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Public health measures to control an epidemic often encounter resistance.

We list here challenges to the ethical practice of public health in the COVID-19 pandemic.

Concerns

  • The most influential spreader of Coronavirus misinformation online. New York Times, July 24, 2021.
  • Just 12 people are behind most vaccine hoaxes on social media. NPR, May 14, 2021.
  • Russian disinformation campaign seeks to undermine confidence in COVID-19 vaccines used in the U.S. CNN, March 8, 2021.
  • COVID-19 disinformation: How to spot it – and stop it. Union of Concerned Scientists, February 12, 2021.
  • Fighting the spread of COVID-19 misinformation. Harvard TH Chan School of Public Health, February 9, 2021.
  • COVID misinformation is killing people. Scientific American, October 11, 2020.
  • The pandemic of disinformation in COVID-19. Nature Public Health Emergency, August 1, 2020.
  • Coronavirus Misinformation Tracking Center. NewsGuard.

Ethical principles challenged

  • Even when access to treatment or prophylaxis is limited, the public is entitled to timely and accurate information. WHO Ethics in Pandemic Flu
  • Some of this information will inevitably be uncertain and this uncertainty should also be com­municated in clear, non-alarmist language. Informa­tion available will change continuously throughout the pandemic, requiring adjustments of response strategies based on ongoing assessments of the risks and potential benefits of interventions. WHO Ethics in Pandemic Flu
  • Information should be consistent, transparent, and widely shared within each community and within each state. Indiana University
  • Incorporate individual and community experiences and perspectives in the development of individual and collective solutions to public health issues. APHA Code of Ethics, 3.6.
  • Incorporate scientifically vetted, research-based data to the fullest extent possible. APHA Code of Ethics, 5.2.
  • Include impartial mechanisms for assessing the ethical appropriateness of public health policies and plans after they have been implemented, as well as mechanisms for adjusting such policies and plans to ensure continued adherence to ethical standards. APHA Code of Ethics, 5.10.

Concerns

  • Rural hospitals can’t find nurses they need to fight COVID. NC Health News, September 5, 2021.
  • The impact of chronic underfunding on America’s public health system. Trust for America’s Health; The Milbank Quarterly, June 2020.federal
  • With a largely preventative goal, public health has been overlooked and underfunded. Washington Post, March 12, 2020.
  • Public health department funding and employment has been steadily decreasing for years, leaving a workforce ill-equipped to handle this outbreak. Associated Press, August 24, 2020.

Ethical principles challenged

  • Developing and maintaining health-care infrastructures for primary care is a ma­jor priority for pandemic preparedness, especially because such investments will be beneficial at all times and not only during a pandemic. WHO Ethics in Pandemic Flu
  • Public health officials have a responsibility to maximize preparedness in order to minimize the need to make allocation decisions later. CDC Ethics in Pandemic Flu 
  • Provide for the recruitment, retention, and career development of highly qualified public health practitioners in managerial roles. APHA Code of Ethics, 4.11.1.

Concerns

  • A CDC error in developing a COVID-19 diagnostic test resulted in blame, mistrust, and silencing of the agency. Washington Post, May 21, 2020.
  • The US federal government blamed WHO for their flawed early response to COVID-19 and lost United States funding. Time Magazine, April 20, 2020.
  • The federal government’s “state authority hand-off” (delegating the COVID responses to the states) early in the pandemic lessened federal level effectiveness and credibility. New York Times, July 18, 2020.
  • The federal executive branch under Trump does not accept responsibility for errors and inadequacies, instead blaming scientists and the prevalence of pre-existing health conditions for high COVID-19 death tolls. CNN, May 18, 2020.

Ethical principles challenged

  • The public should know who is responsible for making and implementing decisions in relation to the outbreak response, and how they can challenge decisions they believe are inappropriate. WHO Ethics in an Outbreak 
  • Public health practitioners and organizations promote competence, honesty, and accuracy and ensure that their work is not unduly influenced by secondary interests. Public health decision makers need to be transparent and honest about disclosing conflicting interests and influences. APHA Code of Ethics, Section 2.

Concerns

  • Kansas lawmakers look to undercut federal vaccine mandates. Kake.com, November 19, 2021.
  • Hospitals were mandated to send data about COVID-19 hospitalizations to a federal database rather than the Centers for Disease Control and Prevention. National Public Radio, July 15, 2020.
  • Due to the invisible nature of public health programs, the United States government has historically ignored and denied threats of new epidemics. The New Yorker, March 17, 2020.
  • Placing the responsibility on individuals to decide for themselves what to do and turning public health measures into partisan issues have rendered public health efforts less effective. CNN, June 26, 2020.
  • Scientists have become a target and conspiracy theories have brought negative attention to public health organizations. Politico, April 21, 2020.
  • Federal executive branch contradictions of the CDC have left citizens unsure of what guidance and precautions to follow. The News & Observer, March 5, 2020.
  • A lack of federal guidelines and rules for reopening businesses has resulted in businesses rather than public health professionals deciding on the measures they will take. Washington Post, July 9, 2020.

Ethical principles challenged

  • Promote constructive communication among the public, nongovernmental entities, individuals, and groups that draft and enact public health legislation and individuals and groups within the government that develop and implement public health activities. APHA Code of Ethics, 4.12.1
  • Avoid conflicts of interest that could interfere with the willingness to acknowledge public health threats. APHA Code of Ethics 4.2.2
  • Public health laws should be established by government authorities authorized to enforce public health laws. APHA Code of Ethics, 4.6.1

Concerns

  • Without public access to CDC data, public health agencies will be hindered since they rely on the information to make projections and crucial decisions.  WRAL, July 15, 2020.
  • A report written by the CDC entitled “Guidance for Implementing the Opening Up America Again Framework” was not published to the public. Associated Press News, May 7, 2020.
  • A government whistleblower faced retaliation for opposing a White House directive allowing widespread access to hydroxychloroquine. Associated Press, May 14, 2020.
  • Hospitals are threatening to fire healthcare workers who share information with the press about their working conditions during the pandemic. Bloomberg, March 31, 2020.

Ethical principles challenged

  • Avoid conflicts of interest that could interfere with the willingness to acknowledge public health threats. APHA Code of Ethics 4.2.2
  • There is a commitment to transparency throughout the pandemic influenza planning and response process. CDC 
  • Transparency requires policymakers to ensure that their decision- making process is open and accessible to the public, through clear and frequent communication of information. WHO Ethics in Pandemic Flu 
  • Establish formal structures, such as ethics committees, to address and resolve ethical disagreements and challenges and to enhance organizational ethics and decision making. APHA Code of Ethics, 4.11.7.

Concerns

  • Water cannons fired at COVID protesters in Belgium (video). BBC News, November 22, 2021.
  • Why Healthcare workers are quitting in droves. The Atlantic, November 16, 2021.
  • “They see us as the enemy”: School nurses battle COVID-19 and angry parents. New York Times, November 13, 2021.
  • Local public health employees receive national courage award. Lookout Santa Cruz, October 5, 2021.
  • NHS doctor receives 20-30 abusive messages a day (video). BBC News, January 13, 2021.
  • Public health workers are facing regular threats around the country, which is leading to burnout and resignation. CNN, June 23, 2020.
  • Public health officials have become targets of threats and harassment. The New York Times, June 22, 2020.
  • Security details have been assigned to state health leaders due to increased public scrutiny. Kaiser Health News, June 12, 2020.

Ethical principles challenged

  • Provide legal protections for health care providers who, during a declared public health emergency, may be asked to perform services outside of their usual realm of responsibilities or to administer interventions which are not yet scientifically validated. CDC Ethics in Pandemic Flu
  • Maintain an organizational culture that promotes ethical integrity and equal dignity and respect in relationships among staff, with the outside community, and with the beneficiaries of the organization’s public health programs and services. APHA Code of Ethics 4.11.4
  • Decision makers will be confronted with the challenge of maintaining stakeholder trust while simultaneously implementing various control measures during an evolving health crisis. Trust is enhanced by upholding such process values as transparency. University of Toronto

Concerns

  • Elected officials and people in the community are pressuring public health officials to ease restrictions. CNBC, June 12, 2020.
  • Attacks and threats towards public health officers impairs their ability to make recommendations solely on science and free from intimidation. Stat News, June 26, 2020.
  • A public health official in Florida was pressured to adjust information on the public facing portal to align with the decision to start loosening restrictions. Washington Post, June 16, 2020.
  • The governor of Georgia s suing the Atlanta mayor and city council to block the city from enforcing its masking mandate. Associated Press, July 17, 2020.

Ethical principles challenged

Concerns

  • The politicization of the pandemic coupled with widespread anxiety and unpopular containment measures has led to a loss of public trust. The Washington Post, June 27, 2020.
  • To many people, masks represent adherence to civic duty and a willingness to make individual sacrifices for the greater good of public health. To others, masks symbolize government overreach and a violation of personal liberty. Washington Post, June 19, 2020.
  • Misinformation about contact tracing has some citizens believing that public health officials are invading their privacy in the name of contact tracing.  National Public Radio, June 11, 2020.
  • The federal executive branch has undermined CDC recommendations, leading to public doubt of the recommendations. Washington Post, July 14, 2020.
  • Individuals claim that mask requirements impair individual freedom. The Guardian, June 29, 2020.

Ethical principles challenged

  • Balance perceived needs with expressed and expert-defined needs to improve community health. APHA Code of Ethics, 4.1.3
  • Be responsive to community perspectives on health challenges, opportunities, and priorities for action. APHA Code of Ethics, 4.4.5
  • Include appropriate publication of the public health law and educate the public on how to comply with both the letter and the spirit of the law. APHA Code Ethics, 4.6.5

Concerns

  • Public health officials are quitting or getting fired. Kaiser Health News, August 11, 2020.
  • Politicians shunt aside public health officials. Pew, June 18, 2020.
  • At least 27 state and local health leaders from 13 states have resigned, retired, or been fired since April 2020. Kaiser Health News, June 12, 2020.
  • Concern for the long-term health impacts of losing so many public health professionals. The San Diego Union-Tribune, June 18, 2020.
  • A West Virginia public health commissioner faced forced resignation due to blame and lack of confidence from the governor. Associated Press, June 29, 2020.

Ethical principles challenged

  • Provide adequate institutional and professional support to enable competent public health workforce performance. APHA Code of Ethics, 4.8.4
  • Provide for the recruitment, retention, and career development of highly qualified public health practitioners in managerial roles. APHA Code of Ethics, 4.11.1