Ramadan and COVID-19 vaccine hesitancy—a call for action
Authors: Sarah N Ali, Wasim Hanif, Kiran Patel, Kamlesh Khunti
Journal: The Lancet (2021)

The Islamic month of fasting, Ramadan, begins around April 12, 2021. In 2020, Ramadan coincided with the beginning of the COVID-19 pandemic, moving what is a month of communal prayers and social gatherings into the era of virtual prayers. 2021 brings further challenges with ongoing virtual prayers and a global vaccination programme. For 1·9 billion Muslims worldwide, Ramadan coinciding with the vaccination programmes crucially means that their vaccinations might be offered during this time. With ongoing concerns of vaccine hesitancy among minority ethnic populations,1Scientific Advisory Group for EmergenciesFactors influencing COVID-19 vaccine uptake among minority ethnic groups, 17 December 2020.https://www.gov.uk/government/publications/factors-influencing-covid-19-vaccine-uptake-among-minority-ethnic-groups-17-december-2020Date: Jan 15, 2021Date accessed: March 13, 2021Google Scholar could Ramadan impede successful vaccination roll-out? Ramadan fasts require Muslims to abstain from food and drink during daylight hours (exemptions include ill-health). Fasting during Ramadan also requires "refraining from anything entering the body cavities".2Ihsan UU The fiqh of fasting in the Hanafi madhhab.https://islamqa.org/hanafi/seekersguidance-hanafi/32700Date: July 31, 2010Date accessed: March 13, 2021Google Scholar Although for most people, this term applies only to nutrition or medicine entering the gastrointestinal tract or brain, some reluctance to receiving vaccinations is anticipated during Ramadan. To date, there is little global information surrounding vaccination hesitancy during this Islamic month of fasting; historically, vaccination programmes have not been rolled out with such urgency. During the west African Ebola epidemic, a study3Peiffer-Smadja N Ouedraogo R D'Ortenzio E et al.Vaccination and blood sampling acceptability during Ramadan fasting month: a cross-sectional study in Conakry, Guinea.Vaccine. 2017; 35: 2569-2574Crossref PubMed Scopus (12) Google Scholar in Guinea showed a high overall acceptability of vaccination during Ramadan by Muslim scholars (80%), but a significantly lower acceptance in the general Muslim population (40%). Furthermore, a boycott of the polio vaccination campaign in three states in Nigeria following misinformation was resolved when Nigerian religious leaders received assurance about vaccine safety, subsequently confirming its acceptability to the communities.4Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (119) Google Scholar Growing concerns around uptake of the COVID-19 vaccine during Ramadan are focused on whether the injection invalidates the fast, any possible side-effects, and whether people have to break the fast. Therefore, there is an urgent need for a global call for action to reduce vaccine hesitancy. The public and health-care professionals need to be made aware of the announcements by Muslim scholars advising that the COVID-19 vaccine is permissible during Ramadan, without invalidating the fast. The statement, made in March, 2021, from the president of Two Holy Mosques in Saudi Arabia, should allay any religious concerns.5Sharifain H COVID-19 vaccine does not invalid the fast during Ramadan: Abdul Rehman Al Sudais.https://www.haramainsharifain.com/2021/03/covid-19-vaccine-does-not-invalid-fast.htmlDate: March, 2021Date accessed: March 10, 2021Google Scholar Ebola and polio vaccination programmes highlight the key role that religious leaders play in promoting acceptability and education of their communities towards vaccination during Ramadan. Religious leaders should use Friday prayer sermons to promote the acceptance of vaccines, dispelling myths with worshippers. Despite these efforts, some people still do not wish to be vaccinated during fasting hours. A solution to this problem would be to extend vaccination times outside of fasts, such as during special Ramadan nightly prayers, Taraweeh. Using mosques as vaccination sites would allow vaccinations to occur during Ramadan, including in non-fasting hours. Concerns about vaccine-related side-effects and requiring to break the fast should be addressed and weighed against the serious morbidity related to COVID-19. Vaccinations are the greatest tool to aid the world back to normality, and to the gradual return of celebrating festivals and future Ramadans. KK is a director at the University of Leicester Centre for Black Minority Ethnic Health, chair of the Ethnicity Subgroup of the Scientific Advisory Group for Emergencies (SAGE), and a member of Independent SAGE. All other authors declare no competing interests.