Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as (...) a strategy that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health. (shrink)

This study investigates how COVID-19 advice is creatively delivered in a one-minute video produced by the Taiwan Centers for Disease Control in February 2022. It examines metaphors in verbal, visual, and multimodal modes, and illustrates how such metaphors interact with multimodal narrativity. Drawing on the insights of studies on multimodal metaphors, this paper seeks to identify which are the most pervasive metaphors or what dominant metaphor, if any, is used in the video. It finds that the metaphorical mappings between coping (...) with the covid pandemic and handling olympic weightlifting are represented across modes and that the creative delivery of COVID-19 advice is woven from a warp of metaphors in various modes and a weft of narrativity across modes. Such metaphorical creativity is underpinned by the semiotic flow that features four interconnected configurations: moving between metaphorization, literalization, and re-metaphorization; somehow blurring the source-target boundary; expanding the range of functions that the multimodal representation can serve; and initiating a metaphorical thought from one or more contextual factors. (shrink)

As Member States of the World Health Organization (WHO) meet in an International Negotiating Body (INB) to negotiate a legally binding agreement on pandemic prevention, preparedness, and response for submission to the 77th World Health Assembly in May 2024, this column reflects on creative but pragmatic and complementary means that could be employed in the short timeframe allotted for this important global health law negotiation.

The United Nations (UN) General Assembly High-Level Meeting (HLM) on pandemic prevention, preparedness and response (PPPR) was a missed opportunity to bring high-level commitment and momentum to the global governance of health emergencies. Intended to bring much-needed attention to a policy issue that is rapidly slipping down the international agenda, the fraught diplomacy among member states, lack of consensus on key issues, and weak UN Political Declaration in New York foreshadow a difficult road ahead for upcoming negotiations under the World (...) Health Organization (WHO) in Geneva. This column chronicles the evolving engagement of the UN in global health governance, examines the diplomatic process leading to the UN HLM on PPPR, and assesses the contributions and missed opportunities of its resulting Political Declaration. (shrink)

This is a pivotal moment in the global governance response to pandemic threats, with crucial global health law reforms being undertaken simultaneously in the coming years: the revision of the International Health Regulations, the implementation of the GHSA Legal Preparedness Action Package, and the negotiation of a new Pandemic Treaty. Rather than looking at these reforms in isolation, it will be necessary to examine how they fit together, considering: how these reforms can complement each other to support pandemic prevention, preparedness, (...) and response; what financing mechanisms are necessary to ensure sustainable health governance; and why vital norms of equity, social justice, and human rights must underpin this new global health system. (shrink)

Background Health care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims (...) to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis. Methods Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis. Results Three themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,” and (3) “The pandemic hindered us; pandemic-related obstacles.” The three themes correspond to the main theme, “Being prevented from providing good care.” Discussion The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions. Conclusions On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon. (shrink)

Background: According to Gelfand et al., COVID-19 infection and case mortality rates are closely connected to the strength of social norms: “Tighter” cultures that abide by strict social norms are more successful in combating the pandemic than “looser” cultures that are more permissive. However, countries with similar levels of cultural tightness exhibit big differences in mortality rates. We are investigating potential explanations for this fact. Using data from Germany and Japan—two “tight” countries with very different infection and mortality rates—we examined (...) how differences in socio-demographic and other determinants explain differences in individual preventive attitudes and behaviors. Methods: We compared preventive attitudes and behaviors in 2020 based on real-time representative survey data and used logit regression models to study how individual attitudes and behaviors are shaped by four sets of covariates: individual socio-demographics, health, personality, and regional-level controls. Employing Blinder-Oaxaca regression techniques, we quantified the extent to which differences in averages of the covariates between Japan and Germany explain the differences in the observed preventive attitudes and behaviors. Results: In Germany and Japan, similar proportions of the population supported mandatory vaccination, avoided travel, and avoided people with symptoms of a cold. In Germany, however, a significantly higher proportion washed their hands frequently and avoided crowds, physical contact, public transport, peak-hour shopping, and contact with the elderly. In Japan, a significantly higher proportion were willing to be vaccinated. We also show that attitudes and behaviors varied significantly more with covariates in Germany than in Japan. Differences in averages of the covariates contribute little to explaining the observed differences in preventive attitudes and behaviors between the two countries. Conclusion: Consistent with tightness-looseness theory, the populations of Japan and Germany responded similarly to the pandemic. The observed differences in infection and fatality rates therefore cannot be explained by differences in behavior The major difference in attitudes is the willingness to be vaccinated, which was much higher in Japan. Furthermore, the Japanese population behaved more uniformly across social groups than the German population. This difference in the degree of homogeneity has important implications for the effectiveness of policy measures during the pandemic. (shrink)

In absence of effective pharmaceutical treatments, the individual's compliance with a series of behavioral recommendations provided by the public health authorities play a critical role in the control and prevention of SARS-CoV2 infection. However, we still do not know much about the rate and determinants of adoption of the recommended health behaviors. This paper examines the compliance with the main behavioral recommendations, and compares sociocultural, psychosocial, and social cognitive explanations for its variation in the French population. Based on the current (...) literature, these 3 categories of factors were identified as potential determinants of individual differences in the health preventive behaviors. The data used for these analyses are drawn from 2 cross-sectional studies conducted after the lockdown and before the peak of the COVID-19 epidemic in France. The participants were drawn from a larger internet consumer panel where recruitment was stratified to generate a socio-demographically representative sample of the French adult population. Overall, the results show a very high rate of compliance with the behavioral recommendations among the participants. A hierarchical regression analysis was then performed to assess the potential explanatory power of these approaches in complying with these recommendations by successively entering sociocultural factors, psychosocial factors, social cognitive factors in the model. Only the inclusion of the cognitive variables substantially increased the explained variance of the self-reported adoption of preventive behaviors, providing better support for the social cognitive than the sociocultural and psychosocial explanations. (shrink)

The current study aims to compare compliance with the COVID-19 prevention guidelines among citizens from 13 districts in Wuhan and to explore the influence of individual-level psychological factors and district-level factors on compliance. A total of 811 participants from 13 districts in Wuhan were invited to complete surveys regarding demographics, psychosocial factors and compliance with epidemic prevention guidelines. Individual-level characteristics were combined with district-level measures to create multilevel predictive models of compliance with prevention guidelines, and used the Hierarchical Linear Model (...) to analyze the data. Findings revealed that there were significant differences in the compliance of citizens from 13 districts of Wuhan. Hierarchical linear model analysis revealed that the risk factors case growth rate, COVID-19-related perceived stress, anxiety, significantly negatively predicted compliance. Hope and conscientiousness significantly positively predicted compliance with prevention guidelines, and the negative predictive effect of anxiety disappeared. Overall, we found significant differences in compliance with prevention guidelines among different districts. Risk factors at the individual level have had a negative impact on individuals’ compliance with prevention guidelines, but this impact can be mitigated by the positive role of personal protective factors such as conscientiousness and hope. (shrink)

The Brazilian Federal Senate created a Parliamentary Inquiry Commission (CPI) to investigate the Bolsonaro government's irregularities in the management of the COVID-19 pandemic. One of the cases that drew attention was the research conducted by Prevent Senior, a private health insurance company, on the early treatment of COVID-19. The article analyzes the scientific validity of the research and the ethical problems related to its implementation. It is based on analysis of Prevent Senior's report of the clinical study, the Brazilian and (...) USA clinical trial registries, the Senate's CPI report, and on the information reported by the media. This case of scientific fraud and political-ideological bias exemplifies how Prevent Senior, using a questionable protocol to enhance its reputation and gain government support, was instrumental in building the “early treatment” narrative for COVID-19, and shows how it served as a basis for a government public policy that promoted the use of ineffective drugs. (shrink)

This study assessed the demographic characteristics of Koreans engaged in leisure sports activities during the COVID-19 pandemic and the differences in their preventive health behaviors and constraints on leisure activities. For this study, the demographic characteristics of 544 leisure sport participants, who were recruited on a nationwide basis, were examined through an online survey. Then, comparisons between groups were performed using independent t-tests, one-way analysis of variance, and multivariate analysis of variance. Women who participated in both indoor and outdoor leisure (...) sports showed higher adoption of health prevention behaviors than their male counterparts, and married individuals who participated in indoor leisure sports showed higher adoption of health prevention behaviors than unmarried participants. Moreover, individuals who participated in both indoor and outdoor leisure sports by themselves had many interpersonal constraints overall, and the group of married individuals who participated in indoor leisure sports showed structural constraints. In conclusion, leisure sports participants have adopted many health prevention behaviors during the COVID-19 pandemic, but this had led to some interpersonal constraints. These results indicate that, in the case of future pandemics, personal and institutional efforts will need to be made to promote participation in leisure sports and prevent excessive social isolation. (shrink)

The COVID-19 pandemic has caused a global societal, economic, and social upheaval unseen in living memory. There have been substantial cross-national differences in the kinds of policies implemented by political decision-makers to prevent the spread of the virus, to test the population, and to manage infected patients. Among other factors, these policies vary with politicians’ sex: early findings indicate that, on average, female leaders seem more focused on minimizing direct human suffering caused by the SARS-CoV-2 virus, while male leaders implement (...) riskier short-term decisions, possibly aiming to minimize economic disruptions. These sex differences are consistent with broader findings in psychology, reflecting women’s stronger empathy, higher pathogen disgust, health concern, care-taking orientation, and dislike for the suffering of other people—as well as men’s higher risk-taking, Machiavellianism, psychopathy, narcissism, and focus on financial indicators of success and status. This review article contextualizes sex differences in pandemic leadership in an evolutionary framework. Evolution by natural selection is the only known process in nature that organizes organisms into higher degrees of functional order, or counteracts the unavoidable disorder that would otherwise ensue, and is therefore essential for explaining the origins of human sex differences. Differential sexual selection and parental investment between males and females, together with the sexual differentiation of the mammalian brain, drive sex differences in cognition and behavioral dispositions, underlying men’s and women’s leadership styles and decision-making during a global pandemic. According to thesexually dimorphic leadership specialization hypothesis, general psychobehavioral sex differences have been exapted during human evolution to create sexually dimorphic leadership styles. They may be facultatively co-opted by societies and/or followers when facing different kinds of ecological and/or sociopolitical threats, such as disease outbreaks or intergroup aggression. Early evidence indicates that against the invisible viral foe that can bring nations to their knees, the strategic circumspection of empathic feminine health “worriers” may bring more effective and humanitarian outcomes than the devil-may-care incaution of masculine risk-taking “warriors”. (shrink)

We use a cultural psychology approach to examine the relevance of the Health Belief Model for predicting a variety of behaviors that had been recommended by health officials during the initial stages of the COVID-19 lockdown for containing the spread of the virus and not overburdening the health system in Europe. Our study is grounded in the assumption that health behavior is activated based on locally relevant perceptions of threats, susceptibility and benefits in engaging in protective behavior, which requires careful (...) attention to how these perceptions might be structured and activated. We assess the validity of the HBM in two European countries that have been relatively understudied, using simultaneous measurements during acute periods of infection in Romania and Italy. An online questionnaire provided a total of valid answers from both countries. First, to understand individual difference patterns within and across populations, we fit a General Linear Model in which endorsement was predicted by behavior, country, their interaction, and a random effect for participants. Second, we assess the effect of demographics and health beliefs on prevention behaviors by fitting a multi-group path model across countries, in which each behavior was predicted by the observed health belief variables and demographics. Health beliefs showed stronger relationships with the recommended behaviors than demographics. Confirming previously reported relationships, self-efficacy, perceived severity, and perceived benefits were consistently related to the greater adoption of individual behaviors, whereas greater perceived barriers were related to lower adoption of health behaviors. However, we also point to important location specific effects that suggest that local norms shape protective behavior in highly contextualized ways. (shrink)

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...) that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...) the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics. (shrink)

This paper examines the case of a recent H5N1virus (avian influenza) outbreak in West Bengal, an eastern state of India, and argues that poorly executed pandemic management may be viewed as a moral lapse. It further argues that pandemic management initiatives are intimately related to the concept of health as a social 'good' and to the moral responsibility of protection from foreseeable social harm from an infectious disease. The initiatives, therefore, have to be guided by special moral obligations towards biorisk (...) reduction, obligations which remain unfulfilled when a public body entrusted with the responsibility fails to manage satisfactorily the prevention and control of the infection. The overall conclusion is that pandemic management has a moral dimension. The gravity of the threat that fatal infectious diseases pose for public health creates special moral obligations for public bodies in pandemic situations. However, the paper views the West Bengal case as a learning opportunity, and considers the lapses cited as challenges that better, more effectively conducted pandemic management can prepare for. It is hoped that this paper will provoke constructive bioethical deliberations, particularly pertinent to the developing world, on how to ensure that the obligations towards health are fulfilled ethically and more effectively. (shrink)

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The (...) latest treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

While the unprecedented lockdown measures were at the heart of the debate in the first year of the pandemic, the focus since then has shifted to vaccination issues. The reason, of course, is that vaccines and vaccinations have become available by now. All experts agree: If mankind had failed to develop vaccines against SARS-CoV-2, the death toll would have been much higher. This issue seeks to explore what could be described as a “generational approach to vaccinations”. The question “What can (...) we do to avoid future pandemics?” is related to different aspects of the failures and successes of humanity’s vaccination strategy against SARS-CoV-2. Pathogens are among the existential risks to humanity that could potentially kill a large part of it in a very short time. For all the tragedy and horror it has brought upon the world, the Corona virus has not been lethal on such a large, all-encompassing scale. But it could serve as a wake-up call for more and better prevention in the future, put differently: as a call to build a “preventive society”. When people look back to the year 2022 from the year 2200, will they think of the absence of mandatory vaccination as a dangerous anachronism? And will the unequal global distribution of vaccines be seen as an unbearable vice of our epoch? And will “human infection studies” still be dismissed as unethical if a dangerous new virus boards human bodies? If intergenerational justice means improving the life chances and living conditions of future generations to the largest possible extent, then its link to (the avoidance) of infectious diseases is obvious. We should protect future generations from foreseeable damage if we have the power to do so. “We” is humankind in its entirety. Politically, humanity is divided into many single nations. But biologically, as members of the same species, we share the same vulnerability regardless of ethnicity. The regular reader of this journal might wonder why this issue of IGJR has a different structure. An unprecedented pandemic calls for an unprecedented reaction and therefore IGJR 1/2021 and 2/2021 are special issues that deal with this disruptive event. We have invited several health experts, politicians and scholars alike to share their perspectives in short opinion pieces (instead of regular peer-reviewed articles). And we are exploring something new: the publication of a FRFG policy paper. This policy paper starts off with a historical overview on how pandemics have afflicted humanity in the past. It separates moral from legal duties and formulates “epidemiological imperatives” – the way of thinking of a responsible and solidary individual facing the task of preventing an outbreak of epidemics in a community. With the discovery of vaccines, and their availability, the catalogue of duties is increased by one more: to get the jabs as an act of solidarity with others, including future generations. This would prevent states from being forced to take disease control measures that bring about drastic collateral damage. During the first two years of the Corona pandemic, states have imposed lockdowns. The closure of schools has put a special burden on the youngest members of society. This could have been prevented during the second and the further waves. The policy paper also calls for more government funding for prophylactic vaccine research and for the designation of vaccines as “global public goods”. The issue then moves on to a section dedicated to opinion papers by various different authors. The first paper, written by Agnes Binagwaho and Kedest Mathewos (both from University of Global Health Equity, Rwanda), focuses on the issue of health inequity, a concern which has gained more and more traction during the Covid-19 pandemic. The paper examines how vaccine distribution during the pandemic was mainly focused on the global north and how such actions might affect future generations’ perception of what is just, fair and morally correct. The second paper, by Samantha Vanderslott (University of Oxford), focuses on the right and wrongdoings connected to pandemic preparedness and response. The third paper, authored by Rajeev Sadanandan (Health Systems Transformation Platform, India), talks about the lessons that can and should be drawn from child immunisations. The fourth paper, by Adriano Mannino (LMU and Parmenides Foundation, Munich), delves into the question how future generations will assess our actions and our response to the current pandemic. The fifth and final paper, written by Jörg Tremmel (FRFG and University Tübingen), is centered around the question whether human infection studies could have been implemented during the early stages of the pandemic to minimise deaths and severe infections. The issue concludes with two reviews on recent books by Alberto Giubilini and Katie Wright. In his review of Giubilini’s The Ethics of Vaccination, Marius Kunte notes that it contains a “thought-provoking plea” for individual, collective and institutional obligations to reach high vaccination rates. Judith Kausch-Zongo concludes her review of Wright’s Gender, Migration and the Intergenerational Transfer of Human Wellbeing with a special emphasis on the book’s empirical findings, and praises it in its entirety as “undoubtedly important”. Both books serve as poignant reminders of how sustainable societies can only emerge once the challenges revolving around its most vulnerable members have been properly addressed. (shrink)

The recent Covid-19 pandemic has brought a broad range of ethical problems to the forefront, raising fundamental questions about the role of government in response to such outbreaks, the scarcity and allocation of health care resources, the unequal distribution of health risks and economic impacts, and the extent to which individual freedom can be restricted. In this clear introduction to the topic Iwao Hirose explores these ethical questions and analyzes the central issues in the ethics of pandemic response and preparedness (...) such as: The general nature of pandemics and the ethics of preparedness Ethical questions about general goals of pandemic response and preparedness The distribution of scarce resources, e.g., ventilators, hospital beds, antiviral drugs and vaccines Restrictions on individual freedom Ethical questions in the wake of pandemics, including contact-tracing, vaccine passports and socioeconomic inequalities. With the use of real-life examples and a clear philosophical approach, The Ethics of Pandemics is a much-needed introduction to some of the most important ethical issues surrounding pandemics. It is essential reading for students of ethics, bioethics, and political philosophy and will also be of interest to those working in related areas such as public policy, public health, health law, nursing and life sciences. (shrink)

By examining the global public good nature of pandemic preparedness we can identify key social justice issues that need to be confronted to increase citizens’ voluntary compliance with prevention and mitigation measures. As people tend to cooperate on a voluntary basis only with systems they consider fair, it becomes difficult to ensure compliance with public health measures in a context of extreme inequality. Among the major inequalities that need to be addressed we can find major differences in the extensiveness and (...) intensiveness of quarantine experiences, lack of opportunities to participate in common efforts, hardship in complying with disease control recommendations, and an unfair distribution of the cooperative surplus. (shrink)

ZusammenfassungDieser Beitrag ist Teil des Forums COVID-19: Perspektiven in den Geistes- und Sozialwissenschaften. Die Spanische Grippe 1918–1920 war mit 50 bis 100 Millionen Toten eines der gravierendsten Seuchenereignisse der Geschichte. Dennoch reagierten westdeutsche Behörden bei zwei weiteren Pandemien 1957/1958 und 1968–1970 mit „geduldige[m] Ausharren“ (Rengeling 2017). Erst ein veränderter Erinnerungsdiskurs führte zu einer „allumfassenden Prävention“, und doch lag die „allumfassende Prävention“ (ebd.) damit noch weit unterhalb dessen, was seit der weltweiten Verbreitung des Corona-Virus SARS-CoV‑2 praktiziert wird.

The Covid-19 pandemic of 2020/21 has posed old ethical questions in a new and sharper form, as well as given rise to some new ethical issues. In this lecture, I look at the lessons we can learn from five of these issues: the allocation of scarce medical resources; experimenting on humans; setting priorities for vaccination; when lockdowns are justified; and preventing more pandemics.

The pandemic caused by the SARS-CoV2 novel coronavirus is creating a global crisis. There is a global ambience of uncertainty and anxiety. In addition, nations have imposed strict and restrictive public health measures including lockdowns. In this heightened time of vulnerability, public cooperation to preventive measures depends on trust and confidence in the health system. Trust is the optimistic acceptance of the vulnerability in the belief that the health system has best intentions. On the other hand, confidence is assessed based (...) on previous experiences with the health system. Trust and confidence in the health system motivate people to accept the public health interventions and cooperate with them. Building trust and confidence therefore becomes an ethical imperative. This article analyses the COVID-19 pandemic in the south Indian state of Tamil Nadu and the state’s response to this pandemic. Further, it applies the Trust-Confidence-Cooperation framework of risk management to analyse the influence of public trust and confidence on the Tamil Nadu health system in the context of the preventive strategies adopted by the state. Finally, the article proposes a six-pronged strategy to build trust and confidence in health system functions to improve cooperation to pandemic containment measures. (shrink)

To address the complex challenge of global antimicrobial resistance (AMR), a pandemic treaty should include mechanisms that 1) equitably address the access gap for antimicrobials, diagnostic technologies, and alternative therapies; 2) equitably conserve antimicrobials to sustain effectiveness and access across time and space; 3) equitably finance the investment, discovery, development, and distribution of new technologies; and 4) equitably finance and establish greater upstream and midstream infection prevention measures globally. Biodiversity, climate, and nuclear governance offer lessons for addressing these challenges.

It is still remarkably difficult for public health officials charged with developing and implementing pandemic influenza preparedness plans at the community levelto obtain clear, concrete, and consistent guidance on how to construct plans that are both ethical and actionable. As of mid-2007, most of the federal and state pandemic plans filed with the Centers for Disease Control and Prevention, describing how public health officials will coordinate public agencies and private entities in the event of an outbreak, failed to include ethical (...) guidance for first responders responsible for providing essential services and making fair decisions during a public health emergency. (shrink)

Control measures, such as “lockdowns”, have been widely used to suppress the COVID-19 pandemic. Under some conditions, they prevent illness and save lives. But they also exact an economic toll. How should we balance the impact of such policies on individual lives and livelihoods (and other dimensions of concern) to determine which is best? A widely used method of policy evaluation, benefit–cost analysis (BCA), answers these questions by converting all the effects of a policy into monetary equivalents and then summing (...) them up. A different method, social welfare analysis, proceeds by determining the effects of a policy on individual wellbeing and then applying an aggregation formula to them to evaluate the overall effects of a policy. In this chapter, we survey these methods and argue that social welfare analysis has important advantages. One crucial advantage is that it enables ethical considerations relating to the impact of policies on individual wellbeing and its distribution to be incorporated into policy assessments in a transparent way. We illustrate this with a simple numerical model for evaluating pandemic policies that vary in terms of the stringency of the controls that they impose on individual behaviour, showing how the evaluation depends on the ethical significance accorded to their impact on the wellbeing of different age and income groups. (shrink)

Intense scientific work on HIV/AIDS has led to the development of effective combination drug therapies and there is hope that effective vaccines will soon be produced. However, the majority of people with HIV/AIDS in the world are not benefiting from such advances because of extreme poverty. This article focuses on the pandemic as a reflection of a complex trajectory of social and economic forces that create widening global disparities in wealth and health and concomitant ecological niches for the emergence of (...) new infectious diseases. While the biomedical approach to HIV/AIDS is necessary, has prolonged the lives of many individuals and could offer much at the level of population health, it cannot, in isolation, improve the health of populations. To achieve the latter will require understanding and addressing the deeper social causes of pandemics. Broadening the discourse on ethics to include public health ethics and the ethics of international relations could contribute to reducing the impact of the pandemic and to preventing the emergence of new infectious diseases in the future. (shrink)

Social contract theories serve a twofold purpose: by addressing acute crises, they elaborate solutions to long-standing social paradoxes. The article reinterprets the stakes of the Covid pandemic from this perspective. Firstly, the long-lasting structural paradoxes of late modernity are linked to the acute crisis of the pandemic with the help of critical theories of late modernity. It is argued that the pandemic provides opportunity for revaluating those social contracts, which are based on universalist principles of justice. Secondly, two paradigmatic historical (...) examples (Hobbes, Rawls) are overviewed in a meta-theoretical fashion, so that the dimensions of revaluation could be highlighted. Thirdly, the foundations of a post-pandemic social contract are outlined. As the pandemic is inseparable from the structural paradoxes caused by unconstrained systems based on universal principles of justice, the post-pandemic social contract aims at preventing the system paradoxes by revaluating their universal principles in a ‘trial of particularity’ (Derrida, Levinas). (shrink)

DISEASE X is the codename given by the World Health Organisation to a pathogen currently unknown to science that could cause havoc to humankind. Emerging infections are sending us multiple warnings that another Disease X is looming. We've had SARS in 2002, H5N1 bird flu in 2004, H1N1 'swine flu' in 2009, MERS in 2012, Ebola in 2014, Zika in 2015 and now COVID-19. These events are not freak events, but are happening continually, and at an increasing cadence. Written by (...) a long-standing ex-Reuters global health and science correspondent, DISEASE X will use privileged access to the body leading international efforts to control viruses, the Coalition for Epidemic Preparedness Innovations (CEPI), and its CEO, Dr Richard Hatchett. CEPI seed-funded three successful COVID vaccines, including Astra-Zeneca and Moderna. DISEASE X will explore the emergence of the novel coronavirus and the crisis it caused, analysing the responses of global health organisations and experts, including the WHO, national governments such as Britain, China and the USA, COVAX, the global vaccine allocation facility, pharmaceutical companies, and leading research scientists. Weaving in insights from the likes of Bill Gates, Sir Jeremy Farrar, Dr Anthony Fauci and Sir Patrick Vallance, the book will explain how the world's public health scientists are embarking on a 100 Days Mission to snuff out future threats before they become deadly pandemics. This is the inside story written for the public. (shrink)

The author finds the possibility of overcoming the current liberal-capitalist system in a different conception of time, which requires a different attitude towards both the past and the future. The paper begins with an analysis of the Benjamin?s critique of Marx, followed by analysis of Derrida?s critique of Benjamin and finally Derrida?s critique of Marx. Benjamin points out the problem of teleological understanding of time, the understanding that the meaning of events comes only from the future, which is present in (...) Marx, and which prevents us from escaping the?circle? of violence. Although he relies on Benjamin?s conception of time, the author seeks to transcend the understanding of law as something separate from justice, and law as violence. Therefore, the paper turns to Derrida and his understanding of the law, eventually providing new possibilities for understanding and constituting the left, social theory, but also critical thinking today. (shrink)

Many democratic countries have failed to stand up to the challenge presented by the COVID-19 pandemic. I argue that the collective response to the pandemic has been incapacitated by an ‘epistemic crisis’, (i.e., a breakdown in the social division of epistemic labor) that led to a failure of citizens’ beliefs to converge towards a shared perception of the situation. Neither a paucity of relevant expert knowledge nor democratic citizens’ irrationality is required for the crisis to emerge. In particular, I highlight (...) three obstacles capable of preventing relevant expert testimony from gaining democratic legitimacy necessary for an effective policy response: 1) the proper domain of expertise is uncertain; 2) regular citizens’ meta-expertise – (i.e., ability to discriminate among the putative experts based on their relative epistemic merit) – is not efficacious enough to trigger truth-convergence of the public opinion; 3) the prominent sources of third-party meta-expertise lack credibility due to their conflicts of interest. Since the first two problems appear irresolvable, I propose that the search for a path towards preclusion of future epistemic crises concentrates on upgrading the institutional fundament for meta-expertise provision. Social epistemology plays a vital role in this search, but its close cooperation with other disciplines is a must. (shrink)

On 18 November 2014, the United Nations launched an urgent new campaign to end AIDS as a global health threat by 2030. With its proposed strategy, the UN follows leading scientists who had declared the failure of former prevention strategies and now were promoting a ‘Seek and Treat for Optimal Prevention’ (STOP) approach as the most cost‐effective response to the pandemic to meet the goal of ‘an AIDS‐free generation’. STOP combines antiretroviral therapy and routine HIV screening to find persons unaware (...) that they are HIV‐positive, because research has shown that people consistently change their behaviour (i.e. increase condom use, have fewer partners) after an HIV diagnosis. AIDS activists have broadly criticized this strategy on different levels. In this article, we go beyond these criticisms and try to analyse the political rationalities behind this ‘new’ strategy. We believe that it is necessary to put the rationale underpinning the STOP programme into the context of broader societal transformations that can best be captured as the development of advanced liberal societies and the new emphasis on self‐controlling or self‐responsibility rather than on disciplining behaviour. (shrink)

PurposeOlder adults aged 60 years and above are classified as being of high-risk for infection during the COVID-19 pandemic. This study aimed to investigate the associations of psychological factors of preventive behaviors with three preventive behaviors among Chinese older adults during the COVID-19 pandemic.MethodsA cross-sectional questionnaire survey was administered via SOJUMP, a widely used online survey platform in China. A total of 928 older adults were recruited using a snowball sampling approach from Hubei Province and outside Hubei Province in China (...) during May 18, 2020 to June 7, 2020. Multiple hierarchical regressions were conducted with four models to examine the association between demographic, past behavior, psychological factors and each preventive behavior.Principal FindingsAll three preventive behaviors in older adults increased dramatically during the pandemic of COVID-19. Gender, living status, educational level, past behavior, health knowledge, intention and planning significantly predicted hand washing behavior, R2 = 0.395, F = 54.372, p < 0.001. Gender, education level, important others infection, past behavior, health knowledge, planning and action control significantly predicted mask wearing behavior, R2 = 0.202, F = 23.197, p < 0.001. Living place, past behavior and health knowledge significantly predicted social distancing behavior, R2 = 0.204, F = 26.201, p < 0.001.Major ConclusionsPast behavior and health knowledge predicted all three preventive behaviors. Planning was an important psychological factor for both hand washing and mask wearing behaviors. All those critical demographic and psychological factors are critical for future interventions to facilitate older adults to comply with three preventive behaviors in daily life and to stay healthy during the COVID-19 pandemic. (shrink)

BackgroundCritical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/aids pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevention Trials Network (HPTN) Ethics Guidance Document (EGD) to situate and analyze (...) key ethical challenges related to the conduct of HIV prevention research during the COVID-19 pandemic as well as identify potential areas for refinement of the guidance document based on this unprecedented state of affairs.Main bodyNecessary actions taken for HIV prevention research studies due to the COVID-19 pandemic involve an array of ethical issues including those related to: (1) risk mitigation; (2) behavior change; (3) compounding vulnerability; (4) community engagement; (5) trial reopening; and 6) shifting research priorities.ConclusionsIn the context of the dueling HIV and COVID-19 global pandemics, research teams and sponsors must be nimble in responding to the rapidly changing environment by being sensitive to the associated ethical issues. The HTPN EGD provides a rich set of tools to help identify, analyze and address many of these issues. At the same time, future refinements of the HPTN EGD and other research ethics guidance could be strengthened by providing explicit advice regarding the ethical issues associated with disrupted research and the reopening of studies. In addition, additional consideration should be given to appropriately balancing domains of risk (e.g., physical versus social), addressing the vulnerability of research staff and community partners, and responding to un-anticipatable ancillary care needs of participants and communities. Appropriately addressing these issues will necessitate conceptual work, which would benefit from the careful documentation of the actual ethical issues encountered in research, the strategies implemented to overcome them, and their success in doing so. Throughout all of these efforts, it is critical to remember that the HIV pandemic not be forgotten in the rush to deal with the COVID-19 pandemic. (shrink)

The main objective of this article is to provide a critique of the pandemic strategy suggested by the World Health Organization (WHO) and implemented by various countries from March 2020 onwards in the wake of the coronavirus outbreak in Wuhan, China. Based on the theories of Michel Foucault, this critique aims to show that, in the first instance, the pandemic may be understood in terms of the art of governing human beings at the point of interaction between politics and medicine; (...) secondly, in Foucauldian terminology, such interaction may be referred to as ‘noso-politics’, that is, a mechanism used to control the body of the population via authoritarian measures exercised in the name of the health of the population; thirdly, such a mechanism exercises its power by invoking a mechanistic truth about the SARS-CoV-2 virus which may be countered by an argument that takes a historical perspective on the virus; fourthly, the pandemic strategy may be opposed by a syndemic approach that takes into account interactions between emerging diseases such as COVID-19 and non-communicable illnesses, as well as the biological and socio-economic conditions that the well-being of the population depends on. In short, by providing a critique of the politics of truth about the pandemic, the virus, and health measures, the article aims to encourage a critical attitude that will challenge both the authorities and the truth they invoke to prevent the pandemic strategy being used as a mechanism for governing, given the predictions of the recurrent emergence of new viruses. (shrink)

From governments to the general public, one may ask about the possible contributions of historians, if any, to the understanding and management of global disasters, as e.g. the ongoing coronavirus disease 2019. Given the confuse situation at the onset of the pandemic in terms of diagnosis, treatment, and prevention, a look into past experience with nonconventional medicine seemed relevant. In the present study I surveyed secondary literature on the role of Chinese medicine, Āyurveda, and homeopathy over time. The quantitative results (...) were disappointing: nothing on Āyurveda, and one single study each on Chinese medicine and homeopathy. The quality of the former compensates for the numerical short age. The case of homeopathy is rather sui generis, since this medical system was born and blossomed during epidemics and pandemics. I conclude with a short comment on reference sources, which might serve as point of departure for future studies of Āyurveda in epidemics. (shrink)

The transition to distance education has led to deterioration in the health of teachers and students. The purpose of the study was to identify controlled factors of the educational environment, the impact of which in an emergency situation due to a pandemic on infectious disease can be influenced by the administration of general secondary education institutions. Material and methods: 339 teachers and 828 parents of general secondary schools of Mykolaiv region (Ukraine) took part in research from May to June 2021. (...) The research tool was a self-administered survey questionnaire.The study found that social networks were the leading source of information on the COVID-19 pandemic situation for educators. The vast majority of educators indicated that they follow certain rules of conduct in order not to get sick. Most respondents admitted that they experienced weakness, mood swings, depressed thoughts, anxiety and tension due to the situation with the COVID-19 pandemic. Mostly more fatigue, hypodynamics and impaired vision were considered by teachers as manifestations of deteriorating physical condition. Manifestations of psychological deterioration, according to teachers, were greater aggression, agitation, signs of depression and emotional instability. The key factors in preventing the deterioration of teachers’ health in the event of an infectious disease pandemic, which can be influenced by the administration of general secondary education institutions, include: reducing the workload of teachers during distance education; conducting professionally oriented education of teachers in the field of health technologies; increasing the level of information competence of teachers; improving the technological base of schools for distance learning. (shrink)

Global health has long been characterized by injustice, with certain populations marginalized and made vulnerable by social, economic, and health disparities within and among countries. The pandemic only amplified inequalities. In response to it, the World Health Organization and the United Nations have embarked on transformative normative and financial reforms that could reimagine pandemic prevention, preparedness, and response (PPPR). These reforms include a new strategy to sustainably finance the WHO, a UN political declaration on PPPR, a fundamental revision to the (...) International Health Regulations, and negotiation of a new, legally binding pandemic agreement (popularly called the “Pandemic Treaty”). We revisit the cavernous shortcomings of the global Covid‐19 response, explain potentially transformative legal reforms and the ethical values that underpin them, and propose actionable solutions to advance both health and justice. (shrink)

An inordinate number of low wage workers in essential industries are Black, Hispanic, or Latino, immigrants or refugees — groups beset by centuries of discrimination and burdened with disproportionate but preventable harms during the COVID-19 pandemic.

The novel pandemic called “Coronavirus Disease 2019”, as a global public health emergency and global threat, has affected many countries in unpredictable ways and impacted on physical activity behaviors to various extents. Specific populations including refugees, asylum seekers, and prisoners, are vulnerable groups with multiple complex health needs and worse health outcomes with respect to the general population worldwide and at high risk of death from the “Severe Acute Respiratory Syndrome-related Coronavirus type 2”. Governments around the world have been implementing (...) preventive healthcare policies, including physical and social distancing, isolation, and confinement, to mitigate against the burden imposed by the COVID-19 outbreak. This pandemic period is characterized by reduced or lack of movement. During this period of lockdown, PA can represent an immunotherapy and a preventative approach to avoid the harmful effects of inactivity due to the pandemic. Moreover, PA could be prescribed to improve the immune system of specific populations, which particularly experience the condition of being confined. The present narrative review discusses the potential impacts of COVID-19 pandemic on these specific populations’ health status and the importance of performing PA/exercise to reduce the deleterious effects of COVID-19 pandemic. In addition, we aim to provide useful recommendations on PA/exercise for these specific populations to maintain their level of independence, physical, and mental health as well as their wellbeing. (shrink)

This article examines discourse on immunity in general public engagements with pandemic influenza in light of critical theory on immuno-politics and bodily integrity. Interview and focus group discussions on influenza with members of the general public reveal that, despite endorsement of government advice on how to avoid infection, influenza is seen as, ultimately, unavoidable. In place of prevention, members of the general public speak of immunity as the means of coping with influenza infection. Such talk on corporeal life under microbial (...) threat is informed by self/not-self, network and ‘choice’ immunity, and therefore makes considerable allowance for cosmopolitan traffic with others, microbes, ‘dirt’ and immune-boosting consumer products. The immuno-political orientation of members of the general public, therefore, appears to trend towards a productive cosmopolitanism that contrasts with more orthodox bioscientific and governmental approaches to pandemic influenza. We reflect on the implications of the immuno-cosmopolitanism of everyday life for the advent of global public health emergency and for biopolitical rule in general. (shrink)

Social contract theories serve a twofold purpose: by addressing acute crises, they elaborate solutions to long-standing social paradoxes. The article reinterprets the stakes of the Covid pandemic from this perspective. Firstly, the long-lasting structural paradoxes of late modernity are linked to the acute crisis of the pandemic with the help of critical theories of late modernity. It is argued that the pandemic provides opportunity for revaluating those social contracts, which are based on universalist principles of justice. Secondly, two paradigmatic historical (...) examples (Hobbes, Rawls) are overviewed in a meta-theoretical fashion, so that the dimensions of revaluation could be highlighted. Thirdly, the foundations of a post-pandemic social contract are outlined. As the pandemic is inseparable from the structural paradoxes caused by unconstrained systems based on universal principles of justice, the post-pandemic social contract aims at preventing the system paradoxes by revaluating their universal principles in a ‘trial of particularity’ (Derrida, Levinas). (shrink)

A close observation on the rapid change in the mind of young cohort has been made. Our Surveillance is before and after pandemic periods compels us to re-write some pre-occupied conceptions in the core of Philosophy and Psychology. We have worked on mind-body & mind-soul relationship from three angles that are Medical Science, Psychology and Philosophy. It is seen that the level of confidence is gradually diminishing among the youth due to different impetus and as a result many powerful strengths (...) are going out. Proclamation of human values in a new way must be declared so that we can save a thankful number of creative lives. Discussions have been made on thoughts, distress, medical causes of suicide or suicidal attempts, personality disorders, neuropsychology to open up a new world before the present generation. Each and every characteristics of life has positive impact and here we have tried to establish this fact. Physical and metaphysical aspects are reciprocating our lives and this should be injected in the mind of present generation and an approach can be taken to incorporate the matter in the curriculum right now. We have the intention to explain metaphysical love and its high, intelligent values proclaimed strength of mind of youth to infuse our dear world with great moral values. It may also save the earth from natural decay with their surprising discoveries. (shrink)

The main aim of this article is to reflect on the impact of biases related to artificial intelligence (AI) systems developed to tackle issues arising from the COVID-19 pandemic, with special focus on those developed for triage and risk prediction. A secondary aim is to review assessment tools that have been developed to prevent biases in AI systems. In addition, we provide a conceptual clarification for some terms related to biases in this particular context. We focus mainly on nonracial biases (...) that may be less considered when addressing biases in AI systems in the existing literature. In the manuscript, we found that the existence of bias in AI systems used for COVID-19 can result in algorithmic justice and that the legal frameworks and strategies developed to prevent the apparition of bias have failed to adequately consider social determinants of health. Finally, we make some recommendations on how to include more diverse professional profiles in order to develop AI systems that increase the epistemic diversity needed to tackle AI biases during the COVID-19 pandemic and beyond. (shrink)

Objective: Mindfulness disposition is associated with various psychological factors and prevent emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining. Methods: An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was (...) performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relations between mindfulness and psychiatric symptoms. Results: Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; p =.000). High negative correlations were found between mindfulness disposition and overall Global Severity Index (r = -.637; p =.000), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales. Discussion: Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem the post-traumatic psychopathological beginnings and preventing the onset of chronic mental disorders. (shrink)

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety and necessity (...) of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future. (shrink)

Mental health crisis has been reported as the third wave of the Covid-19 pandemic. Grief at the loss of loved ones, shock at the loss of jobs, isolation of restrictions of movements, difficult family dynamics, and uncertainty and fear of the future are just few of the psychological sufferings pointed out by the World Health Organization. To ensure that people are mentally healthy, the government takes mental health services as essential part of the responses to the pandemic. Private organizations and (...) academic institutions also take part in this movement to safeguard the mental well-being of people in the community. Despite the efforts to prevent and remediate mental health crisis, limited number of people seek professional help. While we can assume that they might have been adjusting well to the anxieties brought about by Covid-19 pandemic, we also acknowledge the fact that a number of cases of depression and suicide had been reported in the locality for the past five months. This paper aims to provide expositions of the possible variables for young Filipino College Students’ underutilization of mental health services as well as their other possible sources of inner strength and resiliency during the Covid-19 pandemic. Help seeking behaviors of the Young Filipino students in Cor Jesu College will be explored using the lens of uncertainty and anticipation model of anxiety of Grupe and Nitschke, and resilience as a cultural variable among Filipinos. (shrink)

Background The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses’ capacity to meet their ethical responsibilities and what has helped to sustain their efforts to continue to care. Research objectives 1) To explore nurses’ experiences of striving to fulfill their ethical responsibilities of care during the COVID-19 pandemic and 2) to (...) explore what has fostered nurses’ capacity to fulfill these responsibilities. Research Design A generic qualitative approach was used incorporating concepts coming from fundamental features of care. Participants Twenty-four Canadian Registered Nurses from a variety of practice settings were interviewed. Ethical Considerations After receiving ethics approval, signed informed consent was obtained before participants were interviewed. Findings Four themes were identified. 1) Challenges providing good care in response to sudden changes in practice. 2) Tensions in juggling the responsibility to prevent COVID-19 infections with other competing moral responsibilities. 3) Supports to foster nurses’ capacity to meet their caring responsibilities. 4) The preservation of nurses’ moral identity through expressions of gratitude and health improvement. Discussion Infection control measures and priorities set in response to the pandemic made at distant population and organizational levels impacted nurses who continued to try to meet the ideals of care in close proximity to patients and their families. Despite the challenges that nurses encountered, the care they received themselves enabled them to continue to care for others. Nurses benefited most from the moral communities they had with their colleagues and occasionally nurse leaders, especially when they were supported in a face-to-face manner. Conclusion: Moral community can only be sustained if nurses are afforded the working conditions that make it possible for them to support each other. (shrink)