Philosophers seek to make space in pandemic response

Sridhar Venkatapuram, is an Associate Professor at the Global Health Institute, King’s College London. He has spearheaded the Independent Resource Group for Global Health Justice (IRG-GHJ “URGE”), along with other philosophers and experts to address the some of the biggest questions of the times we are now living in.

You can also watch this recent event where these experts lucidly explain what they intend to do in getting organizations to discuss complex global justice matters and the ethical issues that this pandemic has thrown up.

He spoke to Geneva Health Files at length on how issues around allocation and distribution of medical products, for example, are being framed and why it is important to question the framing of these matters.

Q&A: Sridhar Venkatapuram, Associate Professor, Global Health Institute, King’s College London, and Chair of the Independent Resource Group for Global Health Justice

[GHF]: How would you explain to a lay person, what role can ethics play during the current pandemic? Have ethics being sufficiently integrated in our institutional response to COVID-19?

[SV]: To a lot people, ethics is an unknown quantity. There is a general lack of understanding or appreciation of what ethicists do, and what they don’t do. Ethics and bioethics do not mean the same thing.

In WHO, for example, ethics are used in two different contexts – one where it is about issues such as compliance, corruption, sexual harassment among others. That is a kind of professional ethics. Then there is a second area where people use the word ethics which is around research ethics. So, if someone is undertaking in some sort of research study, they have to submit a report to an Institutional Review Board or an Ethics Review Board.

WHO has a small ethics unit dealing with research ethics and increasingly beyond that. But there are concerns over whether this small ethics unit, and academics that are linked to it, is well-represented by relevant experts from different countries. Is there meaningful diversity in the representation of ethical traditions? So far, the bulk of the intellectual work of ethics group was being done by external collaborating centres because WHO does not have the resources. These collaborating centres have been overwhelmingly dominated by Anglo-American bioethicists. That is because, bioethics as field is professional and large in North America.

Well-funded universities, bring their research agenda to WHO and contribute to global ethics guidance.

Therefore, the ethics guidance produced by the WHO, risks being centered around what American ethicists deem as important, which may or may not be relevant to the world.

So, for example, what is interesting for these collaborating centres could be issues such as new technologies, big data, genome editing – which is great. But when it comes to the big public health problems, or understanding the social causes of health, or say how does trade impact, social inequality and health, how do economic policies impact on health – these issues do not get adequate importance. Typically, people working on these issues do not have a “collaborating centre relationship” with WHO. These kinds of issues, move into politics and political philosophy.

So, people who work on public health ethics, or have depth of knowledge of LMICs, have not be as engaged or involved in determining the ethics response to this pandemic.

We now know because of this pandemic that it’s not just about research ethics. If you look back at the WHO meeting in February, the roadmap seemed to present ethics questions as to do with doing ethical research about SARS-Cov2. To be clear, this is not only just about public health ethics, but also about global health ethics, and global ethics in general. So when one country starts stealing the Personal Protective Equipment (PPE) of another country, what do we say about the ethics of that? Worse, what happens when we don’t say anything about it in terms of ethics?

How we should relate to each other across countries during a crisis or what do we say about the fact that a country failed in its ability and responsibility to notify the world quickly and clearly that there’s something dangerous that’s coming out of their country?

So, in order to fill some of the many gaps, we have been trying to get experts on public health and global health ethics involved in this process of a global response.

What began as a group tasked with research ethics at WHO, quickly transformed itself into a group responsible for wider ethical issues on the pandemic. It also took some effort to get the membership be made public. But the group does not necessarily have the expertise on some of these big social and political choices happening at the national and global levels. This is where the politics comes in.

There are concerns by range of actors and Civil Society Organizations (CSOs) that the ACT Accelerator, for example, does not adequately recognize or account for the many ethical dimensions arising in each of its pillars. Rather the focus has largely been on logistics and operations. There is also very little information on who is on these different pillars, how they got there, and who is being asked to do what. There is a need for transparency on how these decisions are taken.

From a social and global ethics perspective, the lack of transparency is a problem because you do not distribute or you do not design distribution of life-saving goods in secret. A secret group of experts cannot decide who lives or gets helped, while others do not help and possible die. That would not be allowed to happen in most democratic societies, and it is certainly not what was envisioned in how the UN systems should world. Especially during a crisis, we must make sure that there is transparency, legitimacy, process, and outcomes and accountability.

Who should be taking the moral decisions on who lives and who dies?

Not enough people are challenging the ideas that are being handed down in some sense. There seems to be worry that scrutinizing what the ACT-A actors are doing will be seen as criticising the ACT-A, especially given the exceptional crisis ethos around all of it.

In political decisions about justice and equity, there is a need for transparency and legitimacy and publicity.


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