Subject(s)Anticoagulants , Venous Thromboembolism , Humans , Uncertainty , Enoxaparin , Freedom , Pyridones
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.
Subject(s)COVID-19/prevention & control , Dissent and Disputes , Health Policy , Mandatory Programs/ethics , Motivation/ethics , Patient Acceptance of Health Care , Vaccination/ethics , Altruism , Coercion , Freedom , Humans , Pandemics , Public Health/ethics , SARS-CoV-2
Subject(s)COVID-19 Vaccines , COVID-19 , COVID-19/epidemiology , COVID-19 Vaccines/therapeutic use , Freedom , Humans , Mandatory Programs
Concerns regarding the safety of COVID-19 vaccination have caused hesitancy and lowered uptake globally. While vaccine hesitancy is documented globally, some continents, countries, ethnic groups and age groups are disproportionately affected, resulting in significant global inequities. To date, Africa has the lowest COVID-19 coverage globally, with only 22% of its population completely vaccinated. It might be argued that the difficulty with COVID-19 vaccine acceptance in Africa was triggered by the anxiety created by misinformation on social media platforms, particularly with the misinformation regarding depopulating Africa, given the significance of maternity in the continent. In this work, we examine numerous determinants of poor vaccination coverage that have received little attention in primary research and that may need to be considered by various stakeholders engaged in the COVID-19 vaccine strategy at the national and continental levels. Our study also emphasizes the importance of a multidisciplinary team when introducing a new vaccine, for people to trust that the vaccine is truly helpful to them and to be convinced that immunization is, all things considered, worthwhile.
Subject(s)COVID-19 Vaccines , COVID-19 , Female , Pregnancy , Humans , COVID-19/prevention & control , Vaccination , Africa , Freedom
During the COVID-19 pandemic, women and girls across the globe faced increased reliance on the digital space to access education, social support, and health and gender-based violence (GBV) services. While research from the last three years has explored how women and girls navigated and responded to their new virtual reality, minimal evidence has been generated from low-resource settings where access to technology may be limited. Further, no studies to date have examined these dynamics in Iraq, where women and girls already face numerous threats to safety due to various forms of structural violence and patriarchal family structures. This qualitative study aimed to examine women and girls' experiences in the digital space during COVID-19 in Iraq, including the benefits and risks of engagement as well as how access to the digital space was controlled. Data for the present analysis come from the authors' larger multi-country study investigating women and girls' safety and access to GBV services in the context of the COVID-19 pandemic and related public health measures employed to control the spread of the virus. In Iraq, semi-structured key informant interviews were conducted virtually with fifteen GBV service providers. Following the translation and transcription of interviews, the thematic analysis highlighted several benefits and challenges women and girls experienced as they tried to access and utilize technology for schooling, support services, and obtaining and spreading information. While many women and girls increasingly and successfully relied on social media to spread awareness of GBV cases, key informants noted that women and girls also faced increased risks of experiencing electronic blackmail. In addition to a substantial digital divide in this context-which manifested as differential access to technology by gender, rural/urban status, and socioeconomic status-intrahousehold control of girls' access to and use of technology left many adolescent girls unable to continue schooling and contributed to their further marginalization and consequent decline in well-being. Implications for women's safety and mitigation strategies are also discussed.
Subject(s)COVID-19 , Pandemics , Adolescent , Humans , Female , Iraq , Violence , Freedom
Several countries have implemented COVID-19 health passes or certificates to promote a safer return to in-person social activities. These passes have been proposed as a way to prove that someone has been vaccinated, has recovered from the disease, or has negative results on a diagnostic test. However, many people have questioned their ethical justification. This article presents some practical and ethical problems to consider in the event of wishing to implement these passes. Among the former, it is questioned how accurate diagnostic tests are as a means of ensuring that a person is not contagious, whether vaccination guarantees immunity, the fact that health passes can be forged, whether they encourage vaccination, and the problem that there is no universally recognized health pass. Among the ethical issues, it is discussed whether health passes promote discrimination and inequality and whether they violate rights to privacy and freedom. It is concluded that health passes have enough ethical justification to be implemented.
Subject(s)COVID-19 , Humans , Freedom , Privacy
Subject(s)Freedom , Public Health , Female , Humans , Human Rights
Health misinformation, most visibly following the COVID-19 infodemic, is an urgent threat that hinders the success of public health policies. It likely contributed, and will continue to contribute, to avoidable deaths. Policymakers around the world are being pushed to tackle this problem. Legislative acts have been rolled out or announced in many countries and at the European Union level. The goal of this paper is not to review particular legislative initiatives, or to assess the impact and efficacy of measures implemented by digital intermediaries, but to reflect on the high constitutional and ethical stakes involved in tackling health misinformation through speech regulation. Our findings suggest that solutions focused on regulating speech are likely to encounter significant constraints, as policymakers grasp with the limitations imposed by freedom of expression and ethical considerations. Solutions focused on empowering individuals - such as media literacy initiatives, fact-checking or credibility labels - are one way to avoid such hurdles.
Subject(s)COVID-19 , Humans , European Union , Public Policy , Communication , Freedom
This rapid qualitative exploratory study focused on perceptions of adopting risk-reduction measures, such as face masks, on campuses within institutions of higher education in the United States. It was intended to identify safety measures to reduce virus spread and develop community-informed public health messaging to promote COVID-19 risk-reduction strategies within campus communities. This study was approved by the institutional review board where the study took place. A total of 113 stakeholders, including students, staff, and faculty attended one of nine focus groups. We use the socioecological model to illustrate the use of COVID-19 public health measures in private and public spaces and how macro-level processes, specifically sociocultural values of personal freedom and social responsibility shape the meaning and interpretation of COVID-19 public health measures. A rapid qualitative data analysis was conducted. This analysis was characterized by three steps: (1) transcription of the interviews, (2) completion of a summary template per focus group analysis (data reduction strategy), and (3) matrix analyses involving a cross-case analysis of the nine focus groups conducted. Based on study findings, we offer community-centered recommendations for safe and healthy reopening of large public research institutions. This article contributes to the foundation of scientific literature that qualitatively describes evidence-based strategies for safe reopening of places of education and employment in the COVID-19 pandemic.
Subject(s)COVID-19 , Freedom , Humans , Pandemics/prevention & control , SARS-CoV-2 , Social Responsibility , United States/epidemiology
Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit's arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe different forms of paternalism arising from a reductionist view of personal identity. I outline an Identity Relative Paternalistic Intervention Principle for determining when we should disallow refusal of treatment where the harm will be accrued by a future self, and consider objections including vagueness and non-identity.Identity relative paternalism does not always justify intervention to prevent harm to future selves. However, there is a stronger ethical case for doing so than is often recognised.
Subject(s)Freedom , Personal Autonomy , Humans , Paternalism , Treatment Refusal
Subject(s)Commerce , Communicable Disease Control/legislation & jurisprudence , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Public Policy/legislation & jurisprudence , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Economics , Employment/legislation & jurisprudence , Freedom , Humans , Liability, Legal , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health , SARS-CoV-2 , United States/epidemiology
Vaccination is an essential public health intervention to control the COVID-19 pandemic. A minority of Canadians, however, remain hesitant about COVID-19 vaccines, while others outright refuse them. We conducted focus groups to gauge perceptions and attitudes towards COVID-19 vaccines in people who live in a region with historically low rates of childhood vaccination. Participants discussed their perception of COVID-19 vaccines and their intention to get vaccinated, and the low rate of COVID-19 vaccine uptake in Manitoba's Southern Health Region compared to other regions in Canada. We identified three drivers of vaccine hesitancy: (1) risk perceptions about COVID-19 and the vaccines developed to protect against it, (2) religious and conservative views; and (3) distrust in government and science. Participant proposed recommendations for improving communication and uptake of the COVID-19 vaccines included: public health messages emphasising the benefits of vaccination; addressing the community's specific concerns and dispelling misinformation; highlighting vaccine safety; and emphasising vaccination as a desirable behaviour from a religious perspective. Understanding the specific anxieties elicited by COVID-19 vaccines in areas with low childhood immunization rates can inform risk communication strategies tailored to increase vaccination in these specific regions. This study adds important information on potential reasons for vaccine hesitancy in areas with historically low rates of childhood vaccination, and provides important lessons learned for future emergencies in terms of vaccine hesitancy drivers and effective risk communication to increase vaccine uptake.
Subject(s)COVID-19 Vaccines , COVID-19 , Humans , COVID-19/prevention & control , Pandemics , Vaccination Hesitancy , Canada , Vaccination , Freedom
PURPOSE: Active travel (AT) incorporates physical activity into daily living, critical for healthy adolescent development. We explore adolescent and parent attitudes and behaviours related to motivations for adolescent AT and effects of the COVID-19 pandemic. METHODS: We conducted semi-structured Zoom interviews with 25 adolescent-parent dyads in communities across Israel during early stages of the COVID-19 pandemic. Thematic content analysis was used to develop categories and themes. RESULTS: We identified key themes related to adolescent AT: Fostering independence enables adolescent AT; Pampering and safety concerns inhibit adolescent AT; Family and community norms influence adolescent travel modes; Personal enjoyment and positive attitudes facilitate AT; Peers and social networks promote adolescent AT and PA; Built environment and transport options influence AT choices. Interestingly, adolescents indicate AT is an opportunity for peer-to-peer communication without screen distraction, yet they use social media to promote AT and PA. CONCLUSIONS: The findings point to the influence of positive parent perceptions, active and supportive family and community norms on adolescent AT. Peer norms and social networks as well as features of the built environment also have the potential to influence AT. The COVID-19 pandemic encouraged use of AT and provided a setting for positive AT experiences.
Subject(s)COVID-19 , Adolescent , Freedom , Humans , Motivation , Pandemics , Parents
Subject(s)COVID-19 , Public Health , Freedom , Humans
Subject(s)Social Media , Female , Freedom , Humans
In the name of health security, individual freedoms were constrained in an unprecedented way in many countries, democratic or authoritarian, all over the world during the COVID-19 pandemic. Yet the constraints have not been consistent across countries, which motivates this paper to examine the relevance of value preferences towards freedom or security in the society for COVID-19 policies. Based on data for 40 democratic and authoritarian countries, the analyses show that the variation in the stringency of COVID-19 policies can be explained by value preferences of the population only in autocracies. In democracies, however, we do not find such a relationship. Governments in democratic political systems, we argue, are responsive to their constitutions and face prosecution by the judiciary if they violate the law or provisions of the constitution, limiting their capacity to implement strong COVID-19 policies. Nevertheless, their COVID-19 policies restricted citizens' freedoms and liberties, which means that these policies were rather not responsive to citizens' preferences for freedom, democratic rights and liberties. By highlighting how autocracies respond to their citizens' value preferences for security, this paper contributes to a better understanding of how autocracies might gain legitimacy in times of crises.
Subject(s)COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Democracy , Freedom , Humans , Pandemics/prevention & control , Policy
Australia's experience of the COVID-19 pandemic has been widely perceived to have been a successful one, based on the relatively few number of lives lost to the virus compared to the rest of the world. There remain, nonetheless, serious ethical challenges at the heart of the Australian response to COVID-19. The broadly positive outcomes of Australia's pandemic response mask more troubling developments within its political culture, and the costs it has imposed on its society. This article examines two concerns in particular: the normalisation of fear and emergency through the language and policy responses adopted by governments, and the significant diminution of individual freedoms and human rights.
Subject(s)COVID-19 , Australia/epidemiology , COVID-19/epidemiology , Fear , Freedom , Humans , Pandemics
Subject(s)COVID-19 , Freedom , Humans , SARS-CoV-2
Plato and Aristotle place opinion intermediate between knowledge and ignorance with all opinions under the suspicion of error. Kant summarized that opinion is a consciously insufficient judgement, subjectively and objectively. Belief is subjectively sufficient, but is recognized as being objectively insufficient. Only knowledge is subjectively and objectively sufficient. Despite this philosophically doubtful value of opinions, thinkers such as Milton, Locke, Montesquieu and Mill maintain that the freedom of opinion and speech are the basis of open societies but find limits when it represents a definite risk of damage, either to an individual or to the public. Also the UN Covenant on Civil and Political Rights proclaims the right to hold opinions without interference provided that it respects the rights or reputations of others and does not interfere with the protection of public health. Hate speech and propaganda for war are expressively prohibited. Postwar US politicians formulated the position that every man has a right to his own opinion, but no man has a right to be wrong in his facts. The impact of this discussion on opinions about control measures of the COVID-19 pandemic is explored in this editorial.
Subject(s)COVID-19 , Speech , Freedom , Humans , Pandemics
Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and public speech that transpires beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression.