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The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next... more
The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health.
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When the COVID-19 pandemic first took the world by storm, the World Health Organization (WHO) issued a Solidarity Call to Action to realize equitable global access to COVID-19 health technologies through pooling of knowledge, intellectual... more
When the COVID-19 pandemic first took the world by storm, the World Health Organization (WHO) issued a Solidarity Call to Action to realize equitable global access to COVID-19 health technologies through pooling of knowledge, intellectual property and data. At the dawn of 2022, 70% of rich countries’ populations were vaccinated but only 4.6% of poor countries (Our World In Data, Coronavirus (COVID-19) vaccinations, 2022). Vaccine nationalism and rampant self-interest grew and our ineffective global response led to new variants of concern - like Omicron - emerging. Rather than abandon the idea of solidarity in global health, we believe that the international community must embrace it. Solidarity, with its emphasis on relationality and recognition of similarities, could offer fertile ground for building an ethical framework for an interconnected and interdependent world. Such a framework would be better than a framework that focuses principally on individual entitlements. To defend th...
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Nationalism has trumped solidarity, resulting in unnecessary loss of life and inequitable access to vaccines and therapeutics. Existing intellectual property (IP) regimens, trade secrets and data rights, under which pharmaceutical firms... more
Nationalism has trumped solidarity, resulting in unnecessary loss of life and inequitable access to vaccines and therapeutics. Existing intellectual property (IP) regimens, trade secrets and data rights, under which pharmaceutical firms operate, have also posed obstacles to increasing manufacturing capacity, and ensuring adequate supply, affordable pricing, and equitable access to COVID-19 vaccines and other health products in low-income and middle- income countries. We propose: (1) Implementing alternative incentive and funding mechanisms to develop new scientific innovations to address infectious diseases with pandemic potential; (2) Voluntary and involuntary initiatives to overcome IP barriers including pooling IP, sharing data and vesting licences for resulting products in a globally agreed entity; (3) Transparent and accountable collective procurement to enable equitable distribution; (4) Investments in regionally distributed research and development (R&D) capacity and manufact...
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The COVID-19 pandemic has both highlighted and exacerbated global health inequities, leading for calls for responses to COVID to promote social justice and ensure that no one is left behind. One key lesson to be learnt from the pandemic... more
The COVID-19 pandemic has both highlighted and exacerbated global health inequities, leading for calls for responses to COVID to promote social justice and ensure that no one is left behind. One key lesson to be learnt from the pandemic is the critical importance of decolonizing global health and global health research so that African countries are better placed to address pandemic challenges in contextually relevant ways. This paper argues that to be successful, programmes of decolonization in complex global health landscapes require a complex three-dimensional approach. Drawing on the broader discourse of political decolonization that has been going on in the African context for over a century, we present a model for unpacking the complex task of decolonization. Our approach suggests a three-dimensional approach which encompasses hegemomic; epistemic; and commitmental elements.
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The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next... more
The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, a...
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The movements of humans have a significant impact on population health. While studies of such movements are as old as public health itself, the COVID-19 pandemic has raised the profile of mobility research using digital technologies to... more
The movements of humans have a significant impact on population health. While studies of such movements are as old as public health itself, the COVID-19 pandemic has raised the profile of mobility research using digital technologies to track transmission routes and calculate the effects of health policies, such as lockdowns. In sub-Saharan Africa, the high prevalence of cell phone and smartphone use is a source of potentially valuable mobility data for public health purposes. Researchers can access call data records, passively collected in real time from millions of clients by cell phone companies, and associate these records with other data sets to generate insights, make predictions or draw possible policy implications. The use of mobility data from this source could have a range of significant benefits for society, from better control of infectious diseases, improved city planning, more efficient transportation systems and the optimisation of health resources. We discuss key ethi...
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This paper questions an exclusively state-centred framing of global health justice and proposes a multilateral alternative. Using the distribution of COVID-19 vaccines to illustrate, we bring to light a broad range of global actors up and... more
This paper questions an exclusively state-centred framing of global health justice and proposes a multilateral alternative. Using the distribution of COVID-19 vaccines to illustrate, we bring to light a broad range of global actors up and down the chain of vaccine development who contribute to global vaccine inequities. Section 1 (Background) presents an overview of moments in which diverse global actors, each with their own priorities and aims, shaped subsequent vaccine distribution. Section 2 (Collective action failures) characterises collective action failures at each phase of vaccine development that contributed to global vaccine disparities. It identifies as critical the task of establishing upstream strategies to coordinate collective action at multiple stages across a range of actors. Section 3 (A Multilateral model of global health governance) takes up this task, identifying a convergence of interests among a range of stakeholders and proposing ways to realise them. Appealin...
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This paper argues for global sharing of COVID-19 treatments during the COVID-19 pandemic and beyond based on principles of global solidarity. It starts by distinguishing two types of COVID-19 treatments and models sharing strategies for... more
This paper argues for global sharing of COVID-19 treatments during the COVID-19 pandemic and beyond based on principles of global solidarity. It starts by distinguishing two types of COVID-19 treatments and models sharing strategies for each in small-group scenarios, contrasting groups that are solidaristic with those composed of self-interest maximizers to show the appeal of solidaristic reasoning. It then extends the analysis, arguing that a similar logic should apply within and between nations. To further elaborate global solidarity, the paper distinguishes morally voluntary, sliding-scale, and mandatory versions. It argues for an all-hands-on-deck approach and gives examples to illustrate. The paper concludes that during the COVID-19 crisis, global solidarity is a core value, and global sharing of COVID-19 treatments should be considered a duty of justice, not of charity.
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This paper offers an African perspective on moral status grounded on an understanding of personhood. These concepts are key to understanding the differences in emphasis and the values at play when global ethical issues are analysed within... more
This paper offers an African perspective on moral status grounded on an understanding of personhood. These concepts are key to understanding the differences in emphasis and the values at play when global ethical issues are analysed within the African context. Drawing from African philosophical reflections on the descriptive and normative concepts of personhood, I propose a dual notion of subject and object moral status. I explain how object moral status, duties owed to persons, is differently grounded with respect to subject moral status, which refers to communally directed agency. This distinction influences the African way of conceptualising and addressing ethical issues, where, without ignoring rights of persons, moral consideration about the agency of right bearers is often factored into ethical deliberation. As a practical example, I look at the debate surrounding legal access to safe abortion on the African continent. I suggest a Gadamerian approach to diffuse the tensions tha...
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The killing of George Floyd by Minneapolis police officers and the subsequent Black Lives Matter protests have been accompanied by calls for the removal of statues of racists from public space. This has generated debate about the role of... more
The killing of George Floyd by Minneapolis police officers and the subsequent Black Lives Matter protests have been accompanied by calls for the removal of statues of racists from public space. This has generated debate about the role of statues in the public sphere. I argue that statues are erected to represent a chosen narrative about history. The debate about the removal of statues is a controversy about history and how we relate to it. From this perspective, the Black Lives Matter movement is not a drive to remove or topple statues, but a call for an honest examination of systemic racism and the residual effects of slavery. This call can be a kairos to engage in a constructive dialogue about the societies we aspire to live in. The result of this dialogue, which includes a re-examination of dominant narratives, will decide which statues and monuments can occupy public space and represent our societies.
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As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed... more
As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed clinical trials involving children are important to ensure safety, efficacy, and dosage of therapies in (developing) children. Within the complex health, social, and political scenario of the ongoing pandemic, ethics committees and policy makers in low-income and middle-income settings need to consider additional ethical questions when called on to review phase III COVID-19 vaccine trials involving in children. We set out some of the ethical questions to keep in mind before, during, and after the implementation of phase III COVID-19 vaccine trials in limited resource settings. Specifically, we discuss and offer succinct answers to the following questions: How relevant will the trial vaccine be for the population participating in the trial? Should vaccines...
Across sub-Saharan Africa, bioethics is an emerging field of scholarly inquiry, informed by contextual features distinct to the region. A cultural mix comprised of Euro-American influences, indigenous traditions, Christian faiths and... more
Across sub-Saharan Africa, bioethics is an emerging field of scholarly inquiry, informed by contextual features distinct to the region. A cultural mix comprised of Euro-American influences, indigenous traditions, Christian faiths and Muslim communities, a bioethics for the sub-Saharan region must be responsive to this milieu. This paper asks, what values and methods can best promote the practice of bioethics in Africa? We set forth a strategy that leans one way or another in response to contextual features of a particular setting. Since our aim is to be responsive to context, we begin with a series of cases and develop values and methods in response to each case as we work through its ethical analysis. Section I introduces a case involving setting priorities for public funding of services that produce large benefits for a small group of people, using the example of dialysis in Ghana. Section II presents a situation involving determining the permissibility of a double standard of qua...
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An overview of bioethical challenges facing the Sub-Saharan African region. The chapter groups these challenges under five headings: health care ethics; bioethics of communo-cultural practices; bioethics of consumerism and corruption;... more
An overview of bioethical challenges facing the Sub-Saharan African region. The chapter groups these challenges under five headings: health care ethics; bioethics of communo-cultural practices; bioethics of consumerism and corruption; natural resources and environmental bioethics; bioethical neo-colonialism. Atuire outlines the peculiar African challenges in each of these areas. He concludes with a ten-point commonsensical list of recommendations for bioethics in Africa.
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The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of... more
The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more ‘local’ perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more ‘universalist’ or ‘relativist’ approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of...
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The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of... more
The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more ‘local’ perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more ‘universalist’ or ‘relativist’ approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of...
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This paper gives an ethical argument for temporarily waiving intellectual property (IP) protections for COVID-19 vaccines. It examines two proposals under discussion at the World Trade Organization (WTO): the India/South Africa proposal... more
This paper gives an ethical argument for temporarily waiving intellectual property (IP) protections for COVID-19 vaccines. It examines two proposals under discussion at the World Trade Organization (WTO): the India/South Africa proposal and the WTO Director General proposal. Section I explains the background leading up to the WTO debate. Section II rebuts ethical arguments for retaining current IP protections, which appeal to benefiting society by spurring innovation and protecting rightful ownership. It sets forth positive ethical arguments for a temporary waiver that appeal to standing in solidarity and holding companies accountable. After examining built-in exceptions to existing agreements and finding them inadequate, the paper replies to objections to a temporary waiver and concludes, in section III, that the ethical argument for temporarily waiving IP protection for COVID-19 vaccines is strong.
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The killing of George Floyd by Minneapolis police officers and the subsequent Black Lives Matter protests have been accompanied by calls for the removal of statues of racists from public space. This has generated debate about the role... more
The killing of George Floyd by Minneapolis police officers and the subsequent Black Lives Matter protests have been accompanied by calls for the removal of statues of racists from public space. This has generated debate about the role of statues in the public sphere. I argue that statues are erected to represent a chosen narrative about history. The debate about the removal of statues is a controversy about history and how we relate to it. From this perspective, the Black Lives Matter movement is not a drive to remove or topple statues, but a call for an honest examination of systemic racism and the residual effects of slavery. This call can be a kairos to engage in a constructive dialogue about the societies we aspire to live in. The result of this dialogue, which includes a re-examination of dominant narratives, will decide which statues and monuments can occupy public space and represent our societies.
KEYWORDS Black Lives Matter; Statues; Racism; Slavery; Dialogue.
KEYWORDS Black Lives Matter; Statues; Racism; Slavery; Dialogue.
The killing of George Floyd by Minneapolis police officers and the subsequent Black Lives Matter protests have been accompanied by calls for the removal of statues of racists from public space. This has generated debate about the role of... more
The killing of George Floyd by Minneapolis police officers and the
subsequent Black Lives Matter protests have been accompanied by
calls for the removal of statues of racists from public space. This
has generated debate about the role of statues in the public sphere. I
argue that statues are erected to represent a chosen narrative about
history. The debate about the removal of statues is a controversy
about history and how we relate to it. From this perspective, the
Black Lives Matter movement is not a drive to remove or topple
statues, but a call for an honest examination of systemic racism and
the residual effects of slavery. This call can be a kairos to engage in
a constructive dialogue about the societies we aspire to live in. The
result of this dialogue, which includes a re-examination of dominant
narratives, will decide which statues and monuments can occupy
public space and represent our societies.
subsequent Black Lives Matter protests have been accompanied by
calls for the removal of statues of racists from public space. This
has generated debate about the role of statues in the public sphere. I
argue that statues are erected to represent a chosen narrative about
history. The debate about the removal of statues is a controversy
about history and how we relate to it. From this perspective, the
Black Lives Matter movement is not a drive to remove or topple
statues, but a call for an honest examination of systemic racism and
the residual effects of slavery. This call can be a kairos to engage in
a constructive dialogue about the societies we aspire to live in. The
result of this dialogue, which includes a re-examination of dominant
narratives, will decide which statues and monuments can occupy
public space and represent our societies.