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Hassoun N, Basu K, Gostin L. Pandemic preparedness and response: a new mechanism for expanding access to essential countermeasures. HEALTH ECONOMICS, POLICY, AND LAW 2024:1-24. [PMID: 38817149 DOI: 10.1017/s1744133124000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
As the world comes together through the WHO design and consultation process on a new medical counter-measures platform, we propose an enhanced APT-A (Access to Pandemic Tools Accelerator) that builds on the previous architecture but includes two new pillars - one for economic assistance and another to combat structural inequalities for future pandemic preparedness and response. As part of the APT-A, and in light of the Independent Panel on Pandemic Preparation & Response's call for an enhanced end-to-end platform for access to essential health technologies, we propose a new mechanism that we call the Pandemic Open Technology Access Accelerator (POTAX) that can be implemented through the medical countermeasures platform and the pandemic accord currently under negotiation through the World Health Assembly and supported by the High-Level Meeting review on Pandemic Prevention, Preparedness, and Response at the United Nations. This mechanism will provide (1) conditional financing for new vaccines and other essential health technologies requiring companies to vest licenses in POTAX and pool intellectual property and other data necessary to allow equitable access to the resulting technologies. It will also (2) support collective procurement as well as measures to ensure equitable distribution and uptake of these technologies.
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Affiliation(s)
- Nicole Hassoun
- Helsinki Collegium for Advanced Studies, University of Helsinki, Fabianinkatu 24 00100 Helsinki, Finland
- Binghamton University, 4400 Vestal Parkway East, Box 6000, Binghamton, NY 13902-6000, USA
| | - Kaushik Basu
- Department of Economics, Cornell University, Ithaca, NY 14850, USA
- Brookings Institution, Washington, DC 20036, USA
| | - Lawrence Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC 20057, USA
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2
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Rishworth A, Wilson K, Adams M, Galloway T. Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada. Health Place 2024; 87:103214. [PMID: 38520992 DOI: 10.1016/j.healthplace.2024.103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Matthew Adams
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Tracey Galloway
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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3
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Alonso Ruiz A, Bezruki A, Shinabargar E, Large K, Vieira M, Slovenski I, Liu Y, Agarwal S, Becker A, Moon S. Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models. Global Health 2024; 20:25. [PMID: 38532484 DOI: 10.1186/s12992-024-01017-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Unequal and inequitable access to Covid-19 vaccines in low- and middle-income countries (L&MICs) was a major political, ethical and public health failure in the pandemic. However, vaccine developers' practices were not monolithic, but rather, took diverse approaches to supplying different countries, with important implications for global access. RESULTS Using data on R&D investments, regulatory approvals, manufacturing and purchase agreements, and vaccine deliveries, we identified six distinct innovation models that apply across the 14 COVID-19 vaccines with more international presence from 2020-2022. "Western Early Arrivers" Pfizer/BioNTech and Moderna supplied the largest volumes quickly and prioritized high-income countries (HICs) from registration to vaccine delivery. "Western Latecomers" Janssen and Novavax supplied intermediate volumes later, also prioritizing HICs but with a greater proportion to L&MICs. "Major Chinese Developers" Sinopharm and Sinovac supplied intermediate volumes early, primarily to middle-income countries (MICs). "Russian Developer" Gamaleya completed development early but ultimately supplied small volumes, primarily to middle-income countries (MICs). "Cosmopolitan Developer" Oxford/AstraZeneca supplied large volumes early to HICs and MICs at the lowest prices. Finally, "Small MIC Developers" CanSino, Bharat Biotech, Medigen, Finlay Institute and the Center for Genetic Engineering and Biotechnology (CGEB), exported relatively small volumes to a few MICs. Low-income countries (LICs) were not targeted by any developer, and received far fewer doses, later, than any other income group. Almost all developers received public funding and other forms of support, but we found little evidence that such support was leveraged to expand global access. CONCLUSIONS Each of the six innovation models has different implications for which countries get access to which vaccines, how quickly, and at which prices. Each offers different strengths and weaknesses for achieving equitable access. Our findings also suggest that Western firms had the greatest capacity to develop and deliver vaccines quickly during the pandemic, but such capacity is rapidly becoming more globally distributed with MICs playing a significant role, especially in supplying other MICs. Given the critical role of public support in enabling pandemic vaccine development and supply, governments have both the capacity and responsibility to craft international rules that will make responses to future pandemics more equitable and effective.
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Affiliation(s)
- Adrián Alonso Ruiz
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland.
| | - Anna Bezruki
- Georgetown University, 3700 O St NW, Washington, DC, 20057, USA
| | - Erika Shinabargar
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Kaitlin Large
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Marcela Vieira
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Iulia Slovenski
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Yiqi Liu
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Surabhi Agarwal
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Anna Becker
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Suerie Moon
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
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Sekalala S, Chatikobo T. Colonialism in the new digital health agenda. BMJ Glob Health 2024; 9:e014131. [PMID: 38413105 PMCID: PMC10900325 DOI: 10.1136/bmjgh-2023-014131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/14/2024] [Indexed: 02/29/2024] Open
Abstract
The advancement of digital technologies has stimulated immense excitement about the possibilities of transforming healthcare, especially in resource-constrained contexts. For many, this rapid growth presents a 'digital health revolution'. While this is true, there are also dangers that the proliferation of digital health in the global south reinforces existing colonialities. Underpinned by the rhetoric of modernity, rationality and progress, many countries in the global south are pushing for digital health transformation in ways that ignore robust regulation, increase commercialisation and disregard local contexts, which risks heightened inequalities. We propose a decolonial agenda for digital health which shifts the liner and simplistic understanding of digital innovation as the magic wand for health justice. In our proposed approach, we argue for both conceptual and empirical reimagination of digital health agendas in ways that centre indigenous and intersectional theories. This enables the prioritisation of local contexts and foregrounds digital health regulatory infrastructures as a possible site of both struggle and resistance. Our decolonial digital health agenda critically reflects on who is benefitting from digital health systems, centres communities and those with lived experiences and finally introduces robust regulation to counter the social harms of digitisation.
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Bell D, Brown GW, Oyibo WA, Ouédraogo S, Tacheva B, Barbaud E, Kalk A, Ridde V, Paul E. COVAX - Time to reconsider the strategy and its target. HEALTH POLICY OPEN 2023; 4:100096. [PMID: 37073303 PMCID: PMC10098302 DOI: 10.1016/j.hpopen.2023.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.
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Affiliation(s)
- David Bell
- Independent Consultant, Lake Jackson, TX, USA
| | - Garrett W Brown
- Professor of Global Health Policy, University of Leeds, United Kingdom
| | - Wellington A Oyibo
- University of Lagos, College of Medicine, Department of Medical Microbiology and Parasitology, Lagos, Nigeria
| | - Samiratou Ouédraogo
- Observatoire national de la santé de la population (ONSP), Institut National de Santé Publique (INSP), Ouagadougou, Burkina Faso
| | | | - Elena Barbaud
- University of Leeds, Global Health Research Unit, United Kingdom
| | - Andreas Kalk
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Kinshasa Country Office, Democratic Republic of the Congo
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Elisabeth Paul
- Université libre de Bruxelles, School of Public Health, Belgium
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6
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Park SP, Lee HJ, Yu Y, Lee EYJ, Park YS. Designing the global vaccine supply chain: balancing intellectual property rights with post COVID-19 vaccine equity. BMJ Glob Health 2023; 8:e013669. [PMID: 38035734 PMCID: PMC10689365 DOI: 10.1136/bmjgh-2023-013669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023] Open
Abstract
This article aims to propose practical solutions that coordinate the conflicting interests between the global community and the pharmaceutical industry on the intellectual property (IP) waiver for COVID-19 vaccines and facilitate a more equitable vaccine supply chain in the post-COVID-19 world. We critically conducted a narrative literature review to identify procedural and practical issues in the current vaccine supply chain. The search was conducted across various academic disciplines, including biomedical science, life science, law and social science, using resources such as PubMed, Web of Science, Scopus and Westlaw. After screening 731 articles, 55 studies were selected for review. The narrative review revealed several critical barriers that hinder vaccine supply in less-developed countries (LDCs) as follows: (1) WTO Trade-Related Aspects of Intellectual Property Rights (TRIPs) waiver requests may not be granted due to its stringent consensus rule; (2) the current compulsory license system may not work due to the complexity of IP rights covering COVID-19 vaccine technologies; (3) only a few LDCs have domestic companies capable of manufacturing vaccines, and (4) political and economic tensions among countries exacerbate existing barriers to vaccine distribution in LDCs. Based on these findings, we proposed a comprehensive compulsory license system, which combines TRIPS's compulsory license system with the third-party beneficiary mechanism under Common Law. This integrated approach offers a balanced solution that ensures fair compensation for vaccine developers while facilitating broader vaccine access.
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Affiliation(s)
- Sung-Pil Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hye Jin Lee
- Intellectual Property High Court, Daejeon, South Korea
| | - Yang Yu
- Shanghai University of International Business and Economics, Shanghai, China
| | | | - Young Soo Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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Doss-Gollin S, Thomas S, Brook B, Abedi K, Lebas C, Auderset F, Lugo-Rodriguez Y, Sanchez-Schmitz G, Dowling DJ, Levy O, van Haren SD. Human in vitro modeling of adjuvant formulations demonstrates enhancement of immune responses to SARS-CoV-2 antigen. NPJ Vaccines 2023; 8:163. [PMID: 37884538 PMCID: PMC10603059 DOI: 10.1038/s41541-023-00759-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
Adjuvants can enhance vaccine immunogenicity, but their mechanism of action is often incompletely understood, hampering rapid applicability for pandemic vaccines. Herein, we characterized the cellular and molecular activity of adjuvant formulations available for pre-clinical evaluation, including several developed for global open access. We applied four complementary human in vitro platforms to assess individual and combined adjuvants in unformulated, oil-in-water, and liposomal delivery platforms. Liposomal co-formulation of MPLA and QS-21 was most potent in promoting dendritic cell maturation, selective production of Th1-polarizing cytokines, and activation of SARS-CoV-2 Spike-specific CD4+ and CD8+ T cells in a co-culture assay. Select formulations also significantly enhanced Spike antigen-specific humoral immunity in vivo. This study confirms the utility of the cumulative use of human in vitro tools to predict adjuvanticity potential. Thus, human in vitro modeling may advance public health by accelerating the development of affordable and scalable adjuvants for vaccines tailored to vulnerable populations.
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Affiliation(s)
- Simon Doss-Gollin
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Sanya Thomas
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Byron Brook
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Kimia Abedi
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Célia Lebas
- Vaccine Formulation Institute, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - Floriane Auderset
- Vaccine Formulation Institute, 1228 Plan-les-Ouates, Geneva, Switzerland
| | | | - Guzman Sanchez-Schmitz
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - David J Dowling
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Ofer Levy
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Simon D van Haren
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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Pushkaran A, Chattu VK, Narayanan P. A critical analysis of COVAX alliance and corresponding global health governance and policy issues: a scoping review. BMJ Glob Health 2023; 8:e012168. [PMID: 37793808 PMCID: PMC10551961 DOI: 10.1136/bmjgh-2023-012168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/05/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION The COVAX alliance is a novel approach to international partnership in global health intended to achieve the worthy goal of 'COVID-19 vaccine equity'. This study aimed to identify the implementation challenges and framework gaps of COVAX and to explore the interconnected global health policy and governance gaps in ensuring equity, accessibility and affordability of vaccines. METHODS A scoping review was conducted to identify the implementation challenges and framework gaps of COVAX and related global health policy and governance gaps. A search was carried out in PubMed, Scopus, Springer Link and Embase databases. Manually searched the grey literature, such as official reports and articles. EndNote V.20 was used to manage the evidence screening, and data extraction was carried out in Microsoft Excel. RESULTS Searches of four electronic databases and official UN, GAVI and WHO websites identified 4686 pieces of evidence. The 937 duplicates were removed, and the remaining 3749 articles were screened for the title and abstract. Most articles were eliminated as they do not address global COVAX or COVID-19 vaccine equity. The remaining 53 pieces of evidence were reviewed for full text, and ultimately 40 articles found eligible were included in the scoping review. CONCLUSIONS The implementation challenges of COVAX were attributed mainly to the phenomenon of vaccine nationalism by rich countries. The future global health policy and governance structure must be re-examined to address the inadequacies of such novel super public-and-private partnership models.
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Affiliation(s)
- Anjali Pushkaran
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vijay Kumar Chattu
- ReSTORE Lab, Department of OS & OT, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India
- Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Prakash Narayanan
- Department of Health Policy, Manipal Academy of Higher Education, Manipal, Karnataka, India
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9
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Yakubu A, Mc Cartney AM, Sprumont D. Editorial: Toward a better understanding and application of benefit sharing in genomic and global health research. Front Genet 2023; 14:1291181. [PMID: 37829281 PMCID: PMC10565473 DOI: 10.3389/fgene.2023.1291181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Aminu Yakubu
- Center for Bioethics and Research, Ibadan, Nigeria
- 54gene Inc., Washington, DC, United States
| | - Ann M. Mc Cartney
- Genomics Institute, University of California, Santa Cruz, Santa Cruz, United States
| | - Dominique Sprumont
- Institute of Health Law, University of Neuchâtel, Neuchâtel, Switzerland
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Mukherjee S, Kalra K, Phelan AL. Expanding global vaccine manufacturing capacity: Strategic prioritization in small countries. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002098. [PMID: 37384623 DOI: 10.1371/journal.pgph.0002098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
The COVID-19 pandemic highlighted significant gaps in equitable access to essential medical countermeasures such as vaccines. Manufacturing capacity for pandemic vaccines, therapeutics, and diagnostics is concentrated in too few countries. One of the major hurdles to equitable vaccine distribution was "vaccine nationalism", countries hoarded vaccines to vaccinate their own populations first which significantly reduced global vaccine supply, leaving significant parts of the world vulnerable to the virus. As part of equitably building global capacity, one proposal to potentially counter vaccine nationalism is to identify small population countries with vaccine manufacturing capacity, as these countries could fulfill their domestic obligations quickly, and then contribute to global vaccine supplies. This cross-sectional study is the first to assesses global vaccine manufacturing capacity and identifies countries with small populations, in each WHO region, with the capacity and capability to manufacture vaccines using various manufacturing platforms. Twelve countries were identified to have both small populations and vaccine manufacturing capacity. 75% of these countries were in the European region; none were identified in the African Region and South-East Asia Region. Six countries have facilities producing subunit vaccines, a platform where existing facilities can be repurposed for COVID-19 vaccine production, while three countries have facilities to produce COVID-19 mRNA vaccines. Although this study identified candidate countries to serve as key vaccine manufacturing hubs for future health emergencies, regional representation is severely limited. Current negotiations to draft a Pandemic Treaty present a unique opportunity to address vaccine nationalism by building regional capacities in small population countries for vaccine research, development, and manufacturing.
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Affiliation(s)
- Sanjana Mukherjee
- Center for Global Health Science and Security, Department of Microbiology and Immunology, Georgetown University, Washington, District of Columbia, United States of America
| | - Kanika Kalra
- Center for Global Health Science and Security, Department of Microbiology and Immunology, Georgetown University, Washington, District of Columbia, United States of America
| | - Alexandra L Phelan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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11
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van Enk B, van Houtum H, van Uden AM. The political autoimmunity of the COVID-19 response: how national borders and patents undermine a sustainable and equitable global health. BMJ Glob Health 2023; 8:bmjgh-2023-012293. [PMID: 37247872 DOI: 10.1136/bmjgh-2023-012293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Ben van Enk
- Human Geography, Planning and International Development, University of Amsterdam, Amsterdam, The Netherlands
- Nijmegen Centre for Border Research, Radboud University, Nijmegen, The Netherlands
| | - Henk van Houtum
- Nijmegen Centre for Border Research, Radboud University, Nijmegen, The Netherlands
- Copernicus Institute of Sustainable Development, Faculty of Geosciences, University Utrecht, Utrecht, Netherlands
| | - Annelies Marleen van Uden
- Copernicus Institute of Sustainable Development, Faculty of Geosciences, University Utrecht, Utrecht, Netherlands
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Jalilian H, Amraei M, Javanshir E, Jamebozorgi K, Faraji-Khiavi F. Ethical considerations of the vaccine development process and vaccination: a scoping review. BMC Health Serv Res 2023; 23:255. [PMID: 36918888 PMCID: PMC10013982 DOI: 10.1186/s12913-023-09237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. METHODS A scoping review of the literature was conducted based on the Arkesy and O'Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. RESULTS In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). CONCLUSION Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Amraei
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farzad Faraji-Khiavi
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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13
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Zimmermann B, Buyx A, McLennan S. Newspaper coverage on solidarity and personal responsibility in the COVID-19 pandemic: A content analysis from Germany and German-speaking Switzerland. SSM Popul Health 2023; 22:101388. [PMID: 37008806 PMCID: PMC10043459 DOI: 10.1016/j.ssmph.2023.101388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Solidarity and personal responsibility have been repeatedly called upon during the COVID-19 pandemic. This study quantifies and contextualizes the use of these terms in newspaper coverage in Germany and German-speaking Switzerland based on n = 640 articles from six functionally equivalent newspapers. The term solidarity in the context of the COVID-19 pandemic was mentioned in 541/640 articles (84.5%) and was primarily used during phases with high death rates and comparatively stringent policies in place, supporting the idea that solidarity was used to explain restrictive measures to the population and motivate people to comply with these measures. German newspapers published more articles on solidarity than Swiss-German newspapers, consistent with more stringent COVID-19 policies in Germany. Personal responsibility was mentioned in 133/640 articles (20.8%), meaning that the term was less frequently discussed than solidarity. Articles covering personal responsibility included more negative evaluations during phases of high infection rates as compared to phases of low infection rates. Findings indicate that the two terms were, at least to some extent, used in newspaper reporting to contextualize and justify COVID-19 policy during phases of high infection rates. Moreover, the term solidarity was used in a high variety of different contexts and the inherent limits of solidarity were rarely mentioned. Policymakers and journalists need to take this into account for future crises to not jeopardize the positive effects of solidarity.
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Aantjes C, Muchanga V, Munguambe K. Exposed and unprotected: Sex worker vulnerabilities during the COVID-19 health emergency in Mozambique. Glob Public Health 2022; 17:3568-3582. [PMID: 35748776 DOI: 10.1080/17441692.2022.2092184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Measures to contain the spread of COVID-19 have been shown to disproportionately affect the marginalised groups in our societies. We studied the impacts of national restrictions on young adult sex workers in Mozambique, and actions at individual, governmental and civil society level to mitigate against these impacts. The country case study was part of a multi-country qualitative research, including fifty-four semi-structured interviews with female sex workers (N = 38), outreach workers (N = 10) in Maputo and Quelimane, and informants with key positions in national COVID coordination bodies, the Ministry of Health and civil society organisations (N = 7). While restrictions impacted all sex worker participants, the COVID crisis was found to deepen existing class differences and further incite violence against the most visible and economically vulnerable category of street-based sex workers. Parallel enforcement of morals against this group of 'urban undesirables' resulted in bodily harm and further degradation of the female sex worker under the guise of COVID emergency decrees, while restrictions weakened protection from peers and outreach workers against abuse by the police and other perpetrators. The State needs to act against unlawful police action and include impact mitigation strategies in its public health response to COVID in order to protect the most vulnerable.
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Affiliation(s)
- Carolien Aantjes
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Vasco Muchanga
- Faculty of Medicine, Community Health Department, Sexual and Reproductive Health Unit, Eduardo Mondlane University, Maputo, Mozambique
| | - Khátia Munguambe
- Faculty of Medicine, Community Health Department, Sexual and Reproductive Health Unit, Eduardo Mondlane University, Maputo, Mozambique
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15
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Borowicz J, Zhang Z, Day G, Pinto da Costa M. Vaccine equity in COVID-19: a meta-narrative review. BMJ Glob Health 2022; 7:bmjgh-2022-009876. [DOI: 10.1136/bmjgh-2022-009876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022] Open
Abstract
The topic of inequitable vaccine distribution has been widely discussed by academics, journalists and policy-makers in the context of the COVID-19 pandemic. However, research into perceptions of vaccine equity has been particularly neglected, resulting in a lack of universal understanding of vaccine equity. To address this, we conducted a meta-narrative review on COVID-19 vaccine equity according to the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standard. The review included articles published between January 2020 and September 2021. It aims to (1) identify research traditions that have considered this topic and investigate how it has been conceptualised; (2) explore any potential differences in understandings of the concept of vaccine equity adopted by distinct research groups; and (3) investigate the angles from which authors based their recommendations on how vaccine equity can be achieved. Five meta-narratives from the literature across various research traditions are identified, contextualised and discussed: frameworks and mechanisms for vaccine allocation, global health law, vaccine nationalism, ethics and morality, and reparative justice. Our findings indicate the need for a comparative review of existing global COVID-19 allocation frameworks, with a focus on explicating understandings of vaccine equity. COVID-19 will not be the last health crisis the world confronts. Heterogeneity in the academic literature is part of the way concepts are debated and legitimised, but in the interests of global public health policy-making, it is desirable to reach a consensus on what constitutes progress on equitable development, production, distribution and research.
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16
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Parker R, Murray L. Introduction: Human rights and global health special issue. Glob Public Health 2022; 17:3090-3097. [PMID: 36342208 DOI: 10.1080/17441692.2022.2135752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The emergence of the field of health and human rights during the closing decades of the twentieth century offered the promise of an important shift of perspective within global health. It has been increasingly questioned, however, to what extent the health and human rights framework has indeed succeeded in ushering in a new era of global health governance and justice, as the topic has remained marginalised, marked by regional inequalities, and often dominated by legalist visions and global North perspectives. The articles and commentaries in this special issue seek to create a space where a number of other perspectives and voices can be part of the discussion. They add new perspectives and offer roadmaps for how to rewire the ways in which knowledge is constructed and relationships are formed in the field of health and human rights. In doing so, they present important possibilities for how to build a more just and egalitarian field.
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Affiliation(s)
- Richard Parker
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,ABIA - Associação Brasileira Interdisciplinar de AIDS, Rio de Janeiro, Brazil.,LIDHS - Laboratório Interdisciplinar de Direitos Humanos e Saúde, Instituto de Estudos em Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Laura Murray
- Núcleo de Políticas Públicas em Direitos Humanos (NEPP-DH), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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17
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Boro E, Stoll B. Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis. Front Public Health 2022; 10:928065. [PMID: 35937225 PMCID: PMC9354133 DOI: 10.3389/fpubh.2022.928065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has intensified the urgency in addressing pressing global health access challenges and has also laid bare the pervasive structural and systemic inequities that make certain segments of society more vulnerable to the tragic consequences of the disease. This rapid systematic review analyses the barriers to COVID-19 health products in low-and middle-income countries (LMICs). It does so from the canon of global health equity and access to medicines by proposing an access to health products in low-and middle-income countries framework and typology adapted to underscore the complex interactive and multiplicative nature and effects of barriers to health products and their root cause as they coexist across different levels of society in LMICs. Methods Modified versions of the Joanna Briggs Institute (JBI) reviewers' manual for evidence synthesis of systematic reviews and the PRISMA-ScR framework were used to guide the search strategy, identification, and screening of biomedical, social science, and gray literature published in English between 1 January 2020 and 30 April 2021. Results The initial search resulted in 5,956 articles, with 72 articles included in this review after screening protocol and inclusion criteria were applied. Thirty one percent of the articles focused on Africa. The review revealed that barriers to COVID-19 health products were commonly caused by market forces (64%), the unavailability (53%), inaccessibility (42%), and unaffordability (35%), of the products, incongruent donors' agenda and funding (33%) and unreliable health and supply systems (28%). They commonly existed at the international and regional (79%), health sectoral (46%), and national cross-sectoral [public policy] (19%) levels. The historical heritage of colonialism in LMICs was a commonly attributed root cause of the barriers to COVID-19 health products in developing countries. Conclusion This review has outlined and elaborated on the various barriers to health products that must be comprehensively addressed to mount a successful global, regional, national and subnational response to present and future epidemics and pandemics in LMICs.
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Affiliation(s)
- Ezekiel Boro
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
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18
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Bedeker A, Nichols M, Allie T, Tamuhla T, van Heusden P, Olorunsogbon O, Tiffin N. A framework for the promotion of ethical benefit sharing in health research. BMJ Glob Health 2022; 7:e008096. [PMID: 35144922 PMCID: PMC8845198 DOI: 10.1136/bmjgh-2021-008096] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/15/2022] [Indexed: 12/22/2022] Open
Abstract
There is an increasing recognition of the importance of including benefit sharing in research programmes in order to ensure equitable and just distribution of the benefits arising from research. Whilst there are global efforts to promote benefit sharing when using non-human biological resources, benefit sharing plans and implementation do not yet feature prominently in research programmes, funding applications or requirements by ethics review boards. Whilst many research stakeholders may agree with the concept of benefit sharing, it can be difficult to operationalise benefit sharing within research programmes. We present a framework designed to assist with identifying benefit sharing opportunities in research programmes. The framework has two dimensions: the first represents microlevel, mesolevel and macrolevel stakeholders as defined using a socioecological model; and the second identifies nine different types of benefit sharing that might be achieved during a research programme. We provide an example matrix identifying different types of benefit sharing that might be undertaken during genomics research, and present a case study evaluating benefit sharing in Africa during the SARS-CoV-2 pandemic. This framework, with examples, is intended as a practical tool to assist research stakeholders with identifying opportunities for benefit sharing, and inculcating intentional benefit sharing in their research programmes from inception.
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Affiliation(s)
- Anja Bedeker
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taryn Allie
- Computational Biology Division, Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Tsaone Tamuhla
- Computational Biology Division, Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Peter van Heusden
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Olorunyomi Olorunsogbon
- Department of Health promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Nicki Tiffin
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
- Computational Biology Division, Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
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19
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Faria CGF, de Matos UMA, Llado-Medina L, Pereira-Sanchez V, Freire R, Nardi AE. Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean. Front Psychiatry 2022; 13:910410. [PMID: 36177216 PMCID: PMC9513790 DOI: 10.3389/fpsyt.2022.910410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal are high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.
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Affiliation(s)
- Clara Gitahy Falcão Faria
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Victor Pereira-Sanchez
- Department of Psychiatry, Columbia University, New York, NY, United States.,Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, United States.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, Amoud University, Borama, Somalia
| | - Rafael Freire
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Psychiatry and Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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20
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Williams F. Extraction, exploitation, expropriation and expulsion in the domestic colonial relations of the British welfare state in the twentieth and twenty-first centuries. THE BRITISH JOURNAL OF SOCIOLOGY 2022; 73:23-34. [PMID: 34784424 DOI: 10.1111/1468-4446.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Fiona Williams
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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21
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Sarfraz A, Sarfraz Z, Sarfraz M. Survival of the wealthiest? Wait in line for COVID-19 vaccination. Postgrad Med J 2021; 98:e81. [PMID: 37066535 DOI: 10.1136/postgradmedj-2021-140970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Azza Sarfraz
- Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zouina Sarfraz
- Research and Publications, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Muzna Sarfraz
- Medical Education, King Edward Medical University, Lahore, Pakistan
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