Brazil.

COVID-19 in Brazil: Institutional Meltdown in the Middle of a Pandemic

By Octávio Luiz Motta Ferraz

There has been no doubt fierce disagreement across the world’s democracies on how to fight the pandemic, i.e.: on how to protect public health while respecting civil liberties; on how to minimize the damage to jobs and businesses; on how strictly to enforce public health measures. Yet nowhere has a democratic country witnessed such frontal and public quarrel within its own government as in Brazil.

Not even in the U.S. have things  gone that far in the delicate relationship between Trump and Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID). No other country seems to have had as many challenges in the courts related to the response to the crisis, either.

Read More

Stockholm, Sweden.

Sweden’s Response to COVID-19: A Tale of Trust, Recommendations, and Odorous Nudges

By Behrang Kianzad and Timo Minssen

Introduction

The Swedish response to the Corona-crisis has been relatively moderate compared to most other countries.

Sweden did not opt for a total lockdown, did not close elementary schools, day cares, bars, restaurants, movie theaters, and other places of business. Public gatherings of up to 50 people are still allowed until further notice. Sweden’s intra EU borders remain open — in contrast to its neighbors Denmark, Finland and Norway — although the government has extended the  temporary entry ban to the EU via Sweden through May 15th.

Read More

Forbidden City, Beijing, China.

Legal Tools Used in China in the COVID-19 Emergency

By Wang Chenguang

The Essential Role of Law in Containing the New Coronavirus

The stark truth in the COVID-19 emergency is the lack of effective drugs, therapies, and a vaccine at the moment and in the near future. Therefore the most effective way of containing the new coronavirus is still the traditional response of cutting off the channels of its human-to-human transmission. Realizing this fact, China has used, from the beginning, measures of social distancing, wearing face masks in public, quarantine and staying home to meet the unprecedented challenges of COVID-19. All of these measures are means to adapt normal human behaviors to an emergency situation. To do so, law — the most effective set of norms used to regulate people’s behavior — is logically utilized to stop the spread of the virus. This idea is clearly expressed by the Chinese government’s policy of legal, scientific and orderly containment of the disease.

Read More

LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

Framing the Digital Symposium – Global Responses to COVID-19: Rights, Democracy, and the Law

By Alicia Ely Yamin, Senior Fellow

This digital symposium presents a pointillistic portrait of the spectrum of rights-related measures adopted to stop the spread of COVID-19 in dozens of countries around the world to date. The impulse for this symposium emerges out of the conviction that it is imperative that we emerge from the throes of this pandemic not only with the fewest possible lives and livelihoods lost, but also with democratic institutions and the rule of law intact.

Although the portrait continues to evolve, the time to begin collectively reflecting on lessons regarding the relationship between population health and decision-making in emerging, consolidated, and illiberal democracies alike — and their implications for the post pandemic future we want — is now.

Read More

Photograph of a doctor in blue scrubs overlaid with an illustration of a padlock

Anonymity in the Time of a Pandemic: Privacy vs. Transparency

By Cansu Canca

As coronavirus cases increase worldwide, institutions keep their communities informed with frequent updates—but only up to a point. They share minimal information such as number of cases, but omit the names of individuals and identifying information.

Many institutions are legally obligated to protect individual privacy, but is this prohibition of transparency ethically justified?

Some even go a step further and ask you, an individual in a community, to choose privacy over transparency as well. Harvard—alongside with  Yale, Chicago, and Northwestern—requests you to “Please Respect Individuals’ Privacy. Anonymity for these individuals remains paramount. Please respect their privacy—even if you believe you know who they are—so they can focus completely on their health” (emphasis in original).

But do you have an ethical obligation to do so at the time of a pandemic?

Read More

a crowd of people shuffling through a sidewalk

Lost in the Shuffle: The Impact of COVID-19 on Immigrants in Need

The recommendations for healthy people who have symptoms consistent with COVID-19, the illness caused by the corona virus called SARS-Co-V2, is to stay at home, get plenty of rest, drink fluids and control fever and body-aches with a non-steroidal medication. For people with pre-existing medical conditions, the elderly or those with more serious symptoms, an evaluation by a healthcare provider is warranted. This is a reasonable recommendation given that for most healthy people, the symptoms are uncomfortable but not life-threatening. There is a population however, that regardless of the severity of their illness, may stay at home and not seek medical care, even when things are serious. Fear of arrest and deportation is a real issue for undocumented immigrants and calling an ambulance or going to a hospital can put them at risk for these actions. The result is that some very sick people may not seek appropriate medical care. In addition, they may be taken care of by people that don’t have the appropriate personal protection, putting even more people at risk.

Read More

Vials of medications with syringe and needle.

Is “Implied Consent” Ethically Permissible in WHO’s Malaria Vaccine Pilot Introduction?

By Beatrice Brown

A recent BMJ article has exposed ethical concerns with the informed consent process in the World Health Organization’s (WHO) large, randomized cluster trial of the world’s first licensed malaria vaccine, RTS,S, known as Mosquirix. The study is being conducted in Malawi, Ghana, and Kenya, and 720,000 children will receive the vaccine. The vaccine is currently limited to pilot implementation because of residual safety concerns from previous clinical trials, including: a tenfold rate of meningitis in those who received the vaccine versus those who did not, “increased cerebral malaria cases, and a doubling in the risk of death in girls.” Rather than engaging in the traditional informed consent process, the WHO is utilizing an implied consent process, leading several bioethicists, including Charles Weijer, Christine Stabell Benn, and Jonathan Kimmelman, to voice concern.

The WHO has defended their use of implied consent to BMJ on the grounds that “the study is a ‘pilot introduction’ and not a ‘research activity.'” A WHO spokesperson explained that in an implied consent process, “parents are informed of imminent vaccination through social mobilisation and communication, sometimes including letters directly addressed to parents. Subsequently, the physical presence of the child or adolescent, with or without an accompanying parent at the vaccination session, is considered to imply consent.” However, as Weijer rightly points out, this is not truly consent, as “We have no assurance that parents, in fact, received information about the study let alone that they understood it.” After the publication of the original article criticizing the WHO for going against international ethical standards for research involving human participants, the WHO released a response in BMJ and on their own website, contending that this implied consent process is “used for all vaccines provided through the Expanded Programme on Immunization” and that the study is in accordance with international ethical standards. Here, I further explore whether this implied consent process is ethically permissible in this specific trial by exploring the guidelines set out by two organizations.

Read More

Gloved hand holding medical rapid test labeled COVID-19 over sheet of paper listing the test result as negative.

Controlling the Novel Coronavirus: Should we have stopped the COVID-19 coronavirus more effectively? Could we still?

By Margaret Battin, Leslie Francis, Jay Jacobson, and Charles Smith

What if, instead of closing airports, shutting down trains and buses, quarantining travelers from China, and enclosing 50 million people inside the city of Wuhan and Hubei province, we had a sophisticated technology that could identify travelers who might spread an emerging infectious disease? This question is not hypothetical. We do have an available technology: polymerase chain reaction (PCR) rapid testing, one among several forms of nucleic acid amplification technology.

But PCR rapid testing has been deployed imperfectly at best, especially in the United States. The initial case of what is thought to have been community transmission in the United States was not tested for several days. The result was preventable exposures to infection of health care workers and potentially others. Testing criteria were set very narrowly. Rapid test kits designed by CDC did not work successfully because of problems with one of the reagents. On February 29, the FDA issued guidance allowing laboratories CLIA-certified for high complexity testing to use tests they had developed and validated before receiving emergency use approval.

Read More