All nations need participatory vaccine strategies

Pandemics constitute major public health concerns that affect the entire population, causing widespread human suffering, often requiring population-scale behavioural change, and bringing in myriad new ethical, legal and medical practice paradigms.

The past two years have been a wake-up call for nations around the world to ensure that health systems are resilient and pandemic-prepared. Africa’s primary healthcare systems must be strengthened, and part of the solution lies in robust vaccination strategies, experts say.

As with many other disease outbreaks, Covid saw the disadvantaged in our society bearing the brunt of the effects of the pandemic, highlighting the need for transparent policies that prioritise the most vulnerable groupings of people.

A collaborative participatory approach, including diverse stakeholder input is crucial, as strategic decision-making during pandemics falls not only onto medical authorities and state actors, but also to community leaders and disaster management specialists.

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Maintaining civil rights, livelihoods and the economy with public health becomes a precarious balancing act, requiring a sophisticated multidisciplinary understanding.

While the vaccine debate has quietened somewhat, in SA the government has yet to reach its target ratios for Covid vaccination and discussions around vaccine mandates remain on the national agenda. Misinformation is still thought to be a strong driver of vaccine hesitancy in SA.

Mandatory immunisations are not new in the country and have otherwise been widely accepted by parents of schoolgoing children who must be up to date with standard immunisations before being enrolled – and international travellers, for example.

All nations and state actors are obliged to comply with international health regulations (IHR). These compel SA to work towards vaccination targets. Having made vaccines available, the SA government may consider a more proactive approach. This may entail some refocusing of values and ethical nudging.

The state may implement mandatory vaccinations for certain groupings like civil servants, teachers and tertiary students, if necessary.

Another strategy under discussion is to enhance community-level accessibility by including Covid vaccines in the standard immunisation packages that are rolled out to all citizens. On the other hand, state interventions that could provoke strong public opposition need to be kept to a minimum and only in service of specific target outcomes.

The complexities around mandates, hesitancy, human rights and ethics in the context of this and future pandemics, will be a major focus area of the 11th Ethics, Human Rights & Medical Law Conference taking place at Africa Health Exhibition at Gallagher Convention Centre at the end of October.

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Ultimately, pandemic preparedness will be directly proportional to the confidence we can instil in the institutions and HCWs within our healthcare systems. Future pandemics can be mitigated by building trust and improving transparency and communication.

We must also be sure to include the evidence and scientific bases for decisions taken, when those decisions are communicated to the people.

Chima is an authority on informed consent in medicine who specialises in bio & research ethics and medical law. He is a speaker at the Africa Health Conference this month.