South Africa shared with the world the warning of a new strain of SARS-CoV2, Omicron, in November 2021. As a result, many high-income countries (HICs) instituted complete travel bans on persons leaving South Africa and other neighbouring countries. These bans were unnecessary from a scientific standpoint, and they ran counter to the International Health Regulations. In short, South Africa was penalized for sharing data. Data sharing during pandemics is commonly justified by appeals to solidarity. In this paper, we argue (...) that solidarity is, at best, an aspirational ideal to work toward but that it cannot ground an obligation to share data. Instead, low-and-middle income countries (LIMCs) should be guided by the principle of reciprocity, which states that we ought to return good for good received. Reciprocity is necessarily a conditional principle. LMICs, we argue, should only share data during future pandemics on the condition that HICs provide enforceable assurances that the benefits of data sharing will be equitably distributed and that LMICs won’t be penalized for sharing information. (shrink)

The paper discusses whether natural phenomena such as epidemics and pandemics of communicable diseases can be interpreted as social pathologies. While providing a positive answer to the question, the manuscript tries to define a set of criteria – a rupture of biological normativity and an evaluation of epidemics’ social impact – that can help to determine in which circumstances such natural phenomena fall under the label of “social pathologies”.

In citing some qualitative case studies and in building on analytical-survey research design, this article explores the place of African women in warding off the pandemics, with particular reference to coronavirus disease 2019 (COVID-19) in its initial stages (March 2020). With Africa being the most religious continent in the 21st century, African women who led the onslaught against COVID-19 (refer to Ellen Johnson Sirleaf [EJS], Graca Machel, Ngozi Okonjo-Iweala, Vera Songwe, Maria Ramos, Zanetor Agyeman-Rawlings, Yvonne Aki-Sawyerr and Blen Sahilu, (...) among others), were largely informed by a religio-cultural concern for the ‘other’ (ubuntu). In demonstrating their sociocultural role of standing out as the bulwark against threats to familyhood, African women met in Monrovia-Liberia on 08 March 2020 during the inauguration of Amujae Leadership Forum that cropped up as a barricade against further COVID-19 spread. In a nutshell, the article draws from Sirleaf’s approach in combating the 2014–2016 Ebola pandemic and samples other leading African women’s contributors who played a pivotal role in responding to the initial stages of the pandemic, a phenomenon that traces its roots from the African heritage.Contribution: This article foregrounds the interface between African women, religious inspiration and health-related matters; and indeed enriches HTS Journal and the academic world. As by-products of a religiously inclined continent, African women’s initial response to the pandemic in March 2020 is well-rooted in their religio-cultural backcloth. (shrink)

A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: A neat organisation of the ethical issues raised by the pandemic. An exploration of (...) the many complex interconnections between these issues. A succinct case for a continued lockdown until we develop a vaccine. An original account of the Deep Moral Problem of the Pandemic, and a Revolutionary Argument for how we should change society post-pandemic. References to, and engagement with, many of the best writings on the pandemic so far (both in popular media and academic journals). ISBN: 978-0-6489016-0-0. (shrink)

This essay revisits the scholarly production around three major pandemics in the region: (a) the Third Plague Pandemic; (b) HIV/AIDS in the 1980s; and (c) COVID-19. The essay aims to provide a comprehensive set of resources (both printed and digital) in four languages (Portuguese, Spanish, English, and French) to examine how scholars have approached these phenomena and how their scope and interpretations have changed over time. Historians of health paid particular attention to sociocultural aspects of the disease, which enabled (...) them to consider usually-neglected actors, such as patients of Indigenous and African descent with their own medical traditions. This added more complexity to our understanding of how these pandemics were fought and received. In addition, the essay suggests that COVID-19 prompted the emergence of historians of health as public scholars. They actively used social networks and other digital tools not only to communicate about the long history of diseases and pandemics in the region, but also to provide an authorized or informed perspective amid misinformation and fake news. In addition, the internet was crucial to the development of helpful databases and virtual conferences beyond academic campuses and paywalls. (shrink)

In 2020, COVID-19, the Australia bushfires, and other global threats served as vivid reminders that human and nonhuman fates are increasingly linked. Human use of nonhuman animals contributes to pandemics, climate change, and other global threats which, in turn, contribute to biodiversity loss, ecosystem collapse, and nonhuman suffering. Jeff Sebo argues that humans have a moral responsibility to include animals in global health and environmental policy. In particular, we should reduce our use of animals as part of our pandemic (...) and climate change mitigation efforts and increase our support for animals as part of our adaptation efforts. Applying and extending frameworks such as One Health and the Green New Deal, Sebo calls for reducing support for factory farming, deforestation, and the wildlife trade; increasing support for humane, healthful, and sustainable alternatives; and considering human and nonhuman needs holistically. Sebo also considers connections with practical issues such as education, employment, social services, and infrastructure, as well as with theoretical issues such as well-being, moral status, political status, and population ethics. In all cases, he shows that these issues are both important and complex, and that we should neither underestimate our responsibilities because of our limitations, nor underestimate our limitations because of our responsibilities. Both an urgent call to action and a survey of what ethical and effective action requires, Saving Animals, Saving Ourselves is an invaluable resource for scholars, advocates, policy-makers, and anyone interested in what kind of world we should attempt to build and how. (shrink)

Between 1983 and 2006 there were two distinct sorts of historical writings on Southeast Asian medical history, with quite different emphases. Some historians focused on the history of medicine in national contexts—a practice that resulted in the neglect of larger socioeconomic factors such as migration—that affected the trajectory of pandemics. At the same time, pursuing a different line of thinking, another group of historians focused on the history of specific diseases from a demographic perspective. These two approaches led to (...) very different conclusions about the nature of epidemic disease and pandemics that have beset the region since the nineteenth century. Nevertheless, regional histories of health are neglected in Southeast Asian medical history in favor of either local, national, or global histories. In this essay, I argue that if historians of global health have forsaken the region in favor of the wider world, Southeast Asian historians have neglected the region in favor of the nation. What is missing in Southeast Asian medical history is a regional perspective that would help understand the ways in which pandemic responses are shaped by colonial, Cold War, or national concerns. Beginning 2019, some historians and political analysts trying to understand global pandemics have adopted a regional approach by treating, as a monolithic group, the ASEAN—the Association of Southeast Asian Nations, which is a regional grouping of Southeast Asian member states, established in 1967. By contrast, others explore specific geographic, political, or economic issues that have contributed to either the spread or containment of disease. In this regard, the COVID-19 crisis in Southeast Asia merits historical attention to comprehend the strengths and weaknesses of a regional approach. (shrink)

This review essay explores the potential of a European perspective on the history of epidemics and pandemics over the last three centuries. To this end, it follows Benoît Majerus’ proposal to distinguish four different “European” perspectives on the history of medicine. Europe is simultaneously an imaginary, geographical, imperial, and integrative space. As an imaginary space (1), “European” ideas about pandemics reveal a specific conception of public health and the state; as a geographical space (2), many historical case studies (...) examined the development of comparable “European” practices at the national level; as an imperial space (3), it is necessary to provincialize Europe and ask about knowledge production and practices in non-European countries; and as an integrative space (4), European responses to pandemics and epidemics represent a neglected but important aspect of European integration. This essay can only suggest that the European perspective is an interesting analytical category for both the history of pandemics and the history of “Europe.”. (shrink)

This paper analyses what kind of conspiracy theories are generated because of the emergence and spread of diseases. Conspiracy theory narratives that are generated during the different kinds of pandemics – cholera, AIDS and COVID-19 – are described and analysed, with special attention given to COVID-19 conspiracy theories. We raise a conceptual issue for further research indicating that the disease-related conspiracies do not perfectly square with the current psychological interpretations of conspiracy beliefs.

DISEASE X is the codename given by the World Health Organisation to a pathogen currently unknown to science that could cause havoc to humankind. Emerging infections are sending us multiple warnings that another Disease X is looming. We've had SARS in 2002, H5N1 bird flu in 2004, H1N1 'swine flu' in 2009, MERS in 2012, Ebola in 2014, Zika in 2015 and now COVID-19. These events are not freak events, but are happening continually, and at an increasing cadence. Written by (...) a long-standing ex-Reuters global health and science correspondent, DISEASE X will use privileged access to the body leading international efforts to control viruses, the Coalition for Epidemic Preparedness Innovations (CEPI), and its CEO, Dr Richard Hatchett. CEPI seed-funded three successful COVID vaccines, including Astra-Zeneca and Moderna. DISEASE X will explore the emergence of the novel coronavirus and the crisis it caused, analysing the responses of global health organisations and experts, including the WHO, national governments such as Britain, China and the USA, COVAX, the global vaccine allocation facility, pharmaceutical companies, and leading research scientists. Weaving in insights from the likes of Bill Gates, Sir Jeremy Farrar, Dr Anthony Fauci and Sir Patrick Vallance, the book will explain how the world's public health scientists are embarking on a 100 Days Mission to snuff out future threats before they become deadly pandemics. This is the inside story written for the public. (shrink)

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical (...) framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. (shrink)

Life among most African families and communities revolves around women. In both African religion and culture, women’s lives oscillate between two opposite extremes of being at the centre and periphery at the same time. Women are both the healers and the often wounded by the system that respects them when there are problems and displaces them whenever there are opportunities. Their central role is expressed by a Shona proverb musha mukadzi (the home is a woman). This proverb expresses how women (...) endure the pain of both religion and culture to create a decent society. Women also endure the pain of pandemics such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and COVID-19 and at times succumb to the same while taking care of some family members who would have fallen victim to the epidemic. Countless married women have been made susceptible to HIV and AIDS as they try to live according to the African cultural dictates of mothering and/or motherhood. Other women and girls also contract the disease because of how religion and culture exert them to some unbearable circumstances. For example, women and girls nurse their ill relatives without protective equipment and clothing. At times they are abused by men because of some cultural beliefs that unprotected sex is a remedy for HIV and AIDS. In addition, most women and girls were also victims of COVID-19 while serving their family members. In doing all the good work to serve families, women are driven by the proverb musha mukadzi. Using desk research methodology, this paper argues that musha mukadzi is both a toolkit for women’s resilience to endure pandemics and at the same time a subtly oppressive statement often used to manipulate and abuse women to stand in places that are too difficult for their capabilities. Contribution: African women bear the brunt of pandemic burdens such as HIV, AIDS and COVID-19. Sometimes they become susceptible to the same while taking care of their family members affected by pandemics in the name of fulfilling the Shona proverb, musha mukadzi. The topic has contributed to the scope of the journal as it advocates to inculcate a peaceful society. The article also challenges African societies not to use musha mukadzi to ill-treat women as objects of African religio-cultural patriarchal ideology. (shrink)

Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse, and by extension, professional and democratic engagement on the subject constitute an unacceptable ethical omission. Not only have African governments failed to develop robust ethical plans for pandemics, ethicists in (...) this region have been unable to ignite public discourse on rationing. Therefore, we aim to initiate a debate on how rationing health and social goods could be done ethically in Ghana during the current and future pandemics. The paper discusses and critiques some moral considerations (utilitarian, equity, equal worth, urgent need, and the prioritarian principles) for rationing and their relevance in the Ghanaian context. This contribution may facilitate ethical decision-making during the current (COVID-19) pandemic - in Ghana and other African settings where hardly any rationing guidelines exist. (shrink)

Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by ‘caution’. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias—exaggerating the moral significance of the risks inherent in medical interventions, while systematically (...) neglecting the (objectively greater) risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes. (shrink)

The COVID-19 pandemic has caused a global societal, economic, and social upheaval unseen in living memory. There have been substantial cross-national differences in the kinds of policies implemented by political decision-makers to prevent the spread of the virus, to test the population, and to manage infected patients. Among other factors, these policies vary with politicians’ sex: early findings indicate that, on average, female leaders seem more focused on minimizing direct human suffering caused by the SARS-CoV-2 virus, while male leaders implement (...) riskier short-term decisions, possibly aiming to minimize economic disruptions. These sex differences are consistent with broader findings in psychology, reflecting women’s stronger empathy, higher pathogen disgust, health concern, care-taking orientation, and dislike for the suffering of other people—as well as men’s higher risk-taking, Machiavellianism, psychopathy, narcissism, and focus on financial indicators of success and status. This review article contextualizes sex differences in pandemic leadership in an evolutionary framework. Evolution by natural selection is the only known process in nature that organizes organisms into higher degrees of functional order, or counteracts the unavoidable disorder that would otherwise ensue, and is therefore essential for explaining the origins of human sex differences. Differential sexual selection and parental investment between males and females, together with the sexual differentiation of the mammalian brain, drive sex differences in cognition and behavioral dispositions, underlying men’s and women’s leadership styles and decision-making during a global pandemic. According to thesexually dimorphic leadership specialization hypothesis, general psychobehavioral sex differences have been exapted during human evolution to create sexually dimorphic leadership styles. They may be facultatively co-opted by societies and/or followers when facing different kinds of ecological and/or sociopolitical threats, such as disease outbreaks or intergroup aggression. Early evidence indicates that against the invisible viral foe that can bring nations to their knees, the strategic circumspection of empathic feminine health “worriers” may bring more effective and humanitarian outcomes than the devil-may-care incaution of masculine risk-taking “warriors”. (shrink)

Social isolation and loneliness are ongoing threats to health made worse by the coronavirus disease 2019 pandemic. During the pandemic, half the globe's population have been placed under strict physical distancing orders and many long-term care facilities serving older adults went into lockdown mode, restricting access to all visitors, including family members. Before the pandemic emerged, a 2020 National Academy of Sciences, Engineering and Medicine report warned of the underappreciated adverse effects of social isolation and loneliness on health, especially among (...) older populations. Social isolation and loneliness predict all-cause mortality at rates that rival clinical risk factors, such as obesity and smoking; they are associated with greater incidence of psychological, cognitive, and physical morbidities. This paper sets forth a proposal to design robots to function as companions and friends for socially isolated and lonely older people during pandemic emergencies and in aging societies more generally. “The proposal” section presents and defends the proposal. The “Replies to objections” section answers objections based on coercive design, replacement of humans with robots, privacy incursions, and counterfeit companionship. The “Conclusion” section submits that sociable robots offer a promising avenue for addressing social isolation and loneliness during pandemics and hold promise for aging societies more broadly. (shrink)

This essay considers how the fact that some morally innocent person is nevertheless a threat to others can bear on the permissibility of health policies that harm some to protect others. Two types of innocent threats are distinguished. In the case of abortion, it is argued that even if the embryo/fetus were a person, abortion could be permissible to protect a woman’s life, health, or bodily autonomy. Whether there nevertheless should be time limits on abortions and what surprising form such (...) limits might take are also considered. In the case of pandemics, it is suggested that discussions of health policies should, but often do not, distinguish morally between innocent threats and their potential victims as well as between providing benefits to people and preventing harms to them. The essay also examines discussions of pandemics by health professionals that make use of the trolley problem, the doctrine of double effect, and related philosophical distinctions. (shrink)

This paper analyzes the ethical breakdowns witnessed during the COVID-19 pandemic through the structural lens of Judgemental Philosophy. We argue that many high-stakes decisions—lockdowns, vaccine mandates, contact tracing—were made in contexts where one or more axes of the Judgemental Triad (Constructivity, Coherence, Resonance) collapsed, rendering individual moral judgement impossible. In response, governments often appealed to public acceptability as a functional substitute. We explore when such substitution is structurally justifiable, and when it merely masks ethical voids. This framework reframes pandemic-era ethics (...) not as failed choices, but as decisions made in structurally unjudgeable fields. (shrink)

Bioethics should pay more attention to globalization and some of its consequences than it has done so far. The COVID-19 pandemic would not have been possible without globalization, which has also increased some of its negative consequences. Globalization has intensified wildlife trade in the world. One of the main hypotheses about the origin of this pandemic is that it originated in illegal forms of wildlife trade in China. In the last 30 or 40 years, there have been zoonotic outbreaks at (...) a much frequent pace than before, many of those have been related to wildlife trade. Legal and illegal wildlife trade has grown in the shadow of globalization. Second, globalization has had a huge impact on the redistribution of wealth in the world. Since 1990 income inequality has increased in most high- and in many middle- and low-income countries. A country’s level of pre-COVID income inequality is the best predictor of the COVID death rate. These two issues are not unrelated. People living in poverty in LMIC tend to suffer more from infectious diseases and tend to be marginalized from the health sector. Additionally, poverty tends to reproduce the conditions under which zoonotic diseases can more easily spread. (shrink)

BackgroundDuring the arrival of the COVID-19 pandemic, various professional ethical guidance was issued to (and for) health and social care professionals in England and Wales. Guidance can help to inform and support such professionals and their patients, clients and service users, but a plethora of guidance risked information overload, confusion, and inconsistency. MethodsDuring the early months of the pandemic, we undertook a rapid review, asking: what are the principles adopted by professional ethical guidance in England and Wales for dealing with (...) COVID-19? We undertook thematic content analysis of the 29 documents that met our inclusion criteria.ResultsThe 29 documents captured 13 overlapping principles: respect, fairness, minimising harm, reciprocity, proportionality, flexibility, working together, inclusiveness, communication, transparency, reasonableness, responsibility, and accountability.ConclusionsWe intend this attempt to collate and outline the prominent principles to be helpful, particularly, for healthcare practice during the COVID-19 pandemic and, hopefully, for future pandemic planning. We also offer some reflections on the guidance and the principles therein. After describing the principles, we reflect on some of the similarities and differences in the guidance, and the challenges associated not only with the specific guidance reviewed, but also with the nature and import of “professional ethical guidance”. (shrink)

This open access casebook addresses complex and important ethical challenges arising when health-related research in conducted in the context of epidemics and pandemics. This book provides contextually-rich real-world case studies illustrating research ethics issues encountered by researchers, ethics reviewers and regulators around the globe during the COVID-19 pandemic. The accompanying commentaries outline relevant conceptual approaches and ethical considerations. These promote understanding and reflection on relevant ethical issues, ethical approaches and competing considerations in a manner supporting thoughtful evaluation of their (...) implications for practice. As such the casebook is relevant to academic and professional audiences with an interest in global health, research ethics, and outbreaks and epidemics. (shrink)

The COVID-19 pandemic has coincided with the proliferation of ethical guidance documents to assist public health authorities, health care providers, practitioners and staff with responding to ethical challenges posed by the pandemic. Like ethical guidelines relating to infectious disease that have preceded them, what unites many COVID-19 guidance documents is their dependency on an under-developed approach to bioethical principlism, a normative framework that attempts to guide actions based on a list of prima facie, unranked ethical principles. By situating them in (...) relation to the key philosophical debates concerning bioethical principlism, we aim to explore the limits and limitations of pandemic ethical guidance documents as, specifically, ethics documents – documents that fulfil the functions of ethics as a fundamentally normative discipline. This means not only determining whether such ethical guidance documents can, in principle, provide adequate action guidance and action justification, but also, more importantly where pandemics are concerned, determining whether they support consistent decision making and transparent processes of justification. Having highlighted the problems with merely furnishing ethical guidelines with substantive ethical content in terms of principles and values, we argue that organizations that develop these documents should, instead, focus on the procedural dimensions of action guidance and action justification, which extend to questions regarding the make-up of the committees, panels and groups that develop such guidelines, the public transparency of justifications for specific pandemic-related advice or interventions and the development of explicit procedures for transparent and consistent decision making. (shrink)

There is too much that we do not know about COVID-19. The longer we take to find it out, the more lives will be lost. In this paper, we will defend a principle of risk parity: if it is permissible to expose some members of society (e.g. health workers or the economically vulnerable) to a certain level of ex ante risk in order to minimize overall harm from the virus, then it is permissible to expose fully informed volunteers to a (...) comparable level of risk in the context of promising research into the virus. We apply this principle to three examples of risky research: skipping animal trials for promising treatments, human challenge trials to speed up vaccine development, and low-dose controlled infection or “variolation.” We conclude that if volunteers, fully informed about the risks, are willing to help fight the pandemic by aiding promising research, there are strong moral reasons to gratefully accept their help. To refuse it would implicitly subject others to still graver risks. (shrink)

Two different kinds of collections have been used to anticipate influenza pandemics: viral strains and bird specimens. These collections have been organized in museums and data banks to fill the gaps when specimens were decaying or when viral strains were missing. This article asks how collecting practices changed when such collections integrated specimens from China, considered a reservoir of influenza viruses and bird species, following a recurrent critical trope that Chinese specimens were missing. The article shows that techniques for (...) hunting viruses and birds were used to accumulate information so as to mitigate the global threat of species extinction. It suggests that in sentinel territories, museums transform samples and specimens into signs and images of future catastrophic events. (shrink)

The crisis of pandemics such as Covid-19 reveals the reality of a crisis-ridden world fraught by devastation of nature and distortion of human life simultaneously. This article tries to bring to light that pandemics actually move from one ‘region’ of human Lifeworld to another. The phenomenological notion of ‘Lifeworld’ can enable one to see ‘natural life’ and ‘civil life’ as two different but related ‘regions of life’ related to each other in the context of an ontological unity. As (...) such, the ‘coming’ of pandemic viruses into human life-sphere is seen as one step in a process which had already begun with the disruptive human interference in the natural environment. These are in fact practical implications of the mastery of the modern ‘ego cogito’ and its use of technological warfare. (shrink)

Early pandemic supply chain disruptions posed unprecedented challenges for logisticians and logistical systems. This article investigates the loss prevention strategies pursued by supply chain operators in the face of these blockages. Focusing on the legal doctrine of force majeure, the redesign of supply chain models and financial risk management, I show how the adjustment of logistical rationalities to pandemic conditions involves their entanglement with legal, ecological and epidemiological logics. Far from being temporary modifications, these intersections register wider mutations of capitalism (...) that both exceed the pandemic and have been hastened by it. (shrink)

Vaccines and vaccination are richly explored areas of study within the history of science and medicine, connecting related fields of the history of science and technology, and spanning across subfields such as biomedical sciences, animal studies, colonial and postcolonial history, and the history of global health. Vaccination is a thoroughly political act that is at once an intimate and local issue and a transnational one, with its particular set of politics connecting stakes for the individual and the community. Vaccination also (...) maps on narratives and temporal frameworks of disease with an ultimate goal of ending epidemics. Therefore, the essay takes these three analytical entry points to discuss the historiography of vaccination: the geographical, the political, and the temporal. We argue that through these lenses we can gain a more nuanced understanding of historical narratives we privilege, and in return, this understanding can enable us to explore past and current questions of health inequalities, validation practices, power relations and resistance and vaccine diplomacy. (shrink)

The COVID‐19 pandemic highlighted the tension between protecting public health and safeguarding individual rights, particularly the right to privacy. In South Africa (SA), privacy is both a constitutional right and a statutory obligation under the Protection of Personal Information Act (POPIA). However, during public health crises, this right may be limited by legal measures such as surveillance, mandatory reporting and data processing under POPIA, the National Health Act and the Disaster Management Act. These instruments collectively define the conditions under which (...) the right to privacy may be limited in the interest of public health. This article examines whether SA’s legal framework allows for the lawful, necessary and proportionate limitation of privacy during disease outbreaks, drawing on key legislation and case law. To assess SA’s compliance with international human rights standards, a benchmarking of domestic provisions against the International Covenant on Civil and Political Rights and the Siracusa Principles is also undertaken. These instruments offer guidance on how states may justifiably limit rights during public health emergencies. The article further briefly examines whether adhering to constitutional and statutory requirements translates into public trust during pandemics. Lastly, it also provides recommended requirements to guide future limitations on privacy that uphold constitutional values while enabling effective public health responses. (shrink)

Inserting the discourse within an existentialist framework, this paper examines our existence of interrupted realities through the lens of Kierkegaardian thoughts and also draws on Simone de Beauvoir’s “Qu’est-ce que l’existentialisme?” (1947). As we navigate a surrealist time of COVID-19 (ab)normal, the lingering pandemic has left an impact on a both societal and psychosocial level. With societies across the globe facing continuous restrictions, what happens to free will? De Beauvoir defines our raison d’être as the individual having reality “only through (...) his engagement in the world”. In this period of limited individual freedom, can we still talk of free will and how shall we engage with this all-pervasive, rule-changing pandemic ‘New Normal’? (shrink)

BackgroundRapid data sharing can maximize the utility of data. In epidemics and pandemics like Zika, Ebola, and COVID-19, the case for such practices seems especially urgent and warranted. Yet rapidly sharing data widely has previously generated significant concerns related to equity. The continued lack of understanding and guidance on equitable data sharing raises the following questions: Should data sharing in epidemics and pandemics primarily advance utility, or should it advance equity as well? If so, what norms comprise equitable (...) data sharing in epidemics and pandemics? Do these norms address the equity-related concerns raised by researchers, data providers, and other stakeholders? What tensions must be balanced between equity and other values?MethodsTo explore these questions, we undertook a systematic scoping review of the literature on data sharing in epidemics and pandemics and thematically analyzed identified literature for its discussion of ethical values, norms, concerns, and tensions, with a particular (but not exclusive) emphasis on equity. We wanted to both understand how equity in data sharing is being conceptualized and draw out other important values and norms for data sharing in epidemics and pandemics.ResultsWe found that values of utility, equity, solidarity, and reciprocity were described, and we report their associated norms, including researcher recognition; rapid, real-time sharing; capacity development; and fair benefits to data generators, data providers, and source countries. The value of utility and its associated norms were discussed substantially more than others. Tensions between utility norms (e.g., rapid, real-time sharing) and equity norms (e.g., researcher recognition, equitable access) were raised.ConclusionsThis study found support for equity being advanced by data sharing in epidemics and pandemics. However, norms for equitable data sharing in epidemics and pandemics require further development, particularly in relation to power sharing and participatory approaches prioritizing inclusion. Addressing structural inequities in the wider global health landscape is also needed to achieve equitable data sharing in epidemics and pandemics. (shrink)

Pandemics and other similar crises force us to make difficult moral trade-offs. It is tempting to think that this challenge should be met by invoking fundamental moral principles. This is a mistake. Instead, we need to work hard at designing institutions that enable the officeholders to make reasonable decisions under both fundamental ethical disagreement and empirical/evaluative uncertainty. It is argued that this is best done by supplementing the ethical-cum-legal platforms already in use with an ethical framework inspired by social (...) welfare theory. (shrink)

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...) that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

The background paper provides an introduction to the concept of pandemics and to the ethical and political issues related with pandemic preparedness.

This article aims to approach the COVID-19 health crisis through the category of precarity in two senses. On the one hand, in the face of power, a state of exception has been configured as the new form of political handling of the new normality. On the other hand, the loss of public space has meant that community ties have been broken, fostering greater atomisation and loneliness. Both processes were already present in modernity and post-modernity and foster an increasing uprooting of (...) the individual through the loss of the symbolic axes of socialisation, as well as more intense social control. In short, the defining characteristic of the pandemic is the precarity of life. (shrink)

Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...) paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

While the unprecedented lockdown measures were at the heart of the debate in the first year of the pandemic, the focus since then has shifted to vaccination issues. The reason, of course, is that vaccines and vaccinations have become available by now. All experts agree: If mankind had failed to develop vaccines against SARS-CoV-2, the death toll would have been much higher. This issue seeks to explore what could be described as a “generational approach to vaccinations”. The question “What can (...) we do to avoid future pandemics?” is related to different aspects of the failures and successes of humanity’s vaccination strategy against SARS-CoV-2. Pathogens are among the existential risks to humanity that could potentially kill a large part of it in a very short time. For all the tragedy and horror it has brought upon the world, the Corona virus has not been lethal on such a large, all-encompassing scale. But it could serve as a wake-up call for more and better prevention in the future, put differently: as a call to build a “preventive society”. When people look back to the year 2022 from the year 2200, will they think of the absence of mandatory vaccination as a dangerous anachronism? And will the unequal global distribution of vaccines be seen as an unbearable vice of our epoch? And will “human infection studies” still be dismissed as unethical if a dangerous new virus boards human bodies? If intergenerational justice means improving the life chances and living conditions of future generations to the largest possible extent, then its link to (the avoidance) of infectious diseases is obvious. We should protect future generations from foreseeable damage if we have the power to do so. “We” is humankind in its entirety. Politically, humanity is divided into many single nations. But biologically, as members of the same species, we share the same vulnerability regardless of ethnicity. The regular reader of this journal might wonder why this issue of IGJR has a different structure. An unprecedented pandemic calls for an unprecedented reaction and therefore IGJR 1/2021 and 2/2021 are special issues that deal with this disruptive event. We have invited several health experts, politicians and scholars alike to share their perspectives in short opinion pieces (instead of regular peer-reviewed articles). And we are exploring something new: the publication of a FRFG policy paper. This policy paper starts off with a historical overview on how pandemics have afflicted humanity in the past. It separates moral from legal duties and formulates “epidemiological imperatives” – the way of thinking of a responsible and solidary individual facing the task of preventing an outbreak of epidemics in a community. With the discovery of vaccines, and their availability, the catalogue of duties is increased by one more: to get the jabs as an act of solidarity with others, including future generations. This would prevent states from being forced to take disease control measures that bring about drastic collateral damage. During the first two years of the Corona pandemic, states have imposed lockdowns. The closure of schools has put a special burden on the youngest members of society. This could have been prevented during the second and the further waves. The policy paper also calls for more government funding for prophylactic vaccine research and for the designation of vaccines as “global public goods”. The issue then moves on to a section dedicated to opinion papers by various different authors. The first paper, written by Agnes Binagwaho and Kedest Mathewos (both from University of Global Health Equity, Rwanda), focuses on the issue of health inequity, a concern which has gained more and more traction during the Covid-19 pandemic. The paper examines how vaccine distribution during the pandemic was mainly focused on the global north and how such actions might affect future generations’ perception of what is just, fair and morally correct. The second paper, by Samantha Vanderslott (University of Oxford), focuses on the right and wrongdoings connected to pandemic preparedness and response. The third paper, authored by Rajeev Sadanandan (Health Systems Transformation Platform, India), talks about the lessons that can and should be drawn from child immunisations. The fourth paper, by Adriano Mannino (LMU and Parmenides Foundation, Munich), delves into the question how future generations will assess our actions and our response to the current pandemic. The fifth and final paper, written by Jörg Tremmel (FRFG and University Tübingen), is centered around the question whether human infection studies could have been implemented during the early stages of the pandemic to minimise deaths and severe infections. The issue concludes with two reviews on recent books by Alberto Giubilini and Katie Wright. In his review of Giubilini’s The Ethics of Vaccination, Marius Kunte notes that it contains a “thought-provoking plea” for individual, collective and institutional obligations to reach high vaccination rates. Judith Kausch-Zongo concludes her review of Wright’s Gender, Migration and the Intergenerational Transfer of Human Wellbeing with a special emphasis on the book’s empirical findings, and praises it in its entirety as “undoubtedly important”. Both books serve as poignant reminders of how sustainable societies can only emerge once the challenges revolving around its most vulnerable members have been properly addressed. (shrink)

The SARS-CoV-2 pandemic has transgressed biomedical categories. According to Horton, it turned out to be a 'syndrome' that infected virtually all spheres of social life. The pandemic has created toxic social atmosphere highly unfavorable to clinical and clinic-ethical decision making. Constraints and pressures related to micro-, meso-, exo- and macro-environments framing doctors, nurses, and medical students in training were identified. These factors exacerbated moral distress (moral injury) amongst clinicians. In a joint Polish-Lithuanian project (IDUB 2020-2022) we examined predictors of moral (...) distress in pandemic clinical contexts. A survey-based, real-time, correlational and comparative study was conducted in Poland and Lithuania after the first year of pandemic with N=227 participants. Unexpected differences on regular and pandemic-type moral distress levels were found between the two national samples. Polish participants showed significantly higher moral distress levels than their Lithuanian counterparts. The following article discusses these findings and recommends the reinforcement of resilient medical decision making. (shrink)

This book contains original essays that look at contagious/infectious disease pandemics and the ethical public policy and administration these have entailed. In particular, the pandemics of the 1918 flu pandemic, HIV in the 1990s, SARS in 2003, Ebola from 2014–2016 and the novel COVID-19 in 2020 are highlighted. The contributions in this work offer the reader insights in these and several other recent pandemics that present differently—either via contagion or mortality rate—and how each should be addressed by (...) countries of various sorts. This book is a must for the ongoing debate on how we should treat public health crises, such as the one we have all just encountered in the novel COVID-19 pandemic. (shrink)

This contribution attempts to shed a light from a phenomenological point of view on the ecological crises that have affected our planet and our surrounding lifeworld in the twentieth century, and particularly on the devastating 2020 global pandemic. I first address some historical-critical aspects that precede the 2020 pandemic that are related to the modern mechanistic view in sciences and culture. I then deal, within the natural attitude, with this current eco-crisis as a “guiding thread” for a retrospective questioning toward (...) the experiential roots of every human sense and validity from the first-person perspective, contrasting it as well with aspects of a new, unified, systems view of life. In what follows, retrieving the paradox of the subject-in-the world and the subject-for-the world, I examine the lifeworld’s structure as the way (path) to the transcendental field of experience—that of the correlation between human life (embodied, intersubjective, and historical-temporal) and the world, namely, the noetic-noematic structure, in order to show how it is not reducible to a mere passive self-affection, but is the original source of a spiritual virtue and transformational capacity: that of responsibility. (shrink)

The most well-known kinds of liberalism are based on the doctrine of the atomism of the individual, sometimes called "the separateness of persons." But these doctrines do not seem to allow a country to restrict immigration for the purpose of protecting a national way of life, except for protecting liberalism itself. This can lead to considerable discontent. In this paper, I present a kind of liberalism that addresses this concern.

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)

The paper discusses the reactions of different political and constitutional systems reactions to the pandemic and also the impact of COVID to populism, constitutionalism, and autocracy. Beyond the choice between economic and health considerations also applied in liberal democratic countries, which have lead either to “under-” or “overreaction” to the pandemic, certain illiberal regimes used the crisis situation as a pretext to strengthen the autocratic character of their systems. In some cases, this needed an “underreach,” like in Poland to insist (...) on the presidential election, which has been important to entrench the power of the governing party’s incumbent, elsewhere “overreach,” like in Hungary, where an unlimited emergency power of government has been introduced after the very first cases of contagion. These autocratic “overreactions” have breached the formerly used authoritarian legalistic approaches by openly violating their own illiberal constitutions. New “conservative” theories on “common good constitutionalism” emerged to legitimize the necessity of authoritative rule by the executive power. The paper concludes that one possibility to overcome authoritarian populism and restore constitutionalism in crisis situation such as the COVID-19 pandemic would be to rely on the involvement of the well informed public, one that is capable to understand and assess the advice of the meritocratic elite. This kind of participation would also help build up a constitutional culture necessary to preserve the values of constitutionalism. (shrink)

In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been (...) largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pandemic ventilator rationing decisions is needed. Arguments for and against appeals processes are considered, and some suggestions are offered to help efforts at devising more rational pandemic preparedness plans. (shrink)

For last couple of years, the subcontinent of India has witnessed a number of influenza epidemic outbreaks. History reveals influenza epidemic to be a constant but neglected companion of India. Considering the repeated occurrences of the event on Indian soil, including influenza A H1N1 after 2009-10 pandemic event, a check to the planning measures has been done at national level. A literature survey on the initiative measures, planning accomplishments etc. reveals that it is only after the emergence of A H5N1, (...) national health authorities have began planning efforts to mitigate and respond to influenza outbreaks. This paper outlines the evolution of Indian pandemic planning that can be traced in the research literature, summarize the accomplishments, and explain the importance of pandemic planning in India. Pandemic influenza, as it is commonly known, emerges, evolves, attacks, and sways a large part of world declaring public health emergency in a short span. Several outbreak events such as SARS, Avian influenza A H5N1, and H1N1 have demonstrated the need of international concern for public health emergency and had established the value of planning in advance. Preparedness planning in India is found to be at its nascent stage and it needs further improvement at multiple aspects to tackle the future public health crises, to rectify ethical failures. (shrink)

This article examines the impact of a pandemic on democratic societies. The central research question is the extent to which a pandemic can alter the trajectory of social and ethical democratic development nationally and internationally. Therefore, the article examines contemporary controversies in democratic society in the aftermath of a pandemic. The leading hypothesis is that the pandemic should reinforce the need for social solidarity, but it is unclear what political form this need will take: populism or deliberative/nonconsensual democracy.

We analyse insufficient epistemic pluralism and associated problems in science-based policy advice during the COVID-19 pandemic drawing on specific arguments in Paul Feyerabend’s philosophy. Our goal is twofold: to deepen our understanding of the epistemic shortcomings in science-based policy during the pandemic, and to assess the merits and problems of Feyerabend’s arguments for epistemic pluralism as well as their relevance for policy-making. We discuss opportunities and challenges of integrating a plurality of viewpoints from within and outside science into policy advice (...) thus contributing to discussions about normative issues concerning evidence and expertise in policy-making. (shrink)

The historiography of pandemics and inequality can be characterized by two distinct but often overlapping traditions. One centers structural and political analysis, the other a race-critical approach to the production of human difference. This bibliographic essay reviews historical scholarship in these traditions spanning the past hundred years, with a focus on Anglophone literature in the history of medicine in the United States over the past half century. Early writing on the history of epidemics celebrated the conquest of disease through (...) the application of laboratory research. Insights from social history and environmental history came to inform new analyses of epidemic inequalities, drawing questions of race, class, and empire into the frame during the 1960s and 1970s. The AIDS pandemic of the 1980s further oriented scholarship toward reckoning with stigma, identity, and human experiences of inequality while also troubling the relationship between medicine and the state. In more recent decades, the scholarship on race, social inequality, and pandemics has become deep and broad, remedying longstanding biases toward elite scientific actors and the metropolitan centers of Europe and the East Coast of the United States. In expanding their vision, historians also have engaged in more nuanced analyses of racialization as a social, environmental, and ideological process of embodying difference. Further, where earlier scholarship often relied on mortality data, there has been growing awareness of how numbers shape narratives and are shaped by them in turn. In its conclusion, the essay highlights emerging themes in race and inequality with particular attention to themes that have become prominent amid the global devastation wrought by the COVID-19 pandemic. (shrink)