This analysis affords an overview and distinct approach to healthcare ethics behind preparedness, planning, and response to a health pandemic. Specifically, it gives descriptive research on the latest world pandemic, COVID-19. The analysis considers the kind of activity entailed by health pandemic preparedness. Moreover, it feels the ethical goals that ought to angle an activity of that kind. It contends that pandemic preparedness should be comprehended as a form of “civic practice,” an activity involving private persons’ rights and interests and the common good without discriminating. Thus, it highlights the values and responsibility of society at large. The analysis also comprehensively discusses specific domains of pandemic preparedness and response. That concerns susceptible populations, professional and personal obligations, and public trust.
The national response to the COVID-19 pandemic highly depends on the national preparedness systems. These systems ought to be perfectly understood as an element of the global public health emergency preparedness systems governed by the World Health Organization (WHO). The COVID-19 pandemic raised the question of why countries in standard public health regimes governed by a similar approach had different responses to the pandemic threat. Expert research conducted in three countries, Norway, Denmark, and Sweden, with a standard public health regime, indicates the significant differences in planning and preparedness and their impacts on the response to the pandemic. COVID-19 raised many ethical issues for the parties involved. These parties include policymakers, public health specialists, and responders. Thus, this analysis provides relevant information on ethical issues in planning and preparedness to reduce risk before, during, and after a pandemic.
Reinforcing pandemic preparedness systems is the primary course of action for moderating the impacts of a pandemic on critical social functions. The COVID-19 pandemic troubled the capacity of the already existing preparedness doctrines and institutions to properly negotiate global health emergencies in many countries (Laage-Thomsen, & Frandsen, 2022). Studies conducted on how different governments have comprehended and acted upon minimizing the effects of the pandemic have highlighted significant differences. As a result, mortality rates and economic repercussions for these countries. Prominently, such policy variances have crystallized regardless of the World Health Organization’s determination to build up and harmonize national pandemic preparedness since the 1990s. The ineffectuality of preceding assessments of pandemic preparedness in forecasting COVID-19 efficacy has by now been documented, for instance, in the 2019 Global Health Security Index (GHSI). The united states were ranked first, and the United Kingdom second regarding their capabilities before the pandemic. However, there has been immense criticism of these ranks due to the initial responses in the US and the UK (Laage-Thomsen, & Frandsen, 2022). Thus, this is a clear illustration of the issues of pandemic preparedness systems coordinated by the WHO.
The initial point of exploring such issues is comparing the preparedness systems configured and governed globally—the International Health Regulations by WHO are active for countries with similar health regimes. Nonetheless, during the first wave of the pandemic, these countries responded differently to the COVID-19 pandemic even though they possess similar health infrastructure and expenditures (Laage-Thomsen, & Frandsen, 2022). The analysis seeks to explore this divergence in response among comparable countries. A study in three countries, Norway, Denmark, and Sweden, indicates that differences in the use of face masks, lockdowns, and implementation of response strategies facilitated the difference amidst similar biological threats.
In evaluating the policy process, studies conducted on policy have long recognized expert-based information as the most influential aspect when explaining policy outcomes. Understanding the sources of policy advice in and out of bureaucracies is essential, as different advisors do it over time (Claeson & Hanson, 2021). Thus, policy influence is conceptualized as a function of location in the offered system. The straightforward indication is that the arrangement of policy subsystems, well-defined as the decision-making complexes structured around policy issues, impact the influence and access of several sources of policy advice in imperative ways. The relevance of policy advice is typically salient in the policy subsystem of pandemic preparedness (Baral et al., 2021). Experts lodge influential places within the subsystem, such as in public health agencies and advisory committees, where they take part in framing biological threats and outlining policy measures and procedures to respond to them. This renders them imperative gatekeepers for comprehending variation between the otherwise esoteric and practical national policy subsystems activated during the COVID-19 pandemic. Studies conducted before the pandemic also indicate that experts’ norms for understanding distinct national responses to health pandemics are essential in influencing pandemic preparedness. In that case, expert advisors endorsed ideas about the pandemic threat established during preparedness planning and from experience that molded policymaking.
Notwithstanding, public health policy in the Nordics traditionally being labeled as what might be called a ‘unitary subsystem,’ with unified authority in public health agencies overriding policy images. Coordinated through the WHO and great intra-coalition belief alignment, responses to the first wave of the pandemic witnessed contradictory expert visions and advice for the most appropriate national response strategy to the COVID-19 pandemic (Laage-Thomsen, & Frandsen, 2022). The presence of contradictory COVID-19 policy advice nurtures the question of the degree to which pandemic response discrepancies between countries belonging to the same public health regime are due to the alterations in the ideas, approaches, and policy preferences of national expert clusters. The question is answered in light of the comparison of the three Nordic countries. Policy divergence is more of a result of politico-administrative factors than preferences among national expert clusters (Laage-Thomsen, & Frandsen, 2022). To best define pandemic preparedness systems, they are established guidelines to respond to infectious disease and mitigate its effects on the vital functioning of society. Thus, they cannot mainly stop a pandemic or catastrophic events from happening, which entails being ready to mitigate the consequences. So, it requires identifying vulnerabilities by the activity of imagined cases and developing plans to handle the potential emergency beforehand through investment in capacities and equipment.
The initial area of concern is equitable access to healthcare during a pandemic. A key issue is how COVID-19 vaccines and hospital beds must be allotted for COVID patients. Moreover, the question is how healthcare resources should be allocated between the needs of the.COVID-19 effort and other health needs. A connected, more precise question is whether it is suitable to alter the criteria for approval of vaccines or drugs for a pandemic because of the insistent public need. The subsequent area of concern is the ethics of public health actions taken in response to a pandemic, including the scrutiny of animal and human pathogens occurrences and the distribution of outbreak information (Baral et al., 2021). For COVID-19, measures for preventing transmission through partings, such as quarantine, isolation, social distancing, and regulation of international travel and borders, are partially in response to the new WHO International Health Regulations.
The next area of ethical concern is the obligations of healthcare workers during a pandemic and the responsibilities of society to them in return. As Dr. Heymann highlighted, a prominent piece of many of the outbreaks he studied was the risk and mortality among the healthcare professionals working during attacks, counting those who were giving treatment and those who were merely monitoring the outbreak (Baekkeskov & Rubin 2014). One can take up that if healthcare personnel is at greater-than-ordinary threat of getting infected due to the nature of their jobs. Then their natural capacity to reduce exposure would contradict their professional responsibilities to discrete patients and society at large. Their recognition of this threat in performing their duties would bring them mutual obligations on the part of society.
Considering the duties of healthcare professionals are possibly most abundantly articulated by physicians but unquestionably recognized by other professionals as well. It is important to note that those responsibilities originate from their distinctive training and position as licensed, independent professionals. On the other hand, they mirror the point that they have a set of skills that are principally needed in the settings. As several ethical issues concerning the role of healthcare workers are unclear, the social-contract prototype could be valuable in determining whether to give these groups special status when allocating prophylaxis and treatment for the COVID-19 pandemic (El Bcheraoui et al., 2020). The reasonableness of concluding that they ought not to get distinctive treatment on the circumstances when these threats essentially arise is reinforced. Precisely because the threats are explicit in their training, they are responsible for taking care of individual patients and society in such circumstances.
The last area of ethical concern cores on responsibilities amid countries and the responsibilities of intergovernmental organizations. That is, different ways that governments should steadily exercise their duties to their populaces as well as the duties to other countries and populaces. Additionally, identifying their role to international organizations, in this case, WHO, in lecturing the cross-border threats and obligations (Baekkeskov & Rubin 2014). The first question raised is closely related to that of vaccine allocation approaches. What are the determinants for the strategies taken up by decision-makers on time to release a particular portion of the medicine, both preventive and curative? Is it appropriate for a state to release scarce supplies to another state when the other state faces the threats of a pandemic other than keeping for its population just in case they face similar threats in the future? When the response is affirmative, the question of at what point the release should be made arises. Suppose the first state holds back, and the epidemic is contained. In that case, the decision-makers will appear as not having responded as required by humanitarian guidelines and maybe human rights responsibilities. They could be held responsible for the death of people who could have been avoided otherwise.
On the other hand, if the decision-makers decide to offer the supplies and the pandemic strikes their country hard, they will face legitimate questions on whether the needs of the second country come before their country arrives in full force in their own country. On the same note, it would be a proactive approach to mitigating spread by offering scarce supplies to a low-resource country. This is an indication of how intricate the issue of policymaking during a pandemic is.
Deliberations on these four ethical issues by the WHO and its consultants have fashioned settlement on some elementary principles to motivate planning responses to a pandemic. The first ethical principle is the principle of utility (Baekkeskov & Rubin 2014). The principle highlights taking on the actions that bring forth the greatest good. The principle faces standard criticism on whether the greatest good is fairly distributed or the greater good is to a small group of people. The other principle is the principle of efficiency. This principle calls for minimizing the resources required to yield a particular result or exploiting the outcome generated from a specific set of resources. Following is the principle of fairness, which is typically articulated in a formal way as treating similar cases alike. To expound this principle prevents healthcare workers from acting in unfair discrimination on the grounds of irrelevant characteristics of an individual or group. Thus, it protects the patients and society from this discrimination. The last principle is the principle of liberty. This principle dictates that one is expected to enact a minimum burden on personal self-determination essential to attain a genuine goal.
Simply put, one is not obligated to trade all their freedom for security. These principles appear to be commonsensical and precise. However, guidelines are imperative when the public is involved in a particular process. The policies should be readily accessible, align with people’s sense of how they lead their lives, and offer them a chance to participate. Conclusively, the principles give the general expectations from the public on how the government should respond to arising issues, in this case, a pandemic. These principles must apply to the professionals and government public health strategies.
In examining the four areas of ethical concern, we look to see how the issues arise and, in turn, how the four principles apply. Commencing with the issue of access to healthcare services, the primary problem is a fair distribution of healthcare resources. The relevant point of consideration is what it means to have an equitable distribution. There are two approaches to justice, in this case, procedural justice. This entails the characteristics of a fair process. In situations where there is difficulty in achieving a comprehensive social agreement, the process will be termed as appropriate if the results are justified and it treats people’s interests. In practicality, the decision results are likely to be more acceptable even if it was not popular. The second aspect of justice is the basis of comparison, whether overall maximization of well-being or economic and social costs. This concept is further discussed below to indicate how the principles played out during the COVID-19 pandemic.
The ethical concern encompasses public health interventions, such as the quarantine of exposed individuals, isolation of infected individuals, social distancing among the general population, border control, personal hygiene, et cetera. One ethical query that has to be probed is whether we genuinely discern how to quantify the advantages of any of these interventions. This is a principally significant issue if one is in the quest of balancing the confines of personal liberty versus the worth of accomplishing a valid public goal that could not be achieved in any less intrusive approach. If there is no model to measure these benefits, it would be imposing on the public’s self–determination. That makes it clear that the decision-making process is critical at this point. The bottom line is that decision-makers should choose the least intrusive alternative whenever some public health intervention.
Healthcare workers possess unique skills that create certain obligations to provide needed care. They carry specific ethical responsibilities towards patients and society, and a pandemic is no different as recognized by oaths and professional codes. The question is whether the obligations have a limit. There are two approaches to this question. First, is it their choice to take on the added risk of exposure to the pandemic, or are the healthcare workers obligated to act since their code of conduct dictates so? Thus, planners need to highlight early on the professional ethics implications and the actions expected during a pandemic as a way of preparedness.
These two issues are undoubtedly interrelated because national governments will give the principal international response. Since the effects of a pandemic will be global, international action will be necessary. International disease scrutiny is being organized under the new International Health Regulations that expect several standards, including ethical standards, by providing a structure for an internationally coordinated response. Regardless of an international agreement, difficulties still arise from the contracts. The arrangements are mainly commitments of laudable goals to offer specific steps that are supposed to be taken while focusing on the long-term development of a rapid response to a pandemic. A significant concern is the human rights obligation to maintain focus on the most vulnerable. However, in the case of COVID-19, vulnerability is determined by both biological and political issues. Say, a citizen from a country with a disorganized response to a pandemic is more vulnerable than one country with a well-organized response to a pandemic. Under human rights conventions, countries with a well-organized response system are obliged to those at risk simply on moral grounds. In sum, a society’s ability to respond appropriately depends on the awareness of the problem and the threats it poses. Moreover, possessing the knowledge, expertise, and technology to control the emergency and having the financial and administrative capacity to do so.
Having deliberated on some ethical theories and the diverse models of pandemic preparedness they may result in, it is essential to highlight some forthright, practical recommendations that ethicists would agree with. One of the fundamentals of an ethically accountable and fitting response is advanced planning which encompasses communication. Communication entails openly conceding the inescapable reality of the scarceness of life-preserving resources, giving rise to the necessity of collective action and personal responsibility.
Practically, the chances of implementing a successful pandemic response plan are influenced by the general population aware of and involved in the crisis. This is undoubtedly true for the COVID-19 pandemic because mitigation of spread and consequences depended on the cooperation of the general public with its requirements. Thus, planners need to engage in realistic planning efforts encompassing emergency simulation. In sum, ethical dilemmas result from choices between one good and another. Dissimilar to human-rights situations, they do not violate one person in favor of another. That’s what makes ethics behind preparedness and response a complex issue in healthcare. Therefore, it is essential for ethical and practical reasons that decision-making involves public opinion. And results might be different with communities. What matters is that decisions can be ethically justifiable. Pandemic preparedness is not only about protecting a populace but also strengthening civic society and sustaining it. Successful pandemic planning proves a preexisting civic responsibility, awareness of justice, and concern for others. Most importantly, emergency preparedness and response meet the ethical obligations of healthcare and are more likely to have effectual practicality.
Baekkeskov, E., & Rubin, O. (2014). Why pandemic response is unique: powerful experts and hands-off political leaders. Disaster Prevention and Management.
Bal, R., de Graaff, B., van de Bovenkamp, H., & Wallenburg, I. (2020). Practicing Corona–Towards a research agenda of health policies. Health Policy, 124(7), 671-673.
Baral, S., Chandler, R., Prieto, R. G., Gupta, S., Mishra, S., & Kulldorff, M. (2021). Leveraging epidemiological principles to evaluate Sweden’s COVID-19 response. Annals of epidemiology, 54, 21-26.
Claeson, M., & Hanson, S. (2021). COVID-19 and the Swedish enigma. The Lancet, 397(10271), 259-261.
El Bcheraoui, C., Weishaar, H., Pozo-Martin, F., & Hanefeld, J. (2020). Assessing COVID-19 through the lens of health systems’ preparedness: time for a change. Globalization and Health, 16(1), 1-5.
Laage-Thomsen, J., & Frandsen, S. L. (2022). Pandemic preparedness systems and diverging COVID-19 responses within similar public health regimes: a comparative study of expert perceptions of pandemic response in Denmark, Norway, and Sweden. Globalization and health, 18(1), 1-18.