PUBLIC HEALTH ETHICS VOLUME 13 • ISSUE 2 • 2020 • 125–126 125

Public Health Ethics in a Pandemic

Marcel Verweij *, Section Communication, Philosophy and Technology,
Department of Social Sciences, Wageningen University
Angus Dawson, Sydney Health Ethics, School of Public Health, University of Sydney
*Corresponding author: Marcel Verweij, Section Communication, Philosophy and Technology, Department of Social Sciences, Wageningen University,
Hollandseweg 1, 6706 KN Wageningen, The Netherlands. Tel.: þ31317484310; Email: marcel.verweij@wur.nl

Ten years ago, we (re)published a historical pamphlet loved ones, loss of jobs and income, reduced access to

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written during the 1665 Great Plague, by an anonymous medical care for non-COVID patients, schools closed for
inhabitant of London, entitled The Shutting Up Infected a long time with life-long impact on children’s oppor-
Houses (Anonymous, 2010; Verweij and Dawson, 2010). tunities etc. Universal measures impact upon everyone,
The author vividly argued against the practice of locking but there will often be already disadvantaged groups who
people up in their own houses as a means of preventing suffer the negative consequences of universal actions
further disease transmission within the community. disproportionately.
Many of those imprisoned in their own houses might In a large and novel pandemic such as the one we are
not have been sick or infected at all. They were not currently living through, in the absence of a vaccine or
treated as victims, but first and foremost, as a threat to adequate treatments, societies fall back upon some of the
others. The ‘quarantined’ families could only hope that oldest and simplest forms of infectious disease control.
they would be given some support in their home prison Quarantine, isolation, physical distancing, the creation
and not left there to die from hunger or thirst. The an- of barriers at borders are central because every contact
onymous author argued that this policy created fear that might be a vehicle for transmission and infection. Many
was highly counterproductive: it would lead to the dis- of us have been staying in our homes, through different
ease going underground, and people who experienced degrees of voluntariness and compulsion. As a result, the
symptoms would rush out of the city, thus contributing societal life that we mostly take for granted, with its many
to the spread of infection elsewhere. (By the way, the opportunities for being together in a crowd at music,
pamphlet also contains some recipes for homemade theatre, sporting and religious events, disappears. This
remedies to prevent and cure the plague. We recom- situation allows us to see the significance of having ad-
mend that you do not rely upon any of them during equate diagnostics, treatments and most importantly a
the infrequent plague outbreaks that still occur.) vaccine, as the means to rebuilding economic and cul-
Now, in 2020, we see a large variety of measures, tural life and meeting family and friends again. Yet the
everywhere in the world, with the aim of containing production of a vaccine raises many public health ethics
the spread of the severe acute respiratory syndrome cor- issues that require discussion in the near future, includ-
onavirus 2 (SARS-CoV-2) virus. These measures are not, ing the consequences of a fast-track quest for a vaccine,
perhaps, as arbitrary as those of 17th Century London. the equitable distribution of what will initially be a scarce
The choice of universal distancing measures and nation- vaccine, and the implications of a global vaccination
al and international lockdowns which apply to everyone, programme that will require a very high level of
might even be seen as protecting, thus expressing some participation.
solidarity with the most vulnerable groups in our society,
for whom the disease is most dangerous. It is also sig- This issue of Public Health Ethics has two sections that
nificant that in many countries the resources of the mod- fit well with current issues. The first is a selection of
ern welfare state have not been used merely to oppress papers that directly deal with or are specifically relevant
but also to support impacted individuals and popula- to the COVID-19 pandemic. They are concerned with a
tions. Notwithstanding this positive aspect, the quaran- diverse range of topics including whether COVID-19
tine and lockdown measures that have been taken, are patients should be isolated together with their loved
unprecedented, dramatic and deeply affect people’s ones, whether there is a maximum level of acceptable
health and well-being. There is a long list of consequen- risk in the context where a novel drug or vaccine is ur-
ces, including: lack of social and physical contact with gently needed, and how a step-by-step opening up of
doi:10.1093/phe/phaa032
Advance Access publication on 28 October 2020
C The Author(s) 2020. Published by Oxford University Press.
V
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/),
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126 • VERWEIJ AND DAWSON

societies after confinement can be achieved in a respon- number of manuscripts submitted to our journal has
sible way. The section also contains a clarification of core doubled in the past half year. We see this as an important
ethical concepts often used in policy making, and a dis- opportunity to strengthen both the discipline of public
cussion of the role of ethical expertise in setting up a health ethics and, in turn, the journal Public Health
triage protocol. Ethics. We are heartened by this lively interest in the
issues but will remain committed to the highest academ-
The issue also has a section on immunization policies. ic standards for our journal. For this reason, we have
Steven Kraaijeveld develops an ethically relevant tax- decided to expand the editorial team of our journal.
onomy of types of vaccination. Although he does not We are happy to announce that Lynette Reid
discuss COVID-19 vaccination, it might be that his con- (Dalhousie University, Canada) and Daniel Goldberg
cept of altruist vaccination will appear to be applicable (University of Colorado at Denver, USA) have taken

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and relevant in this area. One can imagine that young up roles as associate editors, joining James Wilson
people for whom the risk of COVID-19 is reduced may (University College London, UK) who has been an as-
be a target group for effective (‘altruist’) vaccination sociate editor for several years. The team will be further
programmes, thereby aiming, indirectly, to protect broadened as necessary. We also welcome Beatrijs
more vulnerable groups, especially the elderly. The other Haverkamp (Wageningen University, Netherlands) as
papers, by Pierik and by Rashi, are specifically about our new book review editor. We extend our sincere
childhood immunization. Roland Pierik argues that
thanks to the members of our editorial board, to all the
governments must secure basic (not best) interests of
reviewers that perform such essential work, and to our
children and strike a balance between precaution and
outstanding colleagues at Oxford University Press who
proportionality. Tsuriel Rashi discusses vaccination
ensure such high production standards.
from a Jewish ethical perspective. Both papers offer
Public Health Ethics has three issues per year, and so
grounds for restricting and resisting the choice of
space is limited. However, the journal is committed to
parents to refuse vaccination for their children.
covering the whole range of issues across the field of the
One might expect that a serious pandemic like SARS-
ethics of public health and prevention. Although ethical
CoV-2, given the mortality and morbidity it causes, and
issues of importance during pandemics are likely to ap-
the burdens that infection control measures put on
pear often in our table of contents, we look forward to
everybody, would largely silence anti-vaccination voices.
receiving manuscripts on other topics. Just as COVID-
However, this is not the case. Indeed, it seems that con-
spiracy theories that have been endorsed by such groups 19 should not dominate all policies and concerns in the
for some time may be embraced by larger groups who field of public health, we should not neglect, in our jour-
resist the public health measures taken in the name of nal, such important ethical themes as health inequalities,
COVID-19. These diverse groups share a conviction that lifestyle choices, access to clean air, water and healthy
governments and public health authorities seek unlim- food, malaria control, preventive mental health, occu-
ited power over individuals and that active resistance is pational health ethics and screening programmes, etc. As
needed to protect individual liberty. The question as to in other parts of life, we can’t let the pandemic and
which policies may be legitimate and justified, raised by proposed control measures determine each and every
the anonymous author of the 1665 pamphlet mentioned choice we make—indeed, that is also what public health
above, will remain a central theme in public health ethics ethics is about.
as applied political philosophy.

Since this journal was founded in 2008, we have seen

References
public health ethics taking on a more and more prom- Anonymous (2010). The Shutting Up Infected Houses.
inent role in the larger field of bioethics, and this has only Public Health Ethics, 3, 4–12.
grown due to the current pandemic. Just as everyone on Verweij, M. and Dawson, A. (2010). Shutting Up Infected
Twitter is now an (apparent) expert epidemiologist, Houses: Infectious Disease Control, Past and Present.
everyone now seems to be a public health ethicist. The Public Health Ethics, 3, 1–3.