Cover
Pandemic Ethics: From COVID-19 to Disease X
Copyright
Contents
Acknowledgement
Foreword
Preface
List of Figures
Notes on Contributors
Introduction
I.1 Choices
I.2 Freedom
I.3 Equality
I.4 Pandemic X
PART I. GLOBAL RESPONSE TO THE PANDEMIC
1. The Great Coronavirus Pandemic: An Unparalleled Collapse in Global Solidarity
1.1 Norms of Solidarity
1.2 The International Health Regulations: Fracturing of the Global Instrument to Govern Pandemic Response
1.2.1 Core Health System Capacities
1.2.2 China’s Delays in Reporting a Novel Coronavirus Outbreak
1.2.3 WHO’s Inability to Independently Verify State Reports
1.2.4 Declarations of a Public Health Emergency of International Concern and Global Pandemic
1.2.5 Travel Bans
1.3 SARS-CoV-2 Proximal Origin
1.4 Failures in Risk Communication and Lost Public Trust in WHO and Public Health Agencies
1.5 Failures in Scientific Cooperation
1.6 Nationalism, Isolationism, and Science Denial
1.7 WHO Caught in the Middle of Two Political Superpowers
1.8 Exacerbating the Global Narrative of Deep Inequities
1.8.1 Hoarding of Medical Equipment and Public Health Tools
1.8.2 Vaccine Nationalism
1.8.3 Failure to Back the ACT Accelerator and COVAX
1.8.4 Wealthy Countries Hoard Vaccine Supplies
1.8.5 Vaccine Diplomacy from the World’s Largest Dictatorships
1.9 A Failure of Imagination of Global Bodies
1.10 How to Solidify Global Cooperation and Equity
1.11 A Thought Experiment: Pandemic X
Bibliography
2. Institutionalizing the Duty to Rescue in a Global Health Emergency
2.1 Extreme Nationalism
2.2 The Moral Necessity of Institutionalizing Duties of Justice, not Just Duties of Beneficence
2.3 A Dynamic Conception of Morality
2.4 Extreme Cosmopolitanism
2.5 A Positive Cosmopolitan Duty
2.6 Institutional Design
2.6.1 Creation or modification?
2.6.2 Key moral desiderata
2.6.3 Structural-Procedural Desiderata
2.6.4 Formal or Informal?
2.6.5 The Big Question: Why Should Rich Countries Ratify such a Treaty?
Bibliography
3 The Uneasy Relationship between Human Rights and Public Health: Lessons from COVID-19
3.1 Introduction
3.2 Scope
3.3 Content
3.4 Common Goods
3.5 Democracy
3.6 Conclusion
Acknowledgements
Bibliography
PART II. LIBERTY
4. Bringing Nuance to Autonomy-Based Considerations in Vaccine Mandate Debates
4.1 The Standard Approach: Appeal to the Harm Principle
4.2 Application of the Harm Principle to Vaccine Mandate Debates
4.3 Mandates and Freedom of Occupation
4.4 Just a Prick? Bodily Autonomy, Trust, and Psychosocial Harm
4.5 Reasons for Refusal and Implications for Autonomy
4.6 A Word about the Least Restrictive Alternative—Mandates vs. Nudges and Incentives
4.7 Conclusion
Bibliography
5. The Risks of Prohibition during Pandemics
5.1 Policing Pandemic Risks
5.2 Prohibition and Public Health Outcomes
5.3 Public Health Hypocrisy
5.4 General Principles for Prohibition and Pandemics
5.5 Conclusion
Bibliography
6. Handling Future Pandemics: Harming, Not Aiding, and Liberty
6.1 Introduction
6.2 Distinguishing Not Harming from Aiding
6.3 How to Weigh Costs to Some against “Benefits” to Others
Bibliography
7. Against Procrustean Public Health: Two Vignettes
7.1 Introduction
7.2 The Ethics of Considering Vaccination Status to Design Public Health Restrictions
7.2.1 Why Considering Vaccination Status Is Consistent with Freedom and Equality
7.2.2 Implementation, Ineligible Groups, and Vaccine Scarcity
7.2.3 Evaluating Discrimination and Related Objections
7.3 The Ethics of Using “Second-Best” Vaccines
7.4 Coda: Why Research Remains Imperative
7.5 Conclusion
Bibliography
8. Ethics of Selective Restriction of Liberty in a Pandemic
8.1 Introduction
8.2 The Harm Principle and Liberty Restriction
8.3 Easy Rescue Consequentialism
8.4 Applying Easy Rescue Consequentialism to the Pandemic
8.5 Population-Level Consequentialist Assessment
8.6 Individual Costs
8.7 Resource Use and Indirect Harm
8.8 Consistency: Compare with Children
8.9 Objections
8.9.1 Discrimination and the Value of Equality
8.9.2 Relevant Differences
8.9.3 Reinforcing Structural Injustice and Further Disadvantaging the Worst-Off
8.9.4 Historically Wrong Discrimination and Symbolic Value of Equality
8.9.5 Proportionality
8.10 An Algorithm for Decision-Making
8.11 Conclusion
Bibliography
PART III. BALANCING ETHICAL VALUES
9. How to Balance Lives and Livelihoods in a Pandemic
9.1 Introduction
9.2 Benefit–Cost Analysis
9.3 Social Welfare Analysis
9.4 Evaluating Policies: a Numerical Illustration
9.5 Conclusion
Acknowledgements
Bibliography
10. Pluralism and Allocation of Limited Resources: Vaccines and Ventilators
10.1 Conflicting Values, Conflicting Choices
10.1.1 Problems
10.1.2 Choices
10.1.3 Public Values
10.2 Pluralism in Pandemics
10.3 Challenges to Developing Pluralistic Resource Allocation in a Pandemic
10.3.1 Epistemic Challenges
10.3.2 Normative Challenges
10.3.3 Political Challenges
10.4 Disease X
10.4.1 Preparation
10.4.2 Ethical Convergence
10.4.3 Collective Reflective Equilibrium
10.4.4 Dissensus and Parity
10.4.5 AI ethics
10.5 Conclusions
Bibliography
11. Fairly and Pragmatically Prioritizing Global Allocation of Scarce Vaccines during a Pandemic
11.1 Background
11.1.1 The Proportional Allocation Scheme
11.1.2 The Fair Priority Model
11.2 Pragmatic Challenges
11.2.1 Uncertainty
11.2.2 Political Appeal
11.3 Flattening the Curve
11.4 Conclusion
Acknowledgments
Bibliography
12. Tragic Choices during the COVID-19 Pandemic: The Past and the Future
12.1 The Two Main Approaches for Resource Allocation: Ethical (USA) versus Medical (Europe) Framework
12.1.1 The USA: Anticipatory Guidelines, Ethical Debates, and Planning for Scarce Resource Allocation
12.1.1.1 Anticipatory Guidelines and Preparedness
12.1.1.2 Ethical Consensus
12.1.1.3 Guidelines Variations
12.1.1.4 Challenging Issues
12.1.1.5 Age?
12.1.2 Europe: Medically Drafted Guidelines
12.2 Outcomes
12.2.1 Western Europe: Covert Triage
12.2.1.1 Common Features
12.2.1.2 Formal/Informal Triage
12.2.2 The US: Informal Triage and Suboptimal Care
12.2.2.1 Lack of Formal CSC Declaration: Unclear Situation and Suboptimal Care
12.2.2.2 Excessive Emotional Toll on Frontline Healthcare Providers
12.3 Lessons for the Future
12.3.1 Strong Political Centralized Leadership Needed
12.3.2 Consistency and Transparency
12.3.3 Support for HCP: from Moral Distress to Moral Injury
12.3.4 The Role of Experts
12.3.5 Accountability, Transparency, and Ethics
12.3.6 Trust
12.4 Conclusion
Bibliography
PART IV. PANDEMIC EQUALITY AND INEQUALITY
13. Ethical Hotspots in Infectious Disease Surveillance for Global Health Security: Social Justice and Pandemic Preparedness
13.1 Requirements for Effective Pandemic Preparedness
13.1.1 The Central Role of Surveillance
13.1.2 What Does Surveillance Entail for Those who Are Surveilled?
13.1.3 A Global Focus on the Local: Where Will Surveillance Actually Happen?
13.2 Global Justice and Infectious Disease Surveillance
13.2.1 Pandemic Preparedness as a Collective Action Problem
13.2.2 Infectious Disease Surveillance as a Global Public Good
13.3 Surveillance and Social Justice
13.4 Three Tests of Ethical Commitment
13.4.1 Acceptable Sources of Surveillance Data
13.4.2 Data and Duties of Care
13.4.3 Prioritization Decisions between the Needs of Those in the Future and Those in the Present
13.5 Conclusion: Infectious Disease Hotspots Are also Ethical Hotspots
Acknowledgements
Bibliography
14. COVID-19: An Unequal and Disequalizing Pandemic
14.1 Introduction
14.2 COVID-19: An ‘Unequal’ Disease?
14.2.1 Communicable Diseases, Rich Countries, and Poor Countries
14.2.2 Lockdown
14.3 The Pandemic and the Policy Response to it
14.3.1 Introduction
14.3.2 The First Wave
14.3.3 The Second Wave
14.4 Policy and the Pandemic: Some Fallouts
14.4.1 Introduction
14.4.2 The Reach of Infections and Mortality
14.4.3 Economic Growth
14.4.4 Money-Metric Poverty
14.4.5 Livelihoods
14.4.6 Hunger
14.4.7 Education
14.4.8 Casualties of Caste, Religion, and Gender
14.5 Concluding Observations
Bibliography
15. Pandemic and Structural Comorbidity: Lasting Social Injustices in Brazil
15.1 Introduction
15.2 COVID-19 in Brazil: Background and Pandemic
15.3 Making Visible the Intersection of Vulnerabilities: the Effects of COVID-19 in Brazil and its Colonial Entanglements
15.4 Poverty as a Risk Factor: the Case of the Pandemic in Slums
15.5 Racism and Sexism Aggravating Pandemic Risk: Unemployment, Hunger, and Domestic Violence
15.6 LGBTI+ People in the Pandemic: Isolation and Insecurity
15.7 Indigenous Peoples: Socio-environmental and Ethnic-racial Risk in the Pandemic
15.8 At-risk Groups: Colonial Vulnerability in Times of Pandemic
15.9 Adopting a Decolonial Moral Paradigm
15.10 The Colonial Past and the Post-pandemic Future
Bibliography
16. Fair Distribution of Burdens and Vulnerable Groups with Physical Distancing during a Pandemic
16.1 Introduction
16.2 Overview of COVID-19 Control Policies in Japan
16.3 COVID-19: Older Individuals and Foreigners in Japan
16.3.1 Solitary Death and Social Isolation among Older People in Japan
16.3.2 International Students and Foreign Workers in Japan under the COVID-19 Pandemic
16.4 Three Policy Measures to Improve the Welfare of Vulnerable Populations
16.4.1 Minimize Restrictions
16.4.2 Provide Appropriate Information
16.4.3 Alternative Communication Tools
16.5 Adjusting the Public Health Policy for a Future Disease X
16.6 Conclusions
Bibliography
PART V. PANDEMIC X
17. Pondering the Next Pandemic: Liberty, Justice, and Democracy in the COVID-19 Pandemic
17.1 Liberty-Restricting Measures
17.1.1 The Debate
17.1.2 Selective Restrictions
17.1.3 Different Freedoms
17.1.4 Taking Harm Prevention Seriously
17.2 Global Justice
17.3 Going Forward
17.3.1 Democracy
17.3.2 Public Health and Government Overreach
17.3.3 Children
17.4 Conclusion
Bibliography
Index