Covid-19 Vaccine Rollout Should Not Pause During Ramadan — Dr Musa Mohd Nordin

The MOH is predicting a fourth wave, which will be even more devastating with the spread of Covid-19 variants which are more resistant to the available vaccines.

The suggestion by the Deputy Health Minister to pause vaccine shots at night during Ramadan must not be seen in isolation. It must be discussed within the context of the burgeoning Covid-19 pandemic and the need to achieve population immunity.

Malaysia has the highest cumulative cases of Covid-19 per million in the ASEAN region, at 11,000 cases per million population. Even when corrected for Covid-19 testing differences, we are ahead of Singapore (10,000), the Philippines (8,000) and Indonesia (6,000).

The Ministry of Health (MOH) is reporting one to two thousand cases per day, with 188 cases in ICU and 84 cases on respiratory support.

Our vaccination uptake for one dose is only 1.8 per cent, whilst Indonesia is ahead at 4 per cent and Singapore 10 times more at 19 per cent.

The MOH is predicting a fourth wave, and when it arrives, I think it will be even more devastating with the spread of Covid-19 variants which are more resistant to the available vaccines, namely the B117 (UK) and B1351 (South Africa) strains.  

And Europe, South America, North America and India is suffering through this punishing new variant Covid-19 wave.

With these grim statistics, it goes without saying that we must speed up the rollout and scale up the coverage of the Covid-19 vaccines.

The coronavirus does not care whether it is Ramadan or Hari Raya. People will get infected, get hospitalised and die, regardless whether it is Ramadan or Syawal. Therefore, the vaccine rollout should proceed as planned.

The concern that people won’t show up for the vaccines because it might clash with terawih prayers needs to be carefully addressed with caution and sensitivity.

It must be noted that terawih prayers are not mandatory prayers. They are nonetheless a practice, tradition and sunnah of the Prophet and his companions (peace be upon them)

There is a perplexing contradiction of sorts in our Malaysian Muslim religiosity. They gather at the mosques during the month of Ramadan to perform the optional terawih (sunnat muakkad), but the mosques are relatively empty during the mandatory five-times-a day prayers, including the night maghrib and isya’ prayers.

Looking from the perspective of the maqasid shari’ah (the higher objectives of the Islamic jurisprudence), universal Covid-19 within the ambience of the raging pandemic, is to fulfill the maslahah ammah (benefits of the larger community). And it is a fiqhi  (jurisprudential) ruling that that general public interest shall take priority and precedence over maslahah fardhi (individual benefits).

Therefore, a smart compromise must be crafted to ensure that the vaccine rollout is not negatively impacted by religious practices during the blessed month.

In this context, the Muslim Malay leaders, notably the Muslim religious scholars, have to be exemplary. Instead of politicising the issue along religious lines, the Ministry of Religious Affairs and the muftis should rally for the immunisation campaign during the month of Ramadan.

Instead of making trips abroad for meetings or to perform the umrah, they should instead be addressing the pressing needs of the community. Some Malay Muslims may not even want be vaccinated during the day, let alone at night.

These are the demands of Fiqh Awlawiyat, the jurisprudence of priorities, to ensure that the national vaccine rollout is aimed at reducing the burden of Covid-19 in the community

What better show of confidence in the national vaccine campaign than to see the muftis and the asatizah (Muslim religious scholars) taking the lead in getting their Covid-19 vaccines during Phase Two in the month of Ramadan?

The Jawatankuasa Khas Jaminan Akses Bekalan Vaksin Covid-19 (JKJAV) and the authorities have been advocataing for the equitability of the vaccine rollout. Now the real test is upon us.

Should our co-religionists, non-Muslims, be similarly excluded from the shots during Ramadan nights just because their Muslim colleagues are busy engaged in terawih prayers?

If the Muslims are allowed to opt out during the nights of Ramadan, the non-Muslim should not be penalised but allowed to continue with their shots.

While on the topic of equitability, why should the 30,000 or so young (less than 50 years old) pilgrims jump the queue and take precedence over higher-risk senior citizens and those with co-morbidities?

The JKJAV, the the Ministry of Science, Technology and Innovation and the MOH must address this gross infringement of equity vis-à-vis the vaccine distribution.

If they can fork out RM20,000 or more for the haj, they should be made to pay for their vaccines, and ministers have no legitimacy nor credibility to circumvent the long Covid-19 vaccine queue for them.

The strongest religious opinion (and it has very strong consensus among Muslim scholars) that injections, like the Covid-19 shots do not nullify the fast.

Muslim adults are advised to prepare for their upcoming jabs during Ramadan by ensuring that they are well-hydrated and consuming a proper meal during the sahur (waking up before dawn for a meal, which is another strong tradition set by the Prophet).

Elders who are beyond 65 years old should be in good health, and those with co-morbidities should see their respective family physicians to ensure that their conditions are well controlled. Unless this is attained, we should delay some of those with pre-existing disorders to after Ramadan.

In exceptional circumstances, if they develop adverse effects following immunisation (AEFI) which are not tolerable,  they can break their fast.

It needs mentioning that the Sinovac vaccines, though less efficacious (vaccine efficacy of 50-83 per cent but effective against severe Covid-19 and deaths) have less AEFI when compared with the Pfizer vaccines.

If the public can flock to the Ramadan bazaars, I think there is no plausible excuse for them to refuse vaccines. The over-eating often observed at the break of fasting and the smoke particles from the ayam percik stalls at these bazaars are probably more detrimental than the AEFIs of the Covid-19 shots.

There is no precedent of adult vaccination in theNational Immunisation Programme, except for tetanus vaccination for pregnant mothers.

Virtually all adult vaccinations are done by private GPs, family doctors and in private hospitals, e.g. influenza, pneumococcal, meningococcal, shingles and varicella vaccinations.

I have since the initiation of the vaccine rollout on February 24, 2021 advocated for the early engagement of the private health care sector rather than later in September 2021 as mentioned by the JKJAV.

This is a pandemic, and the government has even declared an emergency. Such a situation demands emergency solutions i.e. mass vaccine rollouts at warp speed.

My first suggestion to the NPRA is to issue similar Emergency Use Authorisation (EUA) licensures to the Moderna, Sputnik V, Janssen and Novavax vaccines, which have been published in peer reviewed scientific journals and has been used in well over 30 countries.

This will allow Malaysia to have access to a wider portfolio of vaccines, utilising different modus operandi.

When the Indian public health care facilities rolled out the vaccines, they managed 300,000 doses per day. When the private facilities were involved, they managed to increase it by seven times, i.e. two million doses per day.

The second suggestion is to ramp up the administration of the vaccines, as shown by Israel and the UAE from Day One of the rollout programme.

We do not compare ourselves with Singapore, Australia or New Zealand, who can all take their own time since their Covid-19 incidences is virtually zero. Singapore had only one case of indigenous community spread for the two-week period of March 12-25, 2021.

Thirdly, this is not helped by the MySejahtera app, which is not at all user-friendly. I had to get my tech-savvy daughter to do a third registration for me.

Imagine the difficulties those in rural communities might experience. It is thus not surprising that the registration numbers of the citizens are well below expectation.

Other initiatives like Selangor’s ImuniSel outreach programme to increase the registration of Selangorians needs to be undertaken. It is even worse for those in the East Coast states and Sabah.

Other contributory factors needs to be considered, including low childhood immunisation uptakes in these states. The 2019 uptake of the first-dose MMR was less than 85 per cent in both Kelantan and Terengganu, compared to the national average of 95 per cent.

The overbearing influence of extreme religious sentiments must be addressed by the authorities, despite the national fatwa by the Ministry of Religious Affairs.

Next, the JKJAV should allow the Association of Private Hospitals Malaysia (APHM), states and other stakeholders to begin to procure vaccines which are not within the JKJAV portfolio, for example, the Moderna vaccines. Unlike suggestions by a few specialists, the APHM is not appropriating the MOH vaccine stockpile. It is over and above that.

They would be able to address the immediate and critical needs of the following group:

  • Expatriates.
  • Young businessmen who need to travel.
  • Students undertaking overseas studies.
  • Those who would like a choice of vaccine.
  • T20 citizens who do not mind paying for their vaccines.
  • Migrant workers and refugees which some state government would like to prioritise to protect their industries.
  • Those going for the haj should not be allowed to jump queue, but instead get their shots in the private sector.

Not only will this ensure speed and preserve equity, it would enhance coverage and allow for faster attainment of the 70-80 per cent herd immunity. 

And to facilitate the national vaccine agenda, the ceiling price of the vaccines must be set to protect against criminal profiteering by connected cronies and private health care facilities.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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