The Ethics of Contagion: How We Should Respond to the Spread of Infectious Diseases

The SARS outbreak of 2002-2004, the swine flu pandemic of 2009-10 and the Ebola epidemic of 2014-2016 were all stark warnings of what was to come. Yet the COVID-19 pandemic took most governments to bed. The pandemic not only revealed a lack of pandemic preparedness, but also a number of unresolved ethical problems: What restrictions are the authorities justified in imposing on citizens to protect public health? How should we distribute the burdens of fighting the disease within the population? What role should markets play in distributing scarce goods in times of crisis? To combat the spread of infectious diseases, populations in many countries have lived with highly invasive measures. The measures are often justified with regard to public health, but can we also justify the measures to those who bear the heaviest burdens? If we are to answer this question, we need an understanding of what moral obligations we have to prevent the spread of infectious diseases. I want to build a framework for how governments can respond to the spread of infectious diseases which is based on our individual moral obligations and which can thus be justified towards those affected by the measures. I present three overarching hypotheses: The first is that individuals have more demanding obligations to prevent the spread of disease than theories of moral responsibility suggest. The second hypothesis is that the highly invasive measures to prevent the spread of infection can be justified as payments for participating in a social insurance scheme. The third is that we need a new understanding of when we are justified in using market mechanisms in a pandemic, such as e.g. in the production and distribution of vaccines. My overall goal is to contribute to the further development of ethical thinking around infectious diseases and to point out a way forward that transcends professional boundaries and that can be accepted by people with different ethical starting points.