Bioethics Forum Essay

Islamic Ethics, Covid-19 Vaccination, and the Concept of Harm

Vaccine hesitancy is a concern around the world, but negative attitudes among Muslims in particular toward some coronavirus vaccines have been the focus of attention in the media. Some scholars in Asia recently issued fatwa  against the Chinese Covid-19 vaccine. Media coverage has characterized the Muslim world as a hotspot for vaccine hesitancy, but experts point out biases in this coverage and explain the underlying reasons.

The phenomenon of hesitancy among Muslims can be understood through the lens of the religio-ethical discourse, starting with the smallpox vaccine in the 19th century. Studying the interplay of religion and science is essential for understanding, and effectively addressing, this phenomenon and for reconsidering the scope of “harm” as a moral concept.

In 1796, the English physician, Edward Jenner developed the world’s first vaccine to contain the smallpox pandemic. This great news quickly found its way to the other side of the world. It captured the attention of a Baghdad-based Armenian Catholic merchant named Owannis Moradian, known for his thirst for knowledge, passion about following modern scientific advancements, and multilingual proficiency. Moradian was eager to introduce this new vaccine to people living in Baghdad and to spread the culture of vaccination there.

However, his initial attempts failed because of what was called at the time “widespread delusions,” a vaccine hesitancy tied to certain religious beliefs. To overcome this obstacle, Moradian managed to convince the chief mufti of Baghdad to be vaccinated in public in the presence of some luminaries in the city, together with his six children and grandchildren, in addition to Moradian’s own son. This incident encouraged people from different religions to get vaccinated by helping dispel their fears and concerns. Over the next nine years, as many as 5,400 children were vaccinated.

How could Moradian convince the mufti to get his family vaccinated? Again, historical sources are silent about this point, but it is likely that  Moradian’s scientific knowledge about the efficacy of the vaccine was crucial. Getting his own son vaccinated should have been a good sign to the mufti that Moradian is sure about the efficacy of the vaccine. In his comment on Jenner’s vaccine, the prominent Muslim scholar, Rashid Rida, was clear on that point. For Muslim jurists, Rida explained, the ruling of such medical practices should be premised on information provided by trustworthy physicians who have the expertise to examine possible benefits and harms. Available medical knowledge, Rida concluded, showed that this vaccine proved to be beneficial and, thus, should be approved. Furthermore, the success of the vaccine in containing the smallpox pandemic should have been decisive for Moradian to be able to continue his campaign for many years later.

Developing vaccines to contain pandemics has always been linked to the noble aim of reducing or eliminating harm. That is why historical figures like Edward Jenner and Owannis Moradian are remembered. However, the questions and dilemmas triggered by the coronavirus pandemic, and the previous ones, demand a fresh and critical look at what we exactly mean by “harm.”

Because of the dominantly secular tone of modern medicine and of mainstream bioethics, harm is usually measured through scientific tools that calculate health-related harms and benefits to judge the vaccine’s safety and efficacy. For religiously committed people, the scope of harm is much broader. Consuming religiously prohibited material can cause serious harm, namely punishment in the hereafter.

Some fatwas issued by scholars based in Asia advised Muslims not to use the Chinese vaccine, believed to be manufactured with an ingredient derived from pork. But fatwa councils based in the Arab world adopted less strictive positions in this regard. In the United Arab Emirates, the fatwa stated that the developers of the Pfizer and Moderna vaccines stressed that no such religiously controversial materials were used. Even if this were the case, the fatwa added, it is still permissible to use such vaccines because the  pork should have undergone chemical transformation during the manufacturing process and, thus, would not retain its original nature, for which it was prohibited. Religious scholars continue deliberating on whether the pandemic context would make a sufficient ground to tolerate using vaccines containing prohibited substances and, if yes, under which conditions.

On the other hand, the mainstream Islamic discourse also does not pay due attention to moral harms related to cardinal values like justice and compassion. The lengthy fatwas on vaccines hardly touch upon the moral obligation of the developers of these vaccines and governments towards vulnerable groups and poor countries. The WHO Director-General recently warned that “the world is on the brink of a catastrophic moral failure.” Some reports already spoke about hoarding doses of the vaccines by rich countries to the extent that each citizen can be vaccinated five times, although many of the poor countries would only be able to vaccinate one in ten people.

In a message directed to the producing pharmaceutical companies, the Grand Imam of al-Azhar, Ahmad al-Tayyib, called for adopting fair policies motivated by human conscience rather than financial gains so that vulnerable groups, including refugees, will have affordable access to the vaccines. Such stance should also urge rich Muslim-majority countries to take up their moral obligation of helping poor individuals and countries that cannot afford to buy the Covid-19 vaccines. Acting selfishly by hoarding vaccines in the name of national interest or a “me first” slogan cannot be justified by any morally committed person.

Mohammed Ghaly is professor of Islam and Biomedical Ethics at Hamad Bin Khalifa University in Qatar and Editor-in-Chief of the Journal of Islamic Ethics.  Twitter: @IBioethics