The Covid-19 pandemic around the world is now a perfect storm. It challenges our ways of living, working and celebrating. Country by country, the impact has differed depending on geography, border controls, government leadership and decisions, and preparedness of public health systems.
These are testing times for all. In every case the worst affected are those who cannot socially isolate, who do not have water to wash, who have lost their jobs and so have no daily income, who return to their country as unemployed, hungry migrant workers, who do not have a government that looks out for them. For many the priority is to “flatten the curve” of hunger.
What follows is the second regional webinar of member bodies of Religions for Peace Asia and officers from UNICEF in discussing the Ethics of Humanitarian and Social Aspects of the Public Health Emergency held on 26 April 2020.
This report summarises a global panel discussion webinar in the wake of COVID-19 held on Sunday night (Melbourne time), 26th April under the sponsorship of the Department of Education’s UNESCO Chair in Bioethics located at the University of Haifa which works to encourage the teaching of bioethics in medical and health sciences and law courses across the world. The two-hour meeting was chaired by the Melbourne-based Professor Russell D’Souza, Chair, Department of Education (International Program) of the UNESCO Chair in Bioethics and was facilitated by Professor Mary Mathew, the director of the Indian component of the Chair Input came from eight specialists in (with the percentage of deaths per 100,000 population from the John Hopkins University data centre): Australia (0.33), India (0.07), Kenya (0.03), the UK (31.82) and the USA (17.20). Approximately 5000+ persons were registered online participants and spectators and asked questions through the chat box.
The guiding questions were:
1. What are the ethical/humanitarian implications of imposing a full lockdown?
2. What are the challenges and barriers in implementing lockdowns and social distancing in humanitarian settings?
3. Are there more alternatives and humane approaches?
4. What role do governments have in times of health and social stress?
The webinar began with opening remarks from Professor D’Souza who said that since the March 11th declaration of a global pandemic by the World Health Organisation the world had entered an unprecedented crisis with major challenges at policy and practice levels and within humanitarian and social parameters. He observed that “equity and public health go hand in hand. We are only as safe as the most vulnerable globally”. There has been a worldwide and serious breakdown of structures which were and would impact, particularly upon those in the most vulnerable situations, and disproportionately so, such as poor people, homeless people and so on. A particular worry is for those with no access to running water.
The key concept to guide us must be human solidarity. Hence, the questions becomes: how do we engage ethically with those very affected by COVID-19 together with combatting the risk of exclusion and stigmatisation, the plight of the rural poor and their dying of hunger or of the infection. At the forefront of our considerations in maintaining the views, and rights of people must be human dignity. These human dignity principles must insist that all have equal access to standard health care.
Social networks have been compromised, thus damaging social connectedness, especially among those without the internet or even a phone. Hence, it has become critically important to recognize and protect social connectedness even though the very threat is embedded in that very same network. “COVID-19 is no respecter of persons”.
Professor James James, director of the US Society for Disaster Medicine and Public Health, who had had experience with the anthrax outbreak, argued that “we are schizophrenics in stance” with the individualised medicine vs population health medicine reaching different conclusions. He observed that many health systems were overrun with different measures and even the notion of social distancing differs from country to country. He asked the question: is there any valid evidence that such measures work? Unfortunately there is no consistent evidence to say that they work, and no consistent evidence that lockdown works. Is there a way to achieve the desired results without lockdowns? In the US, the only lockdown ever was in 1918 but only in some cities, e.g. St. Louis and there is no legal basis for a lockdown.
In response to the question, why have we been so accepting of inequality, Professor James pointed out that no one can truly reach the right conclusion. The outbreaks have mainly occurred in high density communities and in economically depressed areas where people live in congested areas. This is where we need to look.
Professor Unni Karunakar of Médecins Sans Frontières who is visiting Shinhan Professor at the Yonsei University in Seoul said there had been no lockdown in South Korea which, however, had acted very early with social distancing and much tracing and testing. “Lockdown is a very blunt instrument”. Restaurants and pubs are open. However, the country had used app technology to reinforce social distancing. Part of South Korean culture observes distancing with more bowing, less hugging etc.. Also South Koreans have a better sense of community and trust in government is most important as seen in Singapore and Kerala. They take the government measures seriously. Testing is not necessary to have universal coverage. The quality of the tests is also very important since the early tests were not reliable. The most at-risk groups have less access to COVID-19 services such as testing. The first victim to die in South Sudan was a UN health worker so the country has stopped all international entry.
In the UK, the Dean of the Medical School at Swansea University, Professor Kamila Hawthorne related how social distancing had been in place for four weeks but already people were looking forward to their lifting. The country had been in a unique situation with the life of the prime minister under life-threat. Everyone is allowed out once a day for a walk or a cycle and food is able to be taken to a relative, friend or neighbour. According to her, the National Health System had risen to the occasion thus far. She regretted the lack of a global response and the poor response from many leaders such as Xi, Trump, Putin and Johnson. The theory about herd immunity is medical nonsense. Professor James said, “Do not write herd immunity off!” He added that most people have been exposed and hence he cautioned against doubting the herd immunity approach. Professor Ravi Wankhedkar called it ‘a poisoned pill”.
She expressed concern for the homeless and very special measures have been introduced to house and protect them. Really vulnerable were the people in aged care facilities.
In Africa, Professor Joachim Osur, Dean of Medical Sciences at Amref International University in Nairobi, said that once one person has been diagnosed, the country goes into lockdown. Countries are already in lockdown for other reasons. Somalia and the DR Congo are in lockdown because of war and humanitarian crises. Also weak health systems are broken, and vulnerable groups cannot access the system. The problem is deeper than social distancing and lockdowns. As with Ebola, the issues are trust in the health system and in governments. Africa is awash with congested slums. There has been a rise in looting leading to a shortage of money to buy food. Many children are not immunised, and many people are not taking their malarial medicine. Do I spend money on sanitisers or on food?
Professor Rajan Sharma, president of the Indian Medical Association, suggested that “no infrastructure could have been ready”. The key is educating the masses such as in the wearing of masks. A vaccine is no good for a country as big as India. No matter how many ventilators, it would not be sufficient. It is necessary to stop the quick doubling of cases as has happened in the US. We have to emphasise cleanliness.
Professor Ravi Wankhedkar, treasurer of the World Medical Association, summarised, “In India, lockdown is on the pause button”. He worried about the urban slums and evictions of the poor. This social discrimination worried him as did the irrationality of social media. And one wonders about the rationality of the critical media. He drew attention to the plight of doctors in villages, and because of lack of burial facilities, three Indian doctors were not properly buried after dying from the virus. As well, there have been attacks on health and tracing personnel in some Indian villages. And young doctors have been evicted from apartment blocks because of the fear. It was not only in India that health workers were feeling insecure.
Professor Russell D’Souza asked: how do we enhance social solidarity? Professor Unni Karunakar suggested there has been no global coming together. Hence, there needed to be more regional cooperation and solidarity. What had to stop was “instrumentalising health for political purposes”. Professor James argued that there was a need to look at groups within a nation so it was difficult for a totally integrated approach. But a global effort was needed for preparedness. “Every disaster is local”. There is a need for 80 per cent of a population to be immune. The global fear narrative has been created by the media whereas public health needs ought to control the narrative.
Prepared by Emeritus Professor Des Cahill, Chair, Religions for Peace Australia. Email: des.cahill@rmit.edu.au
