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

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dc.contributor.authorMoodley, K.en_ZA
dc.contributor.authorBlockman, M.en_ZA
dc.contributor.authorPienaar, D.en_ZA
dc.contributor.authorHawkridge, A. J.en_ZA
dc.contributor.authorMeintjes, J.en_ZA
dc.contributor.authorDavies, M.-A.en_ZA
dc.contributor.authorLondon, L.en_ZA
dc.date.accessioned2021-07-16T06:34:05Z
dc.date.available2021-07-16T06:34:05Z
dc.date.issued2021-03
dc.descriptionCITATION: Moodley, K. et al. 2021. Hard choices : ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa. South African Medical Journal, 111(6):554-558, doi:10.7196/SAMJ.2021.v111i6.15593.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractAccess 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.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/13240
dc.description.versionPublisher's version
dc.format.extent5 pages
dc.identifier.citationMoodley, K. et al. 2021. Hard choices : ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa. South African Medical Journal, 111(6):554-558, doi:10.7196/SAMJ.2021.v111i6.15593.
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.2021.v111i6.15593
dc.identifier.urihttp://hdl.handle.net/10019.1/110734
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publishing Group
dc.rights.holderAuthors retain copyright
dc.subjectCOVID-19 (Disease) -- Preventionen_ZA
dc.subjectPublic health -- South Africaen_ZA
dc.subjectVaccines -- South Africa -- Administrationen_ZA
dc.subjectCovid-19 (Disease) -- Vaccination -- South Africaen_ZA
dc.subjectClinical trials -- South Africaen_ZA
dc.subjectVaccines industry -- South Africaen_ZA
dc.titleHard choices : ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africaen_ZA
dc.typeArticleen_ZA
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