Page - 318 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE318 Just as in normal times, equity concerns related to the pandemic are not only related to access to health care when people are sick with COVID-19 or to claims of new discoveries such as vaccines. We care about equity or fairness in multiple dimensions of health, includ- ing the causes, levels, distribution patterns, health consequences, non-health consequences, health care experiences, differences in outcomes, and even how the dead are treated. The difference is that during epidemics and pandemics, the aim of containing infections seemingly dominates any other considerations of equity in health or other social domains. In normal times, this would be like pursuing policies to maximize health outcomes above all other considerations. Such a position is unacceptable because maximizing health outcomes is not the only equity goal within health care, nor is it the only equity concern across all social domains. Ethics and equity concerns are not novel to infectious disease control; we do not cull human beings like we might a herd of farm animals when infections start to spread. However, equity has not been a foremost concern or as prominent as it needs to be. Vulnerability and Equity In most countries, even when the infections may be starting to get under control, the national responses to control the COVID-19 pan- demic have been negatively affecting the health and well-being of individuals and groups, and making health inequalities worse.7 This is true even in countries where the pandemic looks as if it is being managed well. Importantly, the harmful impacts of both the infections and national responses are not being distributed evenly or randomly. Instead, the negative impacts are most visible among the most socially disadvantaged, and they are likely to track and make the extant socio- economic gradient in health worse in all countries.8 And while stan- dard measurement tools are able to capture health outcomes and other social and economic facts, the uneven increase in vulnerability to diverse harms is less measurable—but it is visible. Vulnerability to harms of individuals and groups is a coherent concept; it is akin 7. Yuwa Hedrick-Wong, “The Great Lockdown Is Saving Lives While Increasing Poverty and Hunger Globally”, Forbes (28 April 2020), online: <www.forbes. com/sites/yuwahedrickwong/2020/04/28/the-great-lockdown-is-saving-lives- while-increasing-poverty-and-hunger-globally/>. 8. Marmot, supra note 6.