Ethics of digital contact tracing wearables.

The success of digital COVID-19 contact tracing requires a strategy that successfully addresses the digital divide-inequitable access to technology such as smartphones. Lack of access both undermines the degree of social benefit achieved by the use of tracing apps, and exacerbates existing social and health inequities because those who lack access are likely to already be disadvantaged. Recently, Singapore has introduced portable tracing wearables (with the same functionality as a contact tracing app) to address the equity gap and promote public health. We argue that governments have an ethical obligation to ensure fair access to the protective benefits of contract tracing during the pandemic and that wearables are an effective way of addressing some important equity issues. The most contentious issues about contact tracing apps have been the potential infringements of privacy and individual liberty, especially where the use of apps or other technology (such as wearables or QR codes) is required for access to certain spaces. Here we argue that wearables, as opposed to apps alone, will make a digital contact tracing mandate more practical and explain some conditions under which such a mandate would be justified. We focus on Singapore as a case study that has recently deployed contact tracing wearables nationally, but also reference debate about wearables in Australia and New Zealand. Our analysis will be relevant to counties trialling similar portable tracing wearables.

Balancing burdens of infection control: Norwegian district medical officers' ethical challenges during the COVID-19 pandemic.

BACKGROUND: In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic. METHODS: The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach. RESULTS: Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other. CONCLUSIONS: The DMOs have a central role in the municipality's handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.

Modeling COVID-19 with big mobility data: Surveillance and reaffirming the people in the data

To better understand the COVID-19 pandemic, public health researchers turned to "big mobility data”—location data collected from mobile devices by companies engaged in surveillance capitalism. Publishing formerly private big mobility datasets, firms trumpeted their efforts to "fight” COVID-19 and researchers highlighted the potential of big mobility data to improve infectious disease models tracking the pandemic. However, these collaborations are defined by asymmetries in information, access, and power. The release of data is characterized by a lack of obligation on the part of the data provider towards public health goals, particularly those committed to a community-based, participatory model. There is a lack of appropriate reciprocities between data company, data subject, researcher, and community. People are de-centered, surveillance is de-linked from action while the agendas of public health and surveillance capitalism grow closer. This article argues that the current use of big mobility data in the COVID-19 pandemic represents a poor approach with respect to community and person-centered frameworks. © The Author(s) 2023.

The ethical, legal and social issues of pandemics: An analysis from the EU perspective

This book proposes an ethical and legal framework to improve the responses to social issues related not only to the current SARS-CoV-2 pandemic, but also to future pandemics. Its contents cover the issues that are likely to be most controversial in any public health crisis. It starts by discussing non-pharmacological measures, such as the appropriateness of confinement, how to control compliance with public health measures and the ethical, legal and social acceptability of health certificates. Then it turns to issues related to the production, distribution and administration of vaccines, with a particular focus on the design and implementation of vaccination policies. Finally, it analyses the most appropriate criteria to develop a triage, when the situation brings us to this terrible scenario. The analyses presented in this book are based on the ethical and legal frameworks, as well as the social context, of the European Union, and aims to address the main dilemmas faced by any liberal democracy dealing with a pandemic: how to reconcile the defense against a public health crisis together with a respect for fundamental rights and freedoms. The European legal systems have developed a number of conceptual tools designed to ensure that there is no room for arbitrariness in the restrictions introduced by the political power in emergency situations, and this book builds upon these tools. The Ethical, Legal and Social Issues of Pandemics: An Analysis from the EU Perspective is a predominantly practice-oriented book, which will help policy makers to adopt policies that effectively combine public health needs with individual rights and freedoms. It will also help health care givers to understand better the ethical and legal issues involved in their work and citizens, in general, to participate in public decision making in an informed manner. Finally, it will help to design tools that faithfully comply with existing fundamental rights standards. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Ethical Issues Arising from the COVID-19 Pandemic in Hong Kong

This article reviews and discusses ethical issues that emerged in the public realm in the first two years of the COVID-19 pandemic in Hong Kong, between January 2021 and March 2022. Emerging infectious diseases are complex and bring about uncertain challenges. Although many of the ethical issues during the pandemic were universally experienced, it is important to understand them within the local contexts in which they arose. The paper reports on observations related to some of these ethical issues, namely, the process of informed consent for COVID-19 vaccination and its limitations, and the challenge of arriving at vaccination decisions for mentally incapacitated elders.

The role of solidarity in a pandemic

Solidarity is part of the map of values and ethical principles of the COVID-19 pandemic that has devastated the world since the end of 2019. Solidarity has been behind the justification for public health measures such as confinement, quarantines, lockdowns, the man-datory use of masks, and the financing, distribution and inoculation of vaccines against the virus;it has also been used to economic compensation, intergenerational sacrifices, the importance of public health care and even mutual aid between citizens, institutions and countries to face the worst effects of the pandemic. However, solidarity has been used interchangeably as a descriptive and normative, motivational and justificatory, sentimental and political, moral and legal idea, thus increasing confusion about its meaning, use and scope. This article reviews the rhetorical use of solidarity during the pandemic, shows the contradictions derived from that use, and sheds light on the normative use it should have in order to more rigorously address responses to future pandemics.

Ethical Failures of the COVID-19 Pandemic Response

This book draws attention to the non-biological—political, economic, societal and cultural—variables shaping both the emergence and persistence of the COVID-19 pandemic and the global response to it, with a particular focus on political decisionmakers' role in the domestic and international politics surrounding the process of the pandemic. The book identifies the strategic and underlying ethical failures of decision making, using a process-tracing approach to reconstruct considerations, decisions and actions by key leaders—interested in thus weaving a global narrative of the response. The author highlights key speech acts, and interprets the causal implications embedded in a chronological and contextualised appraisal of events, statements and public health measures. The book further discusses the normative ethics of pandemic response, and presents lessons drawn from the present experience. It also offers a normative analysis taking into consideration pre-pandemic guidelines for response, including in the literature of public health ethics and pandemic preparedness plans. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.

The Ethical Significance of Post-Vaccination COVID-19 Transmission Dynamics.

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle.

What Type of Person Should I Be? About the Appeal to Virtues in Public Health Interventions.

In line with how ethics has developed for the last three centuries, public health ethics has been widely dominated by a deontological as well as a utilitarian approach. The latter is a version of consequentialism, which states that maximizing utility is the primary goal of the majority of individuals or group action, while, on the other hand, virtue ethics, or at least the appeal to virtues, has been largely marginalized. The aim of this article is twofold. Firstly, we aim to highlight the political and ethical nature of public health interventions, often interpreted and presented as mere scientific enterprises. Secondly, we try to highlight the need to integrate or at least recognize the value of appeal to virtues in public health measures. The analysis will reference the Italian COVID-19 vaccination program as a case study. Initially, we will explore the political and ethical nature of any public health measure, using the implementation of the COVID-19 vaccination program in Italy as an example. Subsequently, we will illustrate the deontological approach to ethics, the utilitarian one, and the virtues one, focusing on the dynamic of the agent's perspective. Lastly, we will briefly analyze both the Italian COVID-19 vaccination program and the communication campaign that promoted it.

Good reasons to vaccinate: mandatory or payment for risk?

Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service.

Translating Cultural Safety to the UK.

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

Roles of genetics and blood type in clinical responses to COVID-19: ethical and policy concerns.

Recently, several genetic variants have been associated with increased or decreased risks of becoming infected and/or seriously ill with COVID-19-not only offering important potential medical benefits but also posing critical ethical questions. These genetic factors, some of which are associated with blood type, may account for variations in observed responses to COVID-19. Hence, assessments of these genetic differences and blood type could provide possible benefits in gauging patients' risks of disease acquisition and prioritising allocation of interventions or vaccines, if supplies are limited. The media has widely reported these findings, and people online are now discussing their blood type and its possible effects on their COVID-19 risks, but several ethical concerns arise. Individuals possessing genetic variants or blood types associated with lower risk may engage in 'risk compensation', erroneously assuming that they can protect themselves less, and hence less frequently wearing masks or washing hands. Given the ongoing COVID-19 pandemic, many physicians, hospitals, patients, policymakers, members of the public, testing companies and others may well consider these factors in making critical prevention/treatment decisions. Researchers, providers and others should thus begin to address these concerns. Increased awareness and education aimed at providers, patients, family members, public health officials, political leaders and the public-at-large are critical. Attitudinal research is vital to examine how providers, patients and the public understand these findings. Ethical frameworks and guidelines are needed, addressing whether such genetic information should be incorporated into decisions regarding allocation of scarce resources-including hospital and ICU beds, ventilators, medications (eg, remdesivir) and vaccines-and if so, how.

Ethical allocation of future COVID-19 vaccines.

The COVID-19 pandemic will likely recede only through development and distribution of an effective vaccine. Although there are many unknowns surrounding COVID-19 vaccine development, vaccine demand will likely outstrip early supply, making prospective planning for vaccine allocation critical for ensuring the ethical distribution of COVID-19 vaccines. Here, we propose three central goals for COVID-19 vaccination campaigns: to reduce morbidity and mortality, to minimise additional economic and societal burdens related to the pandemic and to narrow unjust health inequalities. We evaluate five prioritisation approaches, assess their likely impact on advancing the three goals of vaccine allocation and identify open scientific questions that may alter their outcomes. We argue that no single prioritisation approach will advance all three goals. Instead, we propose a multipronged approach that considers the risk of serious COVID-19 illness, instrumental value and the risk of transmission, and is guided by future research on COVID-19-specific clinical and vaccine characteristics. While we focus this assessment on the USA, our analysis can inform allocation in other contexts.

Newspaper coverage on solidarity and personal responsibility in the COVID-19 pandemic: A content analysis from Germany and German-speaking Switzerland.

Solidarity and personal responsibility have been repeatedly called upon during the COVID-19 pandemic. This study quantifies and contextualizes the use of these terms in newspaper coverage in Germany and German-speaking Switzerland based on n = 640 articles from six functionally equivalent newspapers. The term solidarity in the context of the COVID-19 pandemic was mentioned in 541/640 articles (84.5%) and was primarily used during phases with high death rates and comparatively stringent policies in place, supporting the idea that solidarity was used to explain restrictive measures to the population and motivate people to comply with these measures. German newspapers published more articles on solidarity than Swiss-German newspapers, consistent with more stringent COVID-19 policies in Germany. Personal responsibility was mentioned in 133/640 articles (20.8%), meaning that the term was less frequently discussed than solidarity. Articles covering personal responsibility included more negative evaluations during phases of high infection rates as compared to phases of low infection rates. Findings indicate that the two terms were, at least to some extent, used in newspaper reporting to contextualize and justify COVID-19 policy during phases of high infection rates. Moreover, the term solidarity was used in a high variety of different contexts and the inherent limits of solidarity were rarely mentioned. Policymakers and journalists need to take this into account for future crises to not jeopardize the positive effects of solidarity.

Betting against pandemics: Ethical implications of the "COVID Claimania" in Taiwan, 2020-2022.

Among measures tackling the impacts of the COVID-19 pandemic, the selling of private insurance policies covering individual infection is overlooked by the ethics literature. To record the "COVID Claimania" in Taiwan and to assess its ethical implications, we collected 38 policies from 10 insurers sold between January 2020 and May 2022 and found that their risk calculation of the COVID-19 prevalence ranged from 0.5% to 11.08%. In reality, the prevalence by the end of 2022 was 37% in Taiwan. Selling private insurance policies is ethically problematic in three ways. First, it represents the insurance industry's irresponsible risk-taking profit-seeking behaviors. Second, it would jeopardize the effectiveness of the disease-prevention measures by inducing uncontrollable moral hazards. Third, it would expose the insurance companies to unbearable financial risks and cause substantial negative external impacts. The government should intervene in the private insurance market in preparation for future public health emergencies.

The Right to Protest During a Pandemic: Using Public Health Ethics to Bridge the Divide Between Public Health Goals and Human Rights.

Public protest continued to represent a prominent form of social activism in democratic societies during the COVID-19 pandemic. In Australia, a lack of specific legislation articulating protest rights has meant that, in the context of pandemic restrictions, such events have been treated as illegal mass gatherings. Numerous large protests in major cities have, indeed, stirred significant public debate regarding rights of assembly during COVID-19 outbreaks. The ethics of infringing on protest rights continues to be controversial, with opinion divided as to whether public health goals or human rights should take precedence. This paper applies public health ethical theory to an in-depth analysis of arguments on both sides of the debate. Using the Nuffield Council on Bioethics framework as a backdrop, proportionality and necessity of restrictions are understood as key concepts that are common to both public health and human rights perspectives. The analysis presented here finds a middle-ground between the prevailing arguments on opposing sides and is further able to rationalize the use of protest itself as an important element of a mature public health ethics response to restrictive policy. Thus, this paper aims to influence public health policy and legislation regarding protest rights during public health emergencies.

Assessing the Governance of Digital Contact Tracing in Response to COVID-19: Results of a Multi-National Study.

This paper describes the results of a multi-country survey of governance approaches for the use of digital contact tracing (DCT) in response to the COVID-19 pandemic. We argue that the countries in our survey represent two distinct models of DCT governance, both of which are flawed. The "data protection model" emphasizes privacy protections at the expense of public health benefit, while the "emergency response model" sacrifices transparency and accountability, prompting concerns about excessive governance surveillance. The ethical and effective use of DCT in the future requires a new governance approach that is better suited to this novel use of mobile phone data to promote public health."

COVID-19 Pandemic and Public Health Ethics in Japan.

Public health ethics is a discipline dealing with ethical issues relating to public health. As a branch of medical ethics, it also deals with clinical and research ethics. The core issue of public health ethics is to balance the conflict between individual liberty and the public good. Because of the coronavirus disease 2019 (COVID-19) pandemic, deliberation based on public health ethics is required to reduce social disparities and increase community cohesion. This study presents three public health ethics challenges. The first is to introduce an egalitarian liberal approach to public health concerning social and economic issues experienced by vulnerable populations both domestically and globally. I then propose alternative and compensatory public health policies that serve the principles of justice. Second, public health ethics must ensure procedural justice in all public health policy decisions. For example, when deciding to implement public health policies, including restrictions on individual liberties, the decision making process must be open to the public. Third, citizens and students must be educated on public health ethics. The public must be provided with an open forum to deliberate on ethical issues related to public health as well as the appropriate training to do so.

The (Contrasted) Ethics of Covid-19 and HIV: Will the Favor be Returned?

With 118,000 cases in 114 countries and 4291 global mortalities, the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. The origins were believed to be from Wuhan, China, and SARS CoV-2, a coronavirus, was quickly identified as the causative organism. Researchers at the National Institute of Health Vaccine Research Center identified the spike protein as the critical portion of the virus that allows for attachment to human cells. In just 66 days after identifying the genetic sequence, the first COVID-19 vaccine candidate began the enrollment of human subjects into a Phase I clinical trial. This accelerated effort was due to a collective and collaborative global response. Currently, one COVID-19 vaccine has been approved and two others have received an emergency use authorization (EUA) from the United States Food and Drug Administration (FDA). Thus, there has been a clear comparison of the COVID-19 response efforts and that which was utilized in addressing the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. For over four decades, the HIV/AIDS epidemic has been historically defined by a disproportionate number of infections and related mortalities amongst racially and ethnically minoritized individuals, including those that identify as homosexual. While novel drug therapies have been developed for the treatment of HIV/AIDS; there have been key components employed amid the global health response to COVID-19, that have been absent from the management of the HIV/AIDS epidemic. Majorly, the development and availability of vaccine against HIV/AIDS. Many of the ideas and initiatives that have resulted in a positive COVID-19 response and the eventual successful vaccination development; have been those learned from the trial and error of mitigating increasing global rates of HIV/AIDS infections. Hence, the question remains as to whether the lessons and approaches learned during the COVID-19 pandemic, namely vaccination development, will be applied to managing the HIV/AIDS epidemic. Herein, we aim to compare the HIV/AIDS epidemic and COVID-19 pandemic, by describing how the fight against HIV/AIDs equipped global scientific leaders with effective strategies to overcome future public health crises (COVID-19), discuss the ethical considerations associated with the differences in the global health responses to the HIV/ AIDS epidemic versus the COVID-19 pandemic, and finally, identify lessons learned from the COVID-19 pandemic that can be applied to the quest for an HIV/AIDS vaccine..

Challenges and practices arising during public health emergencies: A qualitative survey on ethics committees.

The particular dynamics of public health emergencies urge scientists and Ethics Committee (EC) members to change and adapt their operating procedures to function effectively. Despite having previous pandemic experiences, ethics committees were unprepared to adapt to COVID-19 pandemic challenges. This survey aims to learn and thoroughly discuss the most salient issues for ECs during the COVID-19 pandemic. The results indicate that the main problems faced by ECs were lack of/insufficient regulations, lack of data/experience/knowledge, sloppy review, poor research design, and poor adaptation to quarantine measures. Coping with factors that threaten the autonomy and independence of ECs, the ethical dilemma regarding maximizing common good versus protecting the rights and well-being of study participants, comprehending the change in the context of vulnerable populations, and redefining the role of ECs to strengthen trust in science and vaccine confidence were outstanding issues.