Human rights law can provide a transparent and fair framework for vaccine allocations, researchers suggest.
- - All countries face the ethical challenge of how to allocate limited supplies of safe, effective COVID-19 vaccines
- Researchers say that governments should look to human rights principles and commitments to help them decide who should get priority for the first available doses of COVID-19 vaccine.
- A human rights approach would include social vulnerability alongside medical vulnerability in decision-making because health is affected by social factors.
- National vaccine roll-outs should take account of these overlapping vulnerabilities
As Governments around the world wrestle with the question of designing a fair system to allocate their COVID-19 vaccine supplies for maximum protection against the pandemic, a team of researchers led by Dr Sharifah Sekalala of Warwick Law School propose that existing human rights legal principles should guide their thinking.
All 171 states have signed at least one human rights treaty, recognising that people have the right to life and health - but how can this guide decisions on distribution of vaccines when demand outstrips supply?
An Intersectional Human-Rights Approach to Prioritizing Access to COVID-19 Vaccines, published in BMJ Global Health, reviews current approaches to vaccine allocation, from the UK age-priority system to Israel's decision to prioritize healthcare workers and first responders, considers these from a human rights perspective, and outlines a model of an ethical intersectional distribution scheme based on human rights legal principles.
Lead author Dr Sharifah Sekalala said: "There are three fundamental human rights which need to be reflected in any vaccine distribution programme - the right to life, the right to health, and the right to benefit from scientific progress.
"In practice, the right to health means that vaccines should be made available to everyone. If there aren't enough vaccines available, then they should be given as a priority to people who are more likely to contract COVID-19, to those whose health is at higher risk of being compromised as a result of coming down with COVID-19, and to those who are most likely to transmit the virus.
"It's also a key human rights issue that vaccines be distributed without discrimination.
"Without a transparent framework that considers these human rights to guide decisions, governments are likely to be accused of unfairness or favouritism in their distribution plans."
The team recommend that governments adopt an intersectional approach to understand how different vulnerabilities and disadvantages affect a person's health.
Taking the example of age and economic status, the paper shows how a fair distribution scheme might prioritize a person from a low-income group compared to a person of similar age from a more well-off background, because economic deprivation, poorer living standards, and worse access to healthcare effectively age that person beyond their years.
Dr Sekalala explains: "In the UK many ethnic minority groups are more likely to be in informal or insecure jobs, live in overcrowded housing and have a lower social economic status. This can make it difficult for them to socially distance, thereby making them more susceptible than people of similar age in other circumstances. Data shows the tragic reality is that people from these groups were not only more likely to catch COVID 19 but also to die from it.
"A fairer and more effective prioritization system would have to take into account not only vulnerability to infection but also more structural underlying determinants of health that increases their vulnerability to the crisis."
Co-author Dr Katrina Perehudoff, Post Doctoral Research Fellow in European and Global Health at the Faculty of Law, University of Amsterdam (Netherlands), added: "This dangerous cocktail of social factors combined with low priority for receiving a vaccine can disadvantage people who are already socially vulnerable although they might not be medically vulnerable. This practice, which we also see in vaccine roll-out in the Netherlands and other countries, actually risks increasing the existing inequalities and injustices in society, running contrary to our governments' human rights commitments."
- Sekalala S, Perehudoff K, Parker M, et al An intersectional human rights approach to prioritising access to COVID-19 vaccines BMJ Global Health 2021;6:e004462.
/ gh. bmj. com/ content/ 6/ 2/ e004462. full
Full list of authors:
- Sharifah Sekalala, School of Law, University of Warwick, Coventry, UK
- Katrina Perehudoff, Faculty of Law, University of Amsterdam, Amsterdam, The Netherlands
- Michael Parker, Ethox Centre, University of Oxford, Oxford, UK
- Lisa Forman, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Belinda Rawson, School of Law, University of Warwick, Coventry, UK
- Maxwell Smith, School of Health Studies, Western University, London, Ontario, Canada
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