ReligionLink

As the world worries about a possible influenza pandemic, Muslim health experts warn that the huge gathering for the hajj poses the risk of rapid international spread of infection. They call for mandatory flu shots for all pilgrims.

More than 2 million people from all over the world will soon converge on Saudi Arabia for the one of the largest gatherings on earth — the five days of the Muslim pilgrimage of hajj, which begins this year on Dec. 29. Hajj is one of the five pillars of Islam, which has more than 1.3 billion followers around the world. All Muslims are required to make a pilgrimage to Mecca at least once in their lifetime if they are physically and financially able to do so.

Health experts, concerned that a global influenza pandemic is overdue, say such a huge gathering of international travelers poses special risks. Pilgrims are packed tightly together – some of have been trampled to death in recent years – for the five days during which religious rituals are performed. The contagion risk posed by so vast an international assembly “can no longer be ignored,” a group of Muslim health experts in Saudi Arabia and Britain wrote in an editorial published in the Dec. 9 issue of the British Medical Journal.

Because the rituals of hajj must be performed at a specific time of the Muslim calendar and in a specific place, pilgrims find themselves in huge crowds and crowded accommodations — conditions conducive to the “rampant spread of the influenza virus and a global pandemic,” the editorial warns. The world has “inadequately prepared” for this “devastating prospect,” the authors add.

Of course, the danger of an international epidemic was even greater in the days before antibiotics, vaccines and modern public health practices. Almost half of those on the 1831 hajj, for example, contracted cholera from contaminated water. Heading homeward, they spread the disease into Turkey and the Middle East, across North Africa, through the Balkans, and, via the Danube, as far as Hungary. Today measures such as mandatory vaccination against polio and meningitis help safeguard the health of the pilgrims as well as those back home.

The percentage of pilgrims getting influenza shots, which are recommended but not required, is “worryingly” low, according to a letter by several of the same authors published in the same issue of British Medical Journal. Although Saudi Arabia’s Ministry of Health advises pilgrims to wear face masks to reduce the spread of germs, many of the faithful see this as violating the requirement that male pilgrims refrain from covering their heads. The World Health Organization and Saudi health authorities should adopt a “coherent international response” as part of the worldwide strategy “to prevent a possible influenza pandemic,” the editorial urges.

Why it matters

The flu warning raises a complicated question that reporters can explore in their local communities: How much should be done to make sacred religious rituals safe for public health? Whose responsibility is it to raise such a question? And whose responsibility is it to see that precautions be taken?

Sources

• Shuja Shafi, a microbiologist at Northwick Park Hospital in Harrow, United Kingdom, is a co-author of the editorial, “Hajj and the Risk of Influenza,” and the letter, “Influenza Vaccine Uptake among British Muslims Attending Hajj, 2005 and 2006,” published in the British Medical Journal, Dec. 9, 2006. Contact shuja.shafi@nwlh.nhs.uk.
• Aziz Sheikh is professor of primary care research and development at the University of Edinburgh, Scotland, and a co-author of the editorial, “Hajj and the Risk of Influenza,” published Dec. 9, 2006, in the British Medical Journal. Contact aziz.sheikh@ed.ac.uk.
• Shiraz A. Malik is executive director of the Islamic Medical Association of North America in Lombard, Ill. Contact 630-932-0000, hq@imana.org.

Background

• Read about travel requirements for the hajj from the U.S. Centers for Disease Control.
• Read an April 23, 2006, Seed magazine article about health on the hajj, “When on Hajj, Wear a Face Mask.”
• Read a brochure about avoiding meningitis and other health problems on the hajj from the Department of Health of the United Kingdom.
• See a Dec. 7, 2006, UPI story about the flu warning.
• See a Dec. 8, 2006, IslamOnline.net article about the flu warning.
• See IslamOnline.net’s page of information about hajj.
• See ReligionLink’s 2006 holiday edition for more background on hajj.