Page - 315 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

315How Should We Allocate Health and Social Resources During a Pandemic? consequent illnesses and deaths—how a society allocates resources also reflects and impacts the parallel social concern of equity. The following discussion argues that the particular use and applications of two scientific ideas profoundly affected national pandemic responses, including the allocation of resources, with sig- nificant harmful implications for social and health equity. First, the familiar “contain and control” approach to infectious diseases was applied maximally by countries (through national lockdowns) and was without precedent. Second, the epidemic forecasting models and modelling that were so influential early on were mono-dimensional; they modelled scenarios of how human bodies will likely spread infec- tions and of the biological impacts infected, recovered, or dead) over time. They used assumptions about equal susceptibility and probabil- ity of death, which then motivated the society-wide lockdowns. The assumptions obfuscated inequalities in the vulnerabilities of social groups to exposures, infections, and death. Plus, used in isolation, with a focus on only one dimension, these models could not identify the impacts of policies to reduce virus transmissions on other health and well-being issues or on other important social domains (for exam- ple, the economy). In light of this argument, a partial answer to the question “how should we allocate resources during a pandemic” is that we should allocate resources with greater attention paid to social equity, particularly through more close scrutiny of the proposed use and application of infectious disease science and control methods. For many readers, the social concern around equity during this pandemic might initially and most easily be recognizable regarding the distribution of limited health care in the face of overwhelming need. Equity as a concept is often used in relation to the distribution of valuable things. Indeed, the ethical or fair allocation of limited ICU beds, ventilators, and protective equipment rose to prominence in the media and scientific journals early on in the pandemic as the infections spread to high-income countries, particularly in the United States.1 Concerns are also being expressed around equity related to the future distribution of treatments or vaccines, both domestically and globally, which are currently being researched and developed.2 1. Ezekiel J Emanuel et al, “Fair Allocation of Scarce Medical Resources in the Time of Covid-19” (2020) 382:21 N Engl J Med 2049. 2. David Pilling & Andrew Jack, “‘People’s Vaccine’ for Coronavirus Must be Free, Leaders Urge”, Financial Times (13 May 2020), online: <www.ft.com/content/ af929941-7c02-415a-a692-bf8443ede58a>.