COVID-19 demands ethical, as well as scientific, decisions

This article, by Jessica Miller, Erika Ziller and Katherine Weatherford Darling of the University of Maine, University of Southern Maine and University of Maine at Augusta and was originally published on the Bangor Daily News opinion page on August 25, 2020.

Visitors walk along the edge of the ocean, Thursday, Aug. 7, 2020, in old Orchard Beach, Maine. As the summer tourist season reaches its peak Maine’s coronavirus positivity rate remains among the lowest in the nation. Credit: Robert F. Bukaty / AP

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Almost six months into the pandemic, a microscopic virus has changed nearly everything about our social interactions and revealed how deeply our lives are interconnected. All of our decisions from a 75-year-old man wondering whether to go to the market, to a school principal deciding how to offer in person and remote learning, to a town official managing a major election — are now epidemiological risk assessments. The uncertainties, medical misinformation, data gaps and difficult choices of the pandemic have underscored the need for values-driven and democratic decision-making within public health policy. But, do we have the right tools for the job?

Experts at the podium argue they are “following the science” and surround themselves with infectious disease and epidemiology experts. While essential, many critical questions about how we should respond to the pandemic also require ethical insights that move beyond science and into the expert domain of social sciences and humanities. Epidemiologists can assess the risk of viral droplets, but communication science experts have insights and skills needed to design the communications plan that helps people understand why masking makes sense.

Analyses of infection rates and hospital capacity can predict the impact of surges on bed use, but the humanities raise critical questions about how to distribute those beds if there aren’t enough for everyone. Public health ethics has long grappled with the wicked problem of balancing community public good and individual rights and freedom. More than 100 years ago, in Jacobson v. Massachusetts, the U.S. Supreme Court ruled that the government has the right to require public health measures to protect communities from infectious disease.

The most challenging questions in public health require us to ethically consider how we balance the greater good with individualism. On what ethical basis do governmental authorities justify public health surveillance and mandates? How should scarce resources — testing, personal protective equipment, intensive care beds, and vaccines — be allocated?

Social science and humanities scholars are also trained to identify and confront health impacts of inequities built into our social institutions. As scholars working at the intersection of health and society, we know health policy and practice reflect society’s core ethical values and also illustrate where espoused values diverge from reality.

Health injustice and inequity persist in our schools, workplaces, health systems and communities. Some groups are structurally vulnerable to illness, whether it’s a novel virus, or well-documented public health threats like tobacco. In Maine, we can see these fundamental causes of health at work in our racial inequities in COVID-19 cases that are among the widest in the nation. The social determinants of health, such as education, employment, and social connections shape who is put “at risk of risks”.

In addition to analyzing the structural influences on health, we also have the conceptual and methodological tools needed to show us the perverse incentives built into biomedicine. Fee-for-service payment models prioritize treating illness over prevention and primary care, and prevention only accounts for a small fraction of healthcare dollars because we’ve come to think of health as a business plan. Strategic investments that promote the biopharmaceutical industry as a path to economic development further entrench the idea that we should think of health as a “growth market” instead of a public good. Our investment strategies and reimbursement policies have yet to account for what we know about the overwhelming impact of social and structural forces on our health.

Many of us are hoping a COVID-19 vaccine or effective antivirals will help us return to “normal.” Will it be enough? Better risk assessments won’t address how we unequally distribute risk or help explain who is made most vulnerable. Better science won’t tell us what we owe each other or how to shift systems to prioritize care for the most vulnerable members of our society.

COVID-19 has shown us the dangers of eroded trust and dismantled public health infrastructures. These fundamental and systemic challenges to our health won’t be addressed by a quick technical fix. We must view social scientists and humanities experts as essential workers for crafting the COVID-19 response, designing the research and development strategies and re-building the health systems we need to support more equitable and resilient communities.

Jessica Miller is a professor of philosophy and associate dean for faculty affairs and interdisciplinary programs in the College of Liberal Arts and Sciences at the University of Maine. Erika Ziller is an assistant professor of public health at the University of Southern Maine. Katherine Weatherford Darling is an assistant professor of sociology at the University of Maine at Augusta. Ziller and Darling are members of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. SSN members’ columns appear in the BDN every other week.

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