KUALA LUMPUR, Sept 5 — In light of a growing opposition to immunisation, health authorities in Perak have recently announced an unprecedented hardline stance on the issue. 

They are prepared to take legal action against parents who refuse to immunise their children, if the same children contract vaccine-preventable diseases. The parents will be prosecuted for neglecting their children under the Child Act.

It is a bold step, but the question must be asked: how did we get to a situation where state health authorities feel the need to file lawsuits against parents who refuse to give their children the healthcare they need?

Late last month, the Perak Health Department held a public forum to discuss immunisation while educating the public on the need to vaccinate children. 

The numbers, which were released at the forum, were alarming.

From January to June this year, Perak recorded 246 cases of vaccine rejection from parents — double the amount that was recorded in the same period last year. 

This included 158 cases reported in health clinics and rural clinics, 76 cases from hospitals and 12 cases reported by school health teams.

Among the reasons given by the parents were confusion about the halal status of the vaccines, a fear of possible side effects and a preference for alternative medicine.

Side effects

During the forum, Raja Permaisuri Bainun Hospital Paediatric Department head and senior consultant paediatrician Datuk Dr Amar Singh said that side effects did exist but were not as bad as many thought.

"There are side effects to everything. The side effects to vaccination are mild if they happen but they are in no way comparable to the consequence of contracting the actual disease.”

Dr Amar said it was vital for everyone to be immunised as it increased the herd immunity of a population.

According to an online World Health Organisation bulletin, herd protection of an unvaccinated group of the population takes place when a sufficient proportion of the group is immune.

"Vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccines, retarding transmission,” said the bulletin.

Dr Amar said children who were not vaccinated were susceptible to contract diseases due to their immature immunity.

"Between two and five per cent of the population do not respond to vaccination, so it is important for the 95 to 98 per cent to be immunised. They will help protect the other group.”

Alternative to vaccination?

Some parents who abstain from vaccination do so because they prefer homeopathic medicine as an alternative.

Many believe homeopathic medicine to be a more natural way of building up the body’s immunity against infections and viruses.

But this belief is misplaced. As forum panellist and Malaysian Homeopathy Council president Zainul Azmi Ahmad argues, homeopathy was never meant as an alternative to modern medicine. Instead, he said it is a complementary practise.

"Things like surgery and prevention of infectious diseases are not the in scope of homeopathic medicine, and don’t let any practitioners tell you otherwise.

"There is no such thing as homeopathic vaccinations either,” he said.

Zainul believes that these misconceptions have been spread by people he calls "unethical”, people who contravene the code of ethics held by homoeopathic practitioners.

"The code tells us not to claim that certain medicines can solve health problems without proof and there is no proof that homeopathy can replace vaccinations.” 

The thorny issue of whether or not vaccines are classified as halal is often raised in the national immunisation discourse.

Perak Health Department director Datuk Dr Juita Ghazalie said most of the rejections came from the Malay community who are educated professionals.

However, her department also revealed that there were only two vaccines that do not adhere to halal qualifications — the vaccines for rotavirus and anthrax. Neither are in the Health Ministry’s immunisation schedule.

But the question could be a moot point. Perak Fatwa committee member and forum panellist Asad Awang said Islam allows its believers to choose non-halal immunisations when there is absolutely no other choice available.

"Islam teaches that we should not allow ourselves to be in destruction. When there is a choice between a halal and non-halal vaccine, of course we must choose the former,” he said.

"But if there is no halal vaccine and we are forced to take it (for safety), we can do so, because it becomes necessary.”

Asad said children should be immunised as failing to do so could expose them to communicable diseases that could lead to lifelong disability or death.

"If the public has doubts or questions about this issue from a religious perspective, they should ask those in the know. Refer to the doctors or fatwa committee for the answers,” he said.

"The Health Ministry is under the supervision of the government. We should have some trust in them because they are acting for the welfare of the people.”

Changing the mindset

The Perak Health Department’s decision to take the legal route could be the silver bullet to extinguish the anti-vaccination movement.

However, every stick needs a carrot, and punishment should not be the long-term solution — not as much as education could.

The Perak health authorities are spreading the message through awareness campaigns, Friday prayer sermons, and social media. Forums like the one held last month are definitely the way forward.

As Malaysia is racked by dengue and Zika, it is time for the public to take the initiative and learn more about health issues.

The information is available and accessible and it is up to us to educate ourselves. After all, it is us who will be the ones affected.

The irony of the rise in vaccine-preventable diseases lies in the fact that they are preventable. In this context, it is perhaps appropriate to heed the words of forum panellist Zainul.

"People have a right not to vaccinate their children, but they don’t have the right to infect other people.”