Remind patients that they can have their COVID-19 vaccine during Ramadan

Ramadan is expected to start on 12 April 2021 (to be confirmed after sighting of the moon) and last until around 12 May — a period in which Muslim people abstain from consuming food or drink from sunrise to sunset.

Concerns have been raised about whether getting the vaccine breaks the fast; feeling unwell after vaccination; and reservations about taking oral pain relief between sunrise and sunset. However, the vaccines are safe and religiously permissible during Ramadan.

Pharmacists should arm themselves with the following information to spread this important message.

The vaccine does not invalidate the fast

The British Islamic Medical Association (BIMA) has said “taking the COVID-19 vaccines that are licensed in the UK does not invalidate the fast”. Citing the opinion of Islamic scholars, the association said that “subcutaneous, subdermal, intramuscular, or intra-articular injections for non-nutritional purposes whilst fasting do not invalidate the fast, regardless of the injected content entering the blood circulation”. Furthermore, BIMA stated: “Individuals should not delay their COVID vaccinations on the account of Ramadan.”

The vaccine is Halal

BIMA has confirmed that the vaccines do not contain pork or other animal derivatives or aborted foetal products — reflecting the opinion of the majority of Islamic scholars that it is permissible.

No-to-negligible alcohol content

There is no alcohol in the Pfizer vaccine, while the Oxford/AstraZeneca vaccine contains a negligible amount of ethanol, as an excipient, which is not enough to cause any noticeable effects.

Side effects and making up fasts

Common side effects include tenderness/redness at the injection site; headache; muscle ache; feeling tired; and fever. Paracetamol can be taken before or after the fast. Side effects will differ. If a person is ill and unable to fast, they may make up the missed fast when feeling better and before the next Ramadan — this will be an individual decision based on severity and duration of side effects experienced. Delaying getting the vaccine means a risk of becoming unwell from COVID-19.

What the Quran says

“Surely with all hardships there is ease” (94:6). We know that “there is no disease that Allah has created, except that he also has created its cure”. Muslims may feel a duty to preserve life, and getting vaccinated is the most effective way to prevent illness and loss of life from COVID-19.

Increasing uptake during Ramadan

• Reassure and advise on the vaccines’ safety, efficacy and availability;
• Review access to vaccination and identify appropriate local venues for the delivery; for example, mosques (places trusted by the community);
• Offer appointments at the end of the day (after sunset) to accommodate people who may be fasting — some mosques have been converted to vaccine centres to encourage take-up and are planning to offer the vaccine to Muslims immediately after Iftar during Ramadan;
• Provide a culturally specific service (for example, offer privacy, especially in an open-plan mass vaccination hub);
• Provide information in different languages to encourage uptake from diverse communities;
• Ensure that messaging is repeated, consistent and culturally sensitive;
• Provide prompts and reminders in the form of letters/leaflets and use translated audio and visual media;
• Use local and credible messengers; for example, GPs, pharmacists, and local faith leaders;
• Put in place a targeted vaccine communications strategy that considers the impact of pre-existing health inequalities and mistrust on lower uptake among some communities.

There are a number of support tools that pharmacy teams can use to support these conversations; for example, a one-page summary and myth-busting tools from the BIMA; and the Royal Pharmaceutical Society’s guide to COVID-19 vaccines.

Farzana Mohammed, learning facilitator, Health Education and Improvement Wales; member, Muslim Doctors Cymru; member, British Islamic Medical Association