The HEALTH | March-April. 2026

• Even small declines in vaccination rates can reopen the door to diseases once under control, putting entire communities- especially the vulnerable- at risk.

• Concerns about halal status, combined with the rapid spread of unverified information, continue to influence decisions despite strong scientific and religious support for vaccination.

• Beyond individual protection, immunisation safeguards society. In both public health and Islamic principles, preserving life and preventing harm take precedence.

BY NUR FASIHAH MD TASIDE

BY YUMI ZUHANIS HAS-YUN HASHIM

International Institute for Halal Research and Training( INHART) International Islamic University Malaysia

With recent advancements, combination vaccines such as the hexavalent vaccine have been introduced to improve efficiency, reduce the number of injections, and enhance protection( Gavi, 2025; Sabin Vaccine Institute, 2025).

Despite these developments, vaccine hesitancy continues to emerge among certain segments of society, including within Muslim communities. Concerns regarding the halal status of vaccines, particularly those involving complex manufacturing processes or potential non-halal-derived components, have led some parents to delay or refuse immunisation for their children.

While these concerns stem from a desire to uphold religious principles, they raise an important public health question: what happens when individuals refuse vaccines that are part of a national programme designed to protect the entire population?

This issue is not merely a matter of personal choice. Vaccination plays a critical role in maintaining herd immunity, which protects not only vaccinated individuals but also vulnerable members of society who cannot be immunised( World Health Organization, 2023).

When participation in the NIP declines due to hesitancy, the consequences can extend far beyond individual households, affecting the safety and wellbeing of the broader community.

NATIONAL IMMUNISATION PROGRAMME

The National Immunisation Programme( NIP) in Malaysia is designed to provide systematic and comprehensive protection against vaccine-preventable diseases. It ensures that children receive scheduled vaccinations at key developmental stages, thereby building immunity early in life.

One of the significant advancements in vaccination is the introduction of combination vaccines such as the hexavalent vaccine. This vaccine protects against six diseases in a single injection: diphtheria, tetanus, pertussis( whooping cough), hepatitis B, poliomyelitis, and Haemophilus influenzae type b( Hib).

By combining multiple antigens into one formulation, the hexavalent vaccine reduces the number of injections required, making immunisation more efficient and less stressful for children and parents( Sabin Vaccine Institute, 2025).

According to global health organisations, hexavalent vaccines have shown to be safe, effective, and beneficial for improving vaccination coverage( World Health Organisation, 2005).

It simplifies immunisation schedules and increases compliance, which is crucial for maintaining high levels of

" Vaccination remains one of the most effective and life-saving public health interventions in modern medicine. "

protection within the population( Gavi, 2025).

Furthermore, international initiatives have supported the adoption of hexavalent vaccines in national programmes worldwide, recognising their role in strengthening immunisation systems and preventing disease outbreaks( World Health Organisation Regional Office for Africa, 2025). Why vaccine hesitancy persists? Vaccine hesitancy is defined as the delay in acceptance or refusal of vaccines despite the availability of vaccination services( MacDonald & SAGE Working Group on Vaccine Hesitancy, 2015). Vaccine hesitancy is present across the population. Among Muslim communities, one of the primary drivers of hesitancy is concern over the halal status of vaccines.

Some vaccines involve ingredients or processes that raise questions about permissibility, such as the use of stabilisers or culture media derived from non-halal sources. Even when these components undergo transformation or are present in negligible amounts, uncertainty can lead to doubt and avoidance.

In addition to religious concerns, misinformation plays a significant role. The rapid spread of unverified information through social media has contributed to fears regarding vaccine safety, side effects, and long-term health impacts( MacDonald & SAGE Working Group on Vaccine Hesitancy, 2015).

This misinformation can overshadow scientific evidence and confuse parents.

Another contributing factor is the perception that vaccines are no longer necessary, given that many infectious diseases are now rare. This misunderstanding fails to recognise that the decline in these diseases is largely due to successful vaccination programmes( World Health Organisation, 2023). Without continued immunisation, these diseases can re-emerge.

Islamic scholars and institutions have

addressed these concerns by emphasising principles such as darurah( necessity) and maslahah( public interest). When vaccines are essential to prevent harm and protect life, their use is generally considered permissible, even if certain elements raise initial concerns( Shaikh Mohd Saifuddeen et al., 2024).

HERD IMMUNITY

Herd immunity occurs when a large proportion of the population is immunised, reducing the spread of infectious diseases. This creates indirect protection for individuals who cannot be vaccinated, such as newborns or those with weakened immune systems( World Health Organisation, 2023).

However, herd immunity depends on high vaccination coverage. When individuals refuse vaccines, the protective barrier weakens. Even a small decline in immunisation rates can lead to the re-emergence of diseases that were previously under control( World Health Organisation, 2023).