Voluntariness or legal obligation? An ethical analysis of two instruments for fairer global access to COVID-19 vaccines.

Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. Methods: The main documents discussing the two strategies are examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. Results: We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. Discussion: A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel.

Features of Social Behavior and the Awareness of Moscow Residents about COVID-19 at the Beginning of the Pandemic

The coronavirus pandemic has raised serious questions about the need to properly inform residents of large cities about the rules of hygiene, behavior in self-isolation, and maintaining health. This study aimed to identify in more detail the sources of information and to assess the levels of awareness and knowledge of the inhabitants of a typical metropolis about coronavirus infection to further search for ways to improve health information during pandemics. This research has a questionnaire survey design. Data from 478 adult Muscovites were collected on 20-25 March 2020 by the Institute of Social Sciences of Sechenov University. The aim of this study was to study the level of awareness in preventing the spread of infection and peculiarities in the perceptions of residents of the city of Moscow toward the large-scale social changes associated with the COVID-19 pandemic as well as their impact on the way of life, social relations, lifestyle, and ideas about the future of the population. This article presents the results of a medical and sociological survey of residents of Moscow implemented at the beginning of the spread of coronavirus infection in the country, which showed the awareness of residents of Moscow regarding the problem of the spread of coronavirus and the prevention of infection as well as a high level of anxiety and the pessimistic expectations of respondents regarding the consequences of the COVID-19 pandemic for the state, society, and people. At the same time, the fears of the survey participants involved both immediate risks of the disease and a wide range of socioeconomic problems from near and distant perspectives.

Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany-An Ethical Analysis.

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.

Balancing public health and civil liberties in times of pandemic.

The ongoing COVID-19 pandemic constitutes not only a danger for public health, but may also threaten civil liberties. Looking at the examples of recent events in Poland and Hungary, the authors argue that governments may misuse pandemic for their political advantage, thus endangering public health. Political decisions taken to stem the spread of pandemics should be limited and strictly proportionate to the situation.

Psychosocial Reactions to Plagues in the Cultural History of Medicine: A Medical Humanities Approach.

The aim of this work is to elucidate psychosocial reactions to plagues by analyzing three landmark descriptions from different eras: Thucydides' description of the plague of Athens (430 BC) in The History of the Peloponnesian War, Giovanni Boccaccio's description of the plague in Florence (1348) in The Decameron, and Albert Camus' description in The Plague (1947). Using a narrative inquiry, we found psychosocial reactions to be complex and ambivalent and could discern several coping strategies. We propose that this knowledge can help psychiatrists and other healthcare professionals during the ongoing COVID-19 pandemic.