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-19, 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.

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-19 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.

Professor Sylvester Chima, an authority on informed consent in medicine who specialises in Bio & Research Ethics and Medical Law, and a speaker at the upcoming Africa Health Conference in October, has a nuanced perspective on the balancing act between public health imperatives and the rights of the individual.

He emphasises transparency and urges that national vaccine guidelines be explained to the public in terms of their rationale and scientific basis, as well as any other relevant factors, considerations, or modifiers.

Professor Chima notes that mandatory immunisations are not new in SA and have otherwise been widely accepted - by parents of school-going 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 refocussing of values and ethical nudging. The state may implement mandatory vaccinations for certain groupings like civil servants, teachers, and tertiary students, if necessary,” says Chima .

Another strategy under discussion is to enhance community-level accessibility by including COVID-19 vaccines in the standard immunization packages that are rolled out to all citizens, he says.

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, Chima observes.

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 in Johannesburg later this year.   

There, Professor Chima will be joined by fellow experts such as Professor Veronica Ueckermann, Adjunct Professor: Department Internal Medicine at UP and Professor David Ndetei, Founding Director, Africa Mental Health Research and Training Foundation (AMHRTF).

Topics on the agenda include ‘South African Population Immunity and the Covid-19 pandemic: Current Perspectives’, and a panel discussion, ‘On Preparing for Covid-19 and other future pandemic in Africa’.

“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,” Prof Chima concludes.