Understanding the make-up of vaccines (Picture designed by rawpixel.com/Freepik.com)

Companies are gearing up for the production of halal vaccines to meet demands, but doctors say this may open doors to new problems.

LAST August, doubts over the halal status of the measles-rubella (MR) vaccine led to millions of Indonesian parents rejecting the immunisation for their children.

It happened after the Indonesian Ulama Council (MUI) of Riau raised concerns since the vaccine was not labelled as halal. The council believes the vaccine’s components are derived from porcine sources.

Soon after, the central MUI body in Jakarta issued a fatwa that the MR vaccine is mubah (permitted for Muslims’ use) and that immunisation is permissible until halal vaccine could be produced. But resistance to the vaccine continued.

In Indonesia, rejection to immunisation on religious grounds is still strong, especially in more conservative provinces such as Aceh, Sulawesi, and the Riau Islands.

It has led to a declining rate for measles and rubella vaccination to as low as six per cent in Aceh compared to 60 per cent in Bali.

Given the outcry, Indonesian state-owned pharmaceutical company PT Bio Farma plans on working with MUI to develop halal MR vaccine.


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NOT ALONE

Indonesia is not the only Muslim-majority country facing problems with Muslim parents’ distrust of the halal status of vaccines.

According to the article titled Outbreak of vaccine-preventable diseases in Muslim majority countries published in the Journal of Infection and Public Health, the halal issue is identified as one of the contributing factors in the increase of vaccine-preventable diseases in countries such as Afghanistan, Malaysia and Pakistan.

The article states that has become viral on social media, with people claiming that they are contaminated with deoxyribonucleic acid (DNA) from pigs.

With the demand for halal vaccines, especially in this region, there are initiatives to manufacture them in Malaysia.

Saudi Arabia’s Aljomaih Group, through its subsidiary AJ Pharma Holding, has set up formulation and fill-finish facilities for halal vaccines.

It is expected to deliver the first vaccine by the end of this year. The Group currently produces tetanus, diphtheria, pertussis and tuberculosis vaccines.

Another venture is by Pharmaniaga, which plans to manufacture halal and affordable vaccines for local use and export within the next five years.

The company, through collaboration with Technology Depository Agency (TDA) and India-based Hilleman Laboratories, will produce vaccines for diphtheria and meningitis.

With these efforts to ensure the availability of halal vaccines, it seems the argument to reject vaccination on religious grounds is no longer valid. On paper, this looks like it will lead to higher rate of immunisation coverage among Muslims in Malaysia.

NEW SET OF PROBLEMS

However, it’s not as simple as that. According to medical experts, instead of eliminating one reason for Muslims to reject immunisation, the issue creates a new set of problems.

One is further confusion and misunderstanding about vaccines. More parents will refuse immunisation with existing vaccines, believing they are haram.

Pantai Hospital Kuala Lumpur consultant paeditrician Dr Azam Mohd Nor says the plan to manufacture halal vaccines would certainly spark debate on the status of the current ones. It gives the public the wrong perception on the existing vaccines’ halal-status that has been clarified by the authorities.


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In his opinion, the halal status of the vaccines should not become an issue since in Islam medicines that are effective in treating diseases and will not harm the person, are harus (permissible).

Dr Azam says manufacturing halal vaccines contradicts the policy about the status of existing ones and gives the public the wrong perception.

“Are we saying the current vaccines are not halal? Are these halal vaccines more effective? What will happen when there is shortage of stock? Do we give the so-called non-halal vaccines or do we wait? Are we willing to see children dying of measles, just because we want only halal vaccines?

“We should be very careful when we take this road. It will create anxiety, confusion and poor understanding of the whole situation. When there is a teaching that tells people it is permissible to take vaccine, the question of halal or haram does not exist.”

Dr Azam says it is also a challenge to create halal vaccines because every single source and process must be certified halal. In addition, the production may take years before people can have access to them.

“Parents, who initially were willing to vaccinate their children, will now wait for the halal vaccines. As a result, there could be a higher number of unvaccinated children. Obviously, it defeats the purpose of making sure all children are vaccinated based on the immunisation schedule.”

SPREADING MISCONCEPTION

The Health Ministry has clarified that vaccines administered under the National Immunisation Programme are halal.

The Ministry says it had conducted checks on the vaccines and those containing porcine DNA were not accepted.

In addition, the National Fatwa Council has ruled that vaccination is permissible for the purpose of treatment and prevention, especially if there are no available halal sources or options, and when refusing them will result in greater harm.

Dr Azam says of the vaccines that are available, only rotavirus is created with trypsin, a porcine enzyme.

However, after going through the manufacturing and filtering process, the vaccine no longer contains the enzyme’s DNA.

However, people still believe there are porcine elements in the vaccine because they trust social media and Google more than doctors, he says.


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They spread the misconception of vaccine being haram and create problems when it should not be a problem in the first place. This has caused unnecessary confusion and misinformation.

It is similar to the belief that measles, mumps and rubella vaccine causes autism, although this has been debunked for years with studies and data, says Dr Azam.

“I believe religious bodies will not forbid Muslims from getting the rotavirus vaccine. Muslim parents do ask me about the vaccine and I will tell them the truth. At the same time, I will also tell them the impact if their child does not receive the vaccine, which, unfortunately, is optional.

“Children infected with the virus suffer from diarrhoea, vomitting and severe dehydration. Unvaccinated children are at risk of dying from rotavirus. If we continue to argue about the vaccine’s halal status, more will suffer.

“Ask any Muslim doctor and he will tell you he does not stop giving rotavirus vaccine because it does not contain porcine element and it is permissible.”

PROTECTION FROM HARM

Dr Azam says instead of telling parents there is a choice of halal vaccines, they should be advised to vaccinate their children because it is permissible in Islam to protect them from infectious diseases.

“As a doctor, I am confident in my knowledge that vaccines are permissible. As far as I am concerned, the government has declared the existing vaccines to be halal and I will tell my patients the same thing.

“We should not be affected by the misconception of halal or haram vaccines. It should never be questioned or become a problem.”


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Columbia Asia Hospital Setapak consultant paediatrician Dr Khairul Zaman Omar says there should not be any question about the halal status of vaccines that are administered under the National Immunisation Programme.

“The only issue people have is with the optional vaccines such as rotavirus, chickenpox and pneumococcal. Some people are concerned that these vaccines contain porcine elements. They are cultured with virus in the porcine property but the end product does not contain the property any longer. And there have been various confirmations that they are halal.

“I don’t know why people still don’t believe it. We have been using these vaccines for decades. Why does the issue of halal status only come up now?

“Unfortunately, the influence of social media has led to this confusion. People will still say the vaccines are not halal when they don’t have any supporting facts. In my opinion, parents will just use any excuse not to vaccinate their child and halal status is just one of the excuses.”

As for the halal vaccines that will be produced soon, Dr Khairul says the most important thing is that their efficacy and safety are proven through clinical studies.

“There are so many questions about these halal vaccines such as what types of vaccines they are coming out with, what are the benefits, will more Muslim parents vaccinate their children or will they wait for these vaccines which could take years to develop?

“It will also create havoc at hospitals because there could two sets of vaccines for Muslims and non-Muslims.

“If they are producing vaccines that we have been using, what is the difference? Current vaccines are already halal.”

The National Immunisation Programme protects against 12 major childhood diseases including diphtheria, measles, rubella, mumps, pertussis, polio, Hepatitis B, Haemophilus influenzae type B and tuberculosis. The vaccinations are provided free at all government hospitals and clinics.

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