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Presented at the Third Oman Bioethics Conference under the theme ‘Public Health Ethics: from pandemic crisis to healthcare resilience’ by Dr Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics, Chairman of Research Ethics and Medical Ethics Committees at King Abdullah bin Abdulaziz University Hospital Riyadh, Saudi Arabia.
Learning Objectives
- Understand the ethical obligations involved in the decision on transition from the pandemic to
the post-pandemic period
- Understand
the ethical obligations involved in resource allocations in the post endemic
period
Ethical dilemmas in decisions on public health pandemic obligations.
- Careful
tightrope ethical balancing of 2 potentially conflicting purposes: the purpose
of protecting life (حفظ النفس) and the purpose of
protecting resources (حفظ المال)
- Careful
balancing of 2 potentially conflicting interests: public interest (المصلحة العامة) and special interest (المصلحة الخاصة).
- The principle
of certainty (قاعدة اليقين) in relating the
level of scientific evidence used in decision-making to the anticipated level
of risk.
- Certainty cannot be voided by doubt اليقين لا يزول بالشك - [1]
Termination of pandemic control measures
- The decision
to impose control measures at the start of the pandemic is more difficult than
the decision to continue those measures towards the end البقاء اسهل من الابتداء[2]
- What is
excused in continuation is not excused at initiation – يغتفر في البقاء ما لا يغتفر في الابتداء[3]
- Too early
termination risks renewed disease transmission but relieve the public from social
and economic stresses.
- Delayed termination
diverts resources from other health priorities and has a long-term economic
impact
. - Data
analysis is needed to test the hypothesis that some of the excess mortality
during the pandemic was not directly due to the virus but indirectly due to the diversion
of health resources from prevalent diseases
- Weaker
members of society (children, the elderly, and minorities) are our ethical
bottom line and have to be protected at all costs
Levels of scientific evidence and protection of vulnerable members of society
- Decisions
should be based on the level of evidence but moral considerations require that
we consider the level of evidence depending on the vulnerable members of
society
- A higher
level of preponderant evidence (غلبة الظن)
is required for decisions that may harm the weaker members of society
- A lower suggestive level of evidence (الظن) is used for decisions that may favor vulnerable members of society.
Post-pandemic vaccination programs
- A booster vaccination is necessary because of waning immunity and the emergence of mutant
variants
- Large-scale
booster vaccination programs divert resources from chronic public health
priorities.
- Booster
vaccination programs cannot catch up with all emerging mutations they should instead
aim at creating herd immunity based on stable regions of the virus genome.
- Vaccines for
new mutants should be mostly for high-risk and vulnerable groups to preserve
resources for other priorities.
General control measures -1
- Individuals
have to accept restrictions on their rights during the pandemic in the general public
interest of controlling disease spread يتحمل الضرر
الخاص لدفع ضرر عام[4]
- Restrictions
on the public must be based on public interest التصرف
في الرعية منوط بالمصلحة [5]
- Measures already
accepted by the public during the pandemic such as face masks, restrictions on
gatherings, and hand hygiene can continue in the post-pandemic period in the
public interest of controlling the current disease and other communicable
diseases.
General control measures - 2
- The general
control measures cannot be enforced by coercion because the public will react
negatively
- General
control measures should depend on education and guidance more than coercion
- The
environment should be enabling for example providing hygiene facilities
- Gentle coercion can be in the form of preventing entry into hospitals and other vulnerable facilities without masks.
Databases and citizen privacy
- Extensive
online databases were developed during the pandemic on vaccination and disease
status, movements, and contacts
- Extensive
personal data collection was justified as a necessity الضرورات
تبيح المحظورات[6]
- Data was not
collected based on informed consent and if there was consent it was not
time-limited
- A lot of
personal information in a central place could be misused to invade the privacy
of citizens
- In the
interest of data privacy, these databases should be de-activated in the post-pandemic period
Keywords: post-pandemic – health protection – resource allocation – public interest – special interest -vaccination – face mask mandate – social distance.
REFERENCES:
- المادة رقم ٤ في مجلة الاحكام العدلية
- المادة رقم ٥٦ في مجلة الاحكام العدلية
- المادة رقم ٥٥ في مجلة الاحكام العدلية
- المادة رقم ٢٦ في مجلة الاحكام العدلية
- المادة رقم ٥٨ في مجلة الاحكام العدلية
- المادة رقم ٢١ في مجلة الاحكام العدلية