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Islamically Permissible Influenza Vaccines Available in the US for 2020-2021 Season

Prepared by Mawlana Dr. Mateen A. Khan, MD and Dr. Ramzan Judge, PharmD

Summary

Permissible influenza vaccines in the US for 2020-2021 season

  • FluadTM Trivalent
  • FluadTM Quadrivalent
  • Fluzone High-DoseTM Quadrivalent
  • AfluriaTM
  • FluarixTM
  • FluLavalTM
  • FluzoneTM Quadrivalent

Impermissible influenza vaccines in the US for 2020-2021 season

  • FlublokTM
  • FluMistTM
  • FlucelvaxTM

Discussion

Background on Influenza

Influenza (commonly known as the flu) is a seasonal viral illness carrying significant health, economic, and social burden. For the past nine years, the Centers for Disease Control and Prevention (CDC) estimates that every year 9.3-49 million symptomatic illnesses, 4.3-23 million medical visits, 140,000-960,000 hospitalizations, and 12,000-79,000 deaths are attributed to seasonal influenza. For the 2017-2018 season, which was considered high severity, a study estimated influenza vaccination prevented:

  • 7.1 million illnesses
  • 3.7 million medical visits
  • 109,000 hospitalizations (10% of expected overall and 41% among young children)
  • 8,000 deaths[i]

In addition to providing immunity to healthy individuals, the vaccine benefits the sick by decreasing the amount of exposure from other individuals (herd immunity). Hence, the CDC, along with most American medical organizations, recommends that every person above six months old receive a seasonal influenza vaccine yearly.[ii]

Improving vaccination rates among Muslims has been a struggle. Muslim majority countries find their populations hesitant. [iii] Similar issues are faced among Muslim minority populations in the West over a concern for the presence of impermissible ingredients in the vaccine.[iv]

The United States currently offers nine different commercially prepared vaccines. We reviewed package inserts and public records for the vaccines to evaluate methods of production and the presence of impermissible products. When necessary, we corresponded with the manufacturers. The results are compiled in Table 1. The vaccines vary in their methods of production and ingredients, which may pose religious challenges for Muslims.

Issue #1 – Methods of Production

Influenza vaccines are prepared through three different processes. Most strains are prepared through an egg-based manufacturing process. This involves injecting vaccine viruses into fertilized chicken eggs. Essentially, the egg is commandeered as a factory by the viruses as they use the egg’s resources to replicate themselves. The viruses are extracted and purified.[v] Islamically, this process per se is not an issue as eggs are considered permissible.

Flucelvax™, a product by Seqirus, is made by incubating influenza viruses in a particular animal cell line, Madin-Darby Canine Kidney (MDCK).[vi] The MDCK cell line was initially isolated in 1958 from an adult Cocker Spaniel dog.[vii] Dogs, like all predators, are ḥarām as Sayyidunā Ibn `Abbās (May Allah be pleased with him) narrated that Allah’s Messenger ﷺ prohibited every predator possessing canine teeth.[viii] Further, when cells like MDCK are removed from an animal, they are considered maytah (carrion) in Islamic terminology. The Prophet ﷺ informed us, “Whatever is cut from an animal while it is alive is carrion.”[ix] Surah al-An`ām states a ruling of najis and arām for carrion.

“Say, “I do not find, in what has been revealed to me, anything prohibited for anyone who eats it, unless it be carrion or blood that pours forth, or flesh of swine – because it is impure.”[x]

Hence, the initially harvested canine cells were najis and ḥarām. Since 1958, the cell line has undergone countless replication cycles in artificial environments, and the parent cells have long died off. Still, being the progeny cells, they will be impure and impermissible.

The MDCK cells used in Flucelvax™ are grown in a medium in which no human or animal-derived materials are used.[xi] After an incubation period, the cells are processed through lysis, and the virus proteins undergo extraction and purification. Despite this, residual amounts of the cells capable of inducing allergic reaction in susceptible patients remain, per the package insert. For these reasons, Flucelvax™ vaccine made from this method is impermissible.

FlublokTM manufactured by Sanofi, is produced by genetically engineering proteins expressed by influenza into an alternate virus, baculovirus (Autographa californica). It is then used to infect an insect cell line (ExpresSF+) derived from the fall armyworm (Spodoptera frugiperda), which produces the desired influenza proteins. This vaccine is especially valuable to those who have severe allergies to eggs. [xii] Insects, like the armyworm, fall into the category of al-khabā’ith explicitly mentioned in the Qur’an as arām in Surah al-A`rāf.

[He ﷺ] makes unlawful for them impure things (al-khabā’ith).[xiii]

Similar to animal cell lines discussed previously, the progeny ExpresSF+ cells are impure and impermissible. Hence, FlublokTM vaccine made from this method is also impermissible.

Issue #2 – Porcine Gelatin as a Stabilizer

Two of the vaccines available in the United States, FluMistTM and Flucelvax™, contain porcine gelatin. The gelatin is added as a stabilizer for the viral vaccine protein. Gelatin is hydrolyzed collagen, which is extracted from collagen-containing tissue like skin and bones. At the outset, the Qur’an declares that all porcine parts are najis and ḥarām.

Say, “I do not find, in what has been revealed to me, anything (out of the cattle under discussion) prohibited for anyone who eats it, unless it be carrion or blood that pours forth, or flesh of swine – because it is impure – or there be an animal slaughtered sinfully by invoking on it the name of someone other than Allah. (Surah al-An`ām:145)[xiv]

He has but prohibited for you the carrion, the blood, the flesh of swine and what has been invoked upon with a name other than that of Allah. (Surah al-Naḥl:115)[xv]

In earlier times, gelatin was prepared in homes through a process of cooking, causing the collagen to hydrolyze and break into peptides of varying lengths. Although the process today is commercialized and done through a series of chemical reactions, extraction, and purification, the result is not much different from home preparations. These peptides do not constitute a significant change from the original porcine collagen. Instead, gelatin is just fragmented hydrolyzed collagen. The resulting gelatin is impermissible.[xvi] Hence, FluMistTM and Flucelvax™ are impermissible particularly when other permissible alternatives exist.

Exceptional Cases

If someone is unable to take or obtain one of the permissible influenza vaccines, and they are relatively healthy, they should not take an impermissible vaccine.[xvii] However, if a strong need exists, then they may take those vaccines that are normally impermissible. An example of a strong medical need is when there is a high likelihood (ghalabah al-ann) of significant morbidity or mortality in contracting influenza such as in the very old or patients with pre-existing significant comorbidities. Ideally, the Sharī`ah prefers a competent Muslim physician to determine this need based upon the evidences at hand. The physician should be pious and have a basic understanding of the relevant Sharī`ah rulings.[xviii] Vaccinations mandated by the government, work places, or schools may also constitute a strong need.[xix] In any of these situations, one may take (in order of preference) FlublokTM, FluMistTM, and FlucelvaxTM.

Conclusion

Of the ten commercially available influenza vaccines available in the US for the 2020-2021 season, seven are Islamically permissible: FluadTM Trivalent, FluadTM Quadrivalent, Fluzone High-DoseTM, AfluriaTM, FluarixTM, FluLavalTM, and FluzoneTM Quadrivalent. The Muslim public is advised to avoid FlublokTM, FluMistTM, and FlucelvaxTM.

In exceptional cases, as outlined above, one may take FlublokTM, FluMistTM, and FlucelvaxTM in that order.

Of note, vaccine formulations are subject to change year to year. The research presented here is accurate for the 2020-2021 season.

Table 1: 2020-2021 Influenza Vaccines


[i] Rolfes, M.A. (2019). Effects of Influenza Vaccination in the United States During the 2017–2018 Influenza Season. Clinical Infectious Diseases, ciz075, doi.org/10.1093/cid/ciz075.

[ii] https://www.cdc.gov/flu/prevent/whoshouldvax.htm.

[iii] Ahmed, A. (2018) Outbreak of vaccine-preventable diseases in Muslim majority countries. Journal of Infection and Public Health, 11 (2), 153-155. doi.org/10.1016/j.jiph.2017.09.007

[iv] https://mcb.org.uk/mcb-updates/position-on-flu-vaccines/.

[v] https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm#targetText=The%20most%20common%20way%20that,for%20more%20than%2070%20years.&targetText=For%20flu%20shots%2C%20the%20influenza,and%20virus%20antigen%20is%20purified.

[vi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177469/

[vii] https://en.wikipedia.org/wiki/Madin-Darby_Canine_Kidney_cells#targetText=Madin%2DDarby%20Canine%20Kidney%20(MDCK,as%20responses%20to%20growth%20factors.

[viii] عَنِ ابْنِ عَبَّاسٍ، قَالَ نَهَى رَسُولُ اللَّهِ صلى الله عليه وسلم عَنْ كُلِّ ذِي نَابٍ مِنَ السِّبَاعِ (مسلم 1934)

[ix] مَا قُطِعَ مِنَ الْبَهِيمَةِ وَهِيَ حَيَّةٌ فَهِيَ مَيْتَةٌ (أبو داوود 2858، الترمذي 1480، ابن ماجه 3216)

وَعَلَى هَذَا يَخْرُجُ مَا إذَا قَطَعَ مِنْ أَلْيَةِ الشَّاةِ قِطْعَةً أَوْ مِنْ فَخِذِهَا أَنَّهُ لَا يَحِلُّ الْمُبَانُ وَإِنْ ذُبِحَتْ الشَّاةُ بَعْدَ ذَلِكَ؛ لِأَنَّ حُكْمَ الذَّكَاةِ لَمْ يَثْبُتْ فِي الْجُزْءِ الْمُبَانِ وَقْتَ الْإِبَانَةِ لِانْعِدَامِ ذَكَاةِ الشَّاةِ لِكَوْنِهَا حَيَّةً وَقْتَ الْإِبَانَةِ، وَحَالَ فَوَاتِ الْحَيَاةِ كَانَ الْجُزْءُ مُنْفَصِلًا وَحُكْمُ الذَّكَاةِ لَا يَظْهَرُ فِي الْجُزْءِ الْمُنْفَصِلِ وَرُوِيَ أَنَّ أَهْلَ الْجَاهِلِيَّةِ كَانُوا يَقْطَعُونَ قِطْعَةً مِنْ أَلْيَةِ الشَّاةِ وَمِنْ سَنَامِ الْبَعِيرِ فَيَأْكُلُونَهَا فَلَمَّا بُعِثَ النَّبِيُّ الْمُكَرَّمُ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – نَهَاهُمْ عَنْ ذَلِكَ فَقَالَ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – «مَا أُبِينَ مِنْ الْحَيِّ فَهُوَ مَيِّتٌ» وَالْجُزْءُ الْمَقْطُوعُ مُبَانٌ مِنْ حَيٍّ وَبَائِنٌ مِنْهُ فَيَكُونُ مَيِّتًا وَكَذَلِكَ إذَا قُطِعَ ذَلِكَ مِنْ صَيْدٍ لَمْ يُؤْكَلْ الْمَقْطُوعُ، وَإِنْ مَاتَ الصَّيْدُ بَعْدَ ذَلِكَ لِمَا قُلْنَا. (بدائع الصنائع في ترتيب الشرائع)

[x] قُل لَّا أَجِدُ فِي مَا أُوحِيَ إِلَيَّ مُحَرَّمًا عَلَىٰ طَاعِمٍ يَطْعَمُهُ إِلَّا أَن يَكُونَ مَيْتَةً أَوْ دَمًا مَّسْفُوحًا أَوْ لَحْمَ خِنزِيرٍ فَإِنَّهُ رِجْسٌ أَوْ فِسْقًا أُهِلَّ لِغَيْرِ اللَّـهِ بِهِ

[xi] European Medicines Agency Assessment Report on Flucelvax Tetra. 18 Oct. 2018. Pg. 14.

[xii] Barr, I. G. (2018). Cell culture-derived influenza vaccines in the severe 2017-2018 epidemic season: a step towards improved influenza vaccine effectiveness. NPJ vaccines, 3, 44. doi:10.1038/s41541-018-0079-z

See also https://www.cdc.gov/flu/prevent/egg-allergies.htm for discussion on egg allergies and influenza vaccines.

[xiii] وَيُحَرِّمُ عَلَيْهِمُ الْخَبَائِثَ

(وَأَمَّا) الَّذِي يَعِيشُ فِي الْبَرِّ فَأَنْوَاعٌ ثَلَاثَةٌ: مَا لَيْسَ لَهُ دَمٌ أَصْلًا، وَمَا لَيْسَ لَهُ دَمٌ سَائِلٌ، وَمَا لَهُ دَمٌ سَائِلٌ مِثْلُ الْجَرَادِ وَالزُّنْبُورِ وَالذُّبَابِ وَالْعَنْكَبُوتِ وَالْعَضَّابَةِ وَالْخُنْفُسَاءِ وَالْبُغَاثَةِ وَالْعَقْرَبِ.

وَنَحْوِهَا لَا يَحِلُّ أَكْلُهُ إلَّا الْجَرَادَ خَاصَّةً؛ لِأَنَّهَا مِنْ الْخَبَائِثِ لِاسْتِبْعَادِ الطِّبَاعِ السَّلِيمَةِ إيَّاهَا وَقَدْ قَالَ اللَّهُ تَبَارَكَ وَتَعَالَى {وَيُحَرِّمُ عَلَيْهِمُ الْخَبَائِثَ} [الأعراف: 157] إلَّا أَنَّ الْجَرَادَ خُصَّ مِنْ هَذِهِ الْجُمْلَةِ بِقَوْلِهِ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – «أُحِلَّتْ لَنَا مَيْتَتَانِ» فَبَقِيَ عَلَى ظَاهِرِ الْعُمُومِ. وَكَذَلِكَ مَا لَيْسَ لَهُ دَمٌ سَائِلٌ مِثْلُ الْحَيَّةِ وَالْوَزَغِ وَسَامِّ أَبْرَصَ وَجَمِيعِ الْحَشَرَاتِ وَهَوَامِّ الْأَرْضِ مِنْ الْفَأْرِ وَالْقُرَادِ وَالْقَنَافِذِ وَالضَّبِّ وَالْيَرْبُوعِ وَابْنِ عِرْسٍ وَنَحْوِهَا، وَلَا خِلَافَ فِي حُرْمَةِ هَذِهِ الْأَشْيَاءِ إلَّا فِي الضَّبِّ (بدائع الصنائع في ترتيب الشرائع)

[xiv] قُل لَّا أَجِدُ فِي مَا أُوحِيَ إِلَيَّ مُحَرَّمًا عَلَىٰ طَاعِمٍ يَطْعَمُهُ إِلَّا أَن يَكُونَ مَيْتَةً أَوْ دَمًا مَّسْفُوحًا أَوْ لَحْمَ خِنزِيرٍ فَإِنَّهُ رِجْسٌ أَوْ فِسْقًا أُهِلَّ لِغَيْرِ اللَّـهِ بِهِ

[xv] إِنَّمَا حَرَّمَ عَلَيْكُمُ الْمَيْتَةَ وَالدَّمَ وَلَحْمَ الْخِنزِيرِ وَمَا أُهِلَّ لِغَيْرِ اللَّـهِ بِهِ

[xvi] Respectfully, the minority opinion considering gelatin to have undergone a significant transformation (tabdīl al-mahiyah) rendering its ruling changed seems doubtful for the reasons outlined. This is an extensive discussion. However, with the availability of clearly ḥalāl alternatives, the opinion given in this article is more cautious.

[xvii] The authors are currently unaware of any clinical scenario in which an Islamically permissible vaccine is contraindicated. The CDC recommends egg cultured vaccines even in patients with prior anaphylactic reactions to eggs. (See: https://www.cdc.gov/flu/prevent/egg-allergies.htm) This statement is included as a hypothetical clinical scenario.

[xviii] وَجَوَّزَهُ فِي النِّهَايَةِ بِمُحَرَّمٍ إذَا أَخْبَرَهُ طَبِيبٌ مُسْلِمٌ أَنَّ فِيهِ شِفَاءً وَلَمْ يَجِدْ مُبَاحًا يَقُومُ مَقَامَهُ. قُلْت: وَفِي الْبَزَّازِيَّةِ وَمَعْنَى قَوْلِهِ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – «إنَّ اللَّهَ لَمْ يَجْعَلْ شِفَاءَكُمْ فِيمَا حُرِّمَ عَلَيْكُمْ» نَفْيُ الْحُرْمَةِ عِنْدَ الْعِلْمِ بِالشِّفَاءِ دَلَّ عَلَيْهِ جَوَازُ شُرْبِهِ لِإِزَالَةِ الْعَطَشِ (رد المحتار على الدر المختار)

[xix] Imdād al-Fatāwa Jadīd ma`a Hāshiyah Shabbīr Aḥmad al-Qāsimī, 9:262

Use of Orally Dissolving and Sublingual Medications While Fasting

Question: Do orally dissolving or sublingual medications like ondansetron and lorazepam break the fast? 

Answer:

Bismihi Ta’ala

Orally dissolving tablets (ODT) and sublingual (SL) routes allow for mucosal absorption of medications. This is particularly beneficial in patients with difficulty swallowing (dysphagia). It also bypasses gastric and enteral breakdown and liver first-pass metabolism. The medication must first be diluted into saliva before absorption into the mucosa. The patient must avoid eating, drinking, smoking, and possibly talking to keep the tablet in place to dissolve and give time to transfer from the saliva into the mucosa. This time is variable depending on drug and patient characteristics. 

In the case of ondansetron ODT and lorazepam SL, bioavailability is about 56% and 94% respectively indicating some portion of the drug remains in the saliva. This is likely the case even more so for the delivery (filling) agents. This is also reflected in the package insert administration instructions: 

  • Ondansetron ODT: “Immediately place the Zofran ODT tablet on top of the tongue where it will dissolve in seconds, then swallow with saliva.” 
  • Lorazepam SL: “The sublingual tablet, when placed under the tongue, will dissolve in approximately 20 seconds. The patients should not swallow for at least 2 minutes to allow sufficient time for absorption.” 

If the package insert is followed for Ondansetron ODT and the medication is swallowed, the fast is broken, and it will need to be repeated (qaā). If there was a medical necessity for taking it, there is no penalty (kaffārah). Otherwise, there is a penalty. 

If the package insert is followed for lorazepam SL, it presents us with two scenarios: 

  1. The drug is not necessary while fasting. Taking the medication is impermissible (makrūh taḥrīmī) because the chances of it entering the posterior pharynx is high and thus, unnecessarily risks one’s fast. If one were to take it, one would incur the sin. Additionally, if any portion of saliva or drug is swallowed unintentionally, the fast breaks, and it will need to be repeated (qaḍā’) without a penalty (kaffārah). If it is swallowed intentionally, then a penalty would also be due. 
     
  2. The drug is necessary. Taking the medication via the orally dissolving or sublingual route is permissible. The saliva should not be swallowed, and any traces of the drug should be washed out of the mouth. If any portion of saliva or drug is swallowed either intentionally or unintentionally, the fast breaks, and it will need to be repeated (qaḍā’) without a penalty (kaffārah).

And Allah knows best

Shaykh Mateen Khan, MD

Mufti Adil Farooki, MD

Dr Ramzan Judge, PharmD

Dr Samad Tirmizi, Pharm D

References

Sublingual route for systemic drug delivery, https://doi.org/10.22270/jddt.v8i6-s.2097 

Orally Disintegrating Tablets: A Review, https://doi.org/10.4314/tjpr.v8i2.44525 

Pharmacokinetic Comparison of Sublingual Lorazepam with Intravenous, Intramuscular, and Oral Lorazepam, https://doi.org/10.1002/jps.2600710227 

Efficacy of orally disintegrating ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy, https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.2008.05860.x 

حاشية الطحطاوي على مراقي الفلاح شرح نور الإيضاح، دار الكتب العلمية بيروت، 679 

قوله: “لما فيه من تعريض الصوم للفساد” لأن الجاذبة قوية فلا يؤمن أن تجذب منه شيئا إلى الباطن عناية 

الفتاوى الهندية، دار الفكر، 1:199 

وَكُرِهَ ذَوْقُ شَيْءٍ، وَمَضْغُهُ بِلَا عُذْرٍ كَذَا فِي الْكَنْزِ. وَمِنْ الْعُذْرِ فِي الْأَوَّلِ مَا لَوْ كَانَ زَوْجُ الْمَرْأَةِ وَسَيِّدُهَا سَيِّئَ الْخُلُقِ فَذَاقَتْ الْمَرَقَةَ، وَمِنْ الْعُذْرِ فِي الثَّانِي أَنْ لَا تَجِدَ مَنْ يَمْضُغُ الطَّعَامَ لِصَبِيِّهَا مِنْ حَائِضٍ أَوْ نُفَسَاءَ أَوْ غَيْرِهِمَا مِمَّنْ لَا يَصُومُ، وَلَمْ تَجِدْ طَبِيخًا، وَلَا لَبَنًا حَلِيبًا كَذَا فِي النَّهْرِ الْفَائِقِ وَذَكَرَ فِي التَّجْنِيسِ أَنَّ كَرَاهَةَ الذَّوْقِ فِي صَوْمِ الْفَرْضِ، وَأَمَّا التَّطَوُّعُ فَلَا بَأْسَ كَذَا فِي النِّهَايَةِ. وَيُكْرَهُ لِلصَّائِمِ أَنْ يَذُوقَ الْعَسَلَ أَوْ الدُّهْنَ لِيَعْرِفَ الْجَيِّدَ مِنْ الرَّدِيءِ عِنْدَ الشِّرَاءِ كَذَا فِي فَتَاوَى قَاضِي خَانْ. وَقِيلَ لَا بَأْسَ بِهِ إذَا لَمْ يَجِدْ بُدًّا مِنْ شِرَائِهِ أَوْ يَخَافُ الْغَبْنَ كَذَا فِي الزَّاهِدِيِّ. 

الفتاوى الهندية، دار الفكر، 1:202 

لَوْ أَكَلَ مُكْرَهًا أَوْ مُخْطِئًا عَلَيْهِ الْقَضَاءُ دُونَ الْكَفَّارَةِ كَذَا فِي فَتَاوَى قَاضِي خَانْ. الْمُخْطِئُ هُوَ الذَّاكِرُ لِلصَّوْمِ غَيْرُ الْقَاصِدِ لِلْفِطْرِ إذَا أَكَلَ أَوْ شَرِبَ هَكَذَا فِي النَّهْرِ الْفَائِقِ. وَالنَّاسِي عَكْسُهُ، هَكَذَا فِي النِّهَايَةِ وَالْبَحْرِ الرَّائِقِ. 

الهداية في شرح بداية المبتدي، دار احياء التراث العربي، 1: 122-123 

ولو أكل أو شرب ما يتغذى به أو ما يداوى به فعليه القضاء والكفارة 

ومن كان مريضا في رمضان فخاف إن صام ازداد مرضه أفطر وقضى 

Jadīd Fiqhī Masā’il, 1:128-129 

Kitāb al-Nawāzil, Muftiī Muḥammad Salmān Mansūrpūrī 6:385 

Islamic Permissibility of Tamiflu

Summary:

Muslims should avoid consuming Tamiflu capsules and must instead either use the suspension form or open the capsule and consume the contents of the capsule without ingesting the capsule itself. 

Question:

Are Tamiflu capsules permissible for Muslims to use?

Answer:

Bismihi Ta’ala

Tamiflu, and its generic equivalent oseltamivir, is an influenza neuraminidase inhibitor that is used for the treatment and prevention of influenza infections[i].  The medication is available in capsule and suspension forms. The suspension does not contain any Islamically unlawful ingredients and is therefore permissible for Muslims to use[ii].  The capsule form contains porcine gelatin in the capsule, which is considered Islamically unlawful to consume by most Islamic scholars[iii].   According to Islamic jurisprudence, medications with unlawful ingredients are not permissible to use unless certain conditions are met. A Muslim patient can only use impermissible medication when instructed to do so by an experienced doctor (thereby making him certain that a cure can be expected from the medication), and when an alternative permissible medication is not available[iv].

In the case of Tamiflu capsules, permissible alternatives exits.  As stated above, the suspension form is permissible to use as it lacks unlawful ingredients.  Even if the capsule form has to be used due to lack of availability or tolerance for the suspension, the capsule can be opened and the contents within the capsule can be consumed, thereby avoiding the impermissible pork gelatin used in the capsule.  As per the FDA[v]:

“If liquid Tamiflu is not available and you have capsules that give the right dose (30 mg, 45 mg or 75 mg), you may pull open the Tamiflu capsules and mix the powder with a small amount of sweetened liquid such as regular or sugar-free chocolate syrup. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine.”

Therefore, Muslims should avoid consuming Tamiflu capsules and must instead either use the suspension form or open the capsule and consume the contents of the capsule without ingesting the capsule itself. 

And Allah Knows Best

Mufti Adil Farooki, MD

Approved by Mufti Abdul Muqtadir Sikander


[i] BMJ. 2003;326(7401):1235

[ii] https://www.gene.com/download/pdf/tamiflu_prescribing.pdf

[iii] for a discussion of porcine gelatin, see the following:  https://muslimmed.org/2019/10/29/islamically-permissible-influenza-vaccines-available-in-the-us-for-2019-2020-season/

[iv] For a detailed discussion on medications with unlawful ingredients, see the following: https://muslimmed.org/category/general-articles/medication-with-unlawful-ingredients/

[v] https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tamiflu-consumer-questions-and-answers

Vaccination Against Typhoid/Enteric Fever

Prepared by Mufti Adil Farooki, MD, Shaykh Mateen Khan, MD and Dr. Ramzan Judge, PharmD

Summary:

The injectable vaccine Typhim Vi is permissible for Muslims as a vaccine for typhoid fever and is preferred over oral Vivotif.

Background:

Enteric fever, also known as “typhoid fever”, is a severe systemic illness characterized by fever and abdominal pain caused by the bacteria Salmonella enterica serotype Typhi. Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000 population) and kills an estimated 200,000 people every year[1].

From the CDC[2]:

“People who are actively ill with typhoid fever and people who are carriers of the bacteria that cause typhoid fever can both spread the bacteria to other people.  When someone eats or drinks contaminated food or drink, the bacteria can multiply and spread into the bloodstream, causing typhoid fever.

Typhoid fever can be a life-threatening disease.  Symptoms of infection include persistent high fever, weakness, stomach pain, headache, diarrhea or constipation, cough, and loss of appetite.

People who do not get treatment can continue to have fever for weeks or months. As many as 30% of people who do not get treatment die from complications of typhoid fever. There are fewer antibiotic treatment options as drug-resistant typhoid bacteria has become more common in many parts of the world.

Typhoid fever is common in many regions of the world, including parts of East and Southeast Asia, Africa, the Caribbean, and Central and South America.  Typhoid fever is not common in the United States.”

CDC Indications for Vaccination:

According to the CDC, routine typhoid vaccination is not recommended in the United States, but is recommended for[3]:

  • Travelers to parts of the world where typhoid is common. (NOTE: typhoid vaccine is not 100% effective and is not a substitute for being careful about what you eat or drink.)
  • People in close contact with a typhoid carrier.
  • Laboratory workers who work with Salmonella typhi bacteria.

Vaccines Available in the United States

There are two typhoid vaccines available in the United States: Vivotif, an oral vaccine, and Typhim Vi, an injectable vaccine.

  1. Vivotif[4]
    • Manufacturer: Crucell Switzerland LTD
    • Form: capsule
    • Contains:  Viable S. typhi Ty21a, Non-viable S. typhi Ty21a,sucrose, ascorbic acid, amino acids, lactose, magnesium stearate, bovine gelatin
    • Culture Medium: digest of yeast extract, an acid digest of casein, dextrose and galactose
  2. Typhim Vi[5]
    • Manufacturer: Sanofi Pasteur
    • Form: injection
    • Contains: purified Vi polysaccharide, formaldehyde, phenol, polydimethylsiloxane, disodium phosphate, monosodium phosphate, sodium chloride, sterile water
    • Culture Medium: semi-synthetic medium. Casein derived raw materials are used early in manufacturing during the fermentation process

Discussion and Recommendations:

For Muslims who require typhoid vaccination, the injectable form, Typhim Vi, is permissible to use.  The capsule form, Vivotif, contains bovine gelatin, which is hydrolyzed collagen extracted from collagen-containing tissue like skin and bones. The cows from which this material is derived are not slaughtered in accordance with Islamic law. Due to the difference of opinion regarding bovine gelatin’s permissibility for consumption, it is preferable and more cautious for Muslims to use the injectable form of the vaccine.

From an Islamic perspective, preventing a health threat such as typhoid fever in high-risk patients is considered to be a necessity[6]. People for whom typhoid vaccination is indicated are considered to be at high risk for getting the infection with a significant potential for serious complications[7],  and infections may be difficult to treat due to rising antibiotic resistance[8]. Although the injectable form is preferred, Muslims may use the oral form if the injectable form is not accessible or is contraindicated (due to allergies or hypersensitivity).


[1] J Prev Med Hyg. 2017;58(1):E1–E8.

[2] https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html

[3] ibid

[4] https://www.fda.gov/media/75988/download

[5] https://www.fda.gov/media/75993/download

[6] For further discussion, see https://muslimmed.org/category/vaccines/use-of-vaccines-with-impermissible-ingredients/

[7] N Engl J Med. 1984;310(2):82.

[8] https://www.cdc.gov/typhoid-fever/symptoms.html

An Islamic Basis for the Use of Vaccines with Impermissible Ingredients

Prepared by Mufti Adil Farooki, MD. Approved by Mufti Abdul Muqtadir Sikander

Download PDF

Background on Vaccination

A vaccine is a “product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease”[1]. Vaccination is the process of administrating a vaccine, most commonly by an injection, with the immediate goal of achieving “active immunity” in the recipient of the vaccine.  Active immunity involves the “stimulation of the immune system to produce antigen-specific humoral (antibody) and cellular immunity”, and can last for many years, sometimes even a lifetime[2].   Vaccination benefits the immunized patient directly and also indirectly benefits unimmunized people through “community immunity”.  This occurs when there are enough people who are immune to an infection to decrease the risk of its transmission, and it also protects people who cannot receive vaccines due to young age or other contraindications[3].

Studies have shown that vaccination is one of the most effective preventative health measures.  After routine childhood vaccines were introduced, the number of cases for most vaccine-preventable diseases has dropped by over 90% in the United States[4]. According to statistical models, for children born between 1994 and 2013, it is estimated that routine vaccination will prevent 322 million illnesses, 21 million hospitalizations, and 732,000 deaths over the course of their lifetimes[5].  

Issue: Impermissible Ingredients in Vaccines

Based on the above findings the benefits of vaccination are clear.  In the United States, routine vaccination is required for public-school children in all 50 states, with possible exemptions varying by state.[6] In certain industries such as healthcare, employees are required to receive vaccination for their own protection as well as the protection of patients.   However, many vaccines contain ingredients that are considered impermissible for Muslims to consume, regardless of whether they are ingested or injected. Some examples are porcine gelatin, calf serum and material from growth mediums that include human, chicken, and monkey cells[7]. If a permissible version of a particular vaccine is not available, then a question arises: is it permissible for a Muslim to receive that vaccine, given that he or she does not currently have that disease and is not guaranteed to be infected by it in the future?  

Principle: Necessity Permits the Unlawful

A general principle in Islamic law is that: “الضرورات تبيح المحظورات”, or “necessity permits the forbidden”, to the extent of the need[8].  Preservation of health and safeguarding of possessions are considered to be a necessity (ضرورة), and this includes protection from serious illness and death.  Something that is otherwise unlawful can be allowed to occur when a person fears that his health or possessions would be harmed, even if he does not have absolute certainty the harm will actually occur.  In other words, the expectation of a particular outcome (غلبة الظن) is considered to be sufficient. According to the principles of Islamic law, this “expectation” is simply defined as thinking that an outcome is more likely to occur than not occur. [9]  In other words, if there is greater than a 50% expectation that a particular outcome will occur, then this is considered to be “ غلبة الظن ”.

For example:

  • If a person is sick and (based on his experience or on the advice of a doctor) he expects to get worse if he fasts during Ramadan, he would be excused from fasting that day and can make up the fast after Ramadan.[10] 
  • If a person is sick and he expects (based on his experience or the advice of a doctor) that performing wudu would make his sickness worse or prolong it, he can perform tayammum[11]
  • A person performing salah must break his salah if he fears that a blind person may fall into danger and he is able to prevent that person from falling into harm. [12]
  • A person performing salah can break his salah if he fears that a thief will steal his possessions if he were to remain busy in prayer[13]

The Importance of Avoiding Populational Harm

These examples apply to the preservation of an individual’s health and safeguarding of possessions. In each case, the threat of harm to an individual (ضررخاص) permitted something that is normally unlawful. According to the principles of Islamic law, the preservation of populational health and wealth is even more important and emphasized.  Therefore, avoiding populational harm is given preference to avoiding harm to an individual[14]. There are numerous examples in which something that is otherwise unlawful and causes harm to an individual is allowed or even required to occur in order to preserve the health and wealth of (i.e. prevent harm to) a group of people[15].  This applies even when there is an expectation (غلبة الظن) of some populational harm, not only when the harm is already occurring or is certain to occur.[16]   Examples include:

  • Forcing landowners to create a dam around a river on their property when there is fear that the water will flood and harm other people[17],[18],[19]
  • Putting restrictions on the type of business transactions that a person can engage in when it is feared that he will harm others by his reckless spending habits, cheating or inability to conform with rules of Islamic law[20]
  • Preventing a doctor from practicing or a judge from ruling due to their ineptitude in order to prevent potential harm to others
  • Forcibly taking down the wall of a privately-owned building when the wall is leaning on a public path and there is fear that it will collapse onto the path and harm people[21]
  • Forcibly selling the possessions of a person in debt in order to avoid continued harm to those whom he owes money [22]
  • Forcibly selling the food of a person who is hoarding it in times of famine in order to aid the general population, even if he refuses to sell it[23]

Application of these Principles to Vaccination

The examples above illustrate the following principles of Islamic law:

  1. Necessity permits the unlawful, to the extent of the need
  2. Preservation of health is considered to be a necessity, therefore avoiding serious threats to health is also considered to be a necessity
  3. An expectation of harm is sufficient to be considered as a threat to health, defined as being more likely than not that the harm would occur (greater than 50% expectation).
  4. Based on #2 and #3, an expectation of harm can be considered necessary to avoid and therefore can allow for the unlawful to be permitted when there is no permissible alternative
  5. The preservation of populational health is emphasized more than the preservation of individual health

Based on these principles, we have seen that in order to prevent a potential harm to the larger population (ضرر عام), a subset of the population is subjected to something that is normally unlawful (ضرر خاص).  These principles can be applied to determine if Muslims can use vaccines when there is only an impermissible version of the vaccine available.  If it is determined that a necessity (ضرورة) exists, then this vaccine would be administered to a portion of the population in order to prevent harm (in terms of morbidity/mortality) to the general population.  In other words, something that is unlawful and involves consumption of impermissible ingredients (ضرر خاص) would be permitted to be used in order to prevent harm to the greater population (ضرر عام) if necessity is established.  

Also, as in the examples discussed, there is an expectation (غلبة الظن) that the harm will occur, but not certainty.  This expectation of harm is based on the known epidemiology of the infection and on clinical trials.  And as in the examples above, the use of something that is unlawful is only allowed to the extent of the need.  In the case of vaccination, if a version of the vaccine with permissible ingredients becomes available, then it would no longer be necessary to use versions with impermissible ingredients to achieve immunization. In that case, Muslims would be required to only use the version with permissible ingredients. This is in line with rulings given by contemporary Islamic scholars stating that vaccines with impermissible ingredients can be used when there is no permissible alternative if there is a need to use the vaccine. 

Variables to Consider for an Infectious Disease and its Vaccine

In order to apply these principles to an infectious disease, it is necessary to establish that there is a necessity (ضرورة) to be immunized from it. Multiple variables need to be considered in order to establish this, such as:

  • Morbidity and Mortality

This data needs to be analyzed in order to understand the level of necessity (ضرورة)  for immunization from that infection.  The examples discussed earlier do not mention a specific number of people that need to be saved from death or illness, but rather stress the importance of preventing harm to a group of people.  In these examples, only a small group of people was threatened compared to the general population, such as in the case of a structure being removed if an unstable wall threatens people passing by, and this was still considered to be potential populational harm (ضرر عام).   In the case of infectious diseases, medical data needs to show that there is a significant impact on the morbidity and mortality of the population, such as serious illness requiring hospitalization or resulting in death.

  • Population-Specific Data

The level of risk to the general vs specific populations needs to be analyzed.  In some cases, the level of morbidity and mortality may not affect a significant proportion of the general population but may be higher in a subset of the population. An example would be the pneumococcal vaccine for adults, which is recommended for ages 65 and above and those with certain chronic medical conditions[24].  In these subsets of the population, there is a greater prevalence of and risk of complications from the infection compared to healthy adults under 65.  Therefore, the data may show that necessity (ضرورة)  for the vaccine is limited to a subset of the population. 

  • Effectiveness of the Vaccine

Data on the impact of the vaccine on reducing the morbidity and mortality of an infection needs to be analyzed.  In the examples we have discussed, an unlawful action can be allowed due to necessity only because it is expected to prevent a harm.  For this to apply to a vaccine, data needs to support that there is a significant decrease in the morbidity or mortality from the infection that is immunized against.

Example: Data for Routine Childhood Vaccinations

Routine childhood vaccination under the “Vaccines for Children” program began in 1993 and initially included vaccines for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b disease, hepatitis B, measles, mumps, and rubella. Five additional vaccines were later added to the program: influenza, hepatitis A, varicella, pneumococcal disease, rotavirus.  The program provides cost-free vaccines to children in the United States who lack health insurance or are otherwise unable to pay for vaccines[25].  Data was analyzed for vaccines administered through this program, and as mentioned above, statistical models estimate that for children born between 1994 and 2013, 21 million hospitalizations and 732,000 deaths will be prevented during their lifetimes.  Data for each individual infection is presented in the table below, with cases measured in the thousands:

(Click image to enlarge. Table is reproduced from MMWR 2014 Apr;63(16):352-5.)

Applying the principles discussed earlier, we first need to establish that there is a necessity (ضرورة) for immunization from diseases for which vaccination with impermissible ingredients is being considered.  As stated above, this can be established by data on morbidity and mortality, both of which can be derived from the table above.  Serious illness requiring hospitalization and deaths represent morbidity and mortality from these infections that would be expected to occur (غلبة الظن) if the vaccine was not administered. 

We also need to establish that the vaccine is effective in removing the expected harm from the infection.   The data above can be used for this purpose as well, as it represents morbidity and mortality that is expected to be prevented by the use of each vaccine. 

We also need to determine if there is a need to use a form of a vaccine that has Islamically impermissible ingredients. This can be determined by analyzing the ingredients of each form that is available on the market and accessible to patients.  If a form of the vaccine with permissible ingredients is available, then there would be no need to use the one with impermissible ingredients.  For example, analysis of influenza vaccines for the 2019-2020  flu season found that permissible forms are available in the United States[26]. Therefore, impermissible forms cannot be used by Muslims unless an impermissible form is specifically required in individual circumstances. 

Some vaccines are only available in combination with others.  In that case, the combined data for the infections that are immunized against should be considered. 

Below are some examples of infections for which necessity (ضرورة) can be established based on the data presented. In each case, the data leads to an expectation (غلبة الظن) of significant populational harm (ضرر عام):

  1. Diphtheria, Tetanus, Pertussis: the vaccine for diphtheria is only available in combination with either tetanus or tetanus and pertussis for young children in the United States[27]. In combination, these infections are expected to cause approximately 7.8 million hospitalizations and 528,000 deaths if the vaccine is not given. 
  2. Measles, Mumps, Rubella: the vaccines for these infections are only available in combinations in the United States[28].  In combination, these 3 infections are expected to cause approximately 144 million hospitalizations and 58,000 deaths if the vaccine is not given. 
  3. Hepatitis B: this infection is expected to cause 623,000 hospitalizations and approximately 60,000 deaths if the vaccine is not given
  4. Pneumococcus-related diseases:  Infections in the form of pneumonia, otitis media and invasive disease are expected to cause approximately 900,000 hospitalizations and 55,000 deaths if the vaccine was not given

Once necessity (ضرورة) is established for immunization from these infections, then further investigation into the available forms of the vaccines for these infections can be done to determine if Muslims have permissible options, or if an impermissible form must be used, as discussed above.

Conditions for Applicability

For a vaccine that contains impermissible ingredients to be considered permissible to use, the following conditions must be met:

  1. Need for immunization from the infection– this can be established based on epidemiologic data on morbidity and mortality
  2. Definition of the Target Population: is the need for immunization established for the general population vs a subset of the population?
  3. Effectiveness of Vaccine: The vaccine needs to have a significant impact on the morbidity/mortality of the target population
  4. Lack of availability of a permissible alternative – if a form of a particular vaccine is produced and is accessible for the target population, then there would no longer be a necessity to use the impermissible form

Limitations

This work is not meant to be a legal verdict (or fatwa) regarding the permissibility of any specific vaccine.  Rather, it provides a legal basis upon which a potential verdict can be given.  A verdict can be given for a particular vaccine based on analysis of medical data and based on recommendations of medical personal in consultation with Islamic scholars

Conclusion

Based on the principles of avoiding populational harm and of necessity permitting the unlawful, Muslims may receive necessary vaccines with impermissible ingredients when there is no alternative form with permissible ingredients. 


[1] CDC: Immunization: The Basics. https://www.cdc.gov/vaccines/vac-gen/imz-basics.htm

[2] CDC: Principles of Vaccination. https://www.cdc.gov/vaccines/pubs/pinkbook/prinvac.html

[3] Meissner HC. Why is herd immunity so important, AAP News. 2015;36:14

[4] https://www.immunize.org/catg.d/p4037.pdf

[5] Whitney CG, Zhou F, Singleton J, Schuchat A, Centers for Disease Control and Prevention (CDC). Benefits from immunization during the vaccines for children program era – United States, 1994-2013, MMWR 2014 Apr;63(16):352-5.

[6] States With Religious and Philosophical Exemptions From School Immunization Requirements,  http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

[7] CDC: Vaccine Excipient Summary. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/excipient-table-2.pdf

[8] الْأَشْبَاهُ وَالنَّظَائِرُ, دار الكتب العلمية   1:73

وَهَذِهِ الْقَاعِدَةُ مَعَ الَّتِي قَبْلَهَا مُتَّحِدَةٌ أَوْ مُتَدَاخِلَةٌ، وَتَتَعَلَّق بِهَا قَوَاعِدُ: الْأُولَى: الضَّرُورَاتُ تُبِيحُ الْمَحْظُورَاتِ،

وَمِنْ ثَمَّ جَازَ أَكْلُ الْمَيْتَةِ عِنْدَ الْمَخْمَصَةِ، وَإِسَاغَةُ اللُّقْمَةِ بِالْخَمْرِ، وَالتَّلَفُّظُ بِكَلِمَةِ الْكُفْرِ لِلْإِكْرَاهِ وَكَذَا إتْلَافُ الْمَالِ، وَأَخْذُ مَالِ الْمُمْتَنِعِ الْأَدَاءِ مِنْ الدَّيْنِ بِغَيْرِ إذْنِهِ وَدَفْعُ الصَّائِلِ، وَلَوْ أَدَّى إلَى قَتْلِهِ.

[9], دار الفكر القواعد الفقهية وتطبيقاتها في المذاهب الأربعة   1:97

والشك: هو التردد بين النقيضين بلا ترجيح لأحدهما على الآخر، أو هو التردد في وقوع الشيء وعدم وقوعه على السواء، وبينه وبين اليقين الظن، أو الظن الغالب.

وهو ترجيح أحد الطرفين على الآخر بدليل ظاهر يبني عليه العاقل أموره، لكن لم يطرح الاحتمال الآخر، ويقابل الظنَّ الوهمُ، وهو الجانب المرجوح لدليل أقوى منه، والفقهاء يريدون بالشك مطلق التردد سواء كان الطرفان سواء أو أحدهما راجحاً، وعلماء الأصول يفرقون بين الشك والظن.

[10] رد المحتار على الدر المختار, دار الفكر  2:422

[10] (قَوْلُهُ خَافَ الزِّيَادَةَ) أَوْ إبْطَاءَ الْبُرْءِ أَوْ فَسَادَ عُضْوٍ بِحَرٍّ أَوْ وَجَعَ الْعَيْنِ أَوْ جِرَاحَةً أَوْ صُدَاعًا أَوْ غَيْرَهُ، وَمِثْلُهُ مَا إذَا كَانَ يُمَرِّضُ الْمَرْضَى قُهُسْتَانِيٌ ط أَيْ بِأَنْ يَعُولَهُمْ وَيَلْزَمَ مِنْ صَوْمِهِ ضَيَاعُهُمْ وَهَلَاكُهُمْ لِضَعْفِهِ عَنْ الْقِيَامِ بِهِمْ إذَا صَامَ (قَوْلُهُ وَصَحِيحٍ خَافَ الْمَرَضَ) أَيْ بِغَلَبَةِ الظَّنِّ كَمَا يَأْتِي، فَمَا فِي شَرْحِ الْمَجْمَعِ مِنْ أَنَّهُ لَا يُفْطِرُ مَحْمُولٌ عَلَى أَنَّ الْمُرَادَ بِالْخَوْفِ مُجَرَّدُ الْوَهْمِ كَمَا فِي الْبَحْرِ وَالشُّرُنْبَلاليّ (قَوْلُهُ وَخَادِمَةٍ) فِي الْقُهُسْتَانِيِّ عَنْ الْخِزَانَةِ مَا نَصُّهُ إنَّ الْحُرَّ الْخَادِمَ أَوْ الْعَبْدَ أَوْ الذَّاهِبَ لِسَدِّ النَّهْرِ أَوْ كَرْيِهِ إذَا اشْتَدَّ الْحَرُّ وَخَافَ الْهَلَاكَ فَلَهُ الْإِفْطَارُ كَحُرَّةٍ أَوْ أَمَةٍ ضَعُفَتْ لِلطَّبْخِ أَوْ غَسْلِ الثَّوْبِ

[11]رد المحتار على الدر المختار, دار الفكر    1:233

(أَوْ لِمَرَضٍ) يَشْتَدُّ أَوْ يَمْتَدُّ بِغَلَبَةِ ظَنٍّ أَوْ قَوْلِ حَاذِقٍ مُسْلِمٍ وَلَوْ بِتَحَرُّكٍ

[12] درر الحكام شرح غرر الأحكام, دار إحياء الكتب العربية  1:109       

وَيَجُوزُ قَطْعُهَا بِسَرِقَةٍ مَا يُسَاوِي دِرْهَمًا وَلَوْ لِغَيْرِهِ وَخَوْفِ ذِئْبٍ عَلَى غَنَمٍ أَوْ خَوْفِ تَرَدِّي أَعْمَى فِي بِئْرٍ وَيَجِبُ قَطْعُهَا بِاسْتِغَاثَةِ مَلْهُوفٍ مَظْلُومٍ بِالْمُصَلِّي وَلَا يَجِبُ قَطْعُهَا بِنِدَاءِ أَحَدِ أَبَوَيْهِ اهـ قَالَ الْوَلْوَالِجِيُّ إلَّا أَنْ يَسْتَغِيثَ بِهِ أَيْ أَحَدُ أَبَوَيْهِ وَهَذَا فِي الْفَرْضِ فَأَمَّا فِي النَّفْلِ إذَا نَادَاهُ أَحَدُ أَبَوَيْهِ إنْ عَلِمَ أَنَّهُ فِي الصَّلَاةِ لَا بَأْسَ أَنْ لَا يُجِيبَهُ، وَإِنْ لَمْ يَعْلَمْ يُجِيبُهُ كَمَا فِي الْبَحْرِ اهـ.

[13] رد المحتار على الدر المختار, دار الفكر    2:52

مطلب قطع الصلاة يكون حراما ومباحا ومستحبا وواجبا.[تتمة] نقل عن خط صاحب البحر على هامشه أن القطع يكون حراما ومباحا ومستحبا وواجبا، فالحرام لغير عذر والمباح إذا خاف فوت مال، والمستحب القطع للإكمال، والواجب لإحياء نفس.

[14]  الْأَشْبَاهُ وَالنَّظَائِرُ, دار الكتب العلمية     1:75

تَنْبِيهٌ: يُتَحَمَّلُ الضَّرَرُ الْخَاصُّ؛ لِأَجْلِ دَفْعِ ضَرَرِ الْعَامِّ. وَهَذَا مُقَيِّدٌ لِقَوْلِهِمْ: الضَّرَرُ لَا يُزَالُ بِمِثْلِهِ

[15]  تبيين الحقائق شرح كنز الدقائق وبهامشه حاشية الشلبي, المطبعة الكبرى الأميرية   6:40

(قَوْلُهُ: وَالْفَاصِلُ بَيْنَ الْخَاصِّ وَالْعَامِّ إلَخْ) قَالَ الْأَتْقَانِيُّ وَجَعَلَ مُحَمَّدٌ الْحَدَّ الْفَاصِلَ بَيْنَ الْعَامِّ وَالْخَاصِّ اسْتِحْقَاقَ الشُّفْعَةِ فَقَالَ الْخَاصُّ مِنْ النَّهْرِ مَا لَوْ بِيعَتْ أَرْضٌ عَلَى هَذَا النَّهْرِ كَانَ لِجَمِيعِ أَهْلِ النَّهْرِ حَقُّ الشُّفْعَةِ فَيَحْتَاجُ إلَى أَنْ يَذْكُرَ الْحَدَّ الْفَاصِلَ بَيْنَ الشَّرِكَةِ الْعَامَّةِ وَالْخَاصَّةِ فِي الشُّفْعَةِ وَاخْتَلَفَ الْمَشَايِخُ فِي تَحْدِيدِ ذَلِكَ، وَلَكِنْ أَحْسَنُ مَا قِيلَ فِيهِ مِنْ التَّحْدِيدِ هُوَ أَنَّ الشُّرَكَاءَ فِي النَّهْرِ إنْ كَانُوا مَا دُونَ الْمِائَةِ فَالشَّرِكَةُ خَاصَّةٌ تُسْتَحَقُّ بِهَا الشُّفْعَةُ، وَإِنْ كَانُوا مِائَةً فَصَاعِدًا فَالشَّرِكَةُ عَامَّةٌ لَا تَجِبُ الشُّفْعَةُ لِلْكُلِّ، وَإِنَّمَا تَكُونُ لِلْجَارِ. اهـبَيْنَ الْخَاصِّ وَالْعَامِّ أَنَّ مَا تُسْتَحَقُّ بِهِ الشُّفْعَةُ خَاصٌّ، وَمَا لَا تُسْتَحَقُّ بِهِ عَامٌّ. وَوَجْهُ الْفَرْقِ بَيْنَهُمَا أَنَّ فِي الْعَامِّ دَفْعَ الضَّرَرِ الْعَامِّ، وَهُوَ ضَرَرُ بَقِيَّةِ الشُّرَكَاءِ، وَمِثْلُ هَذَا جَائِزٌ بِإِلْزَامِ الضَّرَرِ الْخَاصِّ بَلْ وَاجِبٌ إذَا تَعَيَّنَ مِدْفَعًا فَبِدُونِ الضَّرَرِ أَوْلَى؛ لِأَنَّ الْآبِيَ لَا يَلْحَقُهُ بِذَلِكَ ضَرَرٌ بَلْ يَحْصُلُ لَهُ نَفْعٌ بِمُقَابَلَتِهِ فَأَمْكَنَ إجْبَارُهُ عَلَيْهِ بِخِلَافِ مَا إذَا كَانَ خَاصًّا؛ لِأَنَّهُ لَيْسَ فِيهِ دَفْعُ ضَرَرٍ عَامٍّ، وَإِنَّمَا فِيهِ دَفْعُ ضَرَرٍ خَاصٍّ، وَهُوَ ضَرَرُ شُرَكَائِهِ فَلَا يَلْزَمُهُ الضَّرَرُ الْخَاصُّ لِدَفْعِ الضَّرَرِ الْخَاصِّ؛ لِأَنَّهُمَا اسْتَوَيَا، وَيُمْكِنُ دَفْعُ ضَرَرِ شُرَكَائِهَا بِدُونِ ذَلِكَ بِأَنْ يَرْجِعُوا عَلَيْهِ بِحِصَّتِهِ مِنْ الْمُؤْنَةِ إذَا كَانَ ذَلِكَ بِأَمْرِ الْقَاضِي بِخِلَافِ مَا إذَا كَانَ عَامًّا؛ لِأَنَّهُ لَا يُمْكِنُهُ الرُّجُوعُ عَلَيْهِمْ لِكَثْرَتِهِمْ وَرُبَّمَا لَا تُقْبَلُ الْمُؤْنَةُ الْقِسْمَةَ عَلَيْهِمْ، وَلَا يَدْرِي حِصَّةَ كُلِّ وَاحِدٍ مِنْهُمْ

[16]رد المحتار على الدر المختار, دار الفكر  2:422

ط (قَوْلُهُ بِغَلَبَةِ الظَّنِّ) تُنَازِعُهُ خَافَ الَّذِي فِي الْمَتْنِ وَخَافَ وَخَافَتْ اللَّتَانِ فِي الشَّرْحِ ط (قَوْلُهُ بِأَمَارَةٍ) أَيْ عَلَامَةٍ (قَوْلُهُ أَوْ تَجْرِبَةٍ) وَلَوْ كَانَتْ مِنْ غَيْرِ الْمَرِيضِ عِنْدَ اتِّحَادِ الْمَرَضِ ط عَنْ أَبِي السُّعُودِ (قَوْلُهُ حَاذِقٍ) أَيْ لَهُ مَعْرِفَةٌ تَامَّةٌ فِي الطِّبِّ، فَلَا يَجُوزُ تَقْلِيدُ مَنْ لَهُ أَدْنَى مَعْرِفَةٍ فِيهِ ط (قَوْلُهُ مُسْلِمٍ) أَمَّا الْكَافِرُ فَلَا يُعْتَمَدُ عَلَى قَوْلِهِ لِاحْتِمَالِ أَنَّ غَرَضَهُ إفْسَادُ الْعِبَادَةِ كَمُسْلِمٍ شَرَعَ فِي الصَّلَاةِ بِالتَّيَمُّمِ فَوَعَدَهُ بِإِعْطَاءِ الْمَاءِ فَإِنَّهُ لَا يَقْطَعُ الصَّلَاةَ لِمَا قُلْنَا بَحْرٌ (قَوْلُهُ مَسْتُورٍ) وَقِيلَ عَدَالَتُهُ شَرْطٌ وَجَزَمَ بِهِ الزَّيْلَعِيُّ وَظَاهِرُ مَا فِي الْبَحْرِ وَالنَّهْرِ ضَعْفُهُ ط.

[17]  المبسوط السرخسي, دار المعرفة  20:159

وَلَوْ أَنَّ نَهْرًا بَيْنَ قَوْمٍ فَاصْطَلَحُوا عَلَى كَرْيِهِ أَوْ بِوَضْعِ مَمْشَاةٍ أَوْ قَنْطَرَةٍ عَلَيْهِ عَلَى أَنْ يَكُونَ النَّفَقَةُ عَلَيْهِمْ بِحِصَصِهِمْ فَهَذَا جَائِزٌ كُلُّهُ عَلَيْهِمْ؛ لِأَنَّهُمْ يُجْبَرُونَ عَلَى ذَلِكَ لَوْ لَمْ يَصْطَلِحُوا إذَا كَانَ فِيهِ ضَرَرٌ عَامٌّ فَإِنَّ رَفْعَ الضَّرَرِ وَاجِبٌ فَإِذَا اصْطَلَحُوا كَانَ إلَى الْجَوَازِ أَقْرَبُ فَإِنْ كَانَ بِحَيْثُ لَا يَضُرُّهُمْ تَرْكُهَا فَفِي الْقَنْطَرَةِ وَالْمَمْشَاةِ لَا يُجْبَرُونَ عَلَى ذَلِكَ؛ لِأَنَّهُ تَدْبِيرٌ فِي الْمِلْكِ وَهُوَ مُفَوَّضٌ إلَى رَأْيِ الْمُلَّاكِ وَإِنَّمَا يُجْبَرُونَ عَلَى إزَالَةِ الضَّرَرِ الْعَامِّ فَمَا لَيْسَ فِيهِ ضَرَرٌ عَامٌّ لَا يُجْبَرُونَ عَلَيْهِ وَأَمَّا الْكَرْيُ فَإِنِّي أُجْبِرُ عَلَيْهِ؛ لِأَنَّ فِي تَرْكِهِ ضَرَرًا عَامًّا فَإِنَّ لِلنَّاسِ فِي النَّهْرِ حَقَّ السَّقْيِ فَيَتَضَرَّرُونَ بِانْقِطَاعِ ذَلِكَ عَنْهُمْ وَلَا يَصِلُ إلَيْهِمْ مِلْكُ الْمَنْفَعَةِ إلَّا بِالْكَرْيِ وَلِلْإِمَامِ أَنْ يُجْبِرَ الشُّرَكَاءَ فِيهِ عَلَى الْكَرْيِ وَتَمَامُ هَذَا فِي كِتَابِ الشِّرْبِ.

[18]  بدائع الصنائع في ترتيب الشرائع, دار الكتب العلمية  6:191

وَلَوْ زَادَ فِي عَرْضِهِ لَا يَجُوزُ؛ لِأَنَّ الْكُوَى مِنْ حُقُوقِ النَّهْرِ فَيَمْلِكُهُ بِمِلْكِ النَّهْرِ بِخِلَافِ الزِّيَادَةِ فِي الْعَرْضِ، وَلَوْ كَانَ نَهْرٌ يَأْخُذُ الْمَاءَ مِنْ النَّهْرِ الْأَعْظَمِ بَيْنَ قَوْمٍ فَخَافُوا أَنْ يَنْبَثِقَ فَأَرَادُوا أَنْ يُحَصِّنُوهُ فَامْتَنَعَ بَعْضُهُمْ عَنْ ذَلِكَ فَإِنْ كَانَ ضَرَرًا عَامًّا يُجْبَرُونَ عَلَى أَنْ يُحَصِّنُوهُ بِالْحِصَصِ، وَإِنْ لَمْ يَكُنْ فِيهِ ضَرَرٌ عَامٌّ لَا يُجْبَرُونَ عَلَيْهِ؛ لِأَنَّ الِانْتِفَاعَ مُتَعَذَّرٌ عِنْدَ عُمُومِ الضَّرَرِ، فَكَانَ الْجَبْرُ عَلَى التَّحْصِيصِ مِنْ بَابِ دَفْعِ الضَّرَرِ عَنْ الْجَمَاعَةِ فَجَازَ وَإِذَا لَمْ يَكُنْ الضَّرَرُ عَامًّا يُمْكِنُ الِانْتِفَاعُ بِالنَّهْرِ فَكَانَ الْجَبْرُ بِالتَّحْصِيصِ جَبْرًا عَلَيْهِ لِزِيَادَةِ الِانْتِفَاعِ بِالنَّهْرِ وَهَذَا لَا يَجُوزُ وَلَوْ كَانَ نَهْرٌ لِرَجُلٍ مُلَاصِقٌ لِأَرْضِ رَجُلٍ فَاخْتَلَفَ صَاحِبُ الْأَرْضِ وَالنَّهْرِ فِي مُسَنَّاةٍ فَالْمُسَنَّاةُ لِصَاحِبِ الْأَرْضِ عِنْدَ أَبِي حَنِيفَةَ – رَحِمَهُ اللَّهُ – لَهُ أَنْ يَغْرِسَ فِيهَا طِينَهُ وَلَكِنْ لَيْسَ لَهُ أَنْ يَهْدِمَهَا.

[19] الإختيار لتعليل المختار, مطبعة الحلبي  3:72

(وَمَا هُوَ مَمْلُوكٌ لِلْعَامَّةِ فَكَرْيُهُ عَلَى أَهْلِهِ) ؛ لِأَنَّ مَنْفَعَتَهُ لَهُمْ. (وَمَنْ أَبَى مِنْهُمْ يُجْبَرُ) دَفْعًا لِلضَّرَرِ الْعَامِّ، وَهُوَ ضَرَرُ الشُّرَكَاءِ بِالضَّرَرِ الْخَاصِّ، كَيْفَ وَفِيهِ مَنْفَعَتُهُ؟ فَلَا يُعَارِضُهُ.وَإِنْ كَانَ فِيهِ ضَرَرٌ عَامٌّ بِأَنْ خَافُوا أَنْ يَنْشَقَّ النَّهْرُ، فَيَخْرُجَ الْمَاءُ إِلَى طَرِيقِ الْمُسْلِمِينَ وَأَرَاضِيهِمْ – فَعَلَيْهِمْ تَحْصِينُهُ بِالْحِصَصِ. وَالنَّهْرُ الْمَمْلُوكُ لِجَمَاعَةٍ مَخْصُوصِينَ فَكَرْيُهُ عَلَيْهِمْ، وَمَنْ أَبَى مِنْهُمْ قِيلَ: يُجْبَرُ؛ لِمَا مَرَّ، وَقِيلَ: لَا يُجْبَرُ؛ لِأَنَّ كُلَّ وَاحِدٍ مِنَ الضَّرَرَيْنِ خَاصٌّ. وَيُمْكِنُ دَفْعُهُ بِالْكَرْيِ بِأَمْرِ الْقَاضِي، ثُمَّ يَرْجِعُ عَلَى الْآبِي، وَلَا كَذَلِكَ الْأَوَّلُ

[20]  الجوهرة النيرة على مختصر القدوريي, المطبعة الخيرية  1:242

(قَوْلُهُ: وَقَالَ أَبُو حَنِيفَةَ: لَا أَحْجُرُ عَلَى السَّفِيهِ إذَا كَانَ حُرًّا بَالِغًا عَاقِلًا) السَّفِيهُ خَفِيفُ الْعَقْلِ الْجَاهِلُ بِالْأُمُورِ الَّذِي لَا تَمْيِيزَ لَهُ الْعَامِلُ بِخِلَافِ مُوجَبِ الشَّرْعِ، وَإِنَّمَا لَمْ يُحْجَرْ عَلَيْهِ عِنْدَ أَبِي حَنِيفَةَ؛ لِأَنَّهُ مُخَاطَبٌ عَاقِلٌ وَلِأَنَّ فِي سَلْبِ وِلَايَتِهِ إهْدَارَ آدَمِيَّتِهِ، وَإِلْحَاقَهُ بِالْبَهَائِمِ وَذَلِكَ أَشَدُّ عَلَيْهِ مِنْ التَّبْذِيرِ فَلَا يُحْتَمَلُ الْأَعْلَى لِدَفْعِ الْأَدْنَى إلَّا أَنْ يَكُونَ فِي الْحَجْرِ عَلَيْهِ دَفْعُ ضَرَرٍ عَامٍّ كَالْحَجْرِ عَلَى الطَّبِيبِ الْجَاهِلِ، وَالْمُفْتِي الْمَاجِنِ، وَالْمُكَارِي الْمُفْلِسِ فَإِنَّ هَؤُلَاءِ يُحْجَرُ عَلَيْهِمْ فِيمَا يُرْوَى عَنْ أَبِي حَنِيفَةَ؛ إذْ هُوَ دَفْعُ الْأَعْلَى بِالْأَدْنَى، الْمُفْتِي الْمَاجِنُ هُوَ الَّذِي يُعَلِّمُ النَّاسَ حِيَلًا بَاطِلَةً كَارْتِدَادِ الْمَرْأَةِ لِتُفَارِقَ زَوْجَهَا، أَوْ الرَّجُلِ لِيُسْقِطَ الزَّكَاةَ وَلَا يُبَالِي أَنْ يُحَلِّلَ حَرَامًا، أَوْ يُحَرِّمَ حَلَالًا. وَالطَّبِيبُ الْجَاهِلُ هُوَ أَنْ يَسْقِيَ النَّاسَ دَوَاءً مُهْلِكًا. وَالْمُكَارِي الْمُفْلِسُ أَنْ يُكْرِيَ إبِلًا وَلَيْسَتْ لَهُ إبِلٌ وَلَا مَالٌ يَشْتَرِيهَا بِهِ، وَإِذَا جَاءَ أَوَانُ الْخُرُوجِ يُخْفِي نَفْسَهُ. قَوْلُهُ: (وَتَصَرُّفُهُ فِي مَالِهِ جَائِزٌ) لِأَنَّهُ مُخَاطَبٌ عَاقِلٌ لِقَوْلِهِ

[21]  الْأَشْبَاهُ وَالنَّظَائِرُ, دار الكتب العلمية  1:75

مِنْهَا: جَوَازُ الرَّمْيِ إلَى كُفَّارٍ تَتَرَّسُوا بِصِبْيَانِ الْمُسْلِمِينَ.

وَمِنْهَا: وُجُوبُ نَقْضِ حَائِطٍ مَمْلُوكٍ مَالَ إلَى طَرِيقِ الْعَامَّةِ عَلَى مَالِكِهَا؛ دَفْعًا لِلضَّرَرِ الْعَامِّ،

وَمِنْهَا: جَوَازُ الْحَجْرِ عَلَى الْبَالِغِ الْعَاقِلِ الْحُرِّ عِنْدَ أَبِي حَنِيفَةَ رَحِمَهُ اللَّهُ فِي ثَلَاثٍ: الْمُفْتِي الْمَاجِنِ، وَالطَّبِيبِ الْجَاهِلِ، وَالْمُكَارِي الْمُفْلِسِ؛ دَفْعًا لِلضَّرَرِ الْعَامِّ

وَمِنْهَا: جَوَازُهُ عَلَى السَّفِيهِ عِنْدَهُمَا وَعَلَيْهِ الْفَتْوَى، دَفْعًا لِلضَّرَرِ الْعَامِّ.

وَمِنْهَا: بَيْعُ مَالِ الْمَدْيُونِ الْمَحْبُوسِ عِنْدَهُمَا لِقَضَاءِ دَيْنِهِ، دَفْعًا لِلضَّرَرِ عَنْ الْغُرَمَاءِ وَهُوَ الْمُعْتَمَدُ

وَمِنْهَا: التَّسْعِيرُ عِنْدَ تَعَدِّي أَرْبَابِ الطَّعَامِ فِي بَيْعِهِ بِغَبْنٍ فَاحِشٍ.

وَمِنْهَا: بَيْعُ طَعَامِ الْمُحْتَكَرِ جَبْرًا عَلَيْهِ عِنْدَ الْحَاجَةِ وَامْتِنَاعِهِ مِنْ الْبَيْعِ، دَفْعًا لِلضَّرَرِ الْعَامِّ

[22] Ibid

[23] Ibid

[24] CDC. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Morb Mortal Wkly Rep. 2012;61(40):816.

[25] Vaccines for Children Program (VFC), https://www.cdc.gov/vaccines/programs/vfc/index.html

[26] Shaykh Mateen Khand, MD and Ramzan Judge, PharmD. Islamically Permissible Influenza Vaccines Available in the US for 2019-2020 Season, https://muslimmed.org/category/vaccines/influenza-vaccines-2019-2020/

[27] https://www.vaccines.gov/diseases/diphtheria

[28] CDC: Vaccine Excipient Summary. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/excipient-table-2.pdf

Islamically Permissible Influenza Vaccines Available in the US for 2019-2020 Season

Prepared by Shaykh Mateen A. Khan, MD and Dr. Ramzan Judge, PharmD

Summary

Permissible influenza vaccines in the US for 2019-2020 season:

  • Fluad™
  • Fluzone High-Dose™
  • Afluria™
  • Fluarix™
  • FluLaval™
  • Fluzone™ Quadrivalent

Impermissible influenza vaccines in the US for 2019-2020 season:

  • Flublok™
  • FluMist™
  • Flucelvax™

Discussion

Background on Influenza

Influenza (commonly known as the flu) is a seasonal viral illness carrying significant health, economic, and social burden. For the past nine years, the Centers for Disease Control and Prevention (CDC) estimates that every year 9.3-49 million symptomatic illnesses, 4.3-23 million medical visits, 140,000-960,000 hospitalizations, and 12,000-79,000 deaths are attributed to seasonal influenza. For the 2017-2018 season, which was considered high severity, a study estimated influenza vaccination prevented:

  • 7.1 million illnesses
  • 3.7 million medical visits
  • 109,000 hospitalizations (10% of expected overall and 41% among young children)
  • 8,000 deaths1

In addition to providing immunity to healthy individuals, the vaccine benefits the sick by decreasing the amount of exposure from other individuals (herd immunity). Hence, the CDC, along with most American medical organizations, recommends that every person above six months old receive a seasonal influenza vaccine yearly.2

Improving vaccination rates among Muslims has been a struggle. Muslim majority countries find their populations hesitant.3 Similar issues are faced among Muslim minority populations in the West over a concern for the presence of impermissible ingredients in the vaccine.4

The United States currently offers nine different commercially prepared vaccines. We reviewed package inserts and public records for the vaccines to evaluate methods of production and the presence of impermissible products. When necessary, we corresponded with the manufacturers. The results are compiled in Table 1. The vaccines vary in their methods of production and ingredients, which may pose religious challenges for Muslims.

Challenge #1 – Methods of Production

Influenza vaccines are prepared through three different processes. Most strains are prepared through an egg-based manufacturing process. This involves injecting vaccine viruses into fertilized chicken eggs. Essentially, the egg is commandeered as a factory by the viruses as they use the egg’s resources to replicate themselves. The viruses are extracted and purified.5 Islamically, this process per se is not an issue as eggs are considered permissible.

Flucelvax™, a product by Seqirus, is made by incubating influenza viruses in a particular animal cell line, Madin-Darby Canine Kidney (MDCK).6 The MDCK cell line was initially isolated in 1958 from an adult Cocker Spaniel dog.7 Dogs, like all predators, are ḥarām as Sayyidunā Ibn `Abbās (may Allah be pleased with him) narrated that Allah’s Messenger ﷺ prohibited every predator possessing canine teeth.8 Further, when cells like MDCK are removed from an animal, they are considered maytah (carrion) in Islamic terminology. The Prophet ﷺ informed us, “Whatever is cut from an animal while it is alive is carrion.”9 Surah al-An`ām states a ruling of najis and ḥarām for carrion.

“Say, “I do not find, in what has been revealed to me, anything prohibited for anyone who eats it, unless it be carrion or blood that pours forth, or flesh of swine – because it is impure.”10

Hence, the initially harvested canine cells were najis and ḥarām. Since 1958, the cell line has undergone countless replication cycles in artificial environments, and the parent cells have long died off. Still, being the progeny cells, they will be impure and impermissible.

The MDCK cells used in Flucelvax™ are grown in a medium in which no human or animal-derived materials are used.11 After an incubation period, the cells are processed through lysis, and the virus proteins undergo extraction and purification. Despite this, residual amounts of the cells capable of inducing allergic reaction in susceptible patients remain, per the package insert. For these reasons, Flucelvax™ vaccine made from this method is impermissible.

Flublok™ manufactured by Sanofi, is produced by genetically engineering proteins expressed by influenza into an alternate virus, baculovirus (Autographa californica). It is then used to infect an insect cell line (ExpresSF+) derived from the fall armyworm (Spodoptera frugiperda), which produces the desired influenza proteins. This vaccine is especially valuable to those who have allergies to eggs.12 Many insects, like the armyworm, fall into the category of al-khabā’ith explicitly mentioned in the Qur’an as ḥarām in Surah al-A`rāf.

[He ﷺ] makes unlawful for them impure things (al-khabā’ith).13

Similar to animal cell lines discussed previously, the progeny ExpresSF+ cells are impure and impermissible. Hence, Flublok™ vaccine made from this method is also impermissible.

Issue #2 – Porcine Gelatin as a Stabilizer

Two of the vaccines available in the United States, FluMist™ and Flucelvax™, contain porcine gelatin. The gelatin is added as a stabilizer for the viral vaccine protein. Gelatin is hydrolyzed collagen, which is extracted from collagen-containing tissue like skin and bones. At the outset, the Qur’an declares that all porcine parts are najis and ḥarām.

Say, “I do not find, in what has been revealed to me, anything (out of the cattle under discussion) prohibited for anyone who eats it, unless it be carrion or blood that pours forth, or flesh of swine – because it is impure – or there be an animal slaughtered sinfully by invoking on it the name of someone other than Allah. (Surah al-An`ām:145)14

He has but prohibited for you the carrion, the blood, the flesh of swine and what has been invoked upon with a name other than that of Allah. (Surah al-Naḥl:115)15

In earlier times, gelatin was prepared in homes through a process of cooking, causing the collagen to hydrolyze and break into peptides of varying lengths. Although the process today is commercialized and done through a series of chemical reactions, extraction, and purification, the result is not much different from home preparations. These peptides do not constitute a significant change from the original porcine collagen. Instead, gelatin is just fragmented hydrolyzed collagen. The resulting gelatin is impermissible.16 Hence, FluMist™ and Flucelvax™ are impermissible particularly when other permissible alternatives exist.

Exceptional Cases

If someone is unable to take one of the permissible vaccines (e.g., an egg allergy), but they are relatively healthy, they should not take an impermissible vaccine. However, if a strong need exists, then they may take those vaccines that are normally impermissible. An example of a strong medical need is when there is a high likelihood (ghalabah al-ẓann) of significant morbidity or mortality in contracting influenza such as in the very old or patients with pre-existing significant comorbidities. Ideally, the Sharī`ah prefers a competent Muslim physician to determine this need based upon the evidences at hand. The physician should be pious and have a basic understanding of the relevant Sharī`ah rulings.17 Vaccinations mandated by the government, work places, or schools may also constitute a strong need.18 In any of these situations, one may take (in order of preference) Flublok™, FluMist™, and Flucelvax™.

Conclusion

Of the nine commercially available influenza vaccines available in the US for the 2019-2020 season, six are Islamically permissible: Fluad™, Fluzone High-Dose™, Afluria™, Fluarix™, FluLaval™, and Fluzone™ Quadrivalent. The Muslim public is advised to avoid Flublok™, FluMist™, and Flucelvax™.

In exceptional cases, as outlined above, one may take Flublok™, FluMist™, and Flucelvax™ in that order.

Of note, vaccine formulations are subject to change year to year. The research presented here is accurate for the 2019-2020 season.

Acknowledgment

We request Allah ta`āla to send special blessings on Mufti Faisal al-Mahmudi for his invaluable assistance.

Table 1: 2019-2020 Influenza Vaccines

Rolfes, M.A. (2019). Effects of Influenza Vaccination in the United States During the 2017–2018 Influenza Season. Clinical Infectious Diseases, ciz075, doi.org/10.1093/cid/ciz075.

https://www.cdc.gov/flu/prevent/whoshouldvax.htm

Ahmed, A. (2018) Outbreak of vaccine-preventable diseases in Muslim majority countries. Journal of Infection and Public Health, 11 (2), 153-155. doi.org/10.1016/j.jiph.2017.09.007

https://mcb.org.uk/mcb-updates/position-on-flu-vaccines/.

https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm#targetText=The%20most%20common%20way%20that,for%20more%20than%2070%20years.&targetText=For%20flu%20shots%2C%20the%20influenza,and%20virus%20antigen%20is%20purified.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177469/

https://en.wikipedia.org/wiki/Madin-Darby_Canine_Kidney_cells#targetText=Madin%2DDarby%20Canine%20Kidney%20(MDCK,as%20responses%20to%20growth%20factors.

عَنِ ابْنِ عَبَّاسٍ، قَالَ نَهَى رَسُولُ اللَّهِ صلى الله عليه وسلم عَنْ كُلِّ ذِي نَابٍ مِنَ السِّبَاعِ (مسلم 1934)

مَا قُطِعَ مِنَ الْبَهِيمَةِ وَهِيَ حَيَّةٌ فَهِيَ مَيْتَةٌ (أبو داوود 2858، الترمذي 1480، ابن ماجه 3216)
وَعَلَى هَذَا يَخْرُجُ مَا إذَا قَطَعَ مِنْ أَلْيَةِ الشَّاةِ قِطْعَةً أَوْ مِنْ فَخِذِهَا أَنَّهُ لَا يَحِلُّ الْمُبَانُ وَإِنْ ذُبِحَتْ الشَّاةُ بَعْدَ ذَلِكَ؛ لِأَنَّ حُكْمَ الذَّكَاةِ لَمْ يَثْبُتْ فِي الْجُزْءِ الْمُبَانِ وَقْتَ الْإِبَانَةِ لِانْعِدَامِ ذَكَاةِ الشَّاةِ لِكَوْنِهَا حَيَّةً وَقْتَ الْإِبَانَةِ، وَحَالَ فَوَاتِ الْحَيَاةِ كَانَ الْجُزْءُ مُنْفَصِلًا وَحُكْمُ الذَّكَاةِ لَا يَظْهَرُ فِي الْجُزْءِ الْمُنْفَصِلِ وَرُوِيَ أَنَّ أَهْلَ الْجَاهِلِيَّةِ كَانُوا يَقْطَعُونَ قِطْعَةً مِنْ أَلْيَةِ الشَّاةِ وَمِنْ سَنَامِ الْبَعِيرِ فَيَأْكُلُونَهَا فَلَمَّا بُعِثَ النَّبِيُّ الْمُكَرَّمُ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – نَهَاهُمْ عَنْ ذَلِكَ فَقَالَ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – «مَا أُبِينَ مِنْ الْحَيِّ فَهُوَ مَيِّتٌ» وَالْجُزْءُ الْمَقْطُوعُ مُبَانٌ مِنْ حَيٍّ وَبَائِنٌ مِنْهُ فَيَكُونُ مَيِّتًا وَكَذَلِكَ إذَا قُطِعَ ذَلِكَ مِنْ صَيْدٍ لَمْ يُؤْكَلْ الْمَقْطُوعُ، وَإِنْ مَاتَ الصَّيْدُ بَعْدَ ذَلِكَ لِمَا قُلْنَا. (بدائع الصنائع في ترتيب الشرائع)

10 عَ قُل لَّا أَجِدُ فِي مَا أُوحِيَ إِلَيَّ مُحَرَّمًا عَلَىٰ طَاعِمٍ يَطْعَمُهُ إِلَّا أَن يَكُونَ مَيْتَةً أَوْ دَمًا مَّسْفُوحًا أَوْ لَحْمَ خِنزِيرٍ فَإِنَّهُ رِجْسٌ أَوْ فِسْقًا أُهِلَّ لِغَيْرِ اللَّـهِ بِهِ

11 European Medicines Agency Assessment Report on Flucelvax Tetra. 18 Oct. 2018. Pg. 14.

12 Barr, I. G. (2018). Cell culture-derived influenza vaccines in the severe 2017-2018 epidemic season: a step towards improved influenza vaccine effectiveness. NPJ vaccines, 3, 44. doi:10.1038/s41541-018-0079-z

13 وَيُحَرِّمُ عَلَيْهِمُ الْخَبَائِثَ
(وَأَمَّا) الَّذِي يَعِيشُ فِي الْبَرِّ فَأَنْوَاعٌ ثَلَاثَةٌ: مَا لَيْسَ لَهُ دَمٌ أَصْلًا، وَمَا لَيْسَ لَهُ دَمٌ سَائِلٌ، وَمَا لَهُ دَمٌ سَائِلٌ مِثْلُ الْجَرَادِ وَالزُّنْبُورِ وَالذُّبَابِ وَالْعَنْكَبُوتِ وَالْعَضَّابَةِ وَالْخُنْفُسَاءِ وَالْبُغَاثَةِ وَالْعَقْرَبِ.
وَنَحْوِهَا لَا يَحِلُّ أَكْلُهُ إلَّا الْجَرَادَ خَاصَّةً؛ لِأَنَّهَا مِنْ الْخَبَائِثِ لِاسْتِبْعَادِ الطِّبَاعِ السَّلِيمَةِ إيَّاهَا وَقَدْ قَالَ اللَّهُ تَبَارَكَ وَتَعَالَى {وَيُحَرِّمُ عَلَيْهِمُ الْخَبَائِثَ} [الأعراف: 157] إلَّا أَنَّ الْجَرَادَ خُصَّ مِنْ هَذِهِ الْجُمْلَةِ بِقَوْلِهِ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – «أُحِلَّتْ لَنَا مَيْتَتَانِ» فَبَقِيَ عَلَى ظَاهِرِ الْعُمُومِ. وَكَذَلِكَ مَا لَيْسَ لَهُ دَمٌ سَائِلٌ مِثْلُ الْحَيَّةِ وَالْوَزَغِ وَسَامِّ أَبْرَصَ وَجَمِيعِ الْحَشَرَاتِ وَهَوَامِّ الْأَرْضِ مِنْ الْفَأْرِ وَالْقُرَادِ وَالْقَنَافِذِ وَالضَّبِّ وَالْيَرْبُوعِ وَابْنِ عِرْسٍ وَنَحْوِهَا، وَلَا خِلَافَ فِي حُرْمَةِ هَذِهِ الْأَشْيَاءِ إلَّا فِي الضَّبِّ (بدائع الصنائع في ترتيب الشرائع)

14 قُل لَّا أَجِدُ فِي مَا أُوحِيَ إِلَيَّ مُحَرَّمًا عَلَىٰ طَاعِمٍ يَطْعَمُهُ إِلَّا أَن يَكُونَ مَيْتَةً أَوْ دَمًا مَّسْفُوحًا أَوْ لَحْمَ خِنزِيرٍ فَإِنَّهُ رِجْسٌ أَوْ فِسْقًا أُهِلَّ لِغَيْرِ اللَّـهِ بِهِ

15 إِنَّمَا حَرَّمَ عَلَيْكُمُ الْمَيْتَةَ وَالدَّمَ وَلَحْمَ الْخِنزِيرِ وَمَا أُهِلَّ لِغَيْرِ اللَّـهِ بِهِ

16 Respectfully, the minority opinion considering gelatin to have undergone a significant transformation (tabdīl al-mahiyah) rendering its ruling changed seems doubtful for the reasons outlined. This is an extensive discussion. However, with the availability of clearly ḥalāl alternatives, the opinion given in this article is more cautious.

17 وَجَوَّزَهُ فِي النِّهَايَةِ بِمُحَرَّمٍ إذَا أَخْبَرَهُ طَبِيبٌ مُسْلِمٌ أَنَّ فِيهِ شِفَاءً وَلَمْ يَجِدْ مُبَاحًا يَقُومُ مَقَامَهُ. قُلْت: وَفِي الْبَزَّازِيَّةِ وَمَعْنَى قَوْلِهِ – عَلَيْهِ الصَّلَاةُ وَالسَّلَامُ – «إنَّ اللَّهَ لَمْ يَجْعَلْ شِفَاءَكُمْ فِيمَا حُرِّمَ عَلَيْكُمْ» نَفْيُ الْحُرْمَةِ عِنْدَ الْعِلْمِ بِالشِّفَاءِ دَلَّ عَلَيْهِ جَوَازُ شُرْبِهِ لِإِزَالَةِ الْعَطَشِ (رد المحتار على الدر المختار)

18 Imdād al-Fatāwa Jadīd ma`a Hāshiyah Shabbīr Aḥmad al-Qāsimī, 9:262

Opioid Medications

Question:  Is the use of opioid drugs such as oxycodone and codeine for medicinal purposes permissible?

Answer:

Bismihi Ta’ala

Opioid drugs are those that are derived from opium.  These drugs are used for various medicinal purposes, such as relief of pain or cough. Common side effects of opioid medications include constipation, nausea, vomiting, sedation, impaired psychomotor function, and urinary retention. 

In general, the consumption of intoxicating substances is impermissible according to the shariah.  Intoxication is defined in shariah as a state in which a person is insane and this can be as extreme as not being able to differentiate the sky from the ground. At a minimum, a person is considered to be intoxicated if the majority of his speech is non-sensical.[i][ii]

A state of delirium that would fit the criteria of intoxication as defined above is not an expected or common side effect of these medications when used in prescribed amounts.[iii]

If a person is using a small amount of an opioid substance, such as the amount used for medicinal purposes, then this is considered permissible[iv]. However, If he is using a larger amount of it simply for the purpose of intoxication, euphoria or entertainment, then this is not permissible[v].  Therefore, drugs of abuse such as cocaine and heroine are not permissible to use because they are not used for medicinal purposes, but rather to achieve an altered mental state and euphoria.  It would not be unexpected for a person using these drugs of abuse to reach a state of intoxication as defined above.

In conclusion, opioid medications such as oxycodone and codeine are considered permissible to use if prescribed by a doctor for medical treatment. 

And Allah knows best

Mufti Adil Farooki, MD

Checked and approved by Mufti Abdul Muqtadir Sikander


[i]رد المحتار على الدر المختار – دار الفكر – 3:239

قَوْلُهُ أَوْ سَكْرَانَ) السُّكْرُ: سُرُورٌ يُزِيلُ الْعَقْلَ فَلَا يَعْرِفُ بِهِ السَّمَاءَ مِنْ الْأَرْضِ. وَقَالَ: بَلْ يَغْلِبُ عَلَى الْعَقْلِ فَيَهْذِي فِي كَلَامِهِ، وَرَجَّحُوا قَوْلَهُمَا فِي الطَّهَارَةِ وَالْأَيْمَانِ وَالْحُدُودِ

[ii] بدائع الصنائع في ترتيب الشرائع – دار الكتب العلمية – 5:118

قَوْلِهِمَا: شَهَادَةُ الْعُرْفِ وَالْعَادَةِ فَإِنَّ السَّكْرَانَ فِي مُتَعَارَفِ النَّاسِ اسْمٌ لِمَنْ هَذَى وَإِلَيْهِ أَشَارَ سَيِّدُنَا عَلِيٌّ – رَضِيَ اللَّهُ عَنْهُ – بِقَوْلِهِ: إذَا سَكِرَ هَذَى، وَإِذَا هَذَى افْتَرَى

[iii] https://www.drugs.com/sfx/percocet-side-effects.html

[iv] رد المحتار على الدر المختار – دار الفكر – 3:240

قَوْلُهُ أَوْ أَفْيُونٍ أَوْ بَنْجٍ) الْأَفْيُونُ: مَا يَخْرُجُ مِنْ الْخَشْخَاشِ. الْبَنْجُ: بِالْفَتْحِ نَبْتٌ مُنْبَتٌ. وَصَرَّحَ فِي الْبَدَائِعِ وَغَيْرِهَا بِعَدَمِ وُقُوعِ الطَّلَاقِ بِأَكْلِهِ مُعَلِّلًا بِأَنَّ زَوَالَ عَقْلِهِ لَمْ يَكُنْ بِسَبَبٍ هُوَ مَعْصِيَةٌ. وَالْحَقُّ التَّفْصِيلُ، وَهُوَ إنْ كَانَ لِلتَّدَاوِي لَمْ يَقَعْ لِعَدَمِ الْمَعْصِيَةِ، وَإِنْ لِلَّهْوِ وَإِدْخَالِ الْآفَةِ قَصْدًا فَيَنْبَغِي أَنْ لَا يَتَرَدَّدَ فِي الْوُقُوعِ

فَقَدْ فَرَّقَ بَيْنَ مَا إذَا كَانَ بِطَرِيقٍ مُحَرَّمٍ وَغَيْرِ مُحَرَّمٍ كَمَا تَرَى فَتَأَمَّلْ (قَوْلُهُ أَوْ بِمُبَاحٍ) كَمَا إذَا سَكِرَ مِنْ وَرَقِ الرُّمَّانِ فَإِنَّهُ لَا يَقَعُ طَلَاقُهُ وَلَا عَتَاقُهُ وَنَقَلَ الْإِجْمَاعَ عَلَى ذَلِكَ صَاحِبُ التَّهْذِيبِ كَذَا فِي الْهِنْدِيَّةِ ط. قُلْت: وَكَذَا لَوْ سَكِرَ بِبَنْجٍ أَوْ أَفْيُونٍ تَنَاوَلَهُ لَا عَلَى وَجْهِ الْمَعْصِيَةِ بَلْ التَّدَاوِي كَمَا مَرَّ

[v] رد المحتار على الدر المختار – دار الفكر – 4:42

وَفِي كَافِي الْحَاكِمِ مِنْ الْأَشْرِبَةِ: أَلَا تَرَى أَنَّ الْبَنْجَ لَا بَأْسَ بِتَدَاوِيهِ، وَإِذَا أَرَادَ أَنْ يَذْهَبَ عَقْلُهُ لَا يَنْبَغِي أَنْ يَفْعَلَ ذَلِكَ. اهـ.

وَبِهِ عُلِمَ أَنَّ الْمُرَادَ الْأَشْرِبَةُ الْمَائِعَةُ، وَأَنَّ الْبَنْجَ وَنَحْوَهُ مِنْ الْجَامِدَاتِ إنَّمَا يَحْرُمُ إذَا أَرَادَ بِهِ السُّكْرَ وَهُوَ الْكَثِيرُ مِنْهُ، دُونَ الْقَلِيلِ الْمُرَادُ بِهِ التَّدَاوِي وَنَحْوُهُ كَالتَّطَيُّبِ بِالْعَنْبَرِ وَجَوْزَةِ الطِّيبِ، وَنَظِيرُ ذَلِكَ مَا كَانَ سُمَيًّا قِتَالًا كَالْمَحْمُودَةِ وَهِيَ السَّقَمُونْيَا وَنَحْوُهَا مِنْ الْأَدْوِيَةِ السُّمِّيَّةِ فَإِنَّ اسْتِعْمَالَ الْقَلِيلِ مِنْهَا جَائِزٌ، بِخِلَافِ الْقَدْرِ الْمُضِرِّ فَإِنَّهُ يَحْرُمُ، فَافْهَمْ وَاغْتَنِمْ هَذَا التَّحْرِيرَ

The Need for Islamic Ethics in Medicine

Shaykh Mateen A. Khan, MD

As new diseases and treatment modalities arise, health professionals and patients increasingly find themselves facing dilemmas – ranging from birth defects to end-of-life care – that are as much scientific as they are moral. Medicine, as a field, requires a strong ethical directive. However, personal experience and historical references testify to the fact that human intellect alone is often incapable of reaching objective ethical standards or does so in a contradictory manner. More than just outlining the permissible (halāl) and the impermissible (harām), Islam provides the Believer with a worldview and wide-ranging guidance – a guidance not only in our personal lives, but in our professional lives. Not only in our health, but also in our sickness. Similarly, we have come to appreciate in modern Medicine that a holistic approach to patient-care is imperative. We are so much more than biology. With an ethics-based approach, the Muslim health professional can tread a path of greater clarity and purpose.

In Medicine, there is a higher purpose for the student of ethics. Health professionals are honored as agents of Allah as they seek outpatient ease and treatment. The Prophet ﷺ was once asked if there was benefit in Medicine. He replied, “The One who allowed the disease [also] sent the cure.” The cure is from Allah, but its means is the practitioner. Implicitly, in these words, and explicitly in prophetic actions, patients are directed to seek out medical expertise with some Shari`ah rulings predicated on the opinion of a capable medical expert. Their responsibility is to seek out expertise, our responsibility is to serve as the conduit to divine mercy. If we align our intentions properly, we are honored by Allah in this world and benefit ourselves greatly in the Hereafter. The Prophet ﷺ also said, “He who alleviates the suffering of a brother out of the sufferings of the world, Allah would alleviate his suffering from the sufferings of the Day of Resurrection.” This is evidenced in the statements of scholarly greats such as Imam al-Shāfi`ī, who said, “I do not know of any science more noble after the sciences of the permissible and the impermissible than Medicine,” and the great number of Islamic scholar-physicians such as Shaykh Rashīd Ahmad Gangohī. Since then, the two fields have diverged due to the tremendous knowledge required, but both experts of Islamic and medical sciences retain a need to learn Islamic medical ethics.

As health professionals, knowing and understanding Islamic medical ethics fulfills a personal need. It removes the burden, guilt, and anxiety that often accompanies moral decisions dealing with life and death issues. Studies suggest that by practicing Medicine with a clear moral compass “physicians, other healthcare professionals, and healthcare organizations also potentially benefit, but not only because of the satisfaction of conducting themselves in a professionally ethical manner. These groups will benefit by reducing burnout and its personal and professional consequences if attention to health care ethics and values reduces the realities or the perceptions of “incongruence” in these areas between healthcare professionals and the healthcare organizations with which they are associated.”[1]

However, beyond personal contentment, the Muslim health practitioner must also keep the broader good in mind. Indeed, the AMA code of medical ethics concurs, “As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.” An Islamic ethics-based approach to Medicine promises best outcomes spiritually and physically for the individual practitioner, his or her patients, and the community at large. Often, the layperson finds themselves at the mercy of a medical system that is constantly changing, ambiguous or contrary to Islamic morality. Decisions on seemingly impermissible medications to surrogacy can be a great source of anxiety and stress. Increasingly, the Muslim layperson when confronted with such ambiguity or unease in the modern ethical system is looking to their religion for guidance. The characteristic of the All-Wise (Al-Hakīm) means that He has directed us towards our own benefit. Often, the patient will first look to health practitioners for an ethical answer based in religion, and so, it is imperative that we be familiar with the topic. The burden falls upon us to provide initial direction and in complex situations, coordinate a team-approach involving medical and Islamic legal experts.

Every Muslim practitioner should consider it incumbent to learn a certain degree of Islamic medical ethics. Indeed, behind every creation lies the mark of the Creator. He has not left us without guidance. One must only seek it out. Doing so provides ethical direction and beneficial purpose for the health practitioner, patient, and community at-large.

O Allah! The Lord of the people, the Remover of trouble! Heal, for You are the Healer. None brings about healing but You; a healing that will leave behind no ailment.[2]

[1] Mayo Clin Proc. 2011 May; 86(5): 421–424.

[2] Sahih al-Bukhari 5742

Vitamin D

Question:

Vitamin D is commonly derived from sheep wool.  Is this halal to consume?

Answer:

Bismihi Ta’ala

Vitamin D supplements are available in two forms, D2 (ergocalciferol) and D3 (cholecalciferol). Vitamin D2 is manufactured by the UV irradiation of ergosterol in yeast, while vitamin D3 is traditionally manufactured by the irradiation of 7-dehydrocholesterol from lanolin and the chemical conversion of cholesterol. Plant-based sources for vitamin D3 are also now available.

Lanolin is extracted from the wool of sheep. Can Muslims consume vitamin D supplements that are derived from lanolin?

Sheep wool is considered to be pure, therefore the topical use and consumption of products derived from it (such as lanolin) is considered to be permissible. 

Furthermore, in order to produce Vitamin D from Lanolin, a multi-step chemical transformation occurs in addition to irradiation with ultraviolet light. Therefore, a chemical metamorphosis occurs, and the product would therefore be permissible to consume even if it were from an initially impermissible source. 

Due to the above reasons, Vitamin D derived from lanolin from sheep’s wool is permissible to consume.  However, one needs to be sure that the particular form of Vitamin D that he consumes is free from impermissible ingredients, such as gelatin.

And Allah Knows Best

Mufti Adil Farooki, MD

Checked and approved by Mufti Abdul Muqtadir Sikander

بدائع الصنائع في ترتيب الشرائع 1:63

البرهاني في الفقه النعماني (1/ 206)

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h3

https://www.quora.com/What-is-the-industrial-process-involved-in-making-Vitamin-D3

A Sunnah-Minded Approach to Medicine for the Practitioner

Shaykh Mateen A. Khan, MD

Like everything in Islam, the philosophy of practice for a Muslim health practitioner starts with the kalimah. Bear with me on this. The first half of the kalimah explains the reason for our being here. There is no deity other than Allah. As such, there is no creator or sustainer other than Him. We and everyone else exist simply because He willed us to exist. This is not a matter of debate or choice. Rather, it is a reality. The sooner you accept this reality, the sooner you can move forward in life. How should you live so that you’re maximizing your life’s potential? The second half of the kalimah answers this question. Muhammad ﷺ is Allah’s messenger. The way to maximize your life’s potential is to follow the prophetic path as laid out in revelation. When examining the main themes and purposes of revelation, we find one of life’s obligations is the protection and preservation of life itself. The Qur’an states:

وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِ ۛ وَأَحْسِنُوا ۛ إِنَّ اللَّـهَ يُحِبُّ الْمُحْسِنِينَ

Do not throw yourselves into destruction and do good. Indeed, Allah loves those who do good.

Life is precious and calls for good actions as a means of Allah’s love. After examining the primary sources of Islam—the Qur’an, Sunnah, and scholarly consensus, Islamic scholars determined five things to be the purpose of religion (maqāsid al-sharī`ah). From the five maqāsid al-sharī`ah, we find three of them to be directly related to health and of great importance to the health practitioner: preservation of life, mind and mental health, and offspring.1

In numerous narrations, the Prophet ﷺ placed great importance on health.

أَنَّ رَسُولَ اللهِ صلى الله عليه وسلم كَانَ يُكْثِرُ أَنْ يَدْعُوَ‏:‏ اللَّهُمَّ إِنِّي أَسْأَلُكَ الصِّحَّةَ، وَالْعِفَّةَ، وَالأَمَانَةَ، وَحُسْنَ الْخُلُقِ، وَالرِّضَا بِالْقَدَرِ

The Messenger of Allah ﷺ used to supplicate, “Oh Allah, I ask You for health, restraint, trustworthiness, good character, and contentment with the decree.” Al-Adab al-Mufrad

لاَ بَأْسَ بِالْغِنَى لِمَنِ اتَّقَى وَالصِّحَّةُ لِمَنِ اتَّقَى خَيْرٌ مِنَ الْغِنَى وَطِيبُ النَّفْسِ مِنَ النِّعَمِ

“There is nothing wrong with being rich for one who has piety, but good health for one who has piety is better than riches, and being of good cheer is a blessing.” Ibn Mājah

The Sunnah is a reflection and exposition of the Qur’an. As such, it is no surprise to find the Qur’anic command of encouraging the good and prohibiting the evil reflected in the prophetic guidance of preservation of health and prevention of sickness. This applies both to the individual as well as the public.

At the individual level, the prophetic path entails personal hygiene in the form of bathing, cleanliness after using the bathroom, brushing the teeth and tongue, trimming and removing certain hair, trimming the nails, keeping your clothing and personal spaces clean, etc. Any Muslim will immediately realize that there is an overlap between our physical health and worship. All the aforementioned practices, if done with the intent of obeying and emulating the Prophet ﷺ, are credited as acts of divine obedience and worship entailing divine pleasure and reward. Not mentioned above are the obligatory rituals of washing—wuḍu and ghusl—that fall directly into the realm of worship as precursors to prayer and Qur’an recitation. Similarly, preservation and promotion of mental health is found in apparent ritual actions like Allah’s remembrance (al-zikr), Qur’an recitation, and in the prayer (al-ṣalāḥ).2 Although, their primary benefit is spiritual, their health benefits are obvious.

At the public level, the path calls for removal of filth from spaces, prohibition of urinating in areas frequented by people or used by them like water sources, cautious separation of animal vectors from humans, encouraging physical activities like swimming, archery, and horse riding, and making places and times for relaxation. Communicable diseases in the form of outbreaks are regulated using quarantines.3 Although also beneficial on the individual level, prohibition of intoxicants and harmful substances has clear public health benefits in creating a productive, stable, and viable community. Truly, the Muhammadan path is not a path of pointless rituals benefiting neither the Creator nor the creation.

It’s very important that we realize the point of these practices was not primarily to bring a life of ease in the world. The Prophet’s ﷺ purpose was not to be a master health practitioner nor a public health policy-maker way ahead of his time. Rather, these practices bring spiritual benefits that are less visible to the naked eye and untrained mind. His ﷺ purpose was to show us a path that connects us back to our Creator and allows us to comprehensively see the world with ourselves included—the physical and the meta-physical, the seen and the unseen, the rational and the spiritual.

Let’s continue further with the relationship of treatment and worship as it pertains to us. A man asked the Prophet ﷺ, “Should we not seek treatment?” In answer, he ﷺ turned towards the group before him and called on them as worshipers and servants of Allah by saying:

“O worshipers and servants of Allah (Yā `Ibād Allah)! Seek treatment because Allah has not placed a single ailment without also placing a cure…”4

This command is not obligatory in all situations. Nonetheless, it is a call upon us as worshipers to deal with our illnesses, anxieties, and health problems with a particular mindset. Seek treatment from Allah as a means of closeness to Him rather than just another biological hurdle in life to overcome. It is also an indication to health practitioners to specialize in their respective fields to best help these worshipers. As mentioned above, one of the purposes of the Sharī`ah is preservation of health entailing that when one becomes ill, he or she should seek out a cure. Imam al-Dhahabī wrote, “Medical treatment is Sunnah because the Prophet ﷺ did it and ordered that it be done.”5 I would take this one step further and add that treating an ailment as a trained practitioner is itself a Sunnah as he ﷺ treated people and prescribed medications himself.6 Including an intention to obey and emulate the Prophet ﷺ in this respect can be a source of divine pleasure and reward. The Prophet’s ﷺ command, “Give help to the troubled,”7 and the Qur’anic injunction, “If you help [the deen and people of Allah], He will help you”8 should always echo in our minds.

When we understand this about Islam, we will cease to be surprised by its teachings. Did we expect something less from Allah and His messenger ﷺ? Instead, we will be surprised at how we have practiced for so long without our practice advancing our progress on the prophetic path. Muslim health practitioners will need to be at the forefront of advocating and participating in personal and public health. Not only because they are purveyors of up-to-date, evidence-based health practices, but primarily because they strive to incorporate a philosophy that draws from the unseen (al-ghayb), benefits us spiritually by emulating the Prophet ﷺ, and brings us closer to Allah.

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In order of importance, the five are preservation of religion, life, mind, offspring, and property.

Although with weakness in transmission, it has been reported that in the ṣalāḥ, there is a cure. Ibn Mājah 3458

The Prophet ﷺ said, “If you hear of an outbreak of plague in a land, do not enter it; but if the plague breaks out in a place while you are in it, do not leave that place.” Ṣaḥīḥ al-Bukhārī 5728

Sunan al-Tirmidhī 2038

Al-Ṭibb al-Nabawī li al-Dhahabī

Jābir said, “The Prophet ﷺ cauterized Sa`d ibn Mu`ādh from the wound of an arrow.” Abū Dāwūd 3866

Ṣaḥīḥ al-Bukhārī 1445, Sunan Abū Dāwūd 4817, and others

Surah Muḥammad 7