South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality.
Values, Policies and Rights
Enrolling adolescents in HIV vaccine trials: reflections on legal complexities from South Africa
Slack c , Strode A, Fleischer T, Gray G, Ranchod C: BMC Medical Ethics 8:5, 13 May 2007
Ensuring access to essential medicines through the inclusion of the right to health in the Mauritian Constitution
Budoo A: AfricLaw, 5 March 2013
Mauritius is signatory to the 2001 Doha Declaration, which ensures that government can access generic medicines for use in the public sector and without the patent holder’s approval and is an important tool to ensure universal access to medicines. Although the state has been compliant with the Doha Declaration, the Constitution of Mauritius has no provisions for the protection of the right to health. Furthermore, the National Human Rights Commission has no specific mandate to deal with economic, social and cultural rights and there is no National Medicines Policy document. The author calls on government to give effect to the recommendation of the CESCR and bring about a constitutional amendment that will include economic, social and cultural rights in the Constitution thus making the right to health justiciable. After including the right to health in the Constitution, the government should adopt a new legislation to protect the right to health of all the citizens and enshrine access to medicines as a component of the right to health. To avoid any foreseeable problem, the use of generic medicines should be included in the act and there should be a clear demarcation between generic drugs and counterfeiting so that it does not limit the access to medicines of Mauritians.
Ensuring workers’ rights to health and safety in SADC
Work and Health in Southern Africa (WAHASA): September 2008
The Southern African Development Community (SADC) Protocols on Health (1999), and Mining (1997) requires member states to co-operate in delivering and improving occupational health in the region’s mining sector. But the rights of mineworkers and other workers to health and safety have not been realised, according to this policy brief. Harmonisation of standards in the region, and monitoring of compliance with standards, is now more critical in the age of free trade agreements. These agreements should not impact negatively on workers’ health, through the exporting of hazardous processes within the region to where regulation and enforcement is less stringent, as well as through pressure to reduce occupational health requirements to allow companies to become more competitive. Stakeholders should hold SADC and member states to the realisation of workers’ health and safety rights and take action when rights are not upheld and targets are not met. They can also identify issues and areas in which collaboration is necessary and ensure that resources and strategies are in place to deliver what is needed.
Environmental health policies for women’s, children’s and adolescents’ health
Neira M; Fletcher E; Brune-Drisse M; Pfeiffer M; Adair-Rohani H; Dora C: Bulletin of the World Health Organisation 95(7), 2017
Environmental health risks especially affect women and children, because they are more vulnerable socially and because exposures to environmental contaminants create greater risks for children’s developing bodies and cognitive functions. According to the 2016 World Health Organisation (WHO) estimates, modifiable environmental risk factors cause about 1.7 million deaths in children younger than five years and 12.6 million total deaths every year. The sustainable development goals (SDGs) offer opportunities for countries to create healthier environments for women, children and adolescents. This paper explores how the SDGs can be used to reduce environmental health risks and enhance the health of women, children and adolescents. In particular, the authors focus on drivers for urbanisation and sustainable development (e.g. transport, housing, urban design and energy provision) that can advance the global strategy, but have not traditionally been a focus of health policy-making. They frame the discussion around the three pillars of the global strategy: survive, thrive and transform, while recognising the inevitable overlap between these objectives.
Equity and core concepts of human rights in Namibian health policies
Amadhila E, Van Roy G, McVeigh J, Mannan H, MacLachlan M and Amin M: Africa Policy Journal, 28 February 2013
This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. The researchers applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. The authors conclude that the need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.
Equity promoting health care policies in South Africa: A literature review commissioned by the Health Systems Knowledge Network
Chetty K: WHO Commission on Social Determinants of Health (CSDH), 2007
South Africa is one of the youngest democracies in the world, with twelve years of a democratically elected government. Prior to the democratic elections, it was a country marked by oppression and extreme inequality. The democratic government has introduced a range of pro poor and pro equity policies. This paper reviews the system that was inherited by the democratic government, the equity promoting policies of the new government and the strategies adopted to implement these policies. It further analyses if the policy objectives have been met and the challenges that need to be addressed to reach these objectives.
Essential Medicines in National Constitutions: Progress Since 2008
Perehudoff S; Toebes B; Hogerzeil H: Health and Human Rights Journal 18(1), June 2016
A constitutional guarantee of access to essential medicines has been identified as an important indicator of government commitment to the progressive realisation of the right to the highest attainable standard of health. The objective of this study was to evaluate provisions on access to essential medicines in national constitutions, to identify comprehensive examples of constitutional text on medicines that can be used as a model for other countries, and to evaluate the evolution of constitutional medicines-related rights since 2008. Relevant articles were selected from an inventory of constitutional texts from WHO member states. References to states’ legal obligations under international human rights law were evaluated. Twenty-two constitutions worldwide now oblige governments to protect and/or to fulfil accessibility of, availability of, and/or quality of medicines. Since 2008, state responsibilities to fulfil access to essential medicines have expanded in five constitutions, been maintained in four constitutions, and have regressed in one constitution. Government commitments to essential medicines are an important foundation of health system equity and are included increasingly in state constitutions.
Ethical and regulatory issues surrounding African traditional medicine in the context of HIV and AIDS
Nyika A: Developing World Bioethics 7(1): 25-34, April 2007
It has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code,1 African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues. In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given.
Ethical challenges in conducting research in humanitarian crisis situations
Mfutso-Bengo J, Masiye F and Muula A: Malawi Medical Journal 20(2):46–49, 2008
Although the ethical principles of justice, beneficence and respect for autonomy/persons should be upheld in research, their application in emergency situations may differ from non-emergency situations. Just like in non-emergency situations, research in emergency situations should be conducted in the best interest of the victims or future victims. The research should not unnecessarily expose human subjects and the researcher to careless harm, and should be of adequate scientific rigour. Victims of emergency situations are vulnerable populations that need special protection from exploitation. Researchers should conduct a fair risk-benefit assessment in order to come up with a risk management plan, and be culturally sensitive to the needs of the victims of the humanitarian crisis. In emergency situations, the roles of Institutional Review Boards (IRBs) may have to be modified without compromising the ethical standards that health researchers have globally attempted to achieve.
Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemic
Parker M; Fraser C; Abeler-Dörner L: Journal of Medical Ethics, doi:10.1136/medethics-2020-106314, May 2020
In this paper the authors discuss ethical implications of the use of mobile phone apps in the control of COVID-19. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks but the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this many countries globally have deployed or are developing mobile phone apps capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions that need to be understood and analysed against the public health benefits. The authors explore the relative benefit and harms; the impact on identified individuals; the implications for privacy and liberty; the responsibilities of institutions and professionals; and the longer term equity, ethical and public trust issues of how the data is deleted or used, issues that are not only relevant for COVID-19 but also for future outbreaks.