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Pandemic, Public Health and Moral Perspective: A Note

Pandemic, Public Health and Moral Perspective: A Note

An illustration of the ‘Penrose stairs’ impossible object. Image: Sakurambo.

Public health serves the population as a collective whole. It is based on the principle that what is good for the community is good for the individual.

Vaccination is an example of a public good. All vaccines have a low but finite probability of causing harm.

From an individual’s point of view, it may be ideal if everyone around the individual were vaccinated but she herself did not take the vaccine. Her thinking is that the surrounding herd immunity will protect her, and she will not suffer the potential ill-effects of vaccination

If we all thought like this, no one would get vaccinated, and we would all be collectively and individually worse off.

But if we all got vaccinated, we will be collectively better off, most of us will be individually better off and a tiny number may be individually worse off.

This explains the see-sawing of public health recommendations. When masks are in short supply, it is best to conserve the limited units for healthcare workers. Public health professionals will then lean towards proclaiming that masking is unnecessary.

Otherwise, there will be a run on masks and healthcare workers may not have the supply they need.

What is a flawed public health recommendation from an individual’s perspective makes eminent sense when looking at the issue from the perspective of the entire community.

In similar vein, all the to-ing and fro-ing on the AstraZeneca vaccine is because public health professionals are weighing the health of the people against the downside risk to a few individuals.

In Europe, given that continent’s moral bent, they err on the side of minimising harm to the individual, even if it makes no sense at all from a public health perspective.

China is an example from the other end – a place where the individual does not matter, or matters less so, as long as society is well-served.

The former model has worked poorly in Europe, where fits and starts in vaccination have allowed an epidemic already an out-of-control to extend its run. China, on the other hand, has applied draconian measures to suppress the outbreak within its borders.

Pandemics may call for a temporary shift in moral perspective, favouring the public over the individual. This is a tough choice every country must make, although not necessarily in draconian fashion.

And we must make the choice based on available science. The law of averages must not become the flaw of averages.

Swami Subramaniam is the author of Healing Hands, a hand surgeon’s biography.

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