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Fast-tracking COVID-19 vaccination in Uganda: Pondering the proposals of possible mandates

By Charles Ssemugabo
on October 15, 2021

Uganda has been hit hard by the COVID-19 pandemic, especially during the second wave (June – August 2021). As of October 13,  Uganda had recorded 124,808 cases and 3,152 deaths. The social and economic impact has also been huge. And so, just like in other parts of the world, the COVID-19 vaccines have been seen as a ray of light, restoring some hope among people. The uptake of COVID-19 vaccines is quite high in Uganda, despite the limited amounts of doses available. So far, Uganda has administered 2,615,807 doses of COVID-19, with 415,486 people fully vaccinated, representing 0.94% of its population. Still, as it struggles to ensure that everyone gets at least a first shot, Uganda is also grappling with vaccine hesitancy especially among high risk groups like health workers and teachers. For medical, religious and philosophical reasons among others, segments of the population (continue to) have an issue with the COVID-19 Vaccine.

Against that backdrop, to fast-track COVID-19 vaccine uptake, the Ugandan Ministry of Health is said to be considering restrictions to unvaccinated individuals. Around the world different leaders and governments have come up in recent months with strategies to boost the uptake of COVID-19 vaccines. Among them are (compulsory) vaccine mandates which have been instituted and enforced by several authorities especially in the United States. Recently,  President Biden issued vaccine mandates which affect over two thirds of American workers including health care workers, federal contractors and workers with the possibility of facing disciplinary measures if they do not abide.

In Uganda, proposals are currently being floated of tagging health worker salaries to their COVID-19 vaccination status and restricting access to public places for unvaccinated people. On the education front, while many countries have opened up their schools, Ugandan students are still at home. The Ugandan Ministry of Education and Sports has repeatedly said that it will only open schools again after a majority of the teachers have been vaccinated. While teachers were among the priority categories to receive the vaccine when Uganda received its first AstraZeneca batch in March 2021, many remain unvaccinated, both for access and acceptability reasons.  Like earlier in the pandemic, it seems Uganda will again follow the likes of the United States, and jump on the vaccine mandate bandwagon. Vaccination drives are also being launched in the country by corporate companies, especially alcohol brewing companies, in a bid to increase access to vaccination and consequently facilitate the safe reopening of the hospitality industry, in particular bars.

While all the aforementioned efforts are meant to increase vaccination and consequently overcome COVID-19, vaccination should remain voluntary, however, is my strong conviction. Strategies to increase uptake of COVID-19 vaccination are indeed required in order to reach herd immunity (or at least get reasonably close), but they should observe the basic ethical principles of autonomy and justice, among others. Ethical debates on vaccine mandates suggest that unless all other reasonable means have failed to increase vaccine uptake or reduce disease transmission to an acceptable level, a mandate should not be implemented. In a country like Uganda that has not secured enough COVID-19 vaccine doses so far to cover even 10% of its population, mandate proposals should not be discussed.  Instead of imposing mandates on some population groups like health workers and teachers, the Ugandan Ministry of Health should continue to promote hand washing, use of face masks and social distancing among health workers and teachers. And get more vaccines in the country, soon, in collaboration with global actors. Given the  ethical complexity, mandates should remain a ‘last resort’ option. Certainly in a country like Uganda.

Even though COVID-19 vaccines are safe and effective, vaccination should remain voluntary in the view of peoples’ autonomy. Authorities in Uganda and across Africa should continue to promote the public health measures to protect the unvaccinated individuals, and both African and global actors should boost vaccine supply.

As for mandates, leave them to the countries that have been hoarding vaccines since the beginning.

 

About Charles Ssemugabo

Charles Ssemugabo is a Research Associate in the Department of Disease Control and Environmental Health, Makerere University School of Public Health; EV 2016; Consortium for Advanced Research Training in Africa (CARTA) fellow; and a UJMT Fogarty Global Health Fellow. Currently co-chair EV4GH
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1 comments
Anyonga Prisca says:

Thank you Charles for this up date and recommendations. These should indeed inform actions of stakeholders on how best to promote vaccination while observing ethical issues.