Immunisation from the perspective of Maqasid Shariah

Immunisation

Dr Musa Mohd Nordin

The Maqasid Shariah is the highest objective of the Shariah (Islamic Law). As the true and authentic compass of the entire corpus of Islamic legal prescriptions, the Maqasid Shariah defines the cardinal purposes of the Muslim’s individual, societal, national and global life experiences.

The higher objectives of the Shariah is the promotion of the common good and benefit (jalb al-masalih) and the prevention and protection from harm (dar´ al-mafasid).

It is these higher objectives of Shariah that dictate the Muslims’ participation in civil society, political governance, health-related programmes and similar activities in their mutual quest for rahmah (mercy), adl (justice) and falah (success)in the worldly life for all mankind.

The success of humans is reflected in the well-being of society, which is nurtured and protected by the comprehensive preservation of the five essentials in human life, namely faith and morality (deen), life (nafs), intellect (‘aql), progeny (nasl) and wealth (mal).

Three of the priorities of the Maqasid Shariah are directly related to health, while the first (faith and morality) and the fifth (wealth) are indirectly but intimately associated.

This implies that in the realm of medicine and healthcare, any health intervention programme must lead towards a healthy and morally upright being, prevent premature and inappropriate deaths, protect from intellectual and physical disabilities, promote safe reproduction, proliferation of the human progeny and is cost-effective.

Allah says in Surah Al-Maidah; 5:32:

“And if anyone saved one life, it would be as if he had saved mankind entirely”

Embodied in the Maqasid Shariah are a few cardinal principles in relation to medicine and healthcare. These include the close interplay on the concept of:

1. Adl wa-Ihsan (justice with fairness and mercy);
2. Islah (continuous transformation towards the society’s well-being);
3. La Darara wala Dirara (non-maleficence and beneficence);
4. Amanah (individual autonomy) and Maslahah Ammah (public interest and benefits).

1. Adl wa-Ihsan

Justice with fairness and mercy is reflected in the Quranic message that orders both adl and ihsan to be executed in tandem in all aspects of human life. (as written in the Quran 16-90)

“Allah commands doing justice, doing good to others, and giving to near relatives, and He forbids indecency, wickedness, and rebellion: He admonishes you so that you may take heed.”

The World Health Organization’s (WHO) Expanded Programme of Immunisation (EPI) is a relatively inexpensive intervention but yet a powerful equaliser of the inequities that exists between children the world over.

Towards addressing equity in global child health, if all of the basic vaccines in the EPI programme (eg. DTP-IPV-Hib, MMR, TB) and more of the newer vaccines (Rotavirus and Pneumococcal) are made available to developing countries, there is an opportunity to save more lives and prevent disabilities.

It would contribute towards a 25 percent reduction of the United Nations’ Millennium Development Goal 4 (MDG4) whose endpoint is improving the survival of children and decreasing the Under 5 mortality by 2/3.

2. Islah

The perpetual and unrelenting efforts of man (islah) to combat and conquer the ravages of infectious diseases has been rewarded with the many successes in the global immunisation programme.

Since the advent of the smallpox vaccine in 1796, the world has since witnessed the eradication of this deadly and debilitating disease in 1980. The world is now virtually free of polio, which is presently endemic in only two countries in the world.

WHO is now up-scaling strategies towards the elimination of both measles (M) and rubella (R) with their successful MR immunisation program.

This transformation (islah) towards the eventual eradication and elimination of vaccine preventable diseases (VPD) via the global Expanded Programme of Immunisation (EPI) is a cardinal principle of the Maqasid Shariah.

So, Muslims who oppose the immunisation programmes need to reconsider their basic premises and arguments or provide their hujjah (evidence) if they still persist otherwise.

Allah says in the Quran, Surah Yusuf, 12:108;

“Say: This is my way; I call to Allah, I and those who follow me being certain, and glory be to Allah, and I am not one of the polytheists.”

3. La Darara wala Dirara

The principle of non-maleficence asserts an obligation not to inflict harm intentionally. The obligation to avoid any kind of harmful actions were indicated by many verses in the Quran. One of the verses read:

“… make not your own hands contribute to (your) destruction…”
(Al-Baqarah: 195)

The Hippocratic oath asserts “first do no harm”. We act in ways that don’t cause needless harm to others, that is we take “due care”.

The principle of beneficence potentially demands more than the principle of non-maleficence, because as health care providers (HCP), we must take positive actions to help others, not merely refrain from harmful acts.

Immunisation satisfies all the pre-requisites of the principle of beneficence because it benefits the general health and welfare of children.

The global burden of Under-5 deaths was 8.8 million in 2008. Muslim countries contributed 40 percent of the Under-5 deaths in the world.

Approximately 2.5 million deaths are prevented and 750,000 children are saved from disabilities every year by the global immunisation programme. Apart from preventing and removing the sources of harm which are the vaccine preventable diseases, immunisation has been shown to improve the IQ and other cognitive functions namely language and mathematics scores.

Any medical intervention is bound to be associated with some degree of risk. The potential adverse effects of immunisation must be carefully weighed against the individual, societal and economic benefits accrued from WHO’s Expanded Programme of Immunisation (EPI).

It is not logical to avoid any form of medical intervention solely to avoid risks. This paradigm of thought is irrational because even doing nothing is associated with risks, namely the increased risk of epidemics and pandemics of diseases, increased and prolonged hospitalisation, increased utilisation of expensive treatment, increased deaths and increased physical and intellectual disabilities.

The benefit risk ratio unequivocally favours immunisation. Our children and our society enjoy monumental benefits (maslahah) compared with the small risks associated with vaccinations. The most common side effects of immunisations which may be considered as “mafsadah” are mild and transient only.

4. Amanah versus Maslahah Ammah

The health care professional may have the greater knowledge of vaccine preventable diseases, of possibilities, risks, treatment, outcomes and the options of prevention with immunisations. Nonetheless, the principle of autonomy (amanah), in usul fiqh (principles of jurisprudence), respects and values the individual (or the parents or legal guardians) as the one who makes the self-defining choices upon which he then acts and for which he is accountable.

This, however, needs to be considered within the context of the wider public interest and benefits. Thus, the principal Islamic legal maxim (al-Qawa’id al-Fiqhiyyah) which stipulates; “the individual right may have to be sacrificed in order to protect the public interest”.

It is in this vein that medical interventions, such as the global immunisation programmes that have been proven to promote and protect the general health and well being of the public have priority over the considerations of the individual interest.

Another important moral consideration is to ensure that the individual choices one makes does not harm others. Those who do not immunize against VPD are at increased risk of being infected. They, therefore, might pass on the infection to others, who may then be harmed.

The omission to vaccinate has obviously impacted negatively on the well being of the public, which would be enough argument for policymakers to impose an obligation to act.

If sufficient numbers of people in a community are immunized, usually in excess of 80 percent, then the protection against vaccine preventable diseases is conferred to virtually all persons in the community. This is known as herd immunity.

This community immunity offers protection to vulnerable segments of the community who cannot be immunized due to various reasons, eg. too young, have cancers, have HIV/AIDS, are on chemotherapy or radiotherapy.

The common good of the community is served which extends beyond the individual. In addition, the community benefits from the economic savings and improved security as a result of the immunisation programmes.

Conclusions

The maqasidic method in looking into issues concerning health represents a comprehensive, holistic and universal approach towards Shariah. Above all, the whole idea of maqasid implies a comprehensive implementation of justice and mercy in the community through the promotion of the common good and benefit (jalb al-masalih) and the prevention and protection from harm (dar´ al-mafasid) towards the preservation and promotion of human well-being.

Through the lenses of Maqasid Shariah, the global Expanded Programme of Immunisation has been shown and proven to be a very safe, effective and cost-saving global child survival strategy. There is an unequivocal maqasidic and moral case in favour of immunisation.

Justice requires that every child should have ready access to routine vaccination against serious childhood diseases and which should be a global priority for all governments and international health agencies.

With the exception of clean drinking water, immunisation is the most powerful public health intervention program.

We should therefore not be gullible nor easily persuaded by various irresponsible groups which misinform in the various media that immunisation is harmful, not effective and not permissible by Shariah.

Dr Musa Mohd Nordin is Chairman of the Federation of Islamic Medical Associations’ Advisory Council.

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