It looks like the porcine conundrum is making its rounds yet again.

http://www.freemalaysiatoday.com/category/nation/2017/07/24/medical-practitioners-affected-by-halal-debate-over-vaccination/

Suffice to begin the narrative by quoting a verse each from the Quran and the Hadiths which sums up the compassionate and humane nature of Islam.

Allah SWT says in Surah Al-Hajj 22:78: “And strive for Allah with the striving due to Him. He has chosen you and has not placed upon you in the religion any difficulty.”

And an authentic tradition narrated by Aisha (RA): “If given an option between 2 actions, the Prophet (SAW) would surely choose the easier one, as long as it is not sinful.” (Bukhari & Muslim)

And we firmly believe this spirit and approach pervades the corpus of the jurisprudence of facilitation (Fiqh Taysir). And at no point it time does it blemish the belief nor practise of the faithful because the Muslim scholars have anticipated these challenges of modernity and have reiterated, “Allah will bless the believer who recognises and engages with the new world, yet remains true to his religious values.”

History will testify that the Muslim scientists dominated virtually all aspects of knowledge and research from 600 – 1700 AD. Az-Zahrawi (930-1013 AD) the father of modern surgery was pioneering new surgical instrumentations when Europe was restricted by a religious edict in 1163 AD which instructed as follows; “All forms of surgery must be stopped in all medical schools by all surgeons.”

Is it any wonder that Martin Kramer, an American Historian wrote; “Had there been Nobel Prizes in 1000, they would have gone almost exclusively to Muslims.”

Somehow, the Muslims lost it along the way but the following hadith continues to inspire Muslims to catch up on lost ground and rejuvenate their quest for leadership in the sciences; “A word of wisdom is the lost property of a Muslim. He should seize it wherever he finds it.” (Tirmidhi)

It is in this vein that the contemporary Muslim scholar, Syakh Yusuf al-Qaradhawi has said to the effect; “Two areas of human activities (muamalat) which requires cutting edge edicts (fatwa) are economics and medicine.”

Hence, it is not surprising that the many Councils of Jurisprudence, all over the world, eg European Council of Fatwa & Research (ECFR) chaired by Syakh al-Qaradhawi,  has deliberated profusely on the many issues related to medicine and biotechnology. These Councils like the ECFR were kept informed of the latest and best practices in medicine by regular meetings with the likes of the Islamic Organisation of Medical Sciences (IOMS) based in Kuwait.

The issue of the use of substances of porcine origin in food and medicine is an archaic one. Nonetheless, the ECFR has comprehensively dealt with it, when deliberating the permissibility of the use of Oral Polio Vaccine (OPV) which is manufactured using porcine based trypsin. This was published in their 11th Session of the ECFR held from 1-7 July 2003, in Stockholm.

The ECFR argued as follows:

a) what God forbids is the partaking of pork, and trypsin has nothing to do with pork

b) even if we admit that trypsin is forbidden, the amount used in preparing the vaccine is negligible, if one applies the rule that “when the amount of water exceed 2 qullah (216 litres)”, impurities no longer affect it”

c) supposing that trypsin is unclean, it is thoroughly filtered, that it leaves no traces whatsoever in the final vaccine

d) in case the three arguments forwarded are still insufficient, the haram (forbidden) is made permissible in cases of necessity.

In their concluding remarks they emphasized, “The Council urges Muslim leaders and officials at Islamic Centers not to be too strict in such matters that are open to considered opinion and that bring considerable benefits to Muslim children, as long as these matters involve no conflict with any definite text.”

Such is the latitude of rationale and magnanimity of our religious scholars (fuqaha) in addressing the bigger picture of child health, child survival strategies and the advocacy of life saving vaccines.

Rotavirus is the leading cause of severe and fatal diarrhea in infants and young children. Virtually every child in the world would have been infected with the rotavirus  (RV) by the age of five years. Globally, rotavirus gastroenteritis kills 527,000 (475,000-580,000) children under five and is responsible for millions of hospitalizations and clinic visits each year. Ninety-five percent of rotavirus deaths occur in developing countries in Africa and Asia. Muslim majority countries, Pakistan and Nigeria are 2 of 5 countries which together contribute up to half of the global RV diarrheal deaths in 2008.

The manufacturing process of the two oral vaccines (OPV and RV) are similar, involving the use of minute amounts of trypsin which is later removed by ultra-filtration. Therefore, the pivotal judicial edict of the permissibility of OPV, by the European Council for Research & Fatwa can be similarly applied to the RV vaccine.

RVGE  continues to scourge our youngest and most vulnerable, killing more than 1,200 children under five each day. The human tragedy is that RVGE is a vaccine preventable disease (VPD) and many of these deaths can be averted by universal mass vaccination with the RV vaccine. RV vaccination offers the best protection against severe rotavirus diarrhea, and have been shown to save lives in countries which have incorporated RV vaccines in their National Immunization Program (NIP).

About 90 countries in the world have introduced RV vaccination in their national immunization program (NIP). Muslim countries which have included RV vaccination in their NIP include Pakistan, Morocco, Iraq, Bahrain, Qatar, Yemen, Saudi Arabia, Sudan, United Arab Emirates and Jordan,

The RV vaccine has been in use in Malaysia since 2006. Since it is not part of the Malaysian National Immunization Program (NIP), it is mainly utilized in the private health sector.

A study of under-5 mortality in Malaysia in 2006 showed that there were 1,699 deaths. Deaths due to diarrhea was the number 3 cause of deaths, contributing 83 deaths (4.9%), after congenital anomalies (25.1%) and pneumonia deaths (9.2%). This is unacceptably high for a country moving towards a developed nation status. Many of the developed nations in Europe, US, Canada and Australia have included the RV vaccine in their NIP.

Discharge records from government hospitals showed that the cumulative risk of RV related disease by 5 years of age was 1 in 61 for hospitalizations and 1 in 37 for out-patient clinic visits. The out of pocket cost associated with RVGE admission was estimated at RM 106-799 in 2009,  which was 26% of the studied household income. The mean parental day work loss associated with RVGE admission was 4.8 days. All of these data suggest that the burden of RV disease is considerable and would be a substantial drain on the nation’s health expenditure.

At present there are no other medicines or substances which can act as an alternative to the present two oral RV vaccines. These have been studied in virtually all regions of the world and proved to be effective, safe, cost-effective and are life saving.

It behoves Muslim healthcare providers as well as religious leaders to propagate this information especially its similarity with the polio vaccination program and work to increase the utilization of the RV vaccine generally and specifically its inclusion in the NIP of Malaysia.

Lessons can be learnt from a precedent, an earlier fatwa issued on the use of OPV which is similarly manufactured using trace amounts of porcine trypsin. The European Council of Fatwa and Research (ECFR) chaired by Dr Yusuf al-Qaradawi and consisting of numerous renowned scholars in the Muslim world, when allowing the use of OPV added that; “the hesitation of some parents to have their children immunized with this vaccine (OPV) poses a risk to Muslim children alone. At the same time, it gives an unfavorable image which portrays Muslims as hindering a process that aims to eradicate, with God’s permission, the existence of this disease on earth once and for all. After all, this eradication cannot be complete while there is even one child on earth carrying the virus.”

We have learnt and read fatwas from religious scholars in Malaysia which unlike the ECFR and IOMS et al are individual-centric, random, ill-researched and anecdotal in nature. Their lack of grasp and understanding of the new science have made them ultra-conservative, restrictive and prohibitive in their religious edicts.

The Federation of Islamic Medical Associations (FIMA)  has endeavoured to mainstream evidence based medicine (EBM) of the highest quality and which should henceforth  dictate our best clinical practices. And importantly, it is sanctioned as Shari’ah compliant by the highest authorities of jurisprudential scholarship among Muslim scholars world-wide. This excellent collaboration of the best brains in medicine and jurisprudence has lightened the burden upon the Muslim Ummah (community). It has not only truly embraced the jurisprudence of facilitation (Fiqh Taysir) but also the jurisprudence of realities & priorities (Fiqh Waqi’ah) and the jurisprudence of balance (Fiqh Wasatiyah).

We urge the religious authorities to take cognisance of the invaluable heritage of medical fatwas that is before us and not attempt to reinvent the wheel. They should instead incorporate these shari’ah compliant best clinical practise into the corpus of our nation’s jurisprudence in medicine.

Dato’ Dr Musa Mohd Nordin FRCPCH (UK)

Chairman, Federation of Islamic Medical Associations (FIMA) Advisory Council

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