Ethical Considerations In The SARS CoV Vaccination Drive For Pakistanis
The Government of Pakistan has been reaching out to leading pharmaceuticals, organizations and regulatory bodies for procurement of sufficient quantities of SARS CoV vaccines. However, whether these efforts would lead to timely administration is another debate. Part of the debate are the relevant ethical concerns.
When it comes to ethics, the well known Belmont principles of autonomy, beneficence and distributive justice often serve as guide to clinical research and underlying ethics. As far as the availability of this vaccine is concerned, will there be a fair, timely, global, equitable distribution based on susceptibility, population vulnerability, risk of acquiring COVID-19 and relative effectiveness of various vaccines? Or, will the usual disparities prevail globally, regionally and locally?
Expanded Programme on Immunization
The Expanded Programme on Immunization (EPI) was launched in Pakistan in 1978 to protect children by immunizing them against childhood tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus and measles etc. It is a matter of concern that the progress has remained far below the expected benchmarks; Punjab achieves 62% penetrance, Sindh 51 percent, KPK around 31 percent and Baluchistan 18 percent, according to published reports.
In this context, with dismal performance on key health indicators, how is Pakistan going to prioritize its SARS CoV vaccine drive?
Will it be universally available? How are we going to develop herd immunity for 70% of the population? Will there be a pertinent debate and recommendations be sought from the National Bioethics Committee? Is there going to be a scientific body to prioritize the order in which the vaccine will be administered? As Polio teams have seldom come under attacks, how does one guarantee the safety of the team that would administer the COVID vaccine? Some clergymen and others have been supporting the conspiracy narrative that these vaccines will alter our genetic constitution and control our thoughts and belief systems!
It is imperative that our priorities include vaccination of the populations suffering from chronic ailments like diabetes, kidney disease, liver disease, similarly chronic lung ailments and other immunological disorders. We need to target the vulnerable groups like our elderly first. There should be an accepted preference for frontline health workers beginning with elderly and middle aged Nurses, Respiratory technicians and Doctors. In fact, the junior house staff who spend a great deal of time in the COVID wards should receive the very first set of vaccines. Needless to add how much have they been at the receiving end of COVID-19 and fatal risks. Also, as per the relatively sparing effect in teenagers, can we afford to let them serve as ongoing carriers and conduits for viral transmission? Moreover, we neee to ask: Should all new borns be administered the vaccine while knowing well that not too many trials have included the pediatric population?
Will the power differential prevail again i.e. the rich and powerful having unhindered early access to the vaccine regardless of risk stratification?
Lastly, would it be fair to administer the vaccine, in the end, to all the nay sayers as well? Our powerful religious clergy and political entities, who have thrown all caution to the wind, wilfully disobeyed the physical distancing and masking instructions with impunity.
All pertinent aspects need early deliberations at the national level; Health Sciences universities, academic Medical centers and Service providers need to develop guidelines by working along with policymakers, bioethicists, Drug regulatory bodies, scientists and public health experts. Is the NCOC, nerve centre of Pakistan, gearing up for this challenge? All eyes are on the incumbent government.