Efforts to prevent COVID-19 transmission will continue until a national vaccination program is enacted, which is expected to be the most effective way to combat the COVID-19 pandemic. However, vaccination policies remain lax in some places, such as the Madura region, making efforts to create herd immunity slow and challenging. This study used a qualitative descriptive method to collect data using interviews, the COVID-19 task force website, and reliable online sources. Data and information were triangulated to improve researchers' comprehension. Then proceed to data reduction, display, and verification to get detailed results and conclusions. According to this study's findings, the immunization policy's efficiency in the Madura region is still low until early September 2021. Several factors contribute to this, including low citizen participation, a lack of socialization intensity and direct involvement of religious and community leaders, public perception of COVID-19, and numerous post-vaccination symptoms that are not addressed immediately by the government and health workers. As a result, developing herd immunity in Madura is challenging if achieved through vaccination. Herd immunity in Madura was developed not by vaccination successes but by more than 70% positive COVID-19 cases based on government and informant data.