Outbreak of Vaccine-Preventable Diseases in Muslim Majority Countries

"Local governments need to work towards creating awareness among Muslim parents that vaccination is a preventative public health strategy that has been practised and acknowledged by many experts and trusted Muslim doctors."

The increase in Muslim parents' refusal and hesitancy to accept childhood vaccination has been identified as one of the contributing factors to the increase of vaccine-preventable disease (VPD) cases in countries such as Afghanistan, Malaysia, and Pakistan. This brief article examines this phenomenon and makes communication-related recommendations for consideration by health authorities.

The authors are concerned about what they call inaccurate and irresponsible information being spread by the anti-vaccination movement, such as claims that have gone viral on social media that the vaccine is a plot to weaken Muslims. Such misconceptions gained even more traction when a celebrity singer with a huge following in Malaysia and Indonesia openly declared his support for the anti-vaccination stance, posting "Allah is all powerful, vaccines have no power" on social media, reinforcing the suspicion and mistrust of vaccines by parents.

Furthermore, Islamic law (hukm) prohibits the use of medicines or ingredients from haram sources; namely, ingredients containing pig and its derivatives are not permissible. In Muslim-majority countries such as Malaysia, studies have found that the halal (prepared as prescribed by Muslim law) status of vaccine is the most vital factor in considering whether to accept it or not.

In response, the Fatwa Council in Malaysia and internationally have ruled that vaccination is permissible for the purpose of treatment and prevention and that refusing vaccinations will result in greater harm. In addition, the European Council of Fatwa and Research rules that if the amount of porcine sources is insignificant, almost negligible in the vaccine, then it is too small to make any difference. Furthermore, the World Health Organization (WHO) for the Eastern Mediterranean reported that porcine sources have been altered sufficiently into another substance, changed in characteristics, and changed from impure substances into pure substances that are permissible for observant Muslims.

Authorities in some countries have resorted to imposing strict punishments on parents who refuse to allow their children to be vaccinated. For example, in north-west Pakistan, parents have been jailed for refusing to give permission for their children to receive polio vaccines, on charges of endangering public security. However, the authors stress that "mandatory vaccination and punishment are ineffective in encouraging parents to vaccinate their children without extensive public education....Therefore, it is imperative for the relevant authorities to constantly educate the general public in order to promote awareness and to prevent inaccurate information from being spread. Information addressing religious concerns such as the halal issue must be made priority and communicated well to the relevant communities, encouraging not only the acceptance of vaccinations but motivating communities to play an active role in promoting vaccination."

In conclusion: "Although the onus of child vaccination lies on their parents, a concerted effort by all parties, namely the government, civil society and religious leaders (ulama) ought to be made to stop and reverse the current trend of vaccination refusal. Manufacturing of halal vaccine, although is underway, has not materialised. Furthermore, it is unknown in this stage if the proposed manufacturing plan could meet the demand of Muslim population worldwide. Therefore, health authorities in the affected countries need to restore public trust on the importance of vaccine and the health institutions involved with vaccinations."