Electronic supplementary material: 
The online version of this article contains supplementary material.
Cite as: Ewuoso C, Obengo T, Atuire C. Solidarity, Afro-communitarianism, 
© 2022 THE AUTHOR(S) and COVID-19 vaccination. J Glob Health 2022;12:03046.
JoGH © 2022 ISoGH
Solidarity, Afro-communitarianism, 
and COVID-19 vaccination
Cornelius Ewuoso1, Tom Obengo2, Caesar Atuire3,4
1Steve Biko Centre for Bioethics, University of Witwatersrand, Johannesburg, South Africa
2Department of Medicine, University of Cape Town, Cape Town, South Africa
3Department of Philosophy and Classics, University of Ghana, Accra, Ghana
4Nuffield Department of Medicine, University of Oxford, Oxford, UK
This paper appeals to the Afro-communitarian conceptions of solidarity to think critically about the duty (if any and in what ways) to vaccinate. Barbara Prainsack and Alena Buyx [1] describe solidarity as “en-acted commitment to carry the costs (financial, social, emotional, and other contributions) of assisting 
others with whom a person or persons recognise similarity in a relevant aspect”. In sub-Saharan Africa, one 
concrete way Africans have enacted this commitment to carry cost is exemplified by the phenomenon of Black 
tax common in Southern Africa, whereby individuals who are well-off in a family help their indigent relatives.
There are at least two reasons to reflect on the imports of solidar-
Some scholars have suggested that COVID-19 ity for the duty to vaccinate. First, some scholars have suggested 
that COVID-19 vaccine mandates may be justified based on the 
vaccine mandates may be justified based on principle of solidarity [2,3]. Yet, they are hardly clear about the 
the principle of solidarity. Yet, they are hardly formulation(s) of solidarity (in global or African bioethics litera-
clear about the formulation(s) of solidarity (in ture) that supports this view. This is a critical gap.
global or African bioethics literature) that sup- Second, global COVID-19 vaccination remains a challenge. More 
ports this view. This is a critical gap. than 50 countries have been unable to (fully) vaccinate at least 
10% of their population [4], despite RNA vaccines from Moderna 
and Pfizer-BioNTech being freely available in most countries, and 
some studies [4,5] demonstrating their safety and their effectiveness in mitigating severe COVID-19 symptoms 
and death. This includes (largely populated) African countries like Egypt and Nigeria and low-income coun-
tries like Iraq and Afghanistan. Only about 15 (out of 54) African countries have fully vaccinated at least 10% 
of their population, while only 4.4% of Africans are fully vaccinated [4]. In South Africa, the country with the 
largest number of COVID-19 cases (about 2.8 million) and deaths (about 87 000) among African countries as 
of September 27, 2021, the average daily COVID-19 cases remain around 1700 and daily deaths around 200, 
with most infections and deaths occurring in urban and largely populated areas in Gauteng, Western Cape, 
and Kwazulu Natal regions [6,7]. Yet, only about 14% of the population has been fully vaccinated. These sta-
tistics on vaccination in Africa should be interpreted considering the age structure of the population, but this 
is outside of the scope of this paper.
Evidently, some factors are responsible for the low vaccination in African countries, including a shortage of 
doses. Nonetheless, the reluctance to vaccinate has been observed even where doses are available [8]. In fact, 
vaccine hesitancy is one of the top ten global health threats [9]. Vaccination hesitancy threatens everyone and 
undermines the global COVID-19 pandemic response and quest to limit and stop the spread of the virus. The 
global community should not spare any tool for overcoming hesitancy. Any longstanding tradition or cul-
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ture could offer lessons on the human condition. Africans 
have cooperated for a long time and formed solidarity 
with each other. If the principle of solidarity grounded in 
the African way of being or experiencing the world can 
help to scale up COVID-19 vaccination, this ought to be 
explored since no one is safe until everyone is safe.
In this paper, we argue that the principle of solidarity 
grounded in Afro-communitarianism implies we ought 
to vaccinate to further foster vaccine uptake and pre-
vent COVID-19 vaccine-preventable complications and 
deaths. To justify this thesis, in the first section: a) we 
highlight some aspects of this principle in African phi-
Photo: Corona vaccines. Source: Ali Raza, via https://pxhere.com/en/photo/1640977. losophy– namely altruism, reciprocity, and collective re-
Copyright-free under Creative Commons CCO.
sponsibility, and b) outline their moral implications for 
the duty to take safe and effective vaccines. Though we 
focus mainly on the duty to vaccinate, we do not suggest that vaccination is the only means of preventing com-
plications associated with COVID-19. Our analysis equally applies to the duty to socially distance, wear face-
masks, or adhere to COVID-19 mitigation protocols. In the second section, we address the objections to our 
stances on vaccine mandates. Mandates are critical for upscaling vaccine intake, lifting restrictive measures, 
and limiting complications associated with COVID-19 [2,10]. We demonstrate that, despite attractive aspects 
of solidarity in African writings favouring voluntary (rather than mandatory) vaccination, it has considerable 
implications for upscaling COVID-19 vaccination. Following this, we address the objection that the norms we 
describe do not address the real reasons for vaccination hesitancy. Understanding and addressing these rea-
sons is critical for increasing COVID-19 vaccination. We contend that, though these reasons include a complex 
combination of confidence, complacency, and convenience, confidence or mistrust in the vaccines appears to 
be closely associated with reluctance to vaccinate. We then showed how the African view of solidarity implies 
that scientists should use scientific data and social media to build trust and in what ways they can do so. Fi-
nally, we address the objection that the African view of solidarity has no practical relevance for public health 
ethics or decisions since the motivation for forming solidary groups appears to be essentially self-interested. 
We demonstrate how this is not problematic since positive reciprocity (solidarity) rather than negative reci-
procity (solidarity) tends to be encouraged in Afro-communitarianism.
This paper is different from other studies which focus on understanding the factors affecting COVID-19 vac-
cine uptake. It is equally different from other studies that appeal to western approaches like consequential-
ism (or western approaches to solidarity) to reflect on vaccination. Contrarily, the moral implications for the 
responsibility to vaccinate grounded in solidarity match moral intuitions dominant in the Global South. The 
idea of solidarity is not unique to African thought and is also found in the west and east. However, the ways 
of thinking about this concept in African philosophy are based on African modes of being or encountering the 
world, something Africans did not learn from others.
AFRICAN DISCUSSIONS ON SOLIDARITY
In African writings, altruistic service or altruism, reciprocity, and collective responsibility to promote the flour-
ishing of all members are common themes often associated with this concept. These themes do not exhaust 
the concept itself, and a scoping/systematic review is required to map the discussion on solidarity in Afro-
communitarianism adequately.
Altruistic service
The idea that the normative ideal way of exhibiting solidarity entails (an attitude of) altruistic service has been 
defended by Thaddeus Metz. In Metz’s [11] opinion, to exhibit solidarity entails a commitment to act to make 
others better people, sharing in their failures and successes, advancing their self-realisation for their sake, and 
improving their situation, having been deeply aware of (and moved by) the other’s condition. The one who ex-
hibits solidarity is necessarily sympathetic (s/he feels how others are likely to be impacted having received – or 
not – our help), empathetic (s/he recognises others who need help and how they require it), and sensitive (s/
he does not become indifferent to their needs but thoughtfully respond to them). To fail to exhibit solidarity 
is either to be indifferent, exhibit ill will, or act in ways that undermine the well-being or the good of others 
[11]. The core of thinking about solidarity in this way is responsiveness to others for their sake. A likelihood of 
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success and acting to benefit others (and not actually succeeding in meeting 
If vaccination can be mandated from their needs) are crucial to exhibiting solidarity in this way.
the Afro-communitarian perspective, One relevant norm that emerges from this description is that one should 
solidarity appears to be an inadequate act to advance others’ good for their sake. The tremendous support and 
principle to justify this position goodwill given to the University of Cape Town (specifically from external 
donors and agencies, as well as from students and staff who created time 
in the middle of a tedious semester to participate in the various mop-up 
operations) following the fire incident that left many students stranded and destroyed some of the university 
structures like the priceless collection of African studies in the Jagger Reading Room is one concrete way this 
norm was lived out [12].
What does altruistic service imply for the duty to vaccinate? The pandemic significantly impacted older adults 
and people of colour. For example, about 50% of older adults living in the rural communities in the United 
States are believed to be at a higher risk of COVID-19-related complications and death than urban residents, 
owing to underlying medical conditions, fewer health professionals, less well-resourced health care facilities 
and a general lack of intensive care and ventilators [13]. Equally, the COVID-19 pandemic has further deep-
ened social inequalities and provoked troubling economic crises for societies and individuals. In South Af-
rica, the pandemic had an enormous impact on many individuals who depend on their daily income. The 
lockdown measures imposed by the government to curtail the spread of the virus resulted in income loss for 
many, increasing the number of people on the poverty line [14]. The World Bank predicted that the situa-
tion may worsen, with a real possibility that more South Africans (about 45%) will be pushed below the pov-
erty line [14]. There are many ways (such as increasing taxes for the wealthy and allocating helpful economic 
packages to the poor) to address this problem. Within this context, this way of thinking about solidarity im-
plies we should be responsive to those negatively impacted by the pandemic by vaccinating. This will be a 
way of demonstrating goodwill to those who have been significantly affected and overturning the gross social 
inequalities created by this pandemic. With many people vaccinated, governments around the world will be 
able to lift lockdown measures (as many have done) and begin an economic recovery to allow more people to 
find jobs and earn an income.
Reciprocity
Though altruism is one way in which solidarity has been conceptualised in the writings of some African 
scholars, it does not exclude reciprocal obligations, whereby individuals in a solidary group are responsive to 
each other. A relevant African maxim here is the right arm washes the left arm and the left arm washes the right 
arm. Consider the following remark by Julius Nyerere [15]: “in our traditional African society, we were in-
dividuals within a community. We took care of the community, and the community took care of us. We 
neither needed nor wished to exploit our fellow men.” Similarly, the Shona phrases kukura kurerwa and 
Chirere chichazo kurerawo imply that since everyone develops through the contributions of others, every-
one should also play a role in the growth of others [16]. The Shona people believe that a community that 
exhibits solidarity has no orphans, no stepsisters, stepbrothers, or stepmothers. It is one in which we are 
simply sisters or brothers to one another. The duty this gives rise to is that one’s actions should benefit oth-
ers because one has been a beneficiary of (or will benefit from) the other’s actions. This duty excludes cir-
cumstances where one lacks the means to reciprocate, or where reciprocating reasonably undermines one’s 
existence or threatens one’s being.
This way of thinking about reciprocity is more positive, whereby one party in reciprocal relations mostly aims 
to benefit more than others. Precisely, one way of thinking about solidarity in African philosophy is positive 
reciprocity, such as can be found in the black students’ response in 1976 (Soweto uprising) to the introduc-
tion of Afrikaans as the medium of learning in black schools. Despite threats of arrests and even deaths, black 
students who never knew each other began to group based on their racial identity to counter/defeat racist in-
tentions. Mabogo More [17] writes about the grouping of black students in the following way: “This mutu-
al and common comprehension, recognition and appreciation of each other’s destinies and projects by black 
students constitutes reciprocal relations. In such relations, the other becomes an instrument, not for the ne-
gation of the self but for its affirmation, the consequence of which is the emergence of group solidarity.” The 
implication for COVID-19 vaccination is that, as others contribute towards limiting or mitigating the impact 
and spread of (as well as fatalities associated with) COVID-19 through vaccination, social distancing, wearing 
facemasks, and adhering to COVID-19 mitigation protocols, we ought to support them by doing the same. 
The COVID-19 pandemic response will be robust and more effective if we complement each other’s efforts to 
limit or reduce the virus’ spread.
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Collective responsibility
In African philosophical writings, solidarity also tends to entail cooperation among members in ways that im-
ply collective ownership of and responsibility for their (or the community’s) destiny, requiring one to contrib-
ute her/his best effort to realise the group’s aspirations and goals. The Nigerian philosopher Segun Gbadegesin 
[18] similarly remarks: “every member is expected to consider themselves an integral part of the whole and to 
play an appropriate role towards achieving the good of all”. While writing about the apartheid atrocities, the 
former chair of the Truth and Reconciliation commission Archbishop Desmond Tutu [19] also remarks that 
“Ubuntu means that in a real sense even the supporters of apartheid were victims of the vicious system which 
they implemented (…) The humanity of the perpetrator of apartheid’s atrocities was caught up (…) in that of 
his victim whether he liked it or not”.
This way of thinking about solidarity is rooted in the belief that human lives are deeply interconnected and in-
tricately bound up with one another. As Luis Mbigi [20] retorts: “I cannot separate my humanity from the hu-
manity of those around me”. For Barbara Nussbaum [21], “we are so connected that if you did not sleep well, 
or if you are not having a good day, how can I sleep well or have a good day?”. This view sharply contrasts 
Amartya Sen’s [22] capability approach, according to which justice or the individual’s freedom essentially en-
tails independence from others, that is, an individual should value the capability to realise his own functional-
ity regardless of the situation of others. This African view of solidarity implies that one can only discover his 
identity/freedom through others. The choices and decisions we make impact us all because human reality is 
interwoven. One’s own identity is connected both to who others say one is and who all of us are together. This 
is what Dion Forster [23] calls generous ontology: One’s shared identity with others or interconnection with them is 
itself a condition for the possibility of growth. One is human to the extent that s/he can be part of a communal re-
lationship and others can relate with oneself. For this reason, Lekan Balogun [24] remarks: “solidarity involves 
commitment, and work, as well as the recognition that even if we do not have the same feeling or the same 
lives, or the same bodies, we do live [and grow] on common grounds”-
In West Africa, the African motif of the Siamese Crocodile is commonly used to illustrate this. The art depicts 
two crocodile heads who share a single stomach. Everything one head eats impacts the others [25]. Among the 
Igbo people of West Africa, one could be held responsible for the debts owed by others (their crimes, failures, 
and successes). This way, Ngozi (an avenging spirit in the Igbo cosmology) punishes the perpetrator of a crime 
and their relatives, normatively implying that we are accountable for each other [16]. In this way, solidarity is 
grounded in similarity or solidarity among people; we recognise our shared identity (and not the difference) 
with the people to whom we exhibit solidarity, our participation in the creation of the problem undermining 
their dignity, and how our failure to aid them also affect us.
COVID-19 pandemic has revealed that we are not isolated humans. When we undermine the well-being of 
others, we undermine our well-being because we are implicated in one another’s lives. This view gives rise to 
a variety of norms. But relevant here is the idea that we have a responsibility and a debt to promote the flour-
ishing of each other – within this context – by vaccinating since those who do not vaccinate (or observe other 
measures for mitigating the spread of COVID-19) bar any underlying medical conditions that may prevent 
them from vaccinating, put our lives and their own lives, as well as our collective capacity to recover from the 
COVID-19 pandemic, at risk.
MANDATORY VACCINATION AND SOLIDARITY
In this section, we address some objections against our position. A vaccination enthusiast will be correct to point 
out that the conceptions of solidarity described above do not imply that COVID-19 vaccination should be man-
dated to increase its uptake or limit the real impact of the virus. This appears to be the view of Julian Savulescu 
[2] and Keymanthri Moodley [3], whose primarily consequentialist justification for compulsory vaccination 
includes a grave threat to public health by the unvaccinated, lower vaccine risk or high confidence in vaccine 
safety/effectiveness, and greater expected utility of vaccination in comparison to the alternatives. The fatality 
rates in some countries (2530 in the United States, 676 in Brazil, 846 in Russia) remain high as of September 
30, 2021. Other countries like Tanzania and Botswana have been able to limit the real impact the virus could 
have and bring the daily death and infection rates under control through legally enforced restrictive measures 
and lockdowns [26]. However, the catastrophes (economic, health systems, and others) resulting from these 
restrictive measures have been enormous. Eventually, governments would have to ease restrictions, an action 
with its own implications. The global community would witness a resurgence of fatalities due to COVID-19. 
For example, with the government of South Africa easing the lockdown measures, experts think a 5th wave 
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might occur soon in the country. Vaccination could help prevent reinfections. Globally, vaccination is recog-
nised as the most effective public health measure for limiting the spread of vaccine-preventable infections, sav-
ing lives (or preventing harm). Failure to increase vaccine uptake could potentially undermine the well-being 
of vaccinated individuals, since immunity wanes over time. Contrarily, compelling vaccination (through in/
direct consequences) appears to be a reasonable way (and better alternative) of quickly upscaling vaccination 
and reducing the burden to health care systems (a major reason for restricting liberties). Others may critique 
that we have merely focused on the attractive formulations of solidarity in Afro-communitarianism that sup-
ports voluntary vaccination. There may be other accounts of solidarity that could justify vaccine mandates.
In response, we acknowledge that if many people are immune, the capacity of the virus to spread is signifi-
cantly reduced. Evidently, empirical data from Canada, France and the United States support an increased 
vaccine uptake trend in populations to whom vaccine mandates apply [27]. But empirical uncertainty remains 
on whether vaccine mandates in Africa will lead to vaccine uptake on the continent. If social values and pref-
erences are strong influencers of health behaviours [28], then one should tread cautiously when appealing 
to empirical data outside of Africa to inform decisions and policies in Africa, and for Africa, since as scholars 
have shown Africans tend to live by a different value system [29]. Accordingly, understanding people’s social 
values and preferences can become a powerful tool for formulating policies regarding vaccination, increasing 
vaccine confidence and upscaling COVID-19 vaccinations. Health campaigns for COVID-19 vaccination up-
take will be more effective if they take seriously how health behaviours are influenced. In fact, empirical data 
obtained from the continent reveals an existing increase in positive attitudes to COVID-19 vaccines in African 
countries like South Africa [30]. The positive disposition suggests that vaccine mandates may be unnecessary 
for upscaling vaccine intake, at least in these countries. Additionally, this disposition towards COVID-19 vac-
cines appears to also demonstrate that most Africans value solidarity. They seem to recognise the imperative to 
act altruistically to improve the conditions of those most vulnerable to the virus. They are willing to take steps 
to limit the exposure of others to the virus because they see themselves implicated in their lives, and how the 
failure to act (or to vaccinate) also affects them.
Regarding whether we have merely focused on the aspects of solidarity that appeal to us, we acknowledge that 
the formulations of solidarity and its implications we used do not perfectly represent all the ways solidarity is 
conceptualized in African writings. Though we have drawn selectively on some formulations of this concept, 
we do not think this is problematic since our goal is to appeal to its more salient formulations in African phi-
losophy to describe how African scholars are more likely to think about the duty to vaccinate. Also, many Af-
rican scholars believe that cooperation is partly valuable when people willingly come together to share a way 
of life, stay together, and seek others’ well-being for their sake [31]. This has practical relevance for upscaling 
vaccination. A sense of shared identity has been found to be essential to, as well as positively impact, how in-
dividuals cooperate to respond to threats like the COVID-19 pandemic [32]. Additionally, it seems intuitive 
that altruism is hardly altruism if it is compelled. Solidarity is also valuable partly when individuals in the soli-
dary group can believe that others will not disappoint them or take advantage of their “naivety”. Trust enables 
individuals in the solidary group to share a way of life or identity and cooperate to realise the shared vision, 
even when success may be uncertain. It seems to us that any formulation of solidarity entailing vaccine man-
dates will likely imply that we should promote solidarity however we can. Such formulation would imply au-
thoritarian approaches that would result in willing sacrifices of individual rights and liberties with the goal of 
promoting solidarity. Many African scholars believe that this is not the right way to showcase humanity [30]. 
In other words, we have a duty to promote communal relationships through friendly means rather than maxi-
mise or promote it regardless of the consequences. Nonetheless, as we have acknowledged previously, a sys-
temic review is required to map the discussion on solidarity in African philosophy adequately.
UNDERLYING REASONS FOR VACCINE RELUCTANCE AND SOLIDARITY
Another objection to the norms described in this paper is that they do not address the prevailing reasons for 
refusing vaccination. These reasons tend to include a complex combination of confidence, complacency, and 
convenience. But COVID-19 hesitancy is most closely associated with mistrust or lack of confidence in CO-
VID-19 vaccines due to their risks and side effects (more than their effectiveness). The rushing of COVID-19 
vaccine development has had a negative impact on the public’s confidence in the vaccine [33]. Hesitancy is 
also associated with mistrust in the government and the health care system. In fact, studies show that the pub-
lic will not receive the COVID-19  vaccine if they do not trust the health care system, the authority, and the 
communication response from the government and scientific community, implying that trust is a significant 
driver of upscaling vaccination. Most of those who have expressed a lack of confidence also identified social 
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media as their main source of information [10,34]. A theory that aims to foster vaccine uptake should address 
these reasons, particularly trust.
This objection raises essential questions about communication and information dissemination since these will 
be necessary to reassure the public’s confidence in vaccine safety. Communication strategies are required to 
realise these goals, which we will address this in a future study. The objection equally raises essential ques-
tions about how scientists ought to respond to concerns (including conspiracy claims) in a way that is ac-
countable and promotes public trust. Additionally, it raises critical questions about what continues to motivate 
science, and to what extent these motivations are open to public scrutiny. The idea is that these motivations 
must be open to scrutiny because they are essential in allowing the public to make right moral judgements 
about vaccination or trusting science. Put differently, the public will hesitate to cooperate with scientists and 
governments to upscale vaccination if they do not trust them, whereby trust is understood as the readiness 
to be vulnerable because one believes others will do no harm. Evidently, social media plays a role in sustain-
ing mistrust and fostering misinformation (through conspiracy or false theories) and inadequate informa-
tion about COVID-19 vaccines and their effectiveness [10]. However, it can also be a tool for education. For 
example, 31% of persons who said they would not receive the COVID-19 vaccine trust social media [10]. 
Scientists and governments should use this medium to disseminate scientific data that counter inaccurate in-
formation and build public trust in vaccines. Since no vaccine is 100% effective, some side effects have been 
reported in individuals who have received COVID-19 vaccination. However, these cases are rare and do not 
outweigh the expected utility; most COVID-19 deaths or complications continue to occur among the unvac-
cinated [35]. Trust-building measures should also include honest engagement with claims, including claims 
that challenge scientists’ views.
Using scientific data/facts to counter false information and build trust through social media is not enough. 
Some individuals are more likely to believe persons they know and trust and with whom they have formed 
long-standing relationships and co-operations; within the African settings, these persons are elders, traditional 
leaders, clerics, pastors and imams. The principle of solidarity grounded in Afro-communitarianism suggests 
that these trusted individuals should participate in trust-building, COVID-19 vaccination uptake measures, 
and campaigns to make them more effective.
SOLIDARITY AND PUBLIC HEALTH DECISIONS
Someone could claim that solidarity encourages individuals to consider the long-term impact an action may 
have on them or evaluate their decisions through the lens of egoistic calculus. For this reason, it seems not to 
be a good principle for public health ethics. When activists and ethicists appeal to individuals to take COV-
ID-19 vaccines because solidarity requires this, it is not merely for “altruistic” reasons or because they genu-
inely care for the well-being of others. Instead, it is because this costs less than the later intensive care that may 
be required due to COVID-19 complications or the burden on the health system. This can be compared to the 
Prisoner’s Dilemma thought experiment [36]. Whether it is the revised version of the experiment, where there 
is a possibility for retaliating non-cooperation or where only one turn exists and decisions are made anony-
mously, if parties can communicate with one another, however briefly, rationally self-interested individuals 
will cooperate. The point here is that social solidarity appears to be engendered by self-interests. “If solidarity 
can form, it will, and the logic of self-interest will be submerged as a result” [37]. This appears not to be a good 
principle for public health decisions, which may require acting for the common good than our self-interests.
It seems intuitive that self-interested theories like egoism or subjectivism can be a basis for public health deci-
sions in the same way other-regarding approaches like relationalism could be used to realise one’s self-interests. 
Within this context, this implies that one ought to distinguish between how Afro-communitarians have under-
stood this principle and how others may employ it. It seems intuitive that these two are different, and in fact, 
bad people may use good principles to serve their interests. This would not be a problem with the principle 
itself, but how individuals have employed it and to what end. While we acknowledge that the thinking about 
solidarity as entailing reciprocal obligation entails elements of self-interests, altruism as the basis for solidar-
ity (as previously discussed) is not equally unusual in African philosophy. This pro-social behaviour occurs 
frequently enough, implying that the thinking about solidarity in African writings can adequately motivate 
public health decisions. The reader should equally note the distinction we made between negative reciprocity 
and positive reciprocity, wherein positive reciprocity that requires mutual aid is what is encouraged. Precisely, 
positive reciprocity implies that the basis for forming/joining solidary groups is not to gain/get more than others. 
Rather, reciprocity entails an exchange of actions, whereby an act that positively impacts others is reciprocated 
with an approximately equal positive act.
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Finally, the reader should note that we did not aim to determine which formulation of solidarity in African 
philosophy is the best or the most plausible. Instead, we have focused on the implications of dominant formula-
tions of solidarity in African philosophy for the duty to vaccinate. Notwithstanding, many Africans tend to 
think that reciprocity is a strong motivation for action and a valuable public health ethics principle, as evi-
denced in some forms of relationships like letsema, whereby members in a solidary group assist one another 
to harvest crops and equitably share the produce. Participation in this relationship is grounded in the think-
ing that prescribes reciprocal relationship (or entails an expectation of reciprocity). Those who assist others in 
harvesting their produce appear to do so, hoping that others will do the same or support them at the time of 
their harvest. Additionally, one study [38] that explores the preferences of adolescents, parents, and caregivers 
participating in an HIV-TB genomic study in Botswana regarding genetic findings indicates that the majority 
of these Africans consider the obligation to reciprocate participation in genomic research by returning action-
able findings, an ethical necessity.
CONCLUSION
In this paper, we have argued that the principle of solidarity in Afro-communitarianism tend to favour volun-
tary, rather than mandatory, COVID-19 vaccination. Thus, if vaccination can be mandated from the Afro-com-
munitarian perspective, solidarity appears to be an inadequate principle to justify this position. In a previous 
publication [39], one of us demonstrated how ethics of friendliness grounded in a modal relational African 
account may justify the use of coercion or unfriendliness. In this regard, mandatory vaccination may be jus-
tified if it is necessary for the operational requirement of a workplace or accessing public facilities, and there 
is no other way to ensure public safety or prevent harm. Contrarily, if the African views of solidarity were to 
be the default consciousness of humanity, the implications for the duty to vaccinate are that individuals will 
voluntarily vaccinate, 1) because we ought to act for others (disproportionately affected and vulnerable indi-
viduals) sake, 2) within the context of the pandemic, this will be an appropriate way to act for the well-being 
of others and expect others to act for one’s well-being, and 3) we are implicated in one another’s lives and con-
ditions such that the failure to act for their good, entails a failure to be solidaristic. Studies are still required 
to inquire about how these norms can form the basis of public health ethics or decisions during a pandemic.
Acknowledgements: The authors are grateful to the reviewers for their useful suggestions that helped greatly improve 
this article. The authors are equally grateful to Wellcome trust for covering the publication fee.
Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit 
sectors. Tom Obengo’s is a postdoctoral fellow with the Epidemic Ethics network that is funded by the Department for 
International Development and Wellcome [203132/Z/16/Z]. For the purpose of open access, the author has applied a 
CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Authorship contributions: CE, TO, and CA all discussed the idea of exploring how the African value of solidarity can 
help us think about the duty to vaccinate. CE wrote the first draft. TO and CA significantly revised the draft, enhanced 
it, and suggested new references. All authors revised the draft one more time and did not object to its submission. The 
authors are equally responsible for the content of the manuscript. CE submitted the article.
Disclosure of interest: The authors completed the ICMJE Unified Competing Interest Form (available upon request 
from the corresponding author) and disclose no relevant interest.
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Correspondence to:
Cornelius Ewuoso 
Steve Biko Centre for Bioethics 
University of Witwatersrand South Africa 
cornelius.ewuoso@wits.ac.za
2022  •  Vol. 12 •  03046 8 www.jogh.org •  doi: 10.7189/jogh.12.03046
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