Ideas & Debate

Key ethical issues for medics in Covid-19 vaccination drive

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Healthcare staff prepares to administer a Covid-19 vaccine. FILE PHOTO | AFP

Summary

  • The Covid-19 pandemic has raised some critically important ethical challenges as an initial health crisis soon became an economic crisis leading to lockdown measures across the country.
  • However, it is healthcare professionals who have been most affected by the ethical issues raised.

The Ministry of Health has just released the National Covid-19 Vaccines Deployment and Vaccination Plan 2021.

A dispatch from State House last week said the first batch of the vaccines would arrive this week as Kenya races to vaccinate 1.25 million in phase one of the campaign by June, with priority being given to healthcare and frontline workers including security personnel and teachers vulnerable persons and groups and hospitality sector.

The second phase would involve 9.7 million people — comprising those above 50 years and above 18 with underlying medical conditions — between July and next June.

This is very good news.

The Covid-19 pandemic has raised some critically important ethical challenges as an initial health crisis soon became an economic crisis leading to lockdown measures across the country.

However, it is healthcare professionals who have been most affected by the ethical issues raised.

Vaccine hesitancy

The topic of vaccines and hesitancy is important as we gear up to vaccinate Kenyans.

Vaccine hesitancy or refusal is not a new issue.

It is, however, important to appreciate that Kenya is quite compliant with other vaccine protocols with high levels of coverage for measles, typhoid, rubella, and the like.

There are several reasons that people may not want to be inoculated with the Covid-19 vaccines, particularly how new the disease is and the speed with which the vaccines have been developed. This raises important ethical issues.

Ethical issues

In the light of the significantly strained health system in Kenya, care must at times be rationed.

Who decides who can and should receive treatment? On what basis are decisions to be made on who to admit to a hospital or not?

Covid-19 has challenged the medical field. And clinicians are at the forefront of ethical dilemmas in the unchartered waters the pandemic has placed us in.

However, clinical care is guided by the principles of medical practice and the underlying ethics of the discipline.

The medical ethics that underlie practice are the respect for autonomy, beneficence, non-maleficence or do-no-harm, and justice

As patients and the public look forward to receiving the vaccines, it is healthcare professionals — doctors, nurses and paramedics — in hospitals, clinics, and outreach centres they will turn to.

The public will turn to doctors primarily because they have a relationship of trust with them.

Doctors will need to be informed about the Covid-19 disease, the vaccines available and their efficacy, and what patients information and health needs may be for safe and timely inoculation.

At the same time, the healthcare provider is ethically obligated to respect the patient’s right and choices. The ethical issue to be addressed is patient autonomy —the right to decide on treatment — versus communitarianism — the right of society to be protected as a whole.

What needs to be done

The government and healthcare providers need to prepare their healthcare workers. For example, the Aga Khan University Hospital has been facilitating an organisation-wide discussion and health education to address patient communication, symptom management, skills development and a transdisciplinary approach to address physical and emotional suffering brought about by Covid-19.

We recently held a continuous medical education seminar for staff on the topic of ‘Do No Harm and Vaccine Hesitancy in the Light of Covid-19 in Kenya’.

As we go forward, the pandemic has yielded several lessons for all of us.

We have several rights and entitlements enshrined in the Constitution — access to the highest quality of care, the right to confidentiality, the right to informed consent and the right to select the healthcare provider of choice.

Covid-19 has brought questions on how feasible existing guidelines, policies and internationally accepted standards are for us to serve the Kenyan population at large.

Questions such as how we will deal with vaccine hesitancy are, therefore, important issues for us as we may be forced to either confront the lack of knowledge or disinformation about vaccines in social media.

Worse still, we need to ration scarce critical care resources.

Dr Weru, is palliative medicine physician at Aga Khan University Hospital and chair, Hospital Ethics Committee Dr Khamis, is a member, Hospital Ethics Committee and research faculty at Aga Khan University’s Institute of Human Development Dr Muhudhia, is faculty, bioethics at Kabarak University