Ramadan is the ninth month of the Islamic calendar and will begin this year on April 12 or 13 (depending on the sighting of the moon). During this sacred month, Muslims are required to abstain from food and drink from sunrise to sunset. In addition to food and drink, consuming medication is also prohibited.
For those who are sick or those with chronic illness who require medication during daylight hours, an exemption from fasting is granted. There has been much discussion, therefore, on the administration of COVID-19 vaccines and if it is permissible for Muslims who are fasting during Ramadan to receive a vaccine.
Although the vaccine is not administered orally, there may be many Muslims who are concerned that the vaccination may negate their fast and who may therefore refrain from having the vaccine administered. Reassurance and education for patients is essential to ensure they still receive their vaccine.
Muslims may experience vaccine hesitancy following previous experiences with non-permitted vaccines. In Islam, the consumption of porcine products is prohibited. This ruling can cause confusion regarding the administering of porcine-containing medicinal products, for example porcine insulin and vaccines containing pork gelatine.
Pork gelatine is a common ingredient in vaccines and is an extremely effective stabiliser, keeping the vaccine safe and effective during storage.(1) Muslims may prefer not to use these medicinal products, although Islamically they are permissible if there is no alternative and the person’s life is in danger.(2) Vaccines that contain pork gelatine include Fluenz (nasal influenza vaccine), MMR VaxPro (to protect against measles, mumps and rubella) and Zostavax (to protect against shingles).
Patients should be reassured that none of the COVID-19 vaccines contain any pork-derived constituents or animal products. The vaccines are completely halal (permitted in Islam) and have been approved by multiple Muslim organisations in the UK including the British Islamic Medical Association, British Board of Scholars and Imams and Mosques and Imams National Advisory Board.(3)
Risks in ethnic minority groups
It has been well documented that some patient groups are at greater risk of contracting COVID-19 or having worse COVID-19 symptoms than other groups. Ethnic minority groups are at higher risk, with black and South Asian people having the worst outcomes. People of black ethnicity have been shown to have the highest diagnosis rates (with the lowest displayed in white British people), and those from ethnic minority groups had mortality rates twice that of white British people.(4)
With many Muslims belonging to ethnic minority groups, it is imperative that these patients understand their increased risk of contracting COVID-19 and pharmacy teams are well placed to reduce vaccine hesitancy among these groups. Research shows that uptake of the COVID-19 vaccines is much lower in ethnic minority groups, although talking to a trusted healthcare professional has been shown to improve uptake rates.(3)
The Muslim Council of Britain (MCB) has confirmed that the COVID-19 vaccines licensed in the UK do not invalidate the fast during Ramadan as of the opinion of the majority of scholars. Patients can therefore be reassured that there is no need to cancel or postpone a scheduled vaccination or invitation from their doctor for their vaccination.(5)
Vaccine adverse effects
Although Muslim patients may consent to receiving the vaccine while fasting, they may need guidance on what to do if they experience adverse effects following vaccination. The COVID-19 vaccines have displayed adverse in patients similar to other vaccines, for example injection site reactions and generalised flu-like symptoms.
Patients can vary greatly in their experience of post-vaccination effects. Most only experience mild, self-limiting symptoms, however fever may present 1-2 days post-vaccination.(6) Those fasting may need advice on how proceed should they feel unwell. The MCB has confirmed that should the patient feel unwell post-vaccination, they should break their fast (or abstain from fasting) if they feel the fast would worsen their symptoms or delay their recovery. The MCB has produced a helpful flowchart detailing these points.
Role of the pharmacy team
Pharmacy teams can have an open and honest discussion with Muslim patients during Ramandan on the risks and benefits of COVID-19 vaccination. During the conversation, it is important to highlight the following:
- The vaccine and its constituents are halal.
- Receiving the vaccine does not invalidate the fast.
- COVID-19 may result in higher morbidity and mortality for patients from ethnic minorities –therefore, vaccination against the virus is particularly important.
- Side effects from the vaccine are usually mild and self-limiting. Should the patient particularly unwell, the general rules pertaining to illness and fasting apply.
Further reading and signposting for patients
There are a variety of useful resources to signpost patients to for reassurance and further reading. Patients pay also be advised to consult with their local imam for further guidance.
- The Muslim Council of Britain Ramadan 2021
- British Islamic Medical Association Ramadan Guidance
- Muslim Doctors Association: COVID-19 Vaccination, The Facts
- Vaccine Knowledge Project (2020) Gelatin in the nasal flu vaccine
- Specialist Pharmacy Services (2020) What factors to consider when advising on medicines suitable for a Halal diet?
- Muslim Doctors Association (2021) COVID-19 vaccinations: the facts
- The British Medical Journal (2021) Mitigating ethnic disparities in covid-19 and beyond
- The Muslim Council of Britain (2021) Latest COVID-19 advice for British Muslims
- NHS UK (2021) COVID-19 vaccine