Bioethics Forum Essay
Bringing Ethics into the Global Coronavirus Response
Covid-19 is a matter of public and global health ethics, and the pandemic is currently accelerating cooperation within and contributions from these fields. One example of such cooperation is the Ethics Working Group within the German Public Health Competence Network Covid-19. Initiated with a videoconference on March 17, the Competence Network is an ad hoc consortium of more than 25 scientific societies and organizations that are active in the field of public health, representing several thousand scientists from Germany, Austria, and Switzerland. The group has multidisciplinary expertise in research methods, epidemiology, statistics, social sciences, ethics, demography, and medicine. The network’s goals include providing “interdisciplinary expertise on Covid-19 for the current discussion and for decision making in a quick and flexible manner” by compiling, processing, and disseminating scientific evidence in an accessible way, primarily targeting government agencies, institutions, and policymakers.
While Germany has a strong tradition in medical ethics, there does not yet exist an established community of public health ethicists. The Ethics Working Group, therefore, was set up as an international group, comprising public and global health ethicists and others from related fields of applied ethics, and moral and political philosophers. So far, the ethics group has published four policy briefs and background papers.
In mid-April, the Ethics Working Group received several requests from German and European policymakers to draft a policy brief with a set of ethical principles to be put forward at the international pledging conference hosted by the European Union on May 4. The conference aimed to raise funds and strengthen political support for a coordinated Coronavirus Global Response (CGR). It ultimately registered pledges from governments and philanthropies totaling 9.8 billion euros, 2.3 billion above the target. The E.U., along with Global Citizen, an international group that aims to end poverty, will host another global pledging event on June 27, this time going beyond governments and large institutions to also reach individuals and communities worldwide. To contribute to the global conversation leading up to June 27 and beyond, we discuss the motivation and the content of this policy brief, “Ethics Principals for the Coronavirus Global Response.”
The requests for ethical principles to guide the CGR can be understood and justified by at least three considerations. First, the fundraising effort aimed to pool and allocate resources to accelerate the development of an effective Covid-19 vaccine, as well as tests and medicines, but there was uncertainty of how to integrate ethical values such as solidarity and fairness into infectious disease control and financing. Previous experience with the H1N1 pandemic had shown that high-income countries monopolized stocks of vaccines, leaving poorer countries exposed to and increasing the likelihood of a global resurgence of the virus. Addressing specific national vulnerabilities and securing adequate access to response tools where they are needed, thus became a matter of moral urgency.
Second, attempts to effectively and durably contain the Covid-19 pandemic require global coordination across governments, multilateral and nongovernmental organizations, public-private organizations, philanthropies, and other groups. By early April, as the pandemic spread around the world, it was apparent that every country’s national interest to contain infections and limit fatalities domestically is directly affected by the actions and capacities of other countries. And, despite the shared goal of containing the pandemic within and across borders, the many actors involved in the CGR have multiple and diverse interests, resources, constituencies, expertise, public health capacities, and so forth. Ethical principles were thus needed to help clarify, organize and, if possible, align the diverse motivations and capacities, and to provide ethical justification and guidance for cooperative actions.
Third, an ethos of competition between nations and medical technology companies was taking root and threatened any coordinated global response to the pandemic. In a novel situation for the post World War II world order, the United States was not leading efforts to address a global crisis, and not even participating in the May 4 meeting at which governments and philanthropies pledged the 9.8 billion euros. In fact, just prior to the meeting, the American president announced that he was launching Operation Warp Speed, a program to produce vaccines for Americans, and not accessible as global public goods. To mitigate an emerging ethos of competition for pandemic response tools and to guide the necessary global cooperation, the articulation of global ethical principles became necessary.
Members of the Ethics Working Group drafted the policy brief based on the best available research, outlining normative and procedural principles for a coordinated and justified CGR. The policy brief was then given to those who initially requested it and several other representatives of governments and international organizations involved in the pledging conference. It received positive feedback, and has apparently proved helpful for some organizations in their internal deliberations about their role in the CGR.
The Ethics Working Group took a pragmatic methodological approach by drawing on normative principles from different theories and approaches to global health equity and justice. The principles were understood as the most relevant points of overlapping global consensus or points of convergence in incompletely theorized agreements. Practically, the principles were meant to be used to help identify salient normative dimensions that would need to be addressed in justifying decisions and actions. The four normative principles are:
- Global cooperation for solidarity and justice. The pandemic has made clear that people around the world are interconnected and interdependent. Its origins and spread are significantly influenced by social policies or neglect, making responding to it a matter of justice. Failing to acknowledge global interconnections and failing to take cooperative and reciprocal solidarity-based action to address shared problems will only prolong individual and shared vulnerabilities and inequities.
- Equal moral worth of every human being. Every human is a moral being with claims and abilities to pursue a decent life. Whether born into wealth or poverty, and regardless of country of origin or residence, gender, or age, every human being has dignity and moral claims that must be equally considered.
- Moral right to health and duty to protect. The importance of health to every human being is reflected in ethical arguments for every human being’s moral right to health and in international human rights law. A pandemic threatens health and life itself, activating moral and legal duties to protect every human being’s right to health.
- Special concern for vulnerable groups. Specific vulnerabilities in relation to Covid-19 require giving attention to specific groups and individuals. These include those more vulnerable to disease or to suffer from its consequences, or those more likely to suffer deprivations from infection control measures and unintended effects.
The second part of the policy brief outlined procedural principles for decision-making applicable to both the global response and domestic responses within countries in a two-tier approach. The procedural principles—which included transparency and accountability, responsiveness, urgency, reasonableness, and integrity–largely followed other prominent sources on pandemic ethics and Norman Daniels’s’ Accountability for Reasonableness principles.
While the policy brief proposed general principles for the global coronavirus response, some members of the Ethics Working Group produced a second more specific document simultaneously in a collaborative effort that provided more concrete guidance on the allocation of resources. Securing a fair distribution of valuable and scarce goods—within or outside of health care—requires attention to general principles and the concrete challenges that arise in specific settings. In light of the actual and massively unequal distribution of harm caused by Covid-19 and the resulting infection control measures, the Ethics Working Group recognizes that every society’s existing health inequalities and entrenched structural injustices require specific attention and measures. Determining a strategy for an ethically justified, global distribution of Covid-19 response tools, in a transparent and inclusive way, that takes a global cooperation of solidarity and justice seriously, remains one of the biggest moral challenges of our time.
Jan-Christoph Heilinger is researcher and lecturer in moral and political philosophy at Ludwig-Maximilians-University of Munich and permanent visiting professor at Ecole Normale Supérieure, Port-au-Prince, Haiti. Sridhar Venkatapuram is an associate professor of global health and philosophy at King’s College London, Twitter: @sridhartweet. Maike Voss is an associate, Global Issues Division, German Institute for International and Security Affairs (SWP) in Berlin working on global issues, with a portfolio covering German development and global health policy, Twitter: @maike_voss. Verina Wild is researcher and lecturer in medical and public health ethics and deputy director at the Institute of Ethics, History and Theory of Medicine at Ludwig-Maximilians-University of Munich, Twitter: @VeriWil. They are authors of the policy brief, “Ethical Principles for the Coronavirus Global Response.”
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