The Epidemic Ethics Network was launched in 2020 to respond to an unmet need. Despite the existence of numerous ethics guidance documents and a growing community of bioethicists working in the area of pandemics/public health emergencies, no formal mechanisms existed globally to coordinate and support ethical decision-making in this context. This was true for ethical issues that arise not only in the operational response to public health emergencies, but also in preparedness, planning, and recovery activities, and also in the conduct of research during public health emergencies. At the time, in the light of recent experiences of Ebola and Zika, it was clear that there was a significant need to establish a network — a mechanism designed to be global and inclusive—to support ethical decision making by providing advice to researchers, practitioners, and governments. Capacity to develop and implement such support can vary significantly between affected settings locally and regionally.
Responding to these needs and opportunities, and the challenges presented by the COVID-19 pandemic, Epidemic Ethics is a global community of bioethicists and stakeholders involved in public health and research responses to public health emergencies. It brings together the expertise and resources available across the network to identify relevant ethical issues and provide real-time, trusted, contextual support to communities, policy makers, researchers, and responders in relation to ethical issues arising out of public health emergencies, with a current focus on the COVID-19 pandemic.
Epidemic Ethics is led by the World Health Organization and supported by key partners including the Fogarty International Center, Global Forum on Bioethics in Research, Global Network of WHO Collaborating Centres, The Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative (GLIDE), and Wellcome. Epidemics Ethics is supported by a Secretariat which rotates periodically, the initial host is the Ethox Centre at the University of Oxford.
At the time of launch, the intention was to pilot and grow the network through a series of outreach activities throughout 2020. However, COVID-19 took hold, the pilot was abandoned, and the network was launched in real-time. Activities to date have included a series of over twenty webinars, the establishment of four post-doc posts (in Brazil, Singapore, South Africa, and the UK/Switzerland), as well as the funding of over forty research projects focusing on some of the key ethical challenges that arose in the COVID-19 pandemic.
Going forward, key challenges for the network will focus on: how to leverage pre-existing networks to further build ethics capacity in this field; the development of a multi-national collaborative portfolio of conceptual and empirical research; and working further to embed ethics at the heart of decision-making both before and during public health emergencies.
This session will describe the achievements and challenges of the network to date and explore the future role of epidemic ethics and the World Health Organization in future public health emergencies and a post-pandemic world.
Key Themes in Epidemic Ethics
Co-Lead, Global Health Ethics & Governance Unit Katherine Littler | World Health Organization | Switzerland
Show details
Author:
Co-Lead, Global Health Ethics & Governance Unit Katherine Littler | World Health Organization | Switzerland
In October 2020, the World Health Organization and the Epidemic Ethics network put out a call for proposals to address the ethics of COVID-19 public health preparedness and response. There were over 150 expressions of interest and around 40 projects from across the globe funded. This presentation will focus on the key themes emerging from the projects, considering how they can and should feed into future pandemic preparedness and speak to issues of engagement and dissemination of bioethics research.
Public Health Emergency Preparedness and Response in the Global South: Urgent Ethical Questions from a Sexual and Reproductive Health Policy Review
Ilana G. Ambrogi | SRHR and Health Emergencies, Anis | Brazil
Show details
Author:
Ilana G. Ambrogi | SRHR and Health Emergencies, Anis | Brazil
The disproportionate impact of public health emergencies in the global South highlights the centrality of ethics in epidemics response, preparedness, planning, research, and recovery activities. The COVD-19 pandemic uncovered the fragility of a global coordination of epidemic governance and reconfirmed the extensiveness, urgency, and differing impacts of ethical issues during epidemics. Exchange of ethical deliberations among varied networks in different spheres, local, regional, and global, has become essential when rethinking epidemics governance.
The Zika epidemic in Latin America and the Caribbean region in 2015-6, particularly in Brazil demonstrated Sexual and Reproductive Health (SRH) in public health emergency preparedness and response as a critical ethical issue. Now, Brazil is the global leader in maternal mortality due to COVID-19, there has been increase in gender-based violence reported worldwide and women continue to be most affected.
There is urgent need for epidemics governance to effectively address gender inequalities. As such, ethical analysis that includes perspectives that recognize the historical oppressive consequences of colonization and coloniality are relevant and should include concepts of reproductive justice, intersectionality as well as a feminist bioethics analysis.
An ethical analysis of national SRH policies implemented during COVID-19 and mapping of local and regional networks involved in epidemic response and preparedness can promote a basis for common dialogue across networks. The goal is to promote diverse, multinational, and multilevel capacity-building regarding SRH as fundamental in the mitigation of the pandemic’s impact and as a long-term recovery benefit, specially to those most affected: women and girls in the global south.
Epidemic Ethics During the COVID-19 Pandemic: Lessons Learned
Prof. Susan Bull | University of Oxford | United Kingdom
Show details
Author:
Prof. Susan Bull | University of Oxford | United Kingdom
There is a complex, dynamic, and at times contested, landscape of academic literature and policy on ethical issues arising in epidemic preparedness and response. At times this is not informed by an in-depth understanding of practical issues arising in context, nor the voices of relevant stakeholders.
Epidemic Ethics engages with stakeholders globally around the key ethical issues encountered in practice by communities, policy makers, researchers, and responders during the pandemic, to inform priorities for research and support. This presentation reviews the activities, outputs and lessons learned. Areas addressed include the practical and substantive ethical issues arising when decision-making in constrained, inequitable and rapidly-changing pandemic health landscapes.
Integrating Ethics and Policy in Future Pandemic Preparedness and Response
Prof. Maxwell Smith | Western University | Canada
Show details
Author:
Prof. Maxwell Smith | Western University | Canada
A frequent refrain by organizational and national leaders in the COVID-19 pandemic has been that decisions are, or ought to be, evidence-based or science-led. Yet, it is important to acknowledge that values, like equity, fairness, solidarity, and security have also influenced decision-making in this context, even though it may be less clear exactly how they have done so or what they have committed decision-makers to. Values inform decision-making in at least two ways. First, policy is used to pursue an objective, i.e., something considered to be of value or worth. Science and evidence alone cannot tell us what is of value or worth – this requires a judgement informed by values (i.e., about what is ‘right’ or ‘good’). Second, decision-makers may rely more heavily, or at least more explicitly, on values in contexts of scarcity and contexts of uncertainty where the evidential basis for decisions is unclear.
People will have different values and commitments, and sometimes decisions can require us to make choices between important values. This can lead to difficult ethical decisions which need to be navigated by frontline health workers, researchers, and policymakers. Responsibility for these decisions can be burdensome. Sharing of expertise and good practice can be crucial to ensuring actors have the skills and support they need for dealing with these ethical challenges.
This presentation will explore how values inform decision-making in this context, and how, through ethics, values can and ought to be systematically examined and meaningfully incorporated to inform policy during pandemics.