In Practice

Hard choices: Ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa

K Moodley, M Blockman, D Pienaar, A J Hawkridge, J Meintjes, M-A Davies, L London

Abstract


Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight of low- and middle-income countries (LMICs) as they wait in line for restricted tranches of vaccines. Even in high-income countries that received vaccine supplies first, vaccine roll-out globally has been fraught with logistic and ethical challenges. South Africa (SA) is no exception. Flawed global institutional strategies for vaccine distribution and delivery have undermined public procurement platforms, leaving LMICs facing disproportionate shortages necessitating strict criteria for vaccine prioritisation. In anticipation of our first consignment of vaccines, deliberations around phase 1 roll-out were intense and contentious. Although the first phase focuses on healthcare personnel (HCP), the devil is in the detail. Navigating the granularity of prioritising different categories of risk in healthcare sectors in SA is complicated by definitions of risk in personal and occupational contexts. The inequitable public-private divide that characterises the SA health system adds another layer of complexity. Unlike other therapeutic or preventive interventions that are procured independently by the private health sector, COVID-19 vaccine procurement is currently limited to the SA government only, leaving HCP in the private sector dependent on central government allocation. Fair distribution among tertiary, secondary and primary levels of care is another consideration. Taking all these complexities into account, procedural and substantive ethical principles supporting a prioritisation approach are outlined. Within the constraints of suboptimal global health governance, LMICs must optimise progressive distribution of scarce vaccines to HCP at highest risk.


Authors' affiliations

K Moodley, Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

M Blockman, Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

D Pienaar, Western Cape Department of Health, Cape Town, South Africa

A J Hawkridge, Medical Services: Swartland Hospital, Malmesbury, South Africa

J Meintjes, Academic Unit for Infection Prevention and Control, Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

M-A Davies, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town; Health Impact Assessment Directorate, Western Cape Government: Health, Cape Town, South Africa

L London, Division of Public Health Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Full Text

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Keywords

Ethics; COVID-19 vaccines; South Africa; Phase 1 roll-out

Cite this article

South African Medical Journal 2021;111(6):554-558.

Article History

Date submitted: 2021-03-26
Date published: 2021-03-26

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