Topics
More on Population Health

Human rights law can provide a fair, transparent framework for vaccine allocations

Social determinants of health become an important factor in determining whether certain populations are more vulnerable than others.

Jeff Lagasse, Associate Editor

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, proposes that existing human rights legal principles should guide their thinking.

All 171 governments have signed at least one human rights treaty recognizing that people have the right to life and health – but how can this guide decisions on vaccine distribution 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 U.K. age-priority system to the U.S. decision to prioritize healthcare workers and first responders – and considers these from a human rights perspective, outlining a model of an ethical intersectional distribution scheme based on human rights legal principles.

WHAT'S THE IMPACT?

According to Sekalala and his team, the right to health in practice means that vaccines should be made available to everyone. If there aren't enough – which is a common enough occurrence – they should be prioritized for people who are more likely to contract COVID-19, such as those who are immunocompromised or those most likely to transmit the virus.

What the research posits is that three fundamental human rights need to be reflected in any vaccine distribution program: the right to life, the right to health and the right to benefit from scientific progress.

Adhering to those rights necessitates a transparent framework that considers those principles. Otherwise, governments may be accused of unfairness or favoritism in their distribution plans.

The team recommends 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.

In the U.S., U.K. and other nations, many ethnic minority groups are more likely to take on informal or insecure jobs, live in overcrowded housing and have lower overall socioeconomic status, which can make it more difficult for them to stay socially distant. That in turn makes them more susceptible to virus transmission compared to people in similar age groups with more secure circumstances. 

That's where a more intersectional approach comes into play, taking into account not just vulnerability to infection but the underlying social determinants of health.

The authors hope policymakers consider the approach as they continue their vaccination push.

THE LARGER TREND

In August 2020, an analysis of hospitalization rates from the University of Minnesota showed Black, Hispanic, Native American and Alaskan Native populations in the U.S. are significantly more likely to be hospitalized due to COVID-19 than whites.

An LSU Health New Orleans School of Public Health report released this week found a positive association between social vulnerability and COVID-19 incidence, and recommends that more resources be allocated to socially vulnerable populations to reduce the incidence of COVID-19.

On the vaccine front, the supply, which began going out in December, has been short of demand as states announce phases for inoculation. To speed up vaccinations, federal COVID-19 Vaccine Coordinator Jeff Zients announced earlier this month that, starting February 11, a million doses of the vaccine will be shipped directly to 6,500 pharmacies to get shots into arms, following individual state guidelines.

The federal government has been working to speed up the production, distribution and administration of the vaccine, working against spreading coronavirus variants first reported in the U.K. and South Africa.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

Focus on Health Equity

This month we will be reporting on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.