Table of Contents
Introduction
In health care, disease prevention is always better than cure. It can not be denied that vaccines have become an important part of preventive medicine because of their success in controlling vaccine-preventable diseases in the developed world. It is estimated that up to three million children are saved every year with vaccination, but three million lives worldwide are lost due to vaccine-preventable diseases. In addition, the efficacy of the vaccine extends beyond the prevention of certain diseases, but they can prevent the development of antibiotic resistance, protect against biological violence, ensure safe travel and mobility, promote economic growth, increase equity, promote peace and prolong life (Awadh et al., 2014).
In Malaysia, the immunization program was introduced in the early 1950s and vaccines were provided free of charge at public health facilities throughout the country. The impressive childhood immunization level is one of the aspects that contributes to the health of children in Malaysia. Despite global success and impact on human health and life expectancy, vaccines are still underdeveloped. One of the main obstacles to childhood immunization is the misconception of parents against immunization.Parents are primarily responsible for making health decisions for their children, their knowledge and practices regarding immunization generally have a major impact on the status of their children’s immunization.
The huge amount of contrasting information on vaccine safety and misinformation on the Internet can negatively affect parents’ decisions(Awadh et al., 2014). According to Naidu (2015), from the data collected at government clinics, the health ministry has revealed that the number of parents who are refusing vaccines for their children nearly tripled, from 470 cases in 2013 to more than 12,000 in 2014. Malaysia has seen increased number of cases of measles, cough and tetanus since the year 2014, although other factors besides the movement against vaccination can contribute to this increment. Some parents in Malaysia cite fears about side effects of vaccine and relationships with autism but among Muslim parents, there is also the belief that the vaccine contains porcine DNA, which makes the vaccine prohibited or’haram’, because the use of pork in Islam is not allowed (Naidu,2015).
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Health Belief and Practice among the Community against Vaccine
Providing high quality care to Muslim patients requires understanding of cultural and spiritual cultural differences. Important differences include diet, simplicity ideas, privacy, contact restrictions and alcohol-taking restrictions. Worldwide, Muslims represent the majority of society, and it remains the fastest growing religion in the world. Islamic faith encompasses several ethnic groups with various views on medical illnesses and treatments. As a result, the care of Muslim patients is a challenge for many non-Muslim health care providers. Islamic faith can influence decision making, family dynamics, practices and health risks, and the use of medical care.
Understanding Islamic beliefs will help health professionals provide adequate medical care in culturally sensitive ways. This can be achieved by understanding religious implications, family perspectives, health, illness, diet, influencing medical problems and privacy. All health professionals must be able to provide a cultural perspective (Attum & Shamoon,2018). It is proven from the statistic that country with majority of muslim population has increased in vaccine preventable diseases like polio, measles, pertussis and tetanus (Ahmed et. al., 2018).
In Malaysia, most parents who refuse to vaccinate their children in 2016 are from Perak, Terengganu and Pahang revealed by the Health Ministry. Parents mostly oppose the vaccine for religious reasons. In the first six months of this year, the ministry has recorded more than 800 cases of parental refusal according to Suner (2017). Most of the parents who refused vaccine for their children are well educated but still refuse because they unsure whether the vaccine is permissible (halal) or prohibited (haram). According to the rumours from the anti-vaccine community, the vaccine contains porcine DNA which is not allowed in Islam. Islam does prohibit the consumption of pork, and we must respect other religion and culture which is being practice by them. The debate on vaccine is prohibited because it contains porcine DNA been the longest debate which has been going on.
However, according to Naidu (2015), the Malaysian government says that no vaccine in its immunization program contains pig’s DNA. In general, as a government and as a policy of the Ministry of Health, they will do everything possible to prevent a vaccine where there are some elements of pork DNA products. According to Ahmed et., al., (2018), there is also a misinterpretation of parents against the use of vaccines. It is viral in social networks with the news that the vaccine is a plan to undermine Muslims, which strengthens the suspicion and mistrust of the vaccine by parents. Some wild speculations even suggest that vaccines are tactics designed to transmit diseases to non-Western communities. Incorrect and irresponsible information dissemination by anti-vaccination movements can lead to more harm than the good of the Muslim community.
However, according to Naidu (2015), the European Fatwa and Research makes it very clear that the vaccine is permitted because, one, not the animal we talk about, it is an enzyme. Two, the quantity used is very small and three, no matter what the source of the pork is filtered so the final product does not contain any pork. There is also a study which was done in 1998 which is saying that MMR vaccine causes autism among the vaccine children but that study was discredited and was pronounced as fake. There is few studies done for almost 20 years which proofs that MMR vaccine doesn’t cause autism and there is no similarities between autism and vaccines but however th(Suner, 2017).
According to Kata(2010), anti- vaccine claimed vaccines are poisonous and cause idiopathic illnesses.they stressed that vaccines contain substances poisonous to humans, including anti-freeze, ether, formaldehyde, mercury, and nanobacteria. Relevant information was not elaborated upon for instance, that the amount of potentially harmful substances in vaccines is not enough to produce toxic effects in humans, or that ether does not refer to the anaesthetic but to a chemical compound.
Illnesses attributed to vaccines included AIDS, asthma, autism, cancers, diabetes, fibromyalgia, leukemia, lupus, Sudden Infant Death Syndrome, and many more but there are no studies showing any link between vaccines and illnesses such as autism were ignored. This included suggest that vaccination weakens the immune system, or that immunity is ineffective because vaccinated individuals still contact diseases (Kata,2010). According to Omer, Salmon, Orenstein, deHart & Halsey (2009), studies also reported the importance of parent’s concerns about vaccine safety when they decided not to get the vaccine.
A parental national survey from 2001 to 2002 showed that although only 1% of respondents considered the vaccine unsafe, the children of these parents were almost three times as likely to be up to date with the recommended vaccine from their children’s parents who think the vaccine is safe. In separate case control studies with national samples, vaccine refusal is associated with a negative perception of vaccine safety and in other case control studies, it is found that despite concerns about the overall safety of their vaccine no different from the parents of the vaccinated children and the parents of the children not provided or not disposed of, more than half of the parents of the cases and controls expressed concerns about the safety of the vaccine to their child’s health care provider.
In addition, parents of under-vaccine or refused vaccine children are more likely to believe that children receive too much vaccine (Omer, Salmon, Orenstein, deHart & Halsey, 2009). However, many anti-vaccination promotes alternative medicine such as herbalism, homeopathy, chiropractics, naturopathy, and acupuncture as superior to vaccination. This was linked to the idea of moving“back to nature”, where natural methods of disease prevention were preferable this included breastfeeding, eating whole foods, and allowing children to experience illnesses naturally because they tended to reject scientific, clinical, and epidemiological studies demonstrating the safety and efficacy of vaccines. Pro-vaccination studies were criticized as unreliable, conducted by those with vested interests in vaccination(Kata, 2010).
Methods to Overcome Anti-Vaccination
According to Omer, Salmon, Orenstein, deHart & Halsey (2009), health care providers play an important role in making parents decisions about immunization. Health care providers are cited by parents, including parents who refuse to vaccinate their children, as the most frequent source of information on vaccination. There is evidence that health care providers have a positive overall impact on parents’ decision making regarding their children’s immunization. In one study, parents who reported that their immunization results were influenced by their child health care provider almost twice as likely to consider a safe vaccine as a parent who said their decision was not influenced by the provider.
In focus group discussions, some uncertain parents about their children’s vaccination are ready to discuss their immunization problem with health care providers and want providers to offer information related to their specific concerns. This finding highlights the important role that doctors can do in explaining the benefits of immunization and addressing parents’ concerns about their risks (Omer, Salmon, Orenstein, deHart & Halsey, 2009). According to Ahmed et., al., (2015), civil society calls for mandatory vaccines in Malaysia, the Ministry of Health should recommend the Ministry of Education to enforce mandatory vaccination for all school age children. Currently, vaccination is not mandatory or need for school admission.
The Ministry of Health should offer a school-based immunization program through a comprehensive school health program with health education, health screening, light disease treatment and dental health services. The proposal will also advance the first and second vaccines against measles, mumps and rubella (MMR) to 12 months and 9 months respectively, from 12 months and seven years. Children in Sabah and Sarawak will receive the first dose of measles vaccine for six months (Sabah) and a vaccine against Japanese encephalitis ten months (Sarawak).
A strong sentence in the 2001 Child Act to parents who reject the vaccine for their children can not effectively enforce if the vaccine is not mandatory. If no mandatory vaccination fails, the prosecutor will face a difficult task to prove the element of neglect of the child in court (Ahmed et., al.,2018). Authorities in some countries have used strict punishments against parents who refuse to allow their children to be injected (Ahmed et., al.,2018). For example, in Australia the ‘No Jab, No Pay’ law, effective January 1, 2016, prevents parents who reject the vaccine from claiming child care benefits and meanwhile, in north western Pakistan, parents have been jailed for refusing permission to their children to get a vaccine against polio, which is accused of endangering public safety but there is no punishment in Malaysia yet.
The Malaysian government issues a press statement where it warns the parents which refuse to give vaccines against their children, putting the health of these children at risk and possibly causing outbreak will be punished. In fact, the Malaysian government considers it a form of child negligence, and it is a punishable offense under the Child Act 2001, and the offender will sentenced to a fine of up to RM20,000 or a jail term of up to 10 years, or both. In fact, parents can expect further penalties over the next few months, as amendments to Section 31 of the Child Act which have been approved by Parliament in May 2016, but pending official publication (Ahmed et., al.,2018).
However, mandatory vaccination and punishment are ineffective in encouraging parents to vaccinate their children without extensive public education. It has been found that the role of media in spreading inaccurate information and against vaccines, especially on websites and social networks, is more powerful than information in favor of vaccination. This groundless ideology has been slowly spread and has been adopted by several Muslim communities around the world. It is therefore important that the relevant authorities always educate the public to raise awareness and prevent information inappropriately disseminated.
Offering religious concern information, because of ‘halal’ problems, must be prioritized and also communicated to relevant societies, nurturing not only the acceptance of the vaccine, but also promoting the community to play an active role in promoting vaccination. Local governments need to work to raise awareness among Muslim parents of vaccination which is a preventive public health strategy that has been practiced and recognized by many trusted experts and Muslim doctors (Ahmed et., al.,2018).
To justify the concern of Muslim parents on the halal vaccine of the state, the National Fatwa and international councils have issued various fatwa to develop vacacination and immunization practice vaccines like for example hepatitis B, measles, cough, diphtheria, tetanus, polio, meningococcal human papilloma virus. While the responsibility for child vaccination lies with parents, you need to make a concerted effort from all quarters, namely the government, civil society and religious leaders (ulama) to stop and reverse the trends during the vaccination rejection
The halal vaccine production, although in progress, has not yet been completed. In addition, it is unknown at this stage whether the proposed planned manufacturing can meet the demands of Muslims worldwide. Therefore, health authorities in affected countries need to restore public confidence about the importance of vaccination and health institutions involved with the vaccine (Ahmed et., al.,2018).
Conclusion
Vaccine rejection not only increases the risk of individual illness but also increases the risk for the whole community. As a result of major advances in reducing disease can be prevented through the vaccine, the memory of various infectious diseases has faded from public awareness and the calculation of the risks appears to have changed in favor of the risk that vaccination is seen in the minds of some parents. The main reasons for vaccine rejection is the parents’ perceptions and concerns about vaccine safety and low levels of concern about the risk of many diseases can be prevented through the vaccine.
However, some cases of exterminated infectious diseases have reappeared due to the existence of anti-vaccine groups. Vaccination preventable diseases have been increased and observed around the world due to refusal to receive vaccines. Some government actions have provide to the need to enforce and more effort to educate the public, especially those who liberated themselves towards better disease prevention with vaccination.
This strategy will cover any activity or program of interaction with the public to transfer information about vaccination and its benefits to the health of the herd community. Everything in this world has the side effect, like even driving car can cause accidents and deaths but that doesn’t stop us from driving, same goes to vaccines. We should focus on the benefit of the vaccine to everyone, as well for the future health of the country.
