A Series of Community Engagement and Experience Sharing Workshops - UNESCO
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A Series of Community Engagement and Experience Sharing Workshops.
FAIR, EQUITABLE AND TIMELY ALLOCATION OF COVID-19 VACCINES IN AFRICA
A Series of Community Engagement and Experience Sharing Workshops
Concept notes
I. Background
As of 6 March 2021, the COVID-19 virus has infected over 100 million people with over 2.5 million
deaths globally.1 Africa has not been spared in this regard, with more than 3 million reported
COVID-19 cases and over 100 000 reported deaths.2 After the first vaccines started being
administered in December 2020, with more completing development and validation in recent
months, renewed hope began permeating through societies. The pace of development of these
vaccines has been exceptionally rapid, international solidarity mechanisms have been set up
around inter-state donations and the COVID-19 Vaccines Global Access (COVAX), together with
logistical arrangements have being deployed with great efforts by many states.
Vaccines are a powerful public health tool and continuous African engagement in the
development, evaluation and access to existing and potential COVID-19 vaccines and clinical trials
are key. It is expected that approximately 90 million vaccine doses will be delivered in Africa
before June 2021 through COVAX.3 However, to reach population immunity, the continent will
need 1.5 billion doses to reach 60% of the region’s population.
The rush to purchase and distribute vaccines in record time to protect populations and economies
is a global reality. This rush, which results in skewed imbalances of distribution amongst the
global north and south as vaccines are sold to the highest bidder, raises many complex and
difficult questions, which need in-depth reflection, deliberation, and rapid decision-making.
Despite the saying that: “No One is Safe, until Everybody is Safe”, vaccine nationalism has become
a reality in many regions of the world; the tension between public good and intellectual property
remains a major hurdle; selection of priority groups has sometimes been carried out with little to
no transparency, thus triggering public outcry and fueling distrust in institutions. In some cases,
a lack of good governance in vaccine delivery has caused tremendous delays, including vaccine
hesitancy and misinformation that have hindered progress and confidence amongst population
groups.
In this context, ethical deliberations and considerations are required to accompany the
immunization process and allow for a transparent, human rights-based, peaceful and inclusive
approach.
II. Ethical Considerations – COVID-19 Vaccines Fairness, Equity, Solidarity
With the above background in mind, it is timely that two crucial normative frameworks on COVID-
19 vaccination access were successively released in January and February 2021; namely:
• The Framework for Fair, Equitable and Timely Allocation of COVID-19 Vaccines in Africa4,
issued and co-developed by Africa Centres for Disease Control and Prevention (Africa
CDC) and the South African Medical Research Council (SAMRC), with the input of over
1300 policymakers, community advocates, ethicists and public health experts, January
2021; and
• UNESCO´s Ethics Commissions’ Call for Global Vaccines Equity and Solidarity5, a joint
statement by UNESCO’s International Bioethics Committee (IBC) and the World
1 https://www.worldometers.info/coronavirus/
2 https://allafrica.com/stories/202103040472.html
3 https://www.iol.co.za/news/south-africa/western-cape/covid-19-africa-vaccine-roll-out-shifts-into-
second-gear-438cd214-5c0d-4080-96e8-65ad233e23ef
4https://africacdc.org/download/framework-for-fair-equitable-and-timely-allocation-of-covid-19-
vaccines-in-africa/
5 https://unesdoc.unesco.org/ark:/48223/pf0000375608
1• Commission on the Ethics of Scientific Knowledge and Technology (COMEST), February
2021;
These documents emphasise the ethical dimensions that need consideration in vaccine allocation
and governance. Both Frameworks share one common concern – Ensuring that a COVID-19
Vaccine is considered a “global public good” that is accessible to everyone, irrespective of
ethnicity, nationality, gender, sexual orientation, race and religion. They call for international
solidarity among States to safeguard a sense of community, and also highlight equitable treatment
and particular attention for the most vulnerable groups and frontline workers.
In summary, both UNESCO’s international Call and Africa CDC’s Framework converge in
reminding us that the struggle against this pandemic cannot prevail only with the existence of a
vaccine – it requires ethics at the core. Only holistic ethical deliberations can ensure fairness and
equity and it must be ensured that efforts are made relentlessly to achieve solidarity between and
within countries and groups.
Nevertheless, as underscored in the Frameworks, many difficult questions remain, including:
• Vaccine selection criteria: Which criteria should guide the selection of vaccines for the
African continent, and what should the concrete targets be?
• Financing and procurement of vaccines: How should financing and procurement be
organised to maximise value for the Member States along several dimensions, including
affordability and access, but also the safeguarding of sovereignty over critical public health
decisions?
• Vaccine delivery: How should vaccine access and delivery – including the selection and
sequencing of target groups, streamlining of regulatory processes, and setup of critical
vaccine supply and access logistics be organized?
• Community engagement: When and how should critical community stakeholders, including
community leaders and representatives of community-based organisations, non-
governmental organisations, key opinion leaders and civil society, be engaged to ensure
acceptability and uptake of the vaccines?
• Communications: What are the strategic communication strategies to address relevant
audiences and minimise – while taking into account – vaccine hesitancy?
• Research and evidence gathering: what other data and evidence should be generated to
strengthen the decision making process for scale up of COVID-19 vaccine access in Africa?
• Intellectual Property vs Public good: What kind of public-private partnership must be put
in place to ensure that public health prevails beyond private interest? What transformation
is needed in the business model of pharmaceutical companies that have been, in particular
for the case of this pandemic, supported by public funds and benefited from public academic
institutions?
• Politicisation of vaccine: What can be done to prevent politicisation of vaccines, especially
in the contexts of upcoming general electoral processes?
III. The case of Africa
The concern continues that Africa, with many Low and Middle Income Countries (LMICs), may
suffer as a result of current vaccine nationalism, considering the slow rate at which vaccines are
entering the continent. The fact that some developed countries and regions have purchased doses
of vaccines far in excess of their populations’ requirements, while unprotected African healthcare
workers and many vulnerable groups succumb to the virus, is evidence of vaccines not being
considered as a global common good. Furthermore, this undermines the attempt by WHO and
COVAX to ensure access and equitable distribution of COVID-19 vaccines for all people globally.
2The Africa COVID-19 Vaccine Development and Access Strategy pursues three objectives6:
1. Accelerate African involvement in the clinical development of a vaccine to ensure vaccines
are safe and efficacious in African populations.
2. Ensure African countries can access a sufficient share of the global vaccine supply by
providing guidance and support on financing and procurement. The strategy defines
“sufficient share” for Africa as at least 60% coverage with a vaccine that effectively
prevents infection, which is considered necessary to achieve herd immunity.
3. Remove barriers to widespread delivery and uptake of effective vaccines across Africa
through work on streamlined regulatory approvals, preparations for the delivery of the
vaccine, and community engagement and communication campaigns to ensure uptake.
The work towards these objectives raises several critical strategic questions. Given the scarcity
of resources including the vaccine itself and related materials, financial, logistical and human
resources and, above all, time, answering these questions requires a weighting of options and
prioritisation of decisions. These decisions have technical and ethical elements. For example, a
decision on which additional trial data to generate on safety and efficacy in specific subgroups
may imply a trade-off between time to access for a majority, and ensuring equitable access to a
much smaller group. Likewise, the decision on the prioritisation of target groups requires an
assessment of their vulnerability, and a decision on how to take other factors, such as their
likelihood of infecting others, into account. Finally, vaccination strategies and the setup of vaccine
sites need to take into account considerations including cost-efficacy, but also accessibility and
acceptability.
The Africa CDC’s Framework for Fair, Equitable and Timely Allocation of COVID-19 Vaccines in
Africa provides for vaccine allocation guided by African indigenous values in an attempt to
address these critical questions. It affirms the prevalence of the concept of Ubuntu in many
African societies – the humanity of others; the principle of survival of the community; social
solidarity; and meaningful community engagement.
IV. A First in a Series of Community Engagement and Experience Sharing Workshops
Acting on the recommendations contained in the above-mentioned Call and Framework, relevant
partner institutions are convening a series of Community Engagement and Experience Sharing
Workshops. As the African continent is fast-tracking strategies and plans to roll out immunisation
programs, there is a need to engage in continuous public deliberations with healthcare
professionals, citizens, civil society organisations, community leaders, the media, policy makers,
public health experts, and researchers.
The objectives of the first of these series of workshops are:
1. To explain the notion of fair, equitable and timely access of COVID-19 vaccines as a global
public good, as considered by the UNESCO Statement on Global Equity and Solidarity and
the Africa CDC Framework for the Fair, Equitable and Timely Allocation of COVID-19
Vaccines in Africa.
2. To examine the current and potential challenges including intellectual property
considerations, in rolling out immunisation campaigns, which must be addressed from an
ethical point of view, using both universal principles, and value systems that exist in
Africa.
3. To explore appropriate avenues for implementation of both documents at regional and
individual country levels, by facilitating sharing of experiences and case studies.
6https://africacdc.org/download/framework-for-fair-equitable-and-timely-allocation-of-covid-19-
vaccines-in-africa/
3Potential topics include:
• Vaccine selection criteria
• Financing and procurement of vaccines
• Vaccine delivery
• Community engagement
• Communications
• Research and evidence gathering
• Intellectual property vs Public good
• Politicisation of vaccine
• COVID-19 Vaccine and No Harm Principle
PARTICIPANTS
a. UNESCO – national, regional and international
b. Africa CDC
c. South African Medical Research Council
d. World Health Organisation
e. African Coalition of Medical Associations
f. South Africa’s Junior Doctor’s Association
g. Civil Society and community leaders
h. Researchers
i. National Ethics and Bioethics Committees
j. Policymakers from Member States
DATE AND TIME OF THE FIRST WORKSHOP
Wednesday, 14 April 2021
13h00 – 16h00 PM East Africa Time
12h00 – 15h00 PM Central Africa Time
Register in advance for the webinar:
https://unesco-org.zoom.us/webinar/register/WN_mFgVhzRJQiWMU9c86bhUrQ
CONTACT FOR INQUIRIES
Safia Mahomed (South Africa National Bioethics Committee): mahoms1@unisa.ac.za
Phinith Chanthalangsy (UNESCO): p.chanthalangsy@unesco.org
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