Why childhood vaccination continues to be a divisive issue in Malaysia

KUALA LUMPUR: Ms Jacinta Lee said she was stricken with auditory processing disorder and attention deficit hyperactivity disorder after receiving her Bacille Calmette Guerin (BCG) vaccine for tuberculosis.

The vaccines currently available in Malaysia are unsafe as they contain elements like mercury and aluminum, which can be toxic and damaging to the body, she said.

“I am in favour of taking safe vaccines, but not in favour of taking unsafe vaccines, the way they are now,” the 45-year old said in an interview with CNA.

“Vaccines don’t give you immunity, your immune system gives you immunity. Everyone already knows how to stay healthy, they just don’t do it,” she added.

Ms Lee’s views and experiences reflect the complexity surrounding the childhood vaccination issue in Malaysia.

On one side of the debate, those against vaccination cite evidence that they may actually harm the body, while containing porcine DNA. They insist that parents should have a right to decide whether their children undergo vaccination.

However, those who are for vaccination note that it does not contravene Islamic teachings. They also highlight that with important vaccines provided free of charge by the government, parents should not hesitate.

These stark divisions are not new, but the issue took centre stage in February following the death of a child in Johor Bahru that was believed to be due to diptheria. The two-year-old boy was not immunised against the disease — and had not received any vaccination since he was born.

Shortly after the incident, five children below the age of four were quarantined in Johor Bahru’s Sultanah Aminah Hospital upon testing positive for diptheria, including the sister of the late boy. All five had prior contact with the victim.

READ: What is diphtheria and how dangerous is it?

The dangers of diptheria in the absence of vaccination was not the only highlight of the situation. Another controversial observation surfaced then: out of the five children who were quarantined, four had previously been vaccinated against the disease.

These developments, coupled with the Malaysian government’s plan to make vaccination compulsory for all children which has encountered some push back, begs the question: can Malaysian society come to a consensus on the issue?

INCREASE IN VACCINE REFUSAL

According to the Chairman of the Technical Committee of Immunise4Life, Dr Zulkifli Ismail, there has been growing resistance against vaccination in Malaysia.

Citing statistics by Malaysia’s Ministry of Health (MOH), he said documented vaccine refusal has been on an upward trajectory between 2013 and 2016.

Dr Zulkifli (Immunise4Life) Dr Zulkifli Ismail. (Photo: Immunise4Life)

Immunise4Life is a community education initiative set up by MOH, the Malaysian Paediatric Association and Malaysian Society of Infectious Diseases and Hemotherapy.

This increase in vaccine refusal did not happen in isolation, as the number of cases for diseases that can be prevented by vaccines has also swelled in recent years. According to MOH figures, there were 1,934 cases of measles in 2018, as compared to merely 195 in 2013.

READ: Spike in number of measles cases in Singapore during first 11 weeks of 2019

Dr Zulkifli said that in Malaysia, a major reason for vaccine resistance is the belief parents have in alternative medicine. “(Based on nationwide MOH data), there is a belief in homeopathy, naturopathy and traditional medicine to a point that parents think these can supersede vaccination,” he said.

Dr Saeng Fisorn from Kuala Lumpur’s Growell Baby and Child Specialist Clinic added: “Some people believe that vaccines interfere with the natural way the body responds to infection and may actually be harmful rather than beneficial.”

Groups and individuals who do not support vaccination insist that their beliefs are not unfounded, and that the facts are everywhere.

Ms Lee cited the example of a study published in the Journal of Travel Medicine, in which it was found that receiving numerous vaccinations at once or within a short period of time can influence the effectiveness of those vaccines, and even lower the immunity that a person has towards some diseases.

“If your immune system is crap, you will not develop antibodies to vaccines anyway. The more vaccines you inject, the weaker your immune system gets,” she said.

measles vaccination The World Health Organization (WHO) recommends a 95 per cent measles vaccination rate to prevent mass hospitalisations and fatalities. (AFP/CHAIDEER MAHYUDDIN)

Those against immunisation also cite anecdotal evidence that vaccines can result in autism.

Mr Chuah Jinren, 45, is among those who reject the idea of compulsory vaccination. He said that his sister was diagnosed with middle functioning Asperger’s syndrome and autism as a result of the measles, mumps and rubella vaccine she received when she was 12.

“With vaccines in their current form, I would avoid them at all costs and ensure I acquire all the necessary exemptions for my future children,” he stated.

The situation is complicated by the fact that presently, there is no affordable or feasible way to test a child for possible allergic reactions to the ingredients in vaccines before administering them.

“Even if there is a way to test for vaccine allergy, this would not be cost-effective. If a person is at a high risk of an allergic reaction to vaccine, or has had an allergic reaction to a previous vaccine, the better way to approach this is to admit the child for a short observation after vaccine administration,” Dr Fisorn explained.

RELIGIOUS BELIEFS

Another reason often cited by those against vaccination is how certain vaccine ingredients are against their religious beliefs.

This is despite official statements from the MOH and the National Fatwa Council that vaccines are Halal.

Ms Nurul Hidayah, 38, is one such parent who has doubts. She says the official assurances are “still insufficient”.

“I have written a few articles which demonstrate that one of the vaccines used in our National Childhood Immunisation Schedule, which is the Measles Rubella vaccine, actually utilises pigs as its source of gelatine and trypsin. This fact has been highlighted by Majlis Ulama Indonesia as well as the Indonesian Health Authority,” she said.

“The selection of vaccines in Malaysia is done merely based on presumptions that it is Halal, and not based on proper consideration and endorsement by Jabatan Kemajuan Islam Malaysia (JAKIM) in ensuring their Halal status,” she further explained.

baby vaccination A doctor vaccinates a baby. (File photo: AFP/Fred Tanneau)

JAKIM’s official statement in 2016, however, said otherwise. The organisation encourages and endorses vaccination as a means of preserving one’s health and protecting the safety and well-being of others, two important principles in Islam.

It even stated that although some vaccines contain ingredients which are usually prohibited by the religion, they should be taken if no other alternatives were available.

Dr Zulkifli concurred with JAKIM’s position. “(The Halal-Haram issue has) been amplified to an extent that they ignore the bigger picture of prevention being better than cure as taught in Islam,” he said.

Those against childhood vaccination also do not know that historically, the Chinese and Muslims in Turkey had already practised inoculation before Edward Jenner introduced it in 1786, he added. 

Dr Zulkifli noted that the reach of messages by the anti-vaccination lobby has been extended by religious parties, who forward the claims to their followers without proper research.

“There are some vaccines that have porcine materials in their processing, but one needs to know the exact methodology to understand how these are removed at the end.”

Deputy Prime Minister Wan Azizah Wan Ismail first announced in early March that the government was considering allowing only children who had been immunised to enrol for school, only to backtrack later and said parents should be free to make their own choices.

READ: Childhood vaccination will not be made compulsory: Malaysia DPM Wan Azizah

Last week, MOH said it has set up a task force to study the viability of mandatory vaccination, and a report is expected to be ready by end of this month.

Lee Boon Chye generic Malaysia Deputy Health Minister Lee Boon Chye. (File photo: Bernama)

“Unlike other countries, anxi-vaxxers in Malaysia do not band together under an organised movement. From the feedback that we gather, anti-vaxxers make up less than one per cent of the total population here,” Deputy Health Minister Lee Boon Chye said in parliament.

‘PARENTS SHOULD DECIDE FATE OF THEIR CHILDREN’

If the government implements compulsory vaccination for all children, it may need to prepare for backlash.

Ms Nurul said such a decision would be disrespectful towards individuals’ rights, adding that parents who want to avoid the possibility of having their children suffer from the unintended effects of vaccines should be allowed to do so.

“Parents – not the government – should be able to decide the fate, health and well-being of their children,” she stated.

While some may also argue that vaccination can be a fairly costly affair, given that different vaccines are required for different diseases, Dr Fisorn clarifies that this is not — and should not be — a reason for parents to avoid vaccinations in Malaysia.

“Most of the important vaccines are available free-of-charge at government health clinics, so cost is definitely not a factor in vaccine refusal,” he explained.

He also reminded parents that losing a child is a devastating affair, highlighting an incident in which a three-year-old boy passed away due to a pneumococcal infection in his lungs. The boy’s mother had previously postponed his vaccination against the disease due to other commitments.

“She then asked us, ‘Doctor, would my son still be alive if I had brought him for the vaccine?’. We all knew the answer to this question, but none of us were able to look her in the face and tell her the heartbreaking truth,” he recounted.

MORE IN-DEPTH ANALYSIS NEEDED?

Although many have chimed in to support mandatory vaccination in Malaysia, with one petition receiving well over 80,000 signatures across the country, those interviewed say more deliberation is needed before the policy is rolled out.

Parents holding child's hand (Photo: Unsplash/Artem Bali)

Dr Fisorn, for one, questions what the impact would be on children who are denied entry into Malaysian public schools for being unvaccinated, given that the right to education is one that should be enjoyed by every child.

“I feel that further in-depth analysis should be carried out before implementing such monumental policies,” he reasoned.

Dr Zulkifli also hoped that the bigger picture is thoroughly considered before implementing this ruling. “We have to be very clear about what the punishment is if refusal occurs,” he said.

“There should also be some compensation in case there are adverse events following immunisation or hypersensitivity to the vaccine.”

Interestingly enough, it is in the latter suggestion that one may begin to see some semblance of an agreement between the two sides of the debate.

Ms Nurul recommended that instead of making vaccination mandatory, the Malaysian government should consider adopting a policy that is similar to the United Kingdom’s Vaccine Damage Payment system, in which those who are damaged permanently by vaccines can obtain financial assistance and other benefits.

Ms Lee believes that such a policy is necessary if the Malaysian government would like vaccination to be better-received by the public.

She proposed that doctors should brief their patients beforehand on how much compensation they or their next-of-kin will receive in the event that adverse events following immunisation occur, and on how this compensation can be claimed.

“Compensation must be automatic and patients should not have to sue because nobody can afford a lawyer after a vaccine injury,” she said.

Is there a chance that Malaysians could eventually arrive at a consensus on the issue?

Dr Zulkifli said it depends on how people try to understand vaccination and obtain a balanced view of the its benefits versus the risks.

“As long as there are anti-vaccination activities that try to derail the efforts of doctors and other healthcare professionals in preventing these diseases, we will not see any improvement in uptake,” he said.