Addressing ethical remedies and trust deficitWritten by Ahmad Badri Abdullah
Vaccination has become a complex and controversial issue among Malaysians, especially Muslims. It has led to hair-splitting disputes involving safety, efficacy and halal matters.
The anti-vaccine movement in the country began as a social campaign that became widespread over social media. Malaysian households were, and are still, being exposed to conflicting messages on immunisation. The spread of information, more often than not misinformation, has dented the government’s public health policies concerning vaccination.
There are at least three main reasons why Muslim parents refuse to vaccinate their children. The first, probably the foremost reason, is that most of them doubt the vaccine’s halal status. Second, they are more convinced that homoeopathic and traditional medicines are safer alternatives. And third, they fear the vaccine’s side effects such as brain damage and autism, which have been widely circulated on social media.
As a consequence, Malaysia, in recent years has been registering a steady increase of vaccine-preventable diseases like measles, pertussis and tetanus. Cases of measles are reported to have increased from 235 in 2014 to 539 in 2015. Pertussis (whooping cough) had increased from 497 in 2014 to 655 cases in 2015 while tetanus cases have doubled in 2015 compared with 12 cases in the previous year.
Conflicting messages on alternative medicine such as homoeopathy and naturopathy have also challenged the public trust. This trust deficit in vaccination needs to be carefully dealt with, otherwise, the growing anti-vaccine trend could dampen the growth of even the nascent halal vaccine market in the country. This is due to the fact that the movement does not merely suspect the halal status of the vaccines but involves a total rejection of vaccination as a valid healthcare option.
To address these challenges, it is proposed that immunisation be viewed beyond the confines of epidemiological and economic analyses, and include other factors such as social and religious dimensions.
The nature of multiple interactions of different actors needs to be considered. In this perspective, the government — especially the public health department — is not the sole actor and proponent of public health. Broader societal forces like the social network and household decisions need to be carefully observed as well.
An anti-vaccine movement in the country can cause a trust deficit on both vaccination and government health policies. Public trust is a critical element in the success of any public health programme. However, in the Malaysian context, it tends to be driven by a top-down approach.
The governance of vaccination, for instance, is often seen as a top-down approach to maintain control. Therefore, there are limited efforts and awareness on the importance to gain public trust among the bodies who run the immunisation campaign. Hence, a bottom-up approach is needed to reinstitute trust among the public.
To prevent further decline of public trust of the Malaysian society, proactive actions should be taken by the government and mass media. The government should aim to develop “affective trust” with households through building emotional bonds by way of repeated interaction with them. Also advisable is a rigorous social media campaign to inform the public on the importance of vaccination — one that should preferably be promoted through friendly programmes that involve family, parents and children.
The government should also engage with practitioners of homoeopathy or naturopathy — through roundtable and dialogues. A consensus on public health priorities and programmes, including vaccination, could also be developed. Any form of confrontation should be avoided and issues must be addressed rationally since confrontation will only exacerbate the problem.
It is alarming how intense and divisive the debate between vaccine proponents and its detractors has become. Therefore, it is proposed that Islamic ethics of reasoned disagreement (fiqh al-ikhtilaf) should be the guiding principle in vaccination debates.
The late Professor Taha Jabir AI-Alwani, who authored the book of ikhtilaf, proposed that Islamic ethics of disagreement should encompass the attitude of preserving the brotherhood, unity and avoidance of division among fellow Muslims. Moreover, those who are involved need to remain committed to the truth — it means they are willing to listen to others and stand to be corrected.
Ultimately, intellectual humility is of critical importance in dealing with this contentious issue.
The writer is a research fellow at the International Institute of Advanced Islamic Studies (IAIS) Malaysia.
Published in: New Straits Times, Wednesday 20 February 2019