authors’ information DTP is a West Java-based general dentist practitioner in primary health care and private clinics; she is a civil servant and works at the District Public Health Institution. She also obtained a master's degree in public health, and when she conducted and wrote this paper, she was a PhD candidate at Maastricht University in the Netherlands. Her research interests include health policy and management, primary health care, global health, and global health diplomacy. AK is a professor in translational ethnography in Global Health and Education in Maastricht; she has worked on a broad palette of topics whose aim is to build a "Critical Anthropology of Globalization and Health," exploring the co-production of historically and culturally shaped conditions in local communities, contemporary geopolitical trends, and the global economy. RP is a medical doctor, a public health doctor, and a researcher in Global Health. He was a lecturer in Global Health in Maastricht, focusing on the nexus between the health system and its governance, development policy, political economy, and ecological change; he is now research lead in Kuala Lumpur. WBA is an Indonesian government official and public health policy professor at Universitas Indonesia and an adjunct professor at Tufts University, Boston, USA, and the University of Minnesota, USA. He specializes in managing pandemics and potential pandemic situations at both national and international levels. During the COVID-19 pandemic, he served as a government spokesperson appointed by the President and led the expert panel of the Indonesian National Taskforce. WBA's collaborative work extends regionally, particularly in Southeast Asia and African countries, where he helps develop and implement One Health programs to prepare for potential pandemics. He is a member of the Technical Advisory Panel (TPA) of the Pandemic Fund for Pandemic Prevention, Preparedness, and Response (PPR) implementation. Finally, the authors were aware of the potential for bias in qualitative investigations, particularly given that the principal researcher (DTP) is from the studied context. As a result, we tailored the study approach accordingly. Nevertheless, although acknowledging the potential risk, the authors considered that the varied membership of their study team would effectively counteract any such bias. AK and RP, who have expertise in Global Health research in the Netherlands, provided a valuable perspective from (Western) Europe on the study design, data processing, and interpretation. By doing this, they successfully refuted any potential misconceptions. Furthermore, as a senior researcher from Indonesia, WBA guided the process by offering vital recommendations based on his expertise in local and cultural dynamics. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9409919","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630440710,"identity":"21d97a74-4df8-4b29-a3e4-1a48104d22ee","order_by":0,"name":"Dewi Trisia Putri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABZ0lEQVRIie2SP0vDQBiHrxQuyyVdLxzWr/CWQlUq+FW8va2VQnGSSuC6qF3bwe9gKRTHlA5Z0u7iomRUocVFaQbvT2qjSGeR/Ei4h9+9zyWEIJQly1+MjwCpC6NcRxfYMqtsiFpoMibjpBVYKxKI3lYNUVWi+PqQjaJvZCYRPU7AKF9vs1YcPz+MSDM+cQrTi7dTIcF95ov3WII1CyL7bp/3WPA0XQrUMIrr41aZABwIyj02EBJYfeReKSAN7tkh5YPrGvgTgVpGAZ9UWA0AMM11mC0ksPottTuqISXPFrQMIUFK4WKt7K20Uph4K624s9FHHKeUo9B6/K5U8lqRjXkKtceM4I1SBIIgpbhT3GIxlOUAF9X+XAKpj6s7QkGtNLiRCg0J+OGcJooTeMNlPy7Cbi+IHpptCd3Z6P5FNd0QFq/inBQurWhx1j7kPfO986k/Ic0/k8P0t3qbguJtm1myZMnyr/MJZuSEU2DXrTUAAAAASUVORK5CYII=","orcid":"","institution":"Maastricht University","correspondingAuthor":true,"prefix":"","firstName":"Dewi","middleName":"Trisia","lastName":"Putri","suffix":""},{"id":630440711,"identity":"e43dbe2e-5003-4617-ab5b-f09b40166222","order_by":1,"name":"Remco van de Pas","email":"","orcid":"","institution":"United Nations University-International Institute for Global Health","correspondingAuthor":false,"prefix":"","firstName":"Remco","middleName":"van","lastName":"de Pas","suffix":""},{"id":630440712,"identity":"4773b320-116b-4c4c-9c2a-c02acb9a5cdd","order_by":2,"name":"Wiku Bakti Bawono Adisasmito","email":"","orcid":"","institution":"University of Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Wiku","middleName":"Bakti Bawono","lastName":"Adisasmito","suffix":""},{"id":630440713,"identity":"07b34850-2d3a-4898-9682-34341731bd42","order_by":3,"name":"Anja Krumeich","email":"","orcid":"","institution":"Maastricht University","correspondingAuthor":false,"prefix":"","firstName":"Anja","middleName":"","lastName":"Krumeich","suffix":""}],"badges":[],"createdAt":"2026-04-14 03:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9409919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9409919/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108804937,"identity":"669dcd53-db2c-46e6-9454-10126cf745cc","added_by":"auto","created_at":"2026-05-08 15:24:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":361186,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9409919/v1/b2b3f195-4689-4eec-90ae-2f3d34b5d5ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Indonesia’s Halal Vaccine Diplomacy: A Qualitative Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eGlobally, immunization initiatives are increasingly met with resistance, also based on religious grounds. Freedman and Nichols(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) hypothesized that various factors might contribute to declining immunization rates within specific religious communities, which include the marginalization and alienation experienced by the specific religious groups from the larger society, limited availability of social programs, deference to religious leaders\u0026apos; viewpoints, and concerns regarding the use of aborted fetal tissue cell lines or of porcine-based gelatine in vaccine production. In addition, currently, Halal considerations (see textbox 1) have become a significant concern within Islamic states or nations where the Muslim population constitutes a majority. Not to mention, with the transcending of national borders, the need for Halal vaccines has become a worldwide issue and has become an important theme in global health diplomacy among Islamic countries.\u003c/p\u003e\n\u003cp\u003eThe first meeting of the Organization of Islamic Cooperation (OIC) in November 2018, for instance, was dedicated to Halal production of medicines and vaccines. Furthermore, during this meeting, the heads of National Medicines Regulatory Authorities (NMRAs) formulated Halal requirements for medicines and vaccines, outlining them in an Action Plan to foster cooperation, achieve self-sufficiency in the production of Halal medicines and vaccines, and establish a basis for Halal certification.\u003c/p\u003e\n\u003ch3\u003eTextbox 1. Summarized the Concept of Halal and Haram\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ctable style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100.0000%;\"\u003e\n \u003cdiv\u003e\n \u003ch2\u003eJallad(\u003cspan citationid=\"CR2\"\u003e2\u003c/span\u003e) summarized the concept of Halal and Haram as follows:\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eThe word Halal, as used by Arabs and Muslims, refers to anything that is considered permissible and lawful under religion, while Haram is what is forbidden and punishable according to Islamic law. The word Halal is derived from the verb Halla \u0026quot;to be or become lawful, legal, licit, legitimate, permissible, permitted, allowable, allowed, admissible, un-prohibited, unforbidden.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIn western countries, the term is usually used in the context of just Muslim food laws, especially where meat and poultry are concerned. In a Muslim\u0026apos;s life, every aspect of life is regulated by Islamic law; therefore, the Halal-Haram dichotomy almost always applies to everything.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSome Halal categories: milk (from cows, sheep, camels, and goats), honey, fish, plants which are not intoxicant, fresh or naturally frozen vegetables, fresh or dried fruits, legumes, nuts, and grains. Moreover, animals such as cows, sheep, goats, deer, moose, chickens, ducks, game birds, etc., are Halal, but they must be dabiHah (slaughtered according to Islamic Rites).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIn contrast to Halal, Haram refers to any forbidden pattern of behavior, speech, dress, conduct, and manner under Islamic law. It also includes what is unlawful to consume food or beverage. Some examples of Haram are meat from pork (ham, gammon, bacon), pork-based products and by-products (sausages), animals improperly slaughtered, or already dead before slaughtering, animals killed in the name of anyone other than Allah, and intoxicants.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eTo sum up, al-Halal and al-Haram represent the Islamic laws that govern every aspect of a person\u0026apos;s life (speech, behavior, dress, dietary, etc.), and everything Halal is rewarded by God while the Haram is punishable. Put simply, it is the Islamic dichotomy of rights and wrongs and dos and don\u0026apos;ts\u003c/em\u003e,\u003c/p\u003e\n \u003c/div\u003e\u003cbr\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003cp\u003eIndonesia, an archipelago nation with a substantial Muslim population of over 242\u0026nbsp;million, which accounts for about 87% of the demographic majority of the Indonesian population and 11.7% of the world's total Muslim population(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), has also become imperative to consider the religious ramifications of immunization initiatives. Around 2018, Indonesia faced a low coverage of the Measles-Rubella (MR) vaccination program in some regions due to the narrative that the MR vaccine is not Halal because it contains pork.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Similarly, a study conducted by Harapan et al.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e6\u003c/span\u003e) on the acceptance of the Dengue vaccine in Aceh, Indonesia, revealed that the second most significant attribute sought by individuals was the adherence to the vaccine to Islamic dietary guidelines, commonly referred to as Halal (permitted) and the absence of any Haram (forbidden) substances as prescribed by the Qur'an. Further, the primary distinguishing feature of the Dengue vaccine, which could potentially enhance its acceptance among individuals in Aceh, Indonesia, is its compliance with Halal standards and its ability to offer comprehensive protection against dengue virus infection.\u003c/p\u003e \u003cp\u003eIndonesia emerged as a pivotal advocate and initiator of Halal-certified vaccine production, and hosted the first OIC meeting, which highlighted the country's desire to be a key player in the global production and distribution of Halal vaccines, thereby supplying the Islamic population worldwide. An important international strategy associated with this kind of policy is known as vaccine diplomacy. The concepts of \"health\" and \"vaccine\" diplomacy were introduced by the World Health Organization (WHO) in late 2015 and refer to international collaborative efforts to provide the world's population with affordable, accessible medicines and vaccines.\u003c/p\u003e \u003cp\u003eThis paper examines the role of key stakeholders in Indonesia in shaping perceptions of the country's policies on the development and production of Halal vaccines for the global market. Based on interviews with these stakeholders, the paper will explore perspectives on Indonesia's efforts and assess whether and to what extent Indonesia is acting in line with the principles of vaccine diplomacy. The paper will also discuss the barriers that may prevent Indonesia from taking up its intended role as a significant international player in the production of acceptable vaccines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVaccine Diplomacy\u003c/h3\u003e\n\u003cp\u003eThe concept of diplomacy encompasses the skillful management of international relations through the establishment of alliances, treaties, and other agreements.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The main goals of diplomacy are to prioritize the development of discussions that aim to identify common interests and uncover areas of dispute among the parties involved, guided by the nation's foreign policy. In addition, the position of health in foreign policy is the subject of a substantial body of literature that examines historical and contemporary contexts including the roles of drivers and actors involved.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMany scholars acknowledge the crucial role of diplomacy in health-related foreign policy. Health and diplomacy are undergoing significant transformations. As a result, the growing influence of health in the political sphere requires diplomats and health specialists to possess exceptional negotiation skills, which are integral to navigating the complexities of a highly politicized setting.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Furthermore, International Relations scholars have distinguished between foreign policy and diplomacy. Foreign policy encompasses a range of concepts, objectives, and attitudes that guide a nation's interactions with other states. Diplomacy, according to Evans and Newnham, as cited by Lee and Smith(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e), diplomacy is a crucial instrument for executing foreign policy objectives. The correlation between health and foreign policy stands as critical, complex, and challenging. Hence, crafting health policies demands the involvement of governments, international institutions, and non-governmental organizations.\u003c/p\u003e \u003cp\u003eA study by Kickbusch(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e) examined how health has gained significant attention within the framework of foreign policy, with its integration into three key global agendas: security, economics, and social justice, all of which align with the objectives of the United Nations (UN). In addition, UN Secretary-General(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e10\u003c/span\u003e) defined the fundamental goals of 21st-century foreign policy: achieving security, fostering economic prosperity, promoting development in impoverished nations, and safeguarding human dignity. Hence, it is crucial to emphasize the importance of fostering international health cooperation and integrating health considerations into foreign policy, which underpin Global Health Diplomacy (GHD). Moreover, Labont\u0026eacute; and Gagnon(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) classified GHD into six policy framings : security, development, global public goods, trade, human rights, and ethical/moral reasoning. Hence, each conceptual frame shapes how global health emerges as a foreign policy concern.\u003c/p\u003e \u003cp\u003eFinally, vaccine diplomacy encompasses a range of dimensions within GHD, including prioritizing the development, manufacturing, and distribution of vaccines as crucial public health commodities. It is recognized for its potential as a humanitarian intervention in immunization initiatives, highlighting its capacity to address pressing health needs.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e12\u003c/span\u003e) Moreover, vaccine diplomacy pertains to a specific aspect of GHD, which promotes the use and dissemination of vaccines to achieve broader global health goals and cultivate mutual foreign policy interests.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eIndonesian context\u003c/h3\u003e\n\u003cp\u003eDuring 2007 and 2008, Indonesia exhibited a distinct and significant shift in its engagement with international vaccine diplomacy. Indonesia's former health minister caused international concern by refusing to share bird flu samples or report disease incidents, arguing that advanced and more prosperous countries and manufacturers should offer guarantees to access a vaccine publicly.(14, 15) The assurance provided underdeveloped countries with affordable vaccines generated from their respective samples, which have compelled Indonesia to assert its \"viral sovereignty\" regarding Avian influenza A (H5N1) and have played a role in the formation of a novel intergovernmental negotiation process, The Pandemic Influenza Preparedness (PIP) framework overseen by the WHO concerning virus and benefit-sharing. However, this process has not yet achieved a mutually agreeable resolution for years(14, 15). In 2025, WHO member states adopted a Pandemic Agreement (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, its annex on viral access and benefit sharing is still under (difficult) negotiations. Similarly, Asians express support for Indonesia's position on the claims mentioned above, showcasing a longstanding concern with inequitable and potentially exploitative regimes and practices.(15)\u003c/p\u003e \u003cp\u003eNowadays, Indonesia can assume a pivotal position in advancing the health agenda within developing nations, Southeast Asia, and the wider Asia-Pacific region. According to Hiebert(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e17\u003c/span\u003e), Indonesia must effectively participate in a global multilateral platform alongside predominantly Muslim nations. The country would need to make significant investments in acquiring expertise and diplomatic skills. These investments are crucial for successfully advancing a multifaceted agenda at the global level. Indonesia sought to establish itself as a credible participant in international affairs and proactively assumed a more prominent position in health diplomacy.\u003c/p\u003e \u003cp\u003eIn December 2017, the OIC expressed its trust in P.T. Biofarma, a state-owned pharmaceutical company, as a leading manufacturer of vaccines and a recognized Center of Excellence in Vaccine Production and Biotechnology. Additionally, P.T. Biofarma, the leading vaccine producer in Southeast Asia, has a manufacturing capacity exceeding 2\u0026nbsp;billion doses annually and has successfully met demand for national and global vaccines through collaborations with the WHO and United Nations Children\u0026rsquo;s Fund (UNICEF).(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Moreover, Biofarma's vaccine products have been utilized by over 140 countries, particularly developing nations, with 50 of them being members of the OIC.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIndonesia has implemented the Halal Product Assurance Act (HPAA) No. 33 of 2014 to ensure its citizens' access to Halal goods. HPAA mandates that all products and services distributed in Indonesia must comply with the Halal certification process, including biological products and vaccines. Moreover, Indonesia assumed the role of being a Global Halal Center, demonstrating its capabilities and serving as a pilot project to advance Halal-related issues globally.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Therefore, establishing international cooperation plays a significant role in effectively addressing Halal matters at both national and global levels.\u003c/p\u003e\n\u003ch3\u003eWhy this study was necessary?\u003c/h3\u003e\n\u003cp\u003eGiven Indonesia's status as the largest Muslim nation, its track record of practicing health diplomacy, and its concerns regarding Halal issues, we sought to explore the perspectives and attitudes of major Indonesian stakeholders towards Halal vaccine diplomacy.\u003c/p\u003e \u003cp\u003eAlthough many papers have discussed the significance of the relationship between health and foreign policy in GHD, it is rare to obtain perspectives on its implementation from the standpoint of developing countries, particularly those with Muslim-majority populations, such as in Indonesia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis research aims to explore Indonesian experts' attitudes toward the policy and management processes involved in developing Halal vaccines, to position Indonesia as a prominent global actor in Halal products, specifically to establish a Halal vaccine hub. The theoretical framework for this study is derived from the combined works of Kickbush(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and Labont\u0026eacute;(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and serves as a guide for data collection and analysis. Hence, our primary research question is: Can implementing the Halal vaccine make a significant contribution to formulating national health policies and advancing diplomatic practices within Indonesia's GHD framework?\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis is a qualitative-exploratory study of Indonesian experts' views on policy and management processes for the development of Halal vaccines within Indonesia's health policy. It aims to position Indonesia as a leading global center for Halal products, particularly through the establishment of a Halal vaccine hub. It addresses security, economic, social justice, development, global public goods, trade, human rights, and ethical/moral reasoning.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eWe selected Indonesia as the study setting given its pivotal position at the intersection of global health, religion, and diplomacy. Moreover, as the largest Muslim-majority nation globally, Indonesia\u0026rsquo;s vaccine acceptance is greatly influenced by Halal assurance, making it an invaluable context for analyzing the incorporation of religious legitimacy into vaccine governance.\u003c/p\u003e \u003cp\u003eIn addition, Indonesia\u0026rsquo;s institutional capacity and international involvement further validate its selection as a study setting. The National Halal authorities and state-owned vaccine manufacturers have played significant parts in vaccine certification, production, and international collaboration, especially during the COVID-19 pandemic. Indonesia\u0026rsquo;s active engagement in multilateral and South-South health collaboration establishes it as a significant player in influencing Halal standards in global vaccine diplomacy.\u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eWe selected participants, which later we will call all as stakeholders, purposively and iteratively, using inclusion criteria from both local and international institutions operating within Indonesia. We contacted persons holding influential positions, decision-making roles, and policymaking positions related to Indonesia's Halal vaccine, including the government, religious institutions, academia/researchers, the pharmaceutical industry, the Muslim community, and international institutions.\u003c/p\u003e \u003cp\u003eWe identified stakeholders and, during the process, selected key informants using a snowball sampling technique. The snowballing approach involved recruiting stakeholders and requesting them to recommend actors who met the predetermined inclusion criteria and expressed potential interest in participating in the research. Additionally, key informants were individuals with relevant knowledge and expertise in Indonesia's Halal Vaccine sector. They were able to provide valuable insights into how the combined frameworks by Kickbusch(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and Labont\u0026eacute;(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) could portray Indonesian policymaking processes regarding Halal Vaccine policy related to GHD practice.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eWe conducted semi-structured interviews, guided by predetermined research questions on five topics around as follows: 1) role of Halal vaccines in GHD; 2) concept of Halal vaccine development; 3) aims of Halal vaccines policy and productions; 4) policy background of Halal vaccine; 5) diplomatic and governance challenges in Halal vaccine development; and all in all followed up with additional inquiries. Moreover, this study employed online interviews via Zoom, per the stakeholders' preferences, and recorded them digitally. Before starting the interview, the researcher adhered to informed consent procedures, including maintaining the anonymity of stakeholders. Interviewees provided both written and verbal consent to participate in the study. The process underwent incremental refinement through a series of interviews. Furthermore, during the interviews, it is necessary to deepen and refine questions to enhance their coherence.\u003c/p\u003e \u003cp\u003eBefore the interviews, we sent the inquiry topics guide to stakeholders via email Stakeholders contributed essential themes that emerged through discussion and had the opportunity to enhance, modify, or clarify their perspectives.\u003c/p\u003e \u003cp\u003eThe interviews were conducted from January to April 2023. The duration of the interview sessions ranged from 20 to 120 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eWe recorded and transcribed the interviews verbatim, then manually used Microsoft Word for the transcription process. To analyze the interview transcriptions, we utilized a thematic analysis manually, which spanned the following stages: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) generating initial codes, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) searching for themes, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) reviewing themes, (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e4\u003c/span\u003e) defining and naming themes, and (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e5\u003c/span\u003e) writing up.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Furthermore, we extracted representative quotes for each theme from our raw data and translated the provided data from Bahasa Indonesia to English. We used Grammarly, an Artificial Intelligence (AI) writing assistant, to provide real-time checks for grammar, spelling, and punctuation.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDemographic findings\u003c/h2\u003e \u003cp\u003eWe interviewed forty (40) consenting stakeholders, prominent actors in Indonesia's Halal vaccine development and policy, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e(Please place\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eunder the subheading of Demographic findings)\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic stakeholders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStakeholder/level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePosition and role\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational Policy Makers\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe portfolio includes the policy formulation and development of Halal Vaccines.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational Policy Makers\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInvolved in the National COVID-19 Task Force, which encompasses the comprehensive management and response to the COVID-19 pandemic, including developing, distributing, and administering COVID-19 vaccinations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther National Institutions\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInvolved in National Research and Development initiatives, explicitly focusing on the formulation and implementation of policies related to the development of Halal Vaccines\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther National Institutions\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe portfolio includes the development of National Halal Products.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther National Institutions\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eActively engaged with the National COVID-19 Task Force and the Merah Putih Vaccine Consortium\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious Institutions (N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslamic Scholars\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Islamic Scholars\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipated in the deliberations and discussion surrounding the issuance of a fatwa\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademia/Researcher\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLecturers/Researchers\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior National Lecturers/Researchers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) actively engage in International GHD practices and Halal Vaccine issues.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmaceuticals Industry\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Sectors\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe portfolio includes Halal Vaccine Development and Vaccine Diplomacy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate Sectors\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe portfolio includes the development of the Halal Vaccine and the Merah Putih Vaccines Consortium.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim Community\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational NGO for Muslim Consumers\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Officials\u003c/p\u003e \u003cp\u003eEngaged in the Judicial Review of the Halal Certification Status for COVID-19 Vaccines and conducted a Survey on the Demand for Halal Vaccines among Indonesia's Muslim Population.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternational Institutions\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Health Institution-Regional Branch\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Officials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEngaging in the Formulation and Implementation of Policies for Vaccines.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThree themes that emerged from the interviews: 1) The objective of the Halal vaccine policy, 2) The challenges, and 3) The COVID-19 pandemic.\u003c/p\u003e \u003cp\u003e \u003cb\u003e1. The Objective of the Halal Vaccine Policy\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ea. Sovereignty\u003c/h2\u003e \u003cp\u003eThe theme of sovereignty is essential and adds value to Kickbush and Labont\u0026eacute;'s framework, as interview materials reveal that the implicit and explicit main objectives of Halal product policies, particularly regarding Halal vaccines, aim for Indonesia to achieve sovereignty, particularly in health resilience.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eStakeholders agreed that Indonesia's key objective is to establish itself as a global hub for Halal production and services across various industries, including the health sector, specifically vaccinations. Furthermore, stakeholders noted that the Halal vaccines initiative aims to safeguard the Indonesian population by mitigating potential risks posed by the widespread importation of vaccines. Therefore, most stakeholders emphasized that Indonesia's regulation of Halal vaccines reflects the country's assertion of sovereignty, considering its status as a nation with a predominantly Muslim population.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"\u0026hellip;If the decision is to develop (Halal products) by ourselves, this is a decision with high nationalism values\u0026hellip;(if) We do not make it, or (if) it is too late...In the end, if that happens, we buy Halal products from abroad, and the outcome for Indonesia is a setback to being a market-only. Of course, we do not want it to be like that.\" (K10, 2023)\u003c/em\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFurthermore, stakeholders noted that Indonesia's proficiency in developing Halal vaccines would be evident in its capacity to manufacture vaccines for both domestic and international markets. Halal vaccines underscore Indonesia's capacities, self-reliance, and resilience in health products, as demonstrated by its proactive efforts in formulating the Halal vaccine roadmap.\u003c/p\u003e \u003cp\u003eCurrently, stakeholders have stated that Indonesia is developing a Halal vaccine roadmap as a practical application of the HPAA and Presidential Decree (PD) No. 6 of 2023. The interviewees also added information that the Ministry of Health (MoH) is responsible for spearheading the development of a comprehensive plan and fostering partnerships with various organizations involved in addressing Halal vaccines. The stakeholders also agreed that Indonesia had taken a strategic step with the Halal vaccine roadmap to position itself as a global hub for the production and distribution of Halal vaccines.\u003c/p\u003e \u003cp\u003eThe stakeholders explained that the Halal vaccine regulation could constitute a trade barrier to the import of foreign vaccination products, particularly in Muslim countries such as Indonesia. Stakeholders noted that developed nations often adopt advanced technological standards to protect and safeguard their citizens, particularly in product requirements. Nevertheless, stakeholders predicted that countries like Indonesia and other developing nations with predominantly Muslim populations could leverage Halal product regulations to gain competitive trading advantages and establish unique prerequisites, such as Halal requirements.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eb. Health Security\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe stakeholders asserted that the provision of Halal vaccines is a governmental obligation to safeguard the Indonesian population by upholding health protection as outlined in Law No. 36 of 2009 on Health. Moreover, stakeholders emphasized that Islam is the predominant religion among Indonesians. It is worth noting that the HPAA mandates the adherence of medical pharmaceuticals, biological goods, and vaccines to the Halal certification system and serves to assure Muslim consumers.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"There is no (Act of the Halal Product Assurance in other countries yet) ... Indonesia is the only country (in the world) that implements Halal (product) obligations\u0026hellip;\" (K17, 2023)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFurthermore, stakeholders emphasized that establishing health security is crucial to achieving health resilience in Indonesia. They mentioned that the statistics showed a decline in immunization rates, which has had a detrimental impact on the nation's long-term health security. Hence, stakeholders agreed that providing Halal vaccines is pivotal in ensuring health security and resilience in Indonesia. The informants stated that addressing \"vaccine pocket\" concerns and mitigating vaccine hesitancy contribute to achieving health security. Moreover, informants noted that implementing a Halal vaccine policy aligns with the government's commitment to safeguarding the well-being of the majority of the population, which comprises over 80% of Muslims among the total population of nearly 300\u0026nbsp;million inhabitants.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ec. Economy\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eParticipants unanimously agreed that the use of Halal vaccines in Indonesia yields significant economic benefits. The lucrative benefits are primarily due to the vast market potential for Halal vaccines, given the growth of the Muslim community, which is currently the fastest-growing religious group globally. Consequently, stakeholders agreed that the target market for Halal vaccines extends beyond domestic boundaries, encompassing international markets as well. Therefore, the informants stated that the Indonesian government must seize this opportunity, even though the current emphasis is on prioritizing Halal vaccine manufacturing and meeting domestic demand.\u003c/p\u003e \u003cp\u003eThe stakeholders highlighted the presence of regulatory frameworks, including Undang-Undang (the National Law), Peraturan Pemerintah (Government's Regulations), and Peraturan Presiden (Presidential Decree), that pertain to the Halal vaccine. The experts mentioned that all existing regulations serve as the basis for endorsing and guaranteeing the Halal status of vaccines, thereby facilitating the potential for exporting them to other Muslim nations.\u003c/p\u003e \u003cp\u003eFurthermore, most stakeholders agreed on the expansive nature of the prospective market for Halal products, including Halal vaccines. The stakeholders further emphasized that the potential market for Halal vaccinations in the home market accounts for approximately 80% of the total population, or approximately 200\u0026nbsp;million individuals. When considering international expansion, stakeholders emphasized the importance of focusing on specific target markets. In this case, one potential target market is the Muslim population in the European Union (EU), which comprises approximately 5% of the EU's total population. Experts also mentioned other potential markets, including the Middle East, Africa, Nigeria, and countries within the Association of Southeast Asian Nations (ASEAN), such as Malaysia and Brunei Darussalam.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"...we are members of the OIC (Organization of Islamic Cooperation), that is why we have the advantage of this Halal vaccine. So, our market is indeed Muslim countries and OIC countries\u0026hellip;\" (K8, 2023)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ed. Social Justice: Muslims' rights\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMost stakeholders agreed that Halal vaccines uphold the rights of Muslim individuals, particularly within Indonesia, a nation characterized by its significant Muslim population. Furthermore, stakeholders noted that equity, particularly in healthcare accessibility, is a substantial concern. The informants mentioned that presently, Muslim populations face marginalization in their pursuit of vaccine rights on a global scale; consequently, the provision of Halal vaccines emerges as a potential solution to address this issue. Furthermore, the respondents also indicated that the HPAA does not impose a limitation on the entry of non-Halal products or non-Halal vaccines into the Indonesian market, provided that the manufacturers explicitly disclose the presence of non-Halal ingredients and affix a non-Halal label to their products. Therefore, experts considered that the non-Muslim community possesses the option and liberty to select vaccines based solely on their safety and efficacy considerations, and if affordable.\u003c/p\u003e \u003cp\u003eThe stakeholders recognized that vaccine availability is both vital and pressing. The informants stated that, based on lessons learned from the recent pandemic, wealthy nations, which serve as significant vaccine manufacturers, prioritize the distribution of vaccines to their own populations, a phenomenon commonly referred to as vaccine nationalism. Therefore, experts expressed that the availability of Halal vaccines confers a significant competitive benefit to nations with predominantly Muslim populations.\u003c/p\u003e \u003cp\u003eFurthermore, stakeholders noted that developing countries lack the capacity to produce vaccines compared to affluent countries. Consequently, experts recognized that equitable access to diagnostic and therapeutic vaccines is lacking. The stakeholders underscored the importance of expanding manufacturing capabilities in therapeutic vaccines, diagnostics, and Halal health products as a vital component of the overall strategy. Stakeholders emphasized that the promotion of Halal vaccines is crucial, particularly in response to the needs of Muslim communities. The respondents noted that Halal Vaccines are particularly relevant in countries such as Indonesia, where demand for products that adhere to Halal standards is high. Furthermore, stakeholders said that the European market offers growth opportunities, driven by the growing size of the Muslim population and the corresponding demand for Halal products. Indonesia is well-positioned to tap into this expanding Halal product market.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2. The challenges\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ea. Research and Development (R\u0026amp;D) of Halal Vaccines\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe stakeholders expressed concerns about the inadequacy of the laboratory environment for vaccine R\u0026amp;D, particularly its capacity to transition to large-scale vaccine manufacturing. Therefore, the respondents expressed that vaccination R\u0026amp;D results are primarily documented in academic articles and have limited practical application.\u003c/p\u003e \u003cp\u003eThe experts also noted that pharmaceutical companies, particularly those in the private sector, are hesitant to allocate their financial resources. These experts assumed that, from the business sector's perspective, the pharmaceutical industry currently perceives no substantial economic advantage in allocating funds to the exploration and development of vaccines within a Halal research center or a university's Halal research center.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The investment (of Halal vaccine for industrial partners) ...will it be break-even financially or not? Is this assumption accurate? (hahaha).\" (A6, 2023)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe respondents highlighted that P.T. Biofarma, a state-owned pharmaceutical company, occupies a prominent position in Halal vaccine R\u0026amp;D in Indonesia, having been designated as the Center of Excellence in Vaccines and Biotechnology for member nations of the OIC. Additionally, the stakeholders agreed that P.T. Biofarma remains a crucial player in this domain. In addition, stakeholders noted that P.T. Biofarma had gained recognition for its production and as a prominent supplier of vaccines from Indonesia to many nations, particularly those with predominantly Muslim populations. On the P.T. Biofarma website, we can easily access information about 152 countries that have used P.T. Biofarma products, including 52 Islamic states and OIC members.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eb. Collaboration\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMost stakeholders in this study agreed on the importance of collaboration among key institutions associated with Halal vaccines. Most stakeholders noted that collaboration remains disorganized and lacks continuity, initiated only in response to issues and lasting only briefly.\u003c/p\u003e \u003cp\u003eThe informants were also aware that the prevalence of divergent priority goals among stakeholders remains a significant obstacle that may impede the effectiveness of collaborative efforts. The stakeholders stated that collaboration exhibits a positive trajectory during times of crisis, reverting to its previous patterns after the crisis subsides.\u003c/p\u003e \u003cp\u003eAccording to this research's findings, most stakeholders acknowledge that implementing Halal vaccine diplomacy is vital due to its potential benefits for both Indonesia and the global community. However, most experts also mentioned that it is crucial to recognize that there is presently no sustainable framework in operation that adequately coordinates the integration and marketing of Indonesian Halal vaccines in the global market, similar to the approach taken by India in promoting its vaccine Industry. Despite the foreign ministry's efforts to improve international cooperation on Halal vaccination, the current state of linked ministries, industries, legislation, and diplomatic practices remains fragmented.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"\u0026hellip;Yes, collaboration is easy to say in our country, but basically, it is the most difficult thing to do between government institutions, right? However, regarding routine communication, the Ministry of Foreign Affairs has regularly conducted meetings. (K15, 2023)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe respondents noted that The Ministry of Foreign Affairs (MoFA) of Indonesia acknowledges that while they are aware of Indonesia's concerns regarding Halal vaccines, they currently lack detailed knowledge of the specific criteria requested by Indonesia as a consequence of the Lembaga Pengkajian Pangan Obat-Obatan dan Kosmetika Majelis Ulama Indonesia (LPPOM MUI)-a Private Halal Accreditation Institution, and the Indonesia Ulama Council (MUI), which are the technical bodies responsible for comprehending the Halal vaccine criteria applicable in Indonesia.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"...(in practice) on how the Halal vaccine diplomacy we have handled previously is, precisely, how to obtain the vaccine itself. So we do not handle the Halal labeling\u0026hellip;so, maybe about the (Halal criteria), the further information could be obtained from the Indonesia Ulama Council (MUI) \" (K21, 2023)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFurthermore, informants stated that it is noteworthy that the MoFA of Indonesia has not been included in or extended an invitation to participate in the formulation of the Halal vaccine roadmap under the purview of the MoH of Indonesia.\u003c/p\u003e \u003cp\u003eThe participant further elucidated that during 2021 and 2022, the Minister of Foreign Affairs of Indonesia expressed the prioritization of health diplomacy in the country. The stakeholders explained that the President of Indonesia and the Minister of Foreign Affairs had expressed Indonesia's readiness to serve as a regional hub for vaccine production, research, and manufacturing. However, stakeholders noted that their statements do not explicitly address the development of Halal vaccines. Furthermore, the informants explained that in October 2022, the WHO acknowledged Indonesia as a participant in the development of mRNA vaccines. The MoFA of Indonesia is prepared to advocate for the global dissemination of the Halal vaccine. However, the informants also stated that it is essential to acknowledge that there has been no dialogue yet between the MoH and the MoFA regarding the strategic plan for developing and distributing the Halal vaccine.\u003c/p\u003e \u003cp\u003eThe consensus among stakeholders suggests that incorporating Halal vaccine opportunities into both national health policies and international health diplomacy holds promise. The experts observed that the considerable demand for Halal vaccines within OIC member states drives opportunities, supported by the Non-Aligned Movement, especially from countries in Africa, Asia, and the Middle East.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ec. Halal Vaccine Standardization and Certification\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSome experts mentioned that standardizing Halal vaccines within the framework of issuing Halal certification is necessary. The experts stated that the international community has recognized and relied on Indonesia's Halal certification, particularly within OIC member states. The experts further explained that the United Arab Emirates Authority has recognized and accredited the Halal certification provided by the LPPOM-MUI (Indonesia's Ulama Council Certification Body).\u003c/p\u003e \u003cp\u003eThe stakeholders acknowledged that Indonesia is the only nation globally to have enacted the HPAA, a legislative measure that requires Halal certification for all products and services. The respondents noted that the implementation of the HPAA occurs in stages, depending on the classification of the respective products and services. The experts explained that the compulsory requirement for Halal certification concerning vaccines and biological goods will be implemented exclusively by 2039.\u003c/p\u003e \u003cp\u003eMoreover, experts mentioned that the absence of a universally recognized Halal standard or certificate worldwide challenges Muslim countries' automatic acceptance and recognition of Halal vaccines. Therefore, informants explained that nations and Halal certification organizations must establish a mutual recognition agreement for their certificates.\u003c/p\u003e \u003cp\u003eFurthermore, experts explained that in Indonesia, the Badan Penyelenggara Jaminan Produk Halal (BPJPH), or the Indonesian Body for Halal Products Assurance, an institution under the Ministry of Religious Affairs (MoRA), has officially said that no foreign Halal institutions or bodies have met the criteria and gone through the necessary assessment to be automatically accepted and mutually recognized in terms of Halal certification. Consequently, informants noted that Halal certification and registration apply universally to all imported products and services. The informants stated that Halal certification and registration are crucial elements in establishing trust in existing international Halal institutions and safeguarding Indonesia's domestic industry.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003ed. Halal status versus health emergency\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe experts noted that maintaining the Halal status of vaccines poses challenges during health emergencies, as few Halal vaccines are available. Islamic scholars have agreed that non-Halal vaccines can save many lives during health crises. However, most stakeholders in this survey expressed a consensus regarding the pressing need to create Halal vaccines to ensure health security, particularly within the Muslim community.\u003c/p\u003e \u003cp\u003eOne of the stakeholders noted that the MoFA currently lacks a sufficient understanding of the compliance of Halal vaccines with the Indonesian HPAA. Moreover, stakeholders indicated that there is no definitive framework for promoting and pursuing globally recognized criteria for Halal vaccines during crises such as a pandemic, as the MoFA has limited involvement in the technical aspects of Halal vaccine certification.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ee. Fatwa from Ulama and different religious schools\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe Stakeholders were aware that Islamic schools exhibit subtle variations in their perspectives when evaluating the Halal status of certain products, particularly vaccines. Still, the experts explained that Islamic scholars agree that it is essential to recognize and respect different points of view, as long as any Fatwa (Islamic legal ruling) is based on sound and reliable Islamic knowledge and is issued by respected and trusted Islamic scholars to determine if something is Halal.\u003c/p\u003e \u003cp\u003eOne participant clarified that the validity of a Fatwa is not contingent on its acknowledgment or non-acknowledgment by a specific group of Islamic scholars, but instead on mutual respect among individuals and between nations. Moreover, stakeholders explained that adherents who share the same values and perspectives within specific Islamic schools (mazhab) would follow the Fatwa in question. Nonetheless, stakeholders stated that the variations in fatwas on the Halal status of vaccinations continue to pose difficulties for the Muslim community's pursuit of a universally recognized certification and standard.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003ef. Leadership, solid political will, and commitment\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study's findings reveal that most stakeholders believe Indonesia currently lacks strong leadership in developing Halal vaccines. Most stakeholders also emphasize that the lack of strong leadership in Halal vaccines stems from a fragmented strategy that lacks a unified approach, especially in international diplomacy. Stakeholders stressed that a state's political will and strong commitment are paramount for achieving success in Halal vaccine policy and diplomacy in Indonesia and the global environment.\u003c/p\u003e \u003cp\u003eThis study also found that stakeholders noted a substantial disparity between Indonesia's regulations and the implementation of Halal vaccines, from upstream (R\u0026amp;D) to downstream (industrial and marketing). The experts elaborated that Indonesia has implemented comprehensive regulatory measures for the production and distribution of Halal vaccines. However, a participant noted that Malaysia has successfully implemented a Halal vaccine policy, even without a Halal Assurance Act within its jurisdiction.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"\u0026hellip;Well, if we look at Malaysia, studies about Halal are more aggressive and progressive, and they speak in international forums, maybe because they can speak English much better than Indonesian people, more people attend meetings on Halal products as we search on the internet, for example, lectures about Halal products come from Malaysia, only a few from Indonesia.\u003c/em\u003e (A2, 2023)\u003c/p\u003e \u003cp\u003eOne participant underscored the significance of cultivating a sovereign spirit and courageous leadership as a strategic approach to achieving success in GHD, specifically in Halal vaccinations. Stakeholders mentioned that the Minister of Health must actively engage in diplomatic efforts and possess the necessary acumen within the WHO, as well as a steadfast commitment to political objectives. Nevertheless, stakeholders also emphasized that Indonesia could face significant challenges confronting formidable global powers, such as the prominent and established international pharmaceutical sector.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"\u0026hellip;It cannot be denied anymore; the majority are Muslim. So, products that enter Indonesia, including vaccines, must be Halal... Yes, it should be the minister of health (who takes action). The health minister must have the capacity for diplomacy at the WHO and engage in that diplomacy\u0026hellip; As long as it is for the nation's benefit, the people, there is no need to be afraid. Moreover, the international community will admit that we are fighting for humanity. That we will also win the international world\u0026hellip;\" (K10,2023)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFurthermore, stakeholders emphasized that effectively communicating the production of Halal products, specifically Halal vaccines originating in Indonesia, requires concerted efforts, diligence, and collaboration, along with time, effort, and resources from all relevant stakeholders. Nonetheless, the stakeholders agreed that attaining this goal is feasible given the desire and resolute political determination.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3. The COVID-19 pandemic\u003c/b\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eExperts explained that the COVID-19 pandemic has catalyzed advances in Halal vaccination research in Indonesia. In addition, they shared information that Indonesia established the Merah Putih Vaccine National Consortium, which consists of two prominent research organizations, namely Eijkman and Lembaga Ilmu Pengetahuan Indonesia (LIPI) or Indonesian Institute of Sciences, together with five well-recognized universities in Indonesia: Universitas Airlangga (UNAIR), Universitas Indonesia (UI), Universitas Gajah Mada (UGM), Institut Teknologi Bandung (ITB), and Universitas Padjajaran (UNPAD). The informants further explained that all consortium members successfully conducted laboratory research. However, the informants added that only PT Biotis, in partnership with UNAIR, successfully developed and finalized the production of Halal COVID-19 vaccines.\u003c/p\u003e \u003cp\u003eFurthermore, the respondents also expressed that the Merah Putih Vaccine National Consortium members lack initial partnerships with pharmaceutical companies, posing difficulties in achieving the necessary expansion for the ultimate vaccine formulation and production.\u003c/p\u003e \u003cp\u003eOne crucial aspect to consider, as the informants stated, is establishing partnerships, particularly with university alumni working in the pharmaceutical industry. The respondents mentioned that a reliable collaborator is paramount, as is the inclination to engage and contribute to the nation, particularly during a national emergency. In the present study, stakeholders stated that P.T. Biotis has demonstrated a proactive stance since its inception, showing a willingness to take on challenging endeavors, encounter setbacks, make advancements, conduct iterative evaluations, and ultimately achieve successful outcomes.\u003c/p\u003e \u003cp\u003eExperts explained that P.T. Biotis' collaboration exemplifies the successful implementation of the Halal Vaccine Policy. P.T. Biotis and UNAIR, which involve the production of Halal vaccines along the whole supply chain. Furthermore, experts have proposed that the Hexahelix partnership aims to achieve success in developing a Halal vaccine. The experts added that the Hexahelix collaboration encompasses six key sectors: government, industry, academia, mass media, law and regulation, and community.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eGeopolitical strategy of vaccine development and deployment\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study reveals that stakeholders assumed that China, Korea, and several nations in the Global South are more receptive to the Muslim community's requirements, criteria, and needs concerning Halal vaccines, in contrast to those in the Global North, such as the United States and Europe.\u003c/p\u003e \u003cp\u003eThe participant explained the comparative ease with which China's vaccine manufacturers grant access to data on COVID-19 vaccines, as well as their greater flexibility in meeting the standard needs of destination market countries, in contrast to the European and American vaccine industries. They asserted that this disparity is attributable to the Chinese government's policy of bolstering its domestic vaccine sector, which is relatively less developed than those in Europe and the United States.\u003c/p\u003e \u003cp\u003eThe respondents express concern that, during a health crisis such as the ongoing COVID-19 pandemic, countries, including Indonesia and other low- and middle-income countries (LMICs), must rely on vaccine donations through initiatives like the COVID-19 Vaccines Global Access (COVAX) facility. Several stakeholders highlighted that, in Indonesia, the Government is bound to accept vaccines from COVAX facilities without adhering to the HPAA, due to the urgent need to rapidly administer COVID-19 vaccines during the pandemic emergency, exacerbated by an inadequate supply to meet national demand. The stakeholders noted that the Indonesian government must decide whether to decline the vaccines or use them despite the associated expenses.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"\u0026hellip;Moderna had not registered (Halal certification) at that time. Not yet. Nevertheless, that is the COVAX Facility Program, right\u0026hellip;. So, if it is through the COVAX Facility, it is up to Indonesia to accept it or not; that is it. Do you accept it or not? If you do (accept it), you must issue an Emergency Use of Authorization. However, there is no mandatory requirement for vaccine producers to register their products with the (Halal) certification institution.; if Indonesia is willing to accept vaccines (on COVAX facility schemes), there is no such condition\u0026hellip;precisely Indonesia's position is more\u0026hellip;more\u0026hellip;yes (weak).\" (I1, 2023)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis research examines the intricate aspects of Indonesia's Halal vaccine policy and its potential to significantly influence national health policies and enhance diplomatic practices within Indonesia's GHD framework, particularly in establishing the Halal vaccine hub. The study has applied Kickbusch's(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and Labont\u0026eacute;'s(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) framework to capture the perspective of Indonesian experts regarding the Halal vaccine policy, specifically by exploring the policy frames of Halal vaccine diplomacy through the three emerged themes in the findings: 1). The objectives of the Halal vaccine policy (sovereignty, health security, economic, social justice: Muslims' rights), 2). The challenges, and 3) as explored in the COVID-19 pandemic, within the geopolitical ramifications\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003ePolicy framework findings\u003c/h2\u003e \u003cp\u003eIn the context of health security, as discussed in Labont\u0026eacute;'s(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) framework, this study has recognized the importance stakeholders in Indonesia attach to implementing the Halal vaccine policy. They point out that the policy aims to safeguard public health by ensuring the availability of Halal vaccines and adherence to health standards. They add that it is imperative to prioritize health security to enhance health resilience in Indonesia, as many stakeholders are concerned that the adverse effects of a non-Halal vaccine could decline immunization rates, thereby affecting the nation's long-term resilience.\u003c/p\u003e \u003cp\u003eMoreover, based on our stakeholders' analysis, Indonesia is the only nation globally that enforces mandatory Halal product regulations for legal certainty and prioritizes human security by mitigating the prevalence of 'Vaccine Pockets' resulting from non-Halal vaccines.\u003c/p\u003e \u003cp\u003eThe stakeholders also expressed that while Halal product regulations were not mandatory at first, due to the growing awareness and demand of Muslim consumers in Indonesia concerning the legality of Halal status of products, including vaccines, the Indonesian government has upgraded to mandate the Halal certification for all products and services circulating within the country as a legal requirement. The Halal certification measure aims to ensure legal certainty and firmly safeguard the well-being of citizens. Consequently, the Halal vaccine policy also bolsters Indonesia's national security and health resilience. Therefore, our stakeholders' experiences and views suggest that the government's current commitment to ensuring the community's safety, which covers more than 80% of the Muslim population, is well in line with Labont\u0026eacute;'s call for health security.\u003c/p\u003e \u003cp\u003eThe stakeholders also indicate that implementing the Halal vaccine policy in Indonesia offers significant economic benefits due to its vast market potential, particularly for Indonesia's majority Muslim population and the rapidly growing Muslim community globally. Hence, the target market for the Halal vaccine extends beyond domestic boundaries, encompassing international markets, as Indonesia aims to become the global hub for Halal products. Stakeholders emphasized that the Indonesian government must seize this opportunity to gain recognition as a significant global player in Halal products, despite prioritizing Halal vaccine manufacturing primarily to meet domestic demands. Regulatory frameworks serve as the basis for endorsing and guaranteeing the Halal status of vaccines, thereby facilitating the potential for exporting Halal vaccines to other Muslim nations. Moreover, stakeholders emphasized that focusing on specific target markets, such as the Muslim population within the EU, the Middle East, Africa, Nigeria, and ASEAN countries like Malaysia and Brunei Darussalam, is crucial for international expansion. The advantage of being a member of the OIC and having P.T. Biofarma, a longstanding, trusted pharmaceutical company, as a partner makes the market for Halal vaccines in Muslim and OIC countries much more achievable.\u003c/p\u003e \u003cp\u003eEnhancing the distribution of the Halal vaccine through trade could improve health by fostering global market integration, economic growth, and positive health externalities, as elaborated in Labont\u0026eacute;'s framework.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) As the stakeholders imply, Indonesia is well on its way towards achieving this. Additionally, the stakeholders' perspectives on using the Halal vaccine policy as a trade barrier to balance current trade disparities, which skew benefits toward more economically and politically powerful countries, seem to align with Labont\u0026eacute;'s trade framework.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Regulating Halal vaccines is crucial for enforcing protective trade barriers, ensuring that vaccines from high-income countries (HICs) and foreign pharmaceutical companies comply with the requirements of the Indonesian population. Consequently, LMICs like Indonesia have high confidence in their bargaining power.\u003c/p\u003e \u003cp\u003eStakeholders describe the development of the Halal vaccine policy as aligning with Labont\u0026eacute;'s human rights considerations(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e), where Indonesia's practices can reflect attempts to ensure equitable access to health services. In this study, most stakeholders agreed that the Halal vaccine policy is crucial for protecting the rights of Muslim individuals, especially in countries like Indonesia, which has a Muslim majority population. On the other hand, the HPAA is also inclusive, as it allows non-Halal products or vaccines to enter the Indonesian market, provided their components are explicitly disclosed and labeled. Hence, it will enable non-Muslims to have alternatives and choose vaccines based on safety and efficacy. Stakeholders emphasize that the Indonesian government must ensure routine vaccination programs in primary health care services and also ensure that P.T. Biofarma develops and produces Halal vaccines. Additionally, the Government will invest sufficient funds and ensure vaccine availability, allowing targeted communities to access the vaccines free of charge or at an affordable price.\u003c/p\u003e \u003cp\u003eThe issue of vaccine availability is also a pressing concern, as wealthy nations prioritize vaccine distribution for their citizen, particularly in global emergencies. Labont\u0026eacute;(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e) argued that treating health as a global public good is a strong rationale for advancing GHD and that vaccines are crucial public health commodities. However, developing countries often lack the technological and regulatory capacity, as well as the financing, for vaccine production, resulting in limited equitable access to diagnostic and therapeutic vaccines. Hence, expanding manufacturing capabilities for Halal vaccine production is essential for a comprehensive strategy to fulfill Muslims' rights in Indonesia and globally.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSovereignty as a distinctive feature of Halal vaccine diplomacy.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDuring the interviews, the stakeholders highlighted Indonesia's aspiration to establish itself as a major producer and distributor of Halal products, portraying the health sector as a hub for Halal vaccines. Stakeholders in Indonesia underscore the country's aspiration for national sovereignty and view Halal vaccine products as a manifestation of this sovereignty, given its predominantly Muslim population, and as a means to protect the population from risks associated with foreign vaccine imports. Stakeholders perceive Indonesia's commitment to prioritizing a Halal vaccine policy to assert state sovereignty, reflected in the enactment of the HPAA and its derivative legislation. Stakeholders viewed the drafting of the Halal vaccine roadmap as a strategic move by Indonesia to secure a competitive advantage and establish distinct requirements for Halal vaccines.\u003c/p\u003e \u003cp\u003eReferring to developments in 2008, when Indonesia's Minister of Health officially proclaimed Indonesia's \"Viral Sovereignty\" regarding the Avian Influenza virus(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e), stakeholders praised Indonesia's longstanding history of implementing a policy framework that strongly emphasizes sovereignty, particularly in the area of vaccines. A phenomenon like this can be understood in light of an important aspect of sovereignty, as defined by Mayank and Saxena(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Moreover, the stakeholder examples also align with Colon's (2004) articulation, which states, '\u0026hellip;sovereignty protects the right of people to determine their future, without manipulation or exploitation by outside nations.' Therefore, in line with stakeholders' positions, the Halal vaccine policy could be a constitutional obligation to ensure Indonesian citizens' access to Halal goods while advancing the nation's sovereignty.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eThe Challenges\u003c/h2\u003e \u003cp\u003eIn this study, the stakeholders we interviewed also identified challenges in implementing Halal vaccine R\u0026amp;D. These included an insufficient enabling environment for the availability of Halal laboratories, which hinders progress in Halal vaccine R\u0026amp;D. Additionally, pharmaceutical companies\u0026rsquo; reluctance to engage in Halal vaccine research further complicates implementation. According to our stakeholders, the pharmaceutical industry, particularly the private sector, was hesitant to invest in Halal vaccine R\u0026amp;D, probably because there was no guarantee from the Indonesian government of purchasing their Halal products.\u003c/p\u003e \u003cp\u003eMoreover, researchers and developers in the medical field in the Global South, as the stakeholders asserted, can access and develop novel vaccines that align with the specific health needs of their countries and regions without waiting for \"charity\" from the global community. The Global South must have control and authority over vaccine manufacturing technology and facilities, as well as the products they produce and the recipients they serve, they pointed out. This assertion is in line with what Torreele(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e) discusses when she claims that significant areas of disagreement persist between HICs and LMICs around issues such as R\u0026amp;D, intellectual property rights, technology transfer, and access (to pathogen) and Benefit Sharing (ABS), which historical economic power imbalances influence all these matters.\u003c/p\u003e \u003cp\u003eAccording to stakeholders, discussions among Indonesian researchers on intellectual property rights are rare. Researchers in Indonesia perceive intellectual property rights as an additional benefit, as they already receive a salary and place greater value on the inner satisfaction derived from the potential societal impact of their research. Researchers in Indonesia face obstacles in applying their research findings to industry due to the high costs of intellectual property rights. Our analysis indicates that Indonesian researchers prioritize the novelty of vaccine types over attaining Halal status when considering the relationship between intellectual property rights and Halal vaccine products.\u003c/p\u003e \u003cp\u003eThe absence of globally acknowledged Halal standards, the necessity for mutual recognition agreements, and the complications encountered during emergencies hinder standardization and certification. The stakeholders shared an overview of the differing opinions expressed by the Muslim population in Indonesia and many Islamic nations in the Middle East, like Saudi Arabia, concerning the Halal status of vaccines. Various Muslim communities in Saudi Arabia adopt the opinion that, due to the medical benefits of vaccines and their role in emergencies aimed at preserving human lives, the Halal status of vaccines is not a significant factor in their utilization. In contrast to other nations, stakeholders stated that Indonesia is implementing more rigorous Halal-accepted methods and standards in determining Halal vaccine status. Stakeholders emphasized that MUI\u0026rsquo;s approach aims to ensure meticulous adherence to Halal and Haram rules for products and services; they added that several Muslims in Indonesia maintain that any product consumed or processed by the human body must adhere to Halal standards, including health products such as vaccines.\u003c/p\u003e \u003cp\u003eLastly, concerns about insufficient leadership highlight the significance of political commitment, as global diplomacy on the Halal Vaccine lacks clear statements at the Presidential level. It impedes the achievement of establishing a prominent international presence in Halal Vaccine Diplomacy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eLessons learned during the COVID-19 Pandemic\u003c/h2\u003e \u003cp\u003eThis paper critically analyzes the Halal vaccine policy implemented in Indonesia, with particular emphasis on its application during the COVID-19 pandemic. Stakeholders explained that the Indonesian government established the Merah Putih Vaccine National Consortium, comprising a collective of universities, to address the lack of national vaccine resilience and autonomy during the COVID-19 pandemic. This consortium has now achieved the effective development and finalization of the COVID-19 Halal vaccine products, namely Inavac. Nevertheless, difficulties in forming relationships with pharmaceutical corporations impeded the expansion of vaccine R\u0026amp;D. In addition, P.T. Biotis demonstrated proactive collaboration with UNAIR by implementing the proposed Hexahelix partnership to attain favorable results in launching and administering the Inavac vaccine in Indonesia.\u003c/p\u003e \u003cp\u003eThe study further examines the geopolitical implications of vaccine development during the COVID-19 pandemic, highlighting the increased receptiveness of China, Korea, and South Asian states to accommodate the Indonesian Muslim community's Halal vaccine requirements by producing them in accordance with Indonesian Halal standards. Moreover, stakeholders explained that, due to insufficient vaccine availability, Indonesia had to obtain vaccines from COVAX facilities without complying with the HPAA. Hence, the stakeholders stated that the Indonesian government faced a predicament regarding using vaccines from COVAX facilities due to the absence of their Halal certification.\u003c/p\u003e \u003cp\u003eThe case study highlights the complexities and challenges of developing and deploying the Halal vaccine within the context of Halal vaccine diplomacy and the urgency of responding to a health crisis such as the COVID-19 pandemic. It also sheds light on geopolitical considerations and disparities in vaccine access across regions. Moreover, we found that Indonesia has ample opportunity to develop Halal vaccines through Halal vaccine diplomacy among ASEAN countries and through South-South cooperation, as Indonesia has robust Halal product regulations, not to mention P.T. Biofarma, a pharmaceutical company recognized by the WHO and trusted by most Muslim countries globally.\u003c/p\u003e \u003cp\u003eWe observed that our study has strengths in obtaining diverse perspectives from stakeholders, including the government, religious institutions, academia/researchers, the pharmaceutical industry, the Muslim community, and international institutions. A total of 40 stakeholders, with various levels and roles, is adequate to obtain saturated data. This study significantly contributes to Halal vaccine diplomacy, especially for countries globally with needs and concerns for Halal vaccines.\u003c/p\u003e \u003cp\u003eHowever, like other studies, our research also has limitations: most key informants were from Indonesian national institutions, with only one from an international institution; hence, the global perspectives need further elaboration. Moreover, in this study, we did not incorporate the other religious communities acknowledged by the Indonesian government (Christians, Catholics, Hindus, Buddhists, and Confucians); thus, the different religious perspectives on vaccination policy require further elaboration.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOverall, in the face of multifaceted health issues, the interviews with our stakeholders suggest that Halal vaccine diplomacy strategies are promising for more equitable global health governance while simultaneously enhancing acceptance and access. Vaccine diplomacy efforts, such as those taken on by Indonesia, certainly deserve attention. The Halal vaccine policy implemented by Indonesia signifies an important step in advancing health sovereignty, establishing Indonesia as a key and unique player in Halal vaccine diplomacy, and fostering global health equity by ensuring equitable and proportionate availability of healthcare services while also paralleling with existing literature framework such as protecting public health through solid health security measures, promote economic development, and preserve principles of social justice and human rights. The study also highlights the complex relationship between geopolitical factors and the vaccine development process. Indonesia's efforts to manage the complexity of Halal vaccine diplomacy amid worldwide health emergencies underscore the importance of promoting international cooperation and addressing inequalities in vaccine availability.\u003c/p\u003e \u003cp\u003eThe Halal vaccine policy exemplifies Indonesia's dedication to safeguarding its Muslim population as well. In addition, the research emphasizes the importance of collaborative endeavors, strong, proficient Leadership, and strategic decision-making led by the MoH. Hence, Indonesia would do well to finalize the sustainable Halal vaccine roadmap as a vital contribution to formulating Indonesia\u0026rsquo;s health policy, particularly to become the Halal vaccine hub, while advancing diplomatic practices, including the MoFA as a crucial and strategic collaborator for Halal vaccine diplomacy.\u003c/p\u003e \u003cp\u003eAlthough the study has limitations, the results provide valuable insights into the complexities of Halal vaccine diplomacy in Indonesia and its implications for foreign policy. These findings underscore the need for further research and international cooperation to address emerging health issues effectively. Lastly, the findings of this research offer valuable insights for policymakers and stakeholders who encounter the complexities and potential benefits of engaging in Halal vaccine diplomacy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOIC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Organization of Islamic Cooperation\u003c/p\u003e\n\u003cp\u003eNMRAs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; National Medicines Regulatory Authorities\u003c/p\u003e\n\u003cp\u003eMR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Measles-Rubella\u003c/p\u003e\n\u003cp\u003eWHO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u003c/p\u003e\n\u003cp\u003eUN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; United Nations\u003c/p\u003e\n\u003cp\u003eGHD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Global Health Diplomacy\u003c/p\u003e\n\u003cp\u003ePIP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Pandemic Influenza Preparedness\u003c/p\u003e\n\u003cp\u003eUNICEF\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; United Nations Children\u0026rsquo;s Fund\u003c/p\u003e\n\u003cp\u003eHPAA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Halal Products Assurance Act\u003c/p\u003e\n\u003cp\u003ePD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Presidential Decree\u003c/p\u003e\n\u003cp\u003eMoH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Ministry of Health\u003c/p\u003e\n\u003cp\u003eEU\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; European Union\u003c/p\u003e\n\u003cp\u003eASEAN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Association of Southeast Asian Nations\u003c/p\u003e\n\u003cp\u003eR\u0026amp;D\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Research and Development\u003c/p\u003e\n\u003cp\u003eMoFA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Ministry of Foreign Affairs\u003c/p\u003e\n\u003cp\u003eLPPOM MUI\u0026nbsp;\u0026nbsp; Lembaga Pengkajian Pangan Obat-Obatan dan Kosmetika\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Majelis Ulama Indonesia, or Private Halal Accreditation Institution,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;or Indonesia\u0026rsquo;s Ulama Council Certification Body\u003c/p\u003e\n\u003cp\u003eMUI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Indonesia Ulama Council, or Majelis Ulama Indonesia\u003c/p\u003e\n\u003cp\u003eBPJPH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Badan Penyelenggara Jaminan Produk Halal,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;or The Indonesian Body for Halal Products Assurance\u003c/p\u003e\n\u003cp\u003eMoRA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ministry of Religious Affairs\u003c/p\u003e\n\u003cp\u003eLIPI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Lembaga Ilmu Pengetahuan Indonesia, or The Indonesian Institute of Sciences\u003c/p\u003e\n\u003cp\u003eUNAIR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Universitas Airlangga\u003c/p\u003e\n\u003cp\u003eUI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Universitas Indonesia\u003c/p\u003e\n\u003cp\u003eUGM\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Universitas Gajah Mada\u003c/p\u003e\n\u003cp\u003eITB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Institut Teknologi Bandung\u003c/p\u003e\n\u003cp\u003eUNPAD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Universitas Padjajaran\u003c/p\u003e\n\u003cp\u003eLMICs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low-and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eCOVAX\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; The COVID-19 Vaccines Global Access\u003c/p\u003e\n\u003cp\u003eHICs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; High Income Countries\u003c/p\u003e\n\u003cp\u003eABS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Access and Benefit Sharing\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee from The Faculty of Public Health, University of Indonesia, granted ethical approval for this study (Approval number: Ket-499/UN2.F10.D11/PPM.00.02/2022). Before the interviews, we informed the stakeholders about the study\u0026apos;s inquiry topics and obtained both written and verbal consent. We assured the confidentiality of stakeholders\u0026rsquo; responses, and they retained the right to withdraw from the study at any time without consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to confidentiality/anonymity for the participants/stakeholders but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndonesia Endowment Fund for Education or Lembaga Pengelola Dana Pendidikan (LPDP) (Ref: S-1072/LPDP.4/2019 and LOG-427/LPDP/LPDP.3/2023), supported this study. The funders had no role in conceptualization, study design, data collection, data analysis, decision to publish, or preparation of the manuscript. However, monitoring all stages of the study is necessary to ensure the study process is approved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDTP, AK, and RP: designed the study and played a significant role. DTP: conducted interviews, data collection, and data coding, drafted the manuscript, integrating qualitative insights, analyzing data, and critically interpreting findings. AK: guided content structure and ensured academic rigor in the research process. RP: contributed to revisions, reviewed the manuscript for intellectual content, and formatted the article for publication standards. AK and RP: supervised the study, contributed to the critical interpretation of findings, and reviewed the manuscript for coherence and accuracy. WBA: revise and review the pre-final manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to all the individuals who helped conduct this study, as follows: Wahyu Septiono from Faculty of Public Health, University of Indonesia, and Fury Maulina from Faculty of Medicine, University of Malikussaleh, Indonesia for their insightful feedback, comments, \u0026nbsp;and support on conducting and writing an academic paper on the qualitative research in Indonesia; Widya A Munggaran from Coordinating Ministry for Human Development and Cultural Affairs, Indonesia for her helpful and valuable access to stakeholders in Indonesia, and lastly my research team member Finishia Desela, Frea Petra Maheswari, and Rizki Ahmad Nugraha, for their commitment and dedication to scheduling and technical support when conducting online interviews for data collection, with different time zone from the Netherlands and Indonesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDTP is a West Java-based general dentist practitioner in primary health care and private clinics; she is a civil servant and works at the District Public Health Institution. She also obtained a master\u0026apos;s degree in public health, and when she conducted and wrote this paper, she was a PhD candidate at Maastricht University in the Netherlands. Her research interests include health policy and management, primary health care, global health, and global health diplomacy.\u003c/p\u003e\n\u003cp\u003eAK is a professor in translational ethnography in Global Health and Education in Maastricht; she has worked on a broad palette of topics whose aim is to build a \u0026quot;Critical Anthropology of Globalization and Health,\u0026quot; exploring the co-production of historically and culturally shaped conditions in local communities, contemporary geopolitical trends, and the global economy.\u003c/p\u003e\n\u003cp\u003eRP is a medical doctor, a public health doctor, and a researcher in Global Health. He was a lecturer in Global Health in Maastricht, focusing on the nexus between the health system and its governance, development policy, political economy, and ecological change; he is now research lead in Kuala Lumpur.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWBA is an Indonesian government official and public health policy professor at Universitas Indonesia and an adjunct professor at Tufts University, Boston, USA, and the University of Minnesota, USA. He specializes in managing pandemics and potential pandemic situations at both national and international levels. During the COVID-19 pandemic, he served as a government spokesperson appointed by the President and led the expert panel of the Indonesian National Taskforce. WBA\u0026apos;s collaborative work extends regionally, particularly in Southeast Asia and African countries, where he helps develop and implement One Health programs to prepare for potential pandemics. He is a member of the Technical Advisory Panel (TPA) of the Pandemic Fund for Pandemic Prevention, Preparedness, and Response (PPR) implementation.\u003c/p\u003e\n\u003cp\u003eFinally, the authors were aware of the potential for bias in qualitative investigations, particularly given that the principal researcher (DTP) is from the studied context. As a result, we tailored the study approach accordingly. Nevertheless, although acknowledging the potential risk, the authors considered that the varied membership of their study team would effectively counteract any such bias. AK and RP, who have expertise in Global Health research in the Netherlands, provided a valuable perspective from (Western) Europe on the study design, data processing, and interpretation. By doing this, they successfully refuted any potential misconceptions. Furthermore, as a senior researcher from Indonesia, WBA guided the process by offering vital recommendations based on his expertise in local and cultural dynamics.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Human vaccines \u0026amp; immunotherapeutics. 2012;8(3):293-301.\u003c/li\u003e\n\u003cli\u003eJallad NA. The concepts of al-halal and al-haram in the Arab-Muslim culture: a translational and lexicographical study. Language design: journal of theoretical and experimental linguistics. 2008;10:077-86.\u003c/li\u003e\n\u003cli\u003eReview WP. Muslim Population by Country 2026. [Available from: https://worldpopulationreviewcom/country-rankings/muslim-population-by-country 2026.\u003c/li\u003e\n\u003cli\u003ePronyk P, Sugihantono A, Sitohang V, Moran T, Kadandale S, Muller S, et al. Vaccine hesitancy in Indonesia. The Lancet Planetary Health. 2019;3(3):e114-e5.\u003c/li\u003e\n\u003cli\u003eOktavianus J, Dewi H. When religion prevails: examining religious and mainstream news coverage of measles-rubella vaccination in Indonesia. Public health.219:39-43.\u003c/li\u003e\n\u003cli\u003eHarapan H, Anwar S, Setiawan AM, Sasmono RT, Study AD. Dengue vaccine acceptance and associated factors in Indonesia: A community-based cross-sectional survey in Aceh. Vaccine. 2016;34(32):3670-5.\u003c/li\u003e\n\u003cli\u003eLee K, Smith R. What is \u0026lsquo;Global Health Diplomacy\u0026rsquo;? A Conceptual Review. Global Health Governance. 2011;5(1):1-12.\u003c/li\u003e\n\u003cli\u003eAlmeida C. Global health diplomacy: A theoretical and analytical review. Oxford research encyclopedia of global public health2020.\u003c/li\u003e\n\u003cli\u003eKickbusch I. Global health diplomacy: how foreign policy can influence health. BMJ 2011;342:d3154. 2011.\u003c/li\u003e\n\u003cli\u003eSecretary-General U, General WD. Global Health and Foreign Policy: strategic opportunities and challenges: note/by the Secretary-General A/64/365-EN. [Available from: https://digitallibraryunorg/record/667804?v=pdf. 2009.\u003c/li\u003e\n\u003cli\u003eLabont\u0026eacute; R, Gagnon ML. Framing health and foreign policy: lessons for global health diplomacy. Globalization and health. 2010;6:1-19.\u003c/li\u003e\n\u003cli\u003eKickbusch I, Nikogosian H, Kazatchkine M, K\u0026ouml;k\u0026eacute;ny M. A guide to global health diplomacy: better health\u0026ndash;improved global solidarity\u0026ndash;more equity. 2021.\u003c/li\u003e\n\u003cli\u003eHotez PJ. \u0026ldquo;Vaccine diplomacy\u0026rdquo;: Historical perspectives and future directions. PLoS neglected tropical diseases. 2014;8(6):e2808.\u003c/li\u003e\n\u003cli\u003eSeiff A. Indonesia\u0026apos;s year for global health diplomacy. The Lancet. 2013;382(9889):297.\u003c/li\u003e\n\u003cli\u003eFidler DP. Asia\u0026apos;s participation in global health diplomacy and global health governance. Asian J WTO \u0026amp; Int\u0026apos;l Health L \u0026amp; Pol\u0026apos;y. 2010;5:269.\u003c/li\u003e\n\u003cli\u003eWHO. WHO Pandemic Agreement. [Available from: https://appswhoint/gb/ebwha/pdf_files/WHA78/A78_R1-enpdf. 2025;WHA78.1.\u003c/li\u003e\n\u003cli\u003eHiebert M. Indonesia steps up global health diplomacy. Washington DC: Center for Strategic and International Studies. 2013.\u003c/li\u003e\n\u003cli\u003eBiofarma.co.id. Strengthening Cooperation between Indonesia-Morocco-Tunisia, Indonesia is trusted to assist the Self-Reliance of Vaccine Production in OIC member contries 2018, August 28 [Available from: https://www.biofarma.co.id/en/announcement/detail/perkuat-kerjasama-indonesia-maroko-tunisia-indonesia-dipercaya-untuk-membantu-kemandirian-produksi-vaksin-di-negara-anggota-oki.\u003c/li\u003e\n\u003cli\u003eHakim AL. Dissecting the contents of law in Indonesia on halal product assurance. Indon L Rev. 2015;5:88.\u003c/li\u003e\n\u003cli\u003eNowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: Striving to meet the trustworthiness criteria. International journal of qualitative methods. 2017;16(1):1609406917733847.\u003c/li\u003e\n\u003cli\u003eStevenson MA, Cooper AF. Overcoming constraints of state sovereignty: global health governance in Asia. Third World Quarterly. 2009;30(7):1379-94.\u003c/li\u003e\n\u003cli\u003eMayank V, Saxena N. PHEIC and Global Health Governance: Do Human Rights and Sovereignty Carry Any Value? Indian Journal of Human Development. 2023;17(1):148-64.\u003c/li\u003e\n\u003cli\u003eTorreele E. Tackling vaccine inequity in 2023: have we made progress? Expert Review of Vaccines. 2024;23(1):1-4.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"globalization-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"glah","sideBox":"Learn more about [Globalization and Health](https://globalizationandhealth.biomedcentral.com/)","snPcode":"12992","submissionUrl":"https://submission.nature.com/new-submission/12992/3","title":"Globalization and Health","twitterHandle":"@GHJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Halal, Halal vaccine, Halal vaccine diplomacy, vaccine diplomacy, global health diplomacy, Indonesia, health equity","lastPublishedDoi":"10.21203/rs.3.rs-9409919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9409919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIndonesia, as a major Muslim population worldwide, emerged as a significant initiator and player in Halal-certified vaccine production, highlighting its desire to be a key player in the production and distribution of Halal vaccines, thereby supporting the Islamic population worldwide through the Halal vaccine diplomacy strategy. This study aims to explore the role of key stakeholders in Indonesia in shaping perceptions towards policy and management processes involved in the development of Halal vaccines to position Indonesia as a global actor, specifically to establish the Halal vaccine hub. This study draws on the combined work of Kickbush and Labont\u0026eacute;. This qualitative study, conducted in 2023, used semi-structured online Zoom interviews, maintaining recordings until the researcher reached data saturation. Stakeholders contributed essential themes that emerged through discussion and had the opportunity to enhance, modify, or clarify their perspectives. Moreover, we transcribed the interview verbatim and manually used Microsoft Word. We conducted a manual thematic analysis to analyze the transcriptions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe interviewed forty (40) consenting stakeholders, prominent actors in Indonesia\u0026rsquo;s Halal vaccine development and policy (government, religious institutions, academia/researchers, the pharmaceutical industry, the Muslim community, and international institutions). Three themes emerged from the interviews: 1) The objective of the Halal vaccine policy-Sovereignty, Health Security, Economy, Social Justice and Muslims\u0026rsquo; Rights; 2) The challenges - Research and Development of Halal vaccines, Collaboration, Halal vaccine standardization and certification, Halal status versus emergency, Fatwa from Ulama and different religious schools, Leadership, Solid political will and Commitment; 3) The COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHalal vaccine diplomacy strategies are promising for equitable global health governance while simultaneously enhancing vaccine acceptance and access. The Halal vaccine policy implemented by Indonesia represents an important step in advancing health sovereignty and establishing Indonesia as a key and unique player, despite multifaceted challenges. The Halal vaccine policy not only safeguards Indonesia\u0026rsquo;s majority Muslim population but also fosters global health equity by ensuring the availability of healthcare services, protecting public health, promoting economic development, and preserving the principles of social justice and human rights.\u003c/p\u003e","manuscriptTitle":"Indonesia’s Halal Vaccine Diplomacy: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 00:18:36","doi":"10.21203/rs.3.rs-9409919/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T10:37:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190859622085238021164057838099351653774","date":"2026-05-14T05:51:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118941004734897916321814128761226861654","date":"2026-05-14T00:11:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325415424963520988485040970278935785147","date":"2026-05-13T14:48:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29016246653921188122860278787026429620","date":"2026-05-11T13:09:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-27T09:39:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-19T18:28:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-19T18:28:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Globalization and Health","date":"2026-04-14T03:10:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"globalization-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"glah","sideBox":"Learn more about [Globalization and Health](https://globalizationandhealth.biomedcentral.com/)","snPcode":"12992","submissionUrl":"https://submission.nature.com/new-submission/12992/3","title":"Globalization and Health","twitterHandle":"@GHJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5927f7c-f12f-4727-84cb-1876ca1aee18","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T10:37:50+00:00","index":26,"fulltext":""},{"type":"reviewerAgreed","content":"190859622085238021164057838099351653774","date":"2026-05-14T05:51:00+00:00","index":25,"fulltext":""},{"type":"reviewerAgreed","content":"118941004734897916321814128761226861654","date":"2026-05-14T00:11:15+00:00","index":24,"fulltext":""},{"type":"reviewerAgreed","content":"325415424963520988485040970278935785147","date":"2026-05-13T14:48:29+00:00","index":23,"fulltext":""},{"type":"reviewerAgreed","content":"29016246653921188122860278787026429620","date":"2026-05-11T13:09:08+00:00","index":22,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T00:18:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 00:18:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9409919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9409919","identity":"rs-9409919","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}