Seite - 328 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE328 Conclusion As stated in the introduction, a partial answer to the question of how a nation should allocate its resources during a pandemic is that it should seek to deploy a pandemic response that aims to effectively control the epidemic, but with attention to equity. Such attention entails giving greater scrutiny to the scientific ideas at play. The implementation of national lockdowns reflects the use of the contain-and-control approach to infectious diseases to its maximum and unprecedented extent. While the deployment of quarantine measures at such a large scale was designed to protect the health care systems and save as many lives as possible, it also distributed burdens across the popu- lation, and disproportionately to those who are already vulnerable. Every country may have its particular vulnerable groups, and some groups may cut across all countries, but it is clear that the background vulnerabilities prior to the pandemic, the new vulnerability created by COVID-19, and the further vulnerabilities created by national pan- demic responses have resulted in hundreds of thousands of deaths and greater deprivations for millions. We are now entering a difficult period, one that is expected to last one to two years. Thus, low- and middle-income countries are likely to experience the impact of this approach for a longer duration, perhaps even decades. The discussion also aimed to show that basic infectious dis- ease modelling so influential early in this pandemic actually erased inequalities in vulnerabilities. Such erasure of inequalities in vul- nerabilities then produces recommendations for policies such as lockdowns, which do not recognize acute vulnerability, or the fur- ther burdens and vulnerabilities from the interventions. Nor does such modelling provide any indication of the social distributions of immunity and deaths. One potentially practicable and impactful use of resources would be to combine infectious disease modelling and social epidemiology to produce better forecasts that incorporate differences in vulnerability and show social distribution patterns of impacts of infections as well as social responses. This is not a novel assertion. Such a call to improve infectious disease modelling and epi- demiology by incorporating social determinants of unequal vulnera- bility was raised in the mid 1990s in response to HIV/AIDS modelling. But it went unheeded. This shows again how the devastation from this COVID-19 pandemic has a long chain of causes rooted in social choices and neglect, going back decades.