As COVID-19 spreads rapidly across the African continent, causing economic and social disruption and unparalleled morbidity and mortality superimposed on already fragile health care systems, there is a public health and ethical imperative to rapidly vaccinate as many people as possible. Limited vaccine access, vaccine nationalism in high income countries and vaccine hesitancy pose significant threats to rollout in low-to-middle income African countries. There is public distrust in governments, lack of vaccine manufacturing facilities and capacity in Africa, low health literacy levels and lack of community involvement. As a result, Africa lags behind in the global race to roll out COVID-19 mass vaccination. Our symposium examines ethical and contextual challenges with COVID-19 vaccine allocation and distribution in African countries.
This symposium will be chaired by Dr Nair and Dr Obasa. After a brief introduction, each speaker will present for 10 minutes, each offering different perspectives on the broad theme of Covid-19 vaccine access in Africa ranging from vaccine passports and inequity to mandatory vaccination as a strategy to end the pandemic. A discussion session will follow for 30 minutes in which there will be active audience participation. Finally, the symposium will close with a vote of thanks.
Ethics of vaccine documentation for cross-border travel: implications for Africa
Prof. Stuart Rennie | University of North Carolina – Chapel Hill, USA | United States
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Prof. Stuart Rennie | University of North Carolina – Chapel Hill, USA | United States
Requiring health-related documentation for cross-border travel is not a new practice, and has been typically justified in terms of public health goals such as infectious disease control. However, interventions that involve restricting movement across national borders on the basis of health status should be carefully investigated. As witnessed during the history of the HIV epidemic, health policies related to travel may in fact be driven by nationalist political agendas, sometimes fuelled by underlying xenophobia and racism, and have widespread adverse health effects. The increasing interest in the use of ‘Covid-19 vaccine passports’ for international travel should be viewed in this light. Vaccine passports would facilitate freedom of movement for those in high-income countries who currently enjoy high vaccine access. But their use has the potential to (further) restrict international travel for those in low-income countries, where only a small minority have been vaccinated and universal vaccination may take years. This raises the following ethical questions: given current global vaccine inequity, under what conditions (if any) can vaccine documentation be used globally as a condition for international travel? If vaccine documentation cannot be ethically justified, what are some viable alternatives that could facilitate international travel while protecting global health? Unless ways are found to responsibly facilitate cross-border travel for Africans and others from low-vaccine access countries, the old colonial narrative will be replayed: those ‘better off’ will reap the benefits of freely roaming the earth, while most in poor countries will be seen as disease threats to be contained.
Vaccine Hesitancy in Uganda: A case for stronger community engagement
Associate Professor Joseph Ochieng | Stellenbosch University | South Africa
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Associate Professor Joseph Ochieng | Stellenbosch University | South Africa
The acceptance and uptake of COVID-19 vaccines may prevent future waves of infection from both the current and emerging variants. The vaccination program in Uganda was launched on 8 March 2021, but by 18 June 2021, only 803,797 (1.8%) Ugandan’s people had been vaccinated and only with the first shot even though the government had procured 964,000 doses of the AZ vaccine. In preparation for the mass vaccination rollout, it would have been prudent to prepare the ground via a process of public engagement on issues like priority setting, safety concerns, accessibility, and effectiveness of the proposed vaccines. However, despite the need for sharing vaccine information with the public, no such public debate on the acceptability or priority setting for the COVID-19 vaccines has occurred, although the Ministry of Health has produced a tentative priority framework based on the WHO guidelines.
Public trust and acceptance of non-pharmacological COVID-19 interventions like social distancing and face masks have faced resistance from the public, with some openly questioning the legitimacy of such interventions or wondering if the disease exists. This resistance was partly due to implementing the public health measures with limited or no involvement of the social sciences and ethics input. Similar challenges being highlighted by the severe vaccination reluctance could potentially be avoided by legitimizing the vaccine access process through early and meaningful engagement of the critical stakeholders; public debate on priority setting for the vaccine; education on the need for the vaccines; and addressing the associated safety concerns that may arise.
Did science play a role in vaccine prioritization in South Africa?
Professor Shenuka Singh | Stellenbosch University | South Africa
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Professor Shenuka Singh | Stellenbosch University | South Africa
As COVID-19 spreads rapidly across the African continent, causing economic and social disruption and unparalleled morbidity and mortality superimposed on already fragile health care systems, there is a public health and ethical imperative to rapidly vaccinate as many people as possible. Some countries have adopted a three-phased approach to the vaccine rollout, prioritizing frontline healthcare workers, essential workers and co-morbidity-based priority groups. South Africa vaccinated health care workers, those aged 60 years and older, teachers, prisoners, and the police force. The government then proceeded to vaccinate different age groups. Those with co-morbidities were not prioritised, despite their higher risk level. Consequently, those aged 18 years to 59 years were not vaccinated as a priority and the 18 to 34 year age group will be vaccinated on 1 September 2021. During the third wave, younger people contracted the delta variant and hospital beds were full of unvaccinated patients. Although there was a decision not to use Astrazeneca vaccines in South Africa when the beta variant was prevalent, the decision was reversed during the third wave when the delta variant was found to be more susceptible to the AstraZeneca vaccines. To date, only Johnson and Johnson and Pfizer vaccines have been rolled out in the country. This talk will focus on the role played by science advice in prioritising access to vaccines and in the use and procurement of different vaccines.
Technology transfer to increase vaccine production in Botswana: A pipe dream?
Boitumelo Mokgatla | Stellenbosch University | South Africa
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Boitumelo Mokgatla | Stellenbosch University | South Africa
According to an official report from Botswana, the country has received 62,400 AstraZeneca and 19,890 Pfizer doses via the COVAX scheme in addition to the double-dose CoronaVac made by Sinovac from China. The government is experiencing a shortfall of about 15,000 doses in AstraZeneca vaccine, which has caused considerable delays in administrating second doses to citizens who had received their first dose. There have been talks of opting for a multiple-vaccine, protective approach to ensure that the entire population is not put at risk if one of the vaccines underperforms. This standpoint, which is a strategy for many other countries, is a strong indication that unequal research, innovation, and regulatory capacities can result in unequal and delayed access for people to the current evidence-based, most effective solutions. COVID-19 cases and deaths continue to rise in Botswana. Some promising positive steps have been taken, such as Botswana signing an agreement with the COVAX facility. This agreement only allows the procurement of vaccines for 20% of the population, with plans for the remaining 80% still unveiled. The global imbalance of vaccine manufacturing capacity must be addressed to allow African countries to address the vaccine shortfall associated with the current COVID-19 pandemic and to be adequately prepared for future pandemics. Technology transfer for vaccine manufacturing and funding for capacity building in vaccine development and clinical trial implementation is vital to ensure sustainable vaccine development programmes that will ensure that Africa is ready to address future pandemics.
Mandatory Vaccination
Prof. Keymanthri Moodley | Stellenbosch University, Faculty of Medicine and Health Sciences | South Africa
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Prof. Keymanthri Moodley | Stellenbosch University, Faculty of Medicine and Health Sciences | South Africa
Globally there has been a sharp increase in COVID-19 infections mainly due to the emergence of the more transmissible delta variant. Consequently, many countries are mandating vaccination for their essential high-risk healthcare and other aged-care workers. In addition, countries such as the United Kingdom and several European countries have mandated vaccines for entry into nightclubs, restaurants and other indoor venues.. Based on the common good and a public health ethics framework, globally, vaccine mandates are ethically justifiable. This public health framework includes the principles of solidarity, effectiveness, efficiency, proportionality, and transparency. It underscores the need to: save lives, use limited resources efficiently, create social cohesion in the public's interest and build public trust. Mandatory vaccination for COVID-19 can be further justified under the Siracusa principles on the Limitation and Derogation Provisions in the United Nations International Covenant on Civil and Political Rights. Likewise, various pieces of legislation in South Africa, support limitation of individual rights in the public interest. Despite these strong motivations for mandatory vaccination, limited access, and unequal distribution of COVID-19 vaccines in LMICs weaken arguments favouring mandatory vaccination. In South Africa, however, vaccine access has improved considerably, making vaccine mandates a potential strategy. Technology transfer and vaccine production in South Africa will make this strategy a reality.