[ad_1]
Who should South Africa vaccinate first once we have the Covid injections? (Photo: theconversation.com / Wikipedia)
Now that the world has its first effective Covid-19 hits, the next challenge we have to face is who gets them? Here’s why the public could be key to answering this complex question in South Africa.
South Africa’s participation in the vaccine procurement mechanism, COVAX, finally confirmed – but the details of a vaccine implementation plan for the country are still lacking. This strategy, among other things, will guide us as to who will take the hits from Covid-19 first.
As a upper middle income country, We will have the help of COVAX to secure the vaccine doses from the joint supplies, but South Africa would have to finance the purchases itself. the Solidarity fund – a private fund created in South Africa to raise money from the private sector and individuals, to complement the financing of initiatives related to Covid-19 – agreed to make an initial payment of R327 million ($ 22 million) to COVAX to ensure vaccines for approximately 10% of our population.
But the process of deciding which populations within a country should be prioritized for vaccines is not only urgent, it is also complex.
Why did South Africa join COVAX?
Equitable access to a Covid-19 vaccine is an increasingly important global issue. There is a real risk that the poorest countries, including South Africa, will fall behind in the race to get a vaccine quickly. Some richer countries, such as the United States and the United Kingdom, have been able to fund vaccine development and invest billions in candidates being tested, in exchange for obtaining sufficient doses for their populations in advance.
Less wealthy countries like South Africa, which cannot do either of these two things, will likely have more limited access to Covid-19 vaccines.
To help ensure that the poorest countries are not left behind, the World Health Organization (WHO) has negotiated a global collaboration, COVAX – co-chaired by Gavi, Vaccine Alliance and Coalition for Epidemic Preparedness Innovation (CEPI) – part of the WHO-led program Access to the Covid-19 Tool Accelerator (ACT). Through the purchasing power of the richest countries among the 187 that have enrolled in COVAX, the initiative will allow countries with fewer resources to secure sufficient doses of vaccine for the “most vulnerable.” 20% of their populations.
The way COVAX works to help the poorest countries obtain vaccines is through an “advance market commitment” (AMC) mechanism. This mechanism guarantees vaccine manufacturers a huge volume of orders for their vaccines, along with advance payments from the richest participating countries. Late november COVAX had raised $ 2 billion of the $ 7 billion it needs purchase and distribute its two billion specific doses of vaccines to vulnerable groups in “AMC eligible” countries by the end of 2021.
South Africa is too rich to qualify to be part of the AMC mechanism, but will nevertheless be able to benefit from COVAX’s ability to source enough vaccines and potentially lower combined prices.
So who should South Africa vaccinate first once we have Covid-19 injections?
There are opposing views on how vaccines should be allocated within countries.
For countries that were initially able to access sufficient doses of vaccines to cover 20% of their populations, the guidance suggested by COVAX says that the “most vulnerable” sectors or individuals should be inoculated first. International frameworks address issues of equity, evidence, and different disease burdens and risks. But South Africa, and all countries, must make their own allocation decisions, taking into account the specific issues of the context.
Some countries have a higher burden of diseases considered “comorbidities” for Covid-19 and will have a harder time prioritizing the first 20% of people to receive injections. For example, the population of South Africa is quite young (younger people are less likely to develop severe Covid-19 symptoms), but has a high prevalence of HIV (7.7 million HIV-positive people, according to UNAids), tuberculosis and non-communicable diseases such as diabetes, hypertension, and obesity – all known risk factors for severe Covid-19.
Many people in South Africa with such comorbidities live in overcrowded informal settlements, do not have access to clean water, or have structural obstacles that prevent them from consistently practicing some of the recommended public health measures to reduce the spread of Covid-19. Not being able to wash their hands or practicing physical distancing leaves them vulnerable to infection and creates a continuing potential for infection hot spots.
Taken together, these circumstances cast the category of “most vulnerable” in a different light than is imagined in some of the global allocation frameworks. This is the reason why South Africa needs to develop a context-specific way to allocate the limited number of vaccine doses among people in our vulnerable populations, the total number of which substantially exceeds 20% of our population.
Equity is not something pleasant, it is a requirement of our Constitution.
Additionally, our Constitution requires the government to take steps to protect the rights of citizens to access health care. During our Covid-19 lockdown, in cases as the Independent Fair Trade Tobacco Association In defiance of the tobacco ban, South African courts ruled that disease prevention measures are justifiable. A similar rationale could be used to prioritize access to vaccines for the most vulnerable groups at critical points of infection.
Human rights law requires equitable access to life-saving vaccines, which would include one for Covid-19, which the WHO will almost certainly classify as an “essential drug.” Most human rights frameworks would also prioritize access for marginalized and vulnerable groups, and our Constitution stipulates that groups must be treated equally and fairly.
the The Constitution of South Africa upholds “public participation“, in which “the public actively participates in decision-making processes “. But in reality, this often does not happen and sometimes results in government decisions that are disconnected from the needs of the communities. Meaningful public participation would allow citizens to share their views on existing inequalities and who should get vaccinated first. South Africans will also be able to voice their concerns about being shot by Covid-19.
Policy makers must consider all of these inputs, because ongoing vaccine allocation decisions are based on extremely difficult trade-offs, and public participation could be a key component in the success of these decisions.
According to an online survey conducted by the World Economic Forum in August, one in three South Africans does not want to receive the Covid-19 vaccine. Delving further into the reasons for this would allow for an allocation strategy that responds to South Africans’ views and concerns about the safety and efficacy of a Covid-19 vaccine. If people in South Africa feel included in the decision-making process, and the process is transparent, the government will generate greater acceptance and confidence in both the vaccine and the delivery system.
Who could South Africa learn from?
the Public Participation Pilot Project on Pandemic Influenza in the United States in 2005 offers some lessons. The project addressed gaps in flu vaccine allocation that were in short supply during a pandemic and allowed experts and ordinary citizens to have meaningful conversations about how to prioritize which parts of the population will get the shots first. The result was that the existing criteria for vaccine allocation changed so that public values could be more accurately reflected. Participatory approaches like this are known as “public deliberation” and are useful when technical solutions alone cannot provide the best answer to difficult decisions.
The Ebola epidemic in West Africa of 2014-2016 is another example to learn from. the West Africa Readiness Project better prevention and control of outbreaks with “responsive” programs that changed based on community feedback.
South Africa has not established tools and methods for this type of public participation, but decision tools such as CHAT (choosing all together) could help. CHAT was originally developed in the United States and was previously used to design microinsurance programs in India. The tool is used to help low-income groups make health-related decisions and allows people with no health insurance experience to select the benefits they consider appropriate for them. Recently modified for rural use in South Africa, CHAT could now be used to help communities make vaccine-related decisions.
A hybrid approach, in which workshops are conducted with representatives of the community, including those from vulnerable groups, together with surveys or broader online forums, could be an option for South Africa; the outcome of such participation must be taken into account, along with scientific evidence and human rights law, when determining the final allocation framework.
In South Africa, human rights and public participation are not just good ideas, they are a constitutional imperative. Therefore, we will be legally bound to develop a vaccine allocation strategy aligned with human rights and strong principles of equity. Global frameworks may offer some guidance for vaccine allocation, but our country needs a plan that is specific to the priorities and needs of our people, and the only way to do that is to allow for a meaningful contribution from the public. DM / MC
Safura Abdool Karim and Aviva Tugendhaft are researchers at the Center for Health Economics and Decision Sciences, PRICELESS SA, of the South African Medical Research Council, at the Wits School of Public Health.
This story was produced by the Visit the Center for Health Journalism. Sign up for the Newsletter.
