key: cord-0689283-c76gcymi
authors: Ali, Sarah N; Hanif, Wasim; Patel, Kiran; Khunti, Kamlesh
title: Ramadan and COVID-19 vaccine hesitancy—a call for action
date: 2021-04-07
journal: Lancet
DOI: 10.1016/s0140-6736(21)00779-0
sha: 440d85735700476400d1dc695f4f76eea27819d2
doc_id: 689283
cord_uid: c76gcymi

nan

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, 1 could Ramadan impede successful vaccination roll-out?

Ramadan fasts require Muslims to abstain from food and drink during daylight hours (exemptions include illhealth). Fasting during Ramadan also requires "refraining from anything entering the body cavities". 2 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 study 3 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. 4 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. 5 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 on the mental health and wellbeing of all students, regardless of ethnicity, and irrespective of their reasons for travelling home. There is no evidence to suggest that students who specifically celebrate Diwali were intentionally targeted in a policy designed to contain an ongoing pandemic. Second, Bandyopadhyay claims that limitations on the movements of minority ethnic students were imposed to protect the Christmas period. No evidence is provided to support this claim; yet malicious intent on the part of the UK Government is clearly implied. It is, however, more probable that the urgency and severity of lockdown restrictions were in response to an out-of-control pandemic that threatened to collapse the UK health system. Their relationship to university term times, and the proximity of Christmas, is irrelevant, coincidental, and void of discriminatory intent.

Finally, Christmas Day is one of numerous public holidays available to all UK citizens. It is not restricted to those affiliated with Christianity, and there is no requirement for religious observance. Instead, families and friends use the day to gather and celebrate their importance to one another. The inclusion of all people in this public holiday, without excep tion, and regardless of religious affilia tion, strengthens its importance and deepens its meaning. Prime Minister Boris Johnson's statement that, "by taking tough action now, we can allow families across the country to be together [at Christmas]," 3 was in reference to all families. As such, this statement was intended to bolster public motivation for lockdown adherence and not to impose discriminatory policy.

It seems to me that Bandyopadhyay's argument is weak and unfounded. At best, it is simply an unhelpful opinion. At worst, it represents a dangerous trend towards locating institutional racism where it might not exist. Great solidarity is required during the COVID-19 pandemic; everyone must take respon sibility. 

Soham Bandyopadhyay 1 claimed that the UK Government's national lockdown, announced in November, 2020, to control COVID-19, was an institutionally racist policy. Claims of institutional racism are serious allegations and thus warrant critical appraisal. I therefore raise three points.

First, Bandyopadhyay claims that, through these restrictions, the UK Government prevented a large proportion of minority ethnic university students from visiting home. This assessment is an incomplete and unfair representation of the policy, which prohibited all students living at universities, regardless of ethnicity, from travelling during lockdown. 2 In 2020, spending Diwali in lockdown with restrictions could have saved hundreds, if not thousands, of lives, especially considering that Black, Asian, and minority ethnic people have a higher mortality rate following COVID-19 infection, as Bandyopadhyay rightly pointed out. In India, the vibrant festivities of Ganesha Chaturthi and Dussehra were celebrated in different phases of lockdown. Diwali was also celebrated under severe restrictions, with the fear it could turn into a superspreading event. Several Muslim countries, including the United Arab Emirates and Kuwait, introduced strict public policies for celebration of Eid-Al-Fitr to raise awareness and discourage irresponsible behaviour. In the UK, Christmas was celebrated with restrictions on families and other households mixing. 2 Festivities and markets across the UK, events families look forward to and cherish, were cancelled.

Approximately 60% of the UK population is Christian. Hindus, Sikhs,

Scientific Advisory Group for Emergencies. Factors influencing COVID-19 vaccine uptake among minority ethnic groups

The fiqh of fasting in the Hanafi madhhab

Vaccination and blood sampling acceptability during Ramadan fasting month: a cross-sectional study in Conakry, Guinea

Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on

COVID-19 vaccine does not invalid the fast during Ramadan: Abdul Rehman Al Sudais