All but declared dead a few years ago, measles is back in Kyrgyzstan -- and God is largely to blame.
"We live according to Shari'a law," says Bakhtiar Berdikojoev of Ak-Terek, a village in the northern region of Issyk-Kul. "And in our life God orders happiness and sorrow, celebration, death, and risks."
For the father of five, the risks include foregoing vaccinations for his children. His three oldest have been inoculated against only some diseases, and the youngest two have received no vaccinations whatsoever.
In deciding against inoculations Berdikojoev has joined an antivaccine movement that has spurred controversy in the United States -- where dozens of people contracted measles in an outbreak centered on California's Disneyland amusement park-- and is fueling a major measles outbreak in Kyrgyzstan.
The reasoning of Kyrgyz "anti-vaxxers" bears some similarities to their counterparts' in the United States.
Some, like Berdikojoev, seek "healthier" alternatives. "Our predecessors lived quite well without any vaccinations," he argues. "They used herbal treatments and didn't use any chemicals."
Others are conspiratorial, questioning the quality or contents of vaccines, and the motivations of those who provide them. And still others base their conclusions on rumors and bad medical advice spread via the Internet and DVDs.
What sets the anti-vaxxer community apart in Kyrgyzstan, a predominantly Muslim country, is that there is one overarching reason for opting out of inoculations -- religion.
Nearly 70 percent of the 6,400 people who sought vaccination exemptions in 2014 did so on religious grounds, according to the Bishkek-based National Center for Immunization and Disease Prevention. As a result, diseases that were contained or had not been seen in Kyrgyzstan in years are reemerging as a threat to the public health.
Just two years ago, fresh off a 2012 that saw no cases of measles, the Kyrgyz Health Ministry boasted that "children are no longer dying of measles!" But the highly contagious viral disease has returned with a vengeance.
After more than 200 cases were recorded in 2014, more than 3,400 confirmed cases and nearly 1,000 suspected cases have been recorded as of February 5 of this year.
"After the number of parents who refuse to vaccinate their children started increasing the past couple years, we knew that an outbreak was imminent," Center for Immunization and Disease Prevention head Burush Asyqbekova says.
This time it was measles, but she expresses fear that other preventable diseases -- such as tetanus and diphtheria, which she says have not been seen in Kyrgyzstan "in many years" -- could be a source of future outbreaks.
Meningitis and polio -- which broke out in neighboring Tajikistan in 2010 -- are also on the radar, prompting the World Health Organization (WHO) to announce plans to introduce new vaccines to Kyrgyzstan's vaccination schedule in 2015.
Don't Call The Doctor
New vaccines, however, won't help if people won't take them.
In assessing the causes of what it calls a "worrying trend," the WHO attributes the growth of public distrust of vaccines in Kyrgyzstan to "negative media coverage, limited availability of official information on immunization, and increasing popularity of certain anti-immunization religious leaders."
The Kyrgyz Health Ministry, meanwhile, has identified religion as the main factor behind the movement. It notes that the spread of what it calls "antivaccine propaganda" is particularly noticeable in the southern regions of Osh and Jalal-Abad.
One figure touting such views is Niazaly Aripov, the head of the Osh Oblast Muftiat, the region's chief Islamic body. "The problem is in what the vaccines contain. There are doubts," Aripov says. "Vaccines contain special toxic components that affect genetics and lead to infertility after several years. It is not the job of religious servants to eliminate such doubts."
Such views are flourishing as well in the capital, where the majority of measles cases have been recorded. "We all know who rules the world," says father-of-two Almaz Alimbaev. "They use all possible ways to vaccinate people."
The rationale for his vehement opposition to vaccines is a mixture of conspiracy theories, his religious views, and fear of heavy metals and other toxins he says are contained in vaccines. "The vaccine has serum, and as Shari'a law says, the meat and blood of dead animals, pork, and other kind of meats that are not halal [appropriate] are haram [prohibited by Islam]," Alimbaev says.
"You can't find a single word in hadiths or the Koran saying that before the hajj people should be vaccinated," he adds.
Getting The Word Out
Saudi Arabia's Health Ministry sees it otherwise, however. It requires meningitis and seasonal influenza vaccinations for all prospective hajjis, and inoculations for polio, meningitis, and yellow fever for visitors from at-risk countries.
And in Kyrgyzstan, Islamic leaders dismiss the idea that vaccinations are not compatible with their religion. Deputy Mufti of Kyrgyzstan Zamir Rakiev insists the directorate "has never propagated" against vaccines and that it is "not against vaccinations."
"We tell everyone who asks about [vaccinations] to consult with doctors," Rakiev says.
To clarify its position amid the recent measles outbreak, the country's highest Islamic authority, the Kyrgyz Muslim Spiritual Directorate, issued a statement on its website in late January. It said people are "responsible for their own health," adding that "everyone has the right to get vaccinated against various diseases."
Noting the low level of public awareness regarding the quality of vaccines, and suspicion fueled by rumors and online media, it said its religious leaders would contribute to health awareness by regularly discussing disease-prevention issues after Friday Prayers.
As Kyrgyzstan prepares to launch a major measles immunization campaign in March, in which children aged 1 to 6 will receive inoculations, Center for Immunization and Disease Prevention head Asyqbekova is cautiously optimistic. "Now [because of the latest outbreak] parents once again have realized the importance of vaccination and they are bringing their children for vaccination," she says. "Some of those antivaccines parents are bringing their children for vaccinations."
As for those who still refuse vaccinations, she laments, "they are not thinking about the health of their children. I don't know what they are thinking about."
Written by Michael Scollon, based on reporting by RFE/RL's Kyrgyz Service correspondents Gulaiym Ashakeeva and Baktygul Chynybaeva, with additional reporting by Farangis Najibullah