Vulnerable

The Law, Policy and Ethics of COVID-19

Colleen M. Flood, Vanessa MacDonnell, Jane Philpott, Sophie Thériault, Sridhar Venkatapuram, Colleen M. Flood, Vanessa MacDonnell, Jane Philpott, Sophie Thériault, Sridhar Venkatapuram

• Publisher: University of Ottawa Press
• Year: 2020
• ISBN:
  9780776636436
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

The novel coronavirus SARS-CoV-2, which causes the disease known as COVID-19, has infected people in 212 countries so far and on every continent except Antarctica.
Vast changes to our home lives, social interactions, government functioning and relations between countries have swept the world in a few months and are difficult to hold in one's mind at one time. That is why a collaborative effort such as this edited, multidisciplinary collection is needed. This book confronts the vulnerabilities and interconnectedness made visible by the pandemic and its consequences, along with the legal, ethical and policy responses. These include vulnerabilities for people who have been harmed or will be harmed by the virus directly and those harmed by measures taken to slow its relentless march; vulnerabilities exposed in our institutions, governance and legal structures; and vulnerabilities in other countries and at the global level where persistent injustices harm us all.
Hopefully, COVID-19 will forces us to deeply reflect on how we govern and our policy priorities; to focus preparedness, precaution, and recovery to include all, not just some.
Published in English with some chapters in French.

SECTION D

EQUITY AND COVID-19

CHAPTER D-1

How Should We Allocate Health and Social Resources During a Pandemic?

Sridhar Venkatapuram^*

Abstract

In this chapter, I argue that the particular use and applications of two scientific ideas profoundly affected national pandemic responses, including the allocation of resources, with significant harmful implications for social and health equity. First, the familiar “contain and control” approach to infectious diseases was applied maximally by countries (through national lockdowns) and was without precedent. Second, the epidemic forecasting models and modelling that were so influential early on were mono-dimensional; they modelled scenarios of how human bodies will likely spread infections, and of the biological impacts (infected, recovered, or dead) over time. These models erased acute and endemic vulnerabilities, and were not capable of identifying the impacts of policies to reduce virus transmissions on other health and well-being issues, or on other important social domains (for example, the economy).

Résumé
Comment répartir les ressources en santé et services sociaux pendant une pandémie ?

Dans ce chapitre, je soutiens que l’utilisation et les applications particulières de deux idées scientifiques ont profondément influencé les stratégies nationales de lutte contre la pandémie, y compris la répartition des ressources, entraînant des conséquences néfastes majeures pour l’équité sociale et l’équité en matière de santé. Tout d’abord, l’approche familière consistant à « contenir et contrôler » les maladies infectieuses a été appliquée rigoureusement par de nombreux pays (par le confinement des populations) et était sans précédent. Ensuite, les modèles de prévision et la modélisation des épidémies qui ont eu tant d’influence au départ étaient unidimensionnels ; ils présentaient des scénarios sur la manière dont le corps humain est susceptible de propager l’infection et sur les impacts biologiques (infecté, rétabli ou décédé) au fil du temps. Ces modèles ont ignoré les vulnérabilités sévères et endémiques, et n’ont pas permis de cerner les effets des politiques visant à réduire la transmission du virus sur d’autres questions de santé et de bien-être, ou sur d’autres domaines sociaux importants (par exemple, l’économie).

A pandemic such as this was expected. In fact, many of the world’s richest countries had been preparing for years by commissioning pandemic preparedness plans (PPPs), creating new agencies, and even conducting major simulations. A significant part of the national pandemic responses involves “surge capacity” entailing the rapid allocation of health and other social resources, including financial, intellectual, scientific, labour, military, and infrastructure. The world over, trillions of dollars have been marshalled to address issues ranging from increasing health care capacity, procuring testing kits and protective wear, building additional hospitals, providing food rations, helping businesses stay solvent, supporting and investing in scientific research and the development of vaccines, and so forth. How a country allocates resources, or does not, during a pandemic affects how the pandemic evolves within the country, sometimes in other countries, and in the world. Yet, alongside increasing surge capacity to control the pandemic—in terms of the spread of infections as well as managing consequent illnesses and deaths—how a society allocates resources also reflects and impacts the parallel social concern of equity.

The following discussion argues that the particular use and applications of two scientific ideas profoundly affected national pandemic responses, including the allocation of resources, with significant harmful implications for social and health equity. First, the familiar “contain and control” approach to infectious diseases was applied maximally by countries (through national lockdowns) and was without precedent. Second, the epidemic forecasting models and modelling that were so influential early on were mono-dimensional; they modelled scenarios of how human bodies will likely spread infections and of the biological impacts infected, recovered, or dead) over time. They used assumptions about equal susceptibility and probability of death, which then motivated the society-wide lockdowns. The assumptions obfuscated inequalities in the vulnerabilities of social groups to exposures, infections, and death. Plus, used in isolation, with a focus on only one dimension, these models could not identify the impacts of policies to reduce virus transmissions on other health and well-being issues or on other important social domains (for example, the economy). In light of this argument, a partial answer to the question “how should we allocate resources during a pandemic” is that we should allocate resources with greater attention paid to social equity, particularly through more close scrutiny of the proposed use and application of infectious disease science and control methods.

For many readers, the social concern around equity during this pandemic might initially and most easily be recognizable regarding the distribution of limited health care in the face of overwhelming need. Equity as a concept is often used in relation to the distribution of valuable things. Indeed, the ethical or fair allocation of limited ICU beds, ventilators, and protective equipment rose to prominence in the media and scientific journals early on in the pandemic as the infections spread to high-income countries, particularly in the United States.¹ Concerns are also being expressed around equity related to the future distribution of treatments or vaccines, both domestically and globally, which are currently being researched and developed.² The fair social distribution of valuable health care resources is a coherent concern, and speaks to the question of how nations should allocate resources during a pandemic. But concerns about equity or fairness have also been raised regarding the high proportion of deaths among older people and racial and ethnic minorities, the impacts of lockdowns and gender inequalities, and the economic impacts due to loss of incomes and jobs. Beyond the allocation of health care resources, the equity concerns raised by this pandemic go to the very foundations of how the 260-plus countries and territories in the world are organized and function.

Health Equity and Social Determinants of Health

During normal times, the health and well-being of both individuals and a national population, as well as health inequalities across individuals and social groups, are created overwhelmingly by social determinants. Across all high-, middle-, and low-income countries, social determinants of health are what have been described as “the conditions in which people are born, grow, live, work and age.”³ These conditions include such things as early infant care and stimulation, safe and secure employment, housing conditions, discrimination, self-respect, personal relationships, community cohesion, and income inequality, among others. Access to health care for prevention and care is important, but it is only one of the many social determinants of health, illness, impairments, and premature death. Furthermore, these determinants operate at levels ranging from the micro, such as interpersonal interactions affecting neuropsycho-biological pathways, to the meso and macro, such as community cultures, national political regimes, and global processes affecting trade—and, as this pandemic shows, global organizations, governance structures, and norms.

Social determinants of health, unlike the proximate determinants of individual biology, personal behaviours, and exposure to harmful agents (for example, pathogens) are most often the long chain of causes setting up these prox...