The importance of getting the ethics right in a pandemic treaty
- PMID: 37421968
- DOI: 10.1016/S1473-3099(23)00364-X
The importance of getting the ethics right in a pandemic treaty
Abstract
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.
Copyright © 2023 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of interests The views expressed in this Personal View are solely those of the authors and do not reflect the positions of WHO or any other entities with which the authors are affiliated. GOS is a rapporteur for the COVID-19 Ethics and Governance Working Group and was a special rapporteur for the Act Accelerator Ethics & Governance Working Group. CAA is a member of the Access to COVID-19 Tools Accelerator Working Group. CAA has also received a grant from Wellcome Trust Discovery Award to conduct research on solidarity in global health and received honoraria for a webinar on cultural competence and psychiatric diagnosis in low-income and middle-income settings. SK serves on the WHO Ethics and Governance Working Group. MP was a member of the Ethics Working Group on 2019-nCoV (coronavirus) and is a member of the COVID-19 Ethics & Governance Working Group. GP was a consultant for WHO during early 2020 on a project on pandemic influenza. GP has received grants from the Greenwall Foundation and WHO and consulting fees from an American Society of Clinical Oncology post. MJS has served as a member of the following working groups: COVID-19 Ethics & Governance Working Group, Expert Group on Ethical Considerations of Social Listening and Infodemic Management, Ethics and Monkeypox Working Group, ACT Accelerator Ethics & Governance Working Group, Working Group on Ethics and Immunity Certificates, Monitored Emergency Use of Unregistered and Investigational Interventions Working Group, and Working Group on Ethics and Digital Proximity Tracking Technologies for COVID-19 Contact Tracing. RU serves as Co-Chair of the Ethics and Governance Working Group and was Co-Chair of the COVID-19 Ethics Working Group. RU attended a meeting (virtually) organised by the Canadian Government to discuss the provisions of the Pandemic Treaty. EE is Special Adviser to the Director General ofthe WHO and also serves as an Expert Advisory Member on WHO COVID-19 Ethics & Governance Working Group. EE reports payment and honoraria for lectures, presentations, speaker bureaus, manuscript writing, or educational events from The Galien Foundation, WellSky, RightWay, Signature Healthcare Foundation, Healthcare Leaders of New York, Medimpact, Massachusetts Association of Health Plans, Princeton University, Philadelphia Committee on Foreign Relations, Yale University, Hartford Medical Society, Association of Academic Health Centers Global Innovation Forum, Hawaii Medical Service Association & Queens Health System, Advocate Aurora Health Summit, University of Pittsburgh Medical Center Shadyside, University of California San Francisco, Advocate Aurora Health, Cain Brothers Conference New York, Bowdoin College, The Suntory Foundation Tokyo Japan, Ontario Hospital Association, Ontario Canada and University of Oklahoma. EE also declares support for attending meetings or travel from Hartford Medical Society, Association of Academic Health Centers Global Innovation Forum Bethesda, Macalester College, Oak CEO Summit, Advocate Aurora Health Summit Lake Geneva, DPharm Conference, University of Pittsburgh Medical Center Shadyside, University of California San Francisco, Cain Brothers Conference New York, Bowdoin College, Galien Jerusalem Ethics Forum, HLTH 2022 Las Vegas, Hawaii Medical Service Association Honolulu, Tel Aviv University, The Suntory Foundation Tokyo Japan, Ontario Hospital Association, and University of Oklahoma. EE is an adviser to Village MD, Cellares, Notable, HIEx Health Innovation Exchange Partnership (sponsored by UN Geneva), JSL Health Fund, Biden's Transition COVID-19 Committee, Peterson Center on Healthcare, and Clarify Health, and is an expert advisory member of WHO COVID-19 Ethics & Governance Working Group and Special Adviser to the Director General WHO. EE is an editorial board member for the Journal of the American Medical Association, and has stock options for Cellares, Notable, and Clarify. EE reports investment in Oak HC/FT Venture Fund and JSL Health Fund. EE is also a member of the Council on Foreign Relations and a senior fellow for the Center for American Progress.
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