Correspondence published by Ali and others in The Lancet on 7th April.

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 amongst minority ethnic populations, could Ramadan impede successful vaccination rollout?

Ramadan fasts require Muslims to abstain from food and drink during daylight hours.  

Fasting during Ramadan also requires refraining from anything entering the body cavities.  

This may mean that there is a reluctance to receiving vaccinations 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 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 this information was resolved when Nigerian religious leaders received assurance about vaccine safety, subsequently confirming its acceptability to communities.  

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.  

Public and healthcare professionals need to be made aware of the announcement by Muslim scholars advising that the COVID-19 vaccine is permissible during Ramadan without invalidating the fast.  

This statement was made in March 2021 from the president of two holy mosques in Saudi Arabia and should allay any religious concerns.  

A solution to this problem would be to extend vaccination times outside of fast, such as during special Ramadan nightly prayers. 

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 Ramadan celebrations. 

The London General Practice commends the Government on its vaccination programme and encourages all those who are invited for vaccination to accept and be vaccinated.

Dr Paul Ettlinger

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