Sharifah Sekalala, Katrina Perehudoff, Michael Parker, Lisa Forman, Belinda Rawson, Maxwell Smith
With over 170 COVID-19 vaccine candidates in clinical trials, and several already authorised for emergency use, the global community is grappling with how to equitably allocate the first available doses of vaccines that are proven safe and effective. Clinicians at all levels of engagement—from global and national health advisors to decision makers in health regions and facilities—are being confronted with this dilemma. We argue that international human rights, which have been ratified and are legally binding on 171 states, can help in resolving this quandary by integrating an intersectional approach to allocation processes.
Current allocation frameworks are inadequate for fully realising the right to health because they overemphasise epidemiological concerns.1 An intersectional approach to the right to health prioritises population groups who experience vulnerability, marginalisation and multiple forms of discrimination. Thus, we argue that vaccine allocation frameworks ought to prioritise the needs of population groups with pre-existing social, health and economic vulnerabilities. We argue that an intersectional human rights approach provides the best mechanism for dealing with overlapping vulnerabilities of deprivation, ethnic diversity and (baseline) health status, as it considers the social determinants of health and the impact of structural inequalities.
In this article, we first briefly map the current approaches to vaccine allocation, before analysing their shortcomings from a human rights perspective. We then argue that human rights principles are vital when allocating scarce healthcare resources and what these principles could entail at the national level for the first doses of a COVID-19 vaccine. Finally, we outline an intersectional model of how this could be achieved, together with some limitations that we foresee in practice.