Just as it is the case in other issues in clinical ethics, the discourse on COVID-19 has been dominantly preoccupied with the difficulty in taking urgent decision on who gets access to scarce medical resources when demand outstrips supply. The emergence of COVID-19 in the late 2019 and its attendant consequences has created global tension and anxiety. The debate on addressing the ravaging COVID-19 pandemic has gone on at professional and policy levels. It has taken international, intercontinental and inter-racial tones. Critical in this debate are issues of vaccine production, distribution and consumption. Conspiratorial theorists are up in arms against not only the production but also distribution and consumption of the vaccine. The nationalists are taking a hardline posture against free flows of the vaccines across national boundaries while the globalists are pushing for universal access. As this debate continues to inform and enlarge scholarly and policy perspectives, issues of priority in the distribution and consumption still loom large in successes and failures across both the nationalist and globalist paradigms. The nationalists are at the crossroad with respect to prioritizing the distribution and consumption needs of rural dwellers over those of their urban counterparts. The globalists are also confronting priority challenges not only across geographies but also genders. This paper interrogates these dilemmas, with a view to articulating ways in which market and moral dynamics as well as place-specific factors might be mobilized as a game changer in the context of priority in the distribution and consumption of COVID-19 vaccine in Africa. The paper uses conceptual clarification, philosophical argumentation and analysis, to explore the commercial and charity features of the vaccine and demonstrates how some elements within African cosmology may become precursors in the emergence of effective triage system for addressing the nationalist and globalist priority dilemmas in Africa.