“Man is born free, and everywhere he is in chains.”
-Rousseau
The history of Western political thought is fraught with tensions between the rights of the people and their government, between the rights of the individual and the “common good”. Pre-modern thinkers, Plato and Aristotle, each envisioned their own conceptions of a kallipolis, or utopian city-state, ruled by a wise philosopher-king who imposes order so that citizens may lead a happy life of intellectual and moral virtue. Nearly two thousand years later, social contract theorists – Hobbes, Locke, and Rousseau – were challenged with the same set of questions that plagued Plato and Aristotle, albeit with more pragmatic and materialist undertones: how do we design political systems comprised of free and equal citizens with certain unalienable rights while also ensuring the social and economic welfare of the whole?
The design and delivery of public health falls squarely within this longstanding philosophical debate. Where do we draw the line? Who decides and what determines the extent to which an individual should be asked to give up certain personal liberties to protect the public health interests of a society? In his seminal piece On Liberty, utilitarian philosopher John Stuart Mill articulated the “harm principle” in the first chapter, arguing that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.” [1] For Mill, the harm principle would represent the logic behind justifying public health policy. In medicine, the first principle is for doctors to do no harm, but for public health, governments and agencies must step in to ensure that individual actions do not bring harm onto others.
Public health is undeniably an effort of collective action. It requires the participation of individuals so that its cumulative effects can benefit the whole. It is the result of established norms, behaviours and formal and informal sanctions surrounding everyday interactions that serve to protect our health and the health of those around us. For instance, when we cough or sneeze (**please stay at home if you have continuous coughs!**) in public, it would be quite boorish – dangerous even – to let out our airborne germs onto a poor, unsuspecting neighbour rather than sneezing into our elbows. On the order of more formal sanctions, it wasn’t until as recent as July of 2007 that the UK Parliament banned smoking in all indoor workplaces including bars, clubs, and restaurants as a consequence of the Health Act 2006. [2]
As we see with these examples, public health necessarily requires some sort of trade-off negotiated between the individual and the society in which an individual resides. My earlier suggestion for you to stay at home if you have coughing fits would be an infringement on your personal liberties to freely travel in public, but by containing you (and your germs) in your own home, it would directly prevent the transmission of COVID-19 onto others. Following the passage of the Health Act of 2006, individuals were no longer allowed to exercise their choice to smoke in indoor places, yet at the same time, bystanders were protected from the dangerous effects of second-hand smoke. In both of these scenarios, it is fairly straightforward to observe that the momentary infringements on individual liberties were far outweighed by the overall benefits brought to the public.
However, in times of a global pandemic, the tensions between personal freedoms and the public good has resurfaced as a hot-button issue because it is not immediately clear that the benefits to the whole outweigh the sacrifices from its parts. Should fines be introduced for those who refuse to wear masks in public? Should governments employ intrusive mass surveillance techniques in order to track-and-trace those who have been infected? Should compulsory vaccination laws be drafted once a safe and effective SARS-CoV-2 vaccine becomes available? In a recent opinion piece published in The Lancet, professor of political science at the University of Paris Pantheon-Sorbonne, Olivier Nay, argues that under conditions that constitute imminent danger to the health of a population, national governments have the right to expand its reach and capacity to protect the public. [3] Emergencies may justify the state to impose harsh limitations of short durations on individual freedoms to convene in public or to travel or to engage in entrepreneurial activities. But again, this does not answer the question: how stringent should these limitations be?
Nay puts forward the concern that “exceptional” measures such as mass surveillance technologies used by some governments may jeopardise the democratic freedoms upon which many Western nations are founded. In China, for example, the government has used tools such as facial recognition cameras that take people’s temperatures, drones that enforce quarantines, GPS tracking from mobile phones, and data recorded from credit card transactions. [4] While China’s mass surveillance measures have long face criticism from around the world, it has also been praised for swiftly containing the spread of COVID-19. Other countries including Singapore, Israel, Iran, Taiwan, Russia, and South Korea have rapidly followed suit in adopting some of these measures. Yet Nay warns us that once a government gains new powers over its citizens during a crisis, it may be unwilling to relinquish these powers once the crisis subsides. In the United States, for example, following the 9/11 terrorist attacks, government efforts – particularly new mass surveillance measures – were increased and remains in effect to this very day.
But I would be remiss – ignorant, even – to not address the fact that Western notions of democracy and individual rights cannot and should not be imposed on different governments with their own sets of traditions, cultures, and norms. Given that exceptional times sometimes do call for exceptional measures, perhaps the question concerning the role of government during a pandemic should be redressed as such: how can we ensure that public health authorities and national legislators employ adequate containment, surveillance, and monitoring measures that is proportionate to the scope of the pandemic while also preserving transparency, ethics, and the rights of its citizens?
You’d likely get very different responses depending on the country that you happen to survey. After all, transparency can operate on a slippery, sliding scale and ideas surrounding rights and ethics vary from person-to-person and from country-to-country. And the measures that are put in place with regards to these very region-specific notions of ethics can hardly be transferred across different spatial, temporal, and cultural contexts. More importantly, it is still far too early to know which measures made by governments – including mass surveillance – have been entirely necessary or effective. Ongoing research is being conducted at the Oxford Blavatnik School on Government on whether the most stringent policy responses around the world have had the most overall net positive effect on curbing the spread of the coronavirus and on the economy. [5]
There are still so many unknowns in our response to the COVID-19 pandemic. Which policies have been effective? What is the appropriate level of response needed? Were any human rights violated in the process? If the United Nations or any large international governing body were to draft a dummy protocol for governments to respond to any future pandemics, here’s the one premise it should include regardless of what brand of ethics any government subscribes to: establish a basic foundation of trust between its citizens and the government so that any agreed-upon policies established to protect the public have its intended effects.
Unfortunately, we don’t live in utopian kallipoleis ruled by benevolent, all-knowing philosopher-kings, and many of our governments have failed us in responding to a worldwide pandemic that has uprooted the livelihoods of international communities. Where I’m from, the United States, our political leaders have turned matters of public health into politics, disrupting the norms surrounding wearing masks, challenging the recommendations made by our top public health officials, and eroding the basic trust that our citizens have in our scientific and medical communities. The SARS-CoV-2 vaccine is perhaps our best hope at eradicating the disease, yet it will also enter a world that is deeply resistant to its reception and deeply sceptical of what benefits it can actually bring to mankind.
When governments fail, we, as individuals, should step up to protect each other. Perhaps the best measure to combat coronavirus is to simply have a well-informed public that chooses to adhere to many common-sense scientific guidelines regardless of whether the government response has been borderline-Orwellian or dangerously disunified. Here’s the real kicker: we don’t have to choose between maintaining our private lives and public health when the two are intimately intertwined. Take masks for example: by wearing one you are protecting others from your germs while also being protected from the germs of others. So, stay at home if you’re sick, wear a mask and remain socially distant to others when you’re outside, and please take the vaccine once it has been proven to be safe and effective by our scientists who are working hard to find a cure. Stay safe, keep well, and I’ll see you (in-person) on the other side.
Author; Winni Yang, MSc Student in Evidence-Based Social Intervention and Policy Evaluation, Department of Social Policy and Intervention, St. Hilda’s College
References:
[1] J.S. Mill. On Liberty. Oxford, England: Oxford University Press, 1859, p. 21-22.
[2] Health Act 2006, c.28. Available from: https://www.legislation.gov.uk/ukpga/2006/28/pdfs/ukpga_20060028_en.pdf [Accessed: 20 October 2020]
[3] O. Nay. Can a virus undermine human rights?. The Lancet, 2020, volume 5, issue 5. [Online] Available from: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30092-X/fulltext#%20 [Accessed 22 October 2020]
[4] J. Tidy. Coronavirus: How China’s using surveillance to tackle outbreak. BBC. 2020 [Online] Available from: https://www.bbc.co.uk/news/av/world-asia-52104798 [Accessed 22 October 2020]
[5] Blavatnik School of Government. Coronavirus Government Response Tracker, 2020. [Online] Available from: https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker [Accessed 22 October 2020]