Proportionality and Pandemics-A Difficult Assessment
By David Mullins
In the current health crisis, many goods have to be balanced. The big question is whether the good done by the lockdown is proportionate to the harm caused by it. So far, a big majority of people think that it is.
The principle of proportionality is used within Catholic Just War theory, for example. We do not go to war to resolve minor diplomatic incidents.
If we did, then the chosen means of resolution would be grossly disproportionate to any good that might be achieved and would therefore contradict the principle of proportionality.
Can we apply the same thinking to the ‘war on Covid-19’?
At the time of writing the European Centre for Disease Control estimate that 2.35 million cases of COVID-19 (in accordance with the applied case definitions and testing strategies in the affected countries) have been reported, including 164,656 deaths.
However, the public health response to combatting Covid-19 has included measures that will ensure more than 117 million children are now at risk of missing out on measles vaccines. This is according to the United Nations International Children’s Emergency Fund (UNICEF).
In 2018, measles infected an estimated 10 million people and killed 140,000.
According to the World Health Organisation the measles virus, which is highly contagious, has a mortality rate of 3% to 6% with malnourished children especially at risk.
The Covid-19 mortality rate is difficult to be precise about but during a March 3rd media briefing, WHO Director-General Dr Tedros Adhanom Ghebreyesus stated: “Globally, about 3.4% of reported COVID-19 cases have died.” It is likely to be much lower than this, however.
The public health response to Covid-19 has also brought about the suspension by the Global Polio Eradication Initiative (GPEI) of all activities that cannot adhere to guidance on physical distancing, such as house-to-house or other immunization activities using oral or injectable vaccines.
Augustin Augier, executive director of the Alliance for International Medical Action was reported on April 9th as saying that programs with the capacity to train about 500,000 African mothers to diagnose acute, potentially fatal malnutrition in their children have also been suspended.
Closer to home all cancer screening programmes related to routine cervical cancer screening, routine breast cancer screening, bowel cancer screening, abdominal aortic aneurysm (AAA) screening and surveillance monitoring, and routine diabetic eye screening and surveillance monitoring, have all been suspended in Northern Ireland.
Here in the Republic all test appointments and invitations to screening for cervical cancer are cancelled.
If we take proportionality to mean that our actions must not bring about a worse state of affairs than if we had done nothing-then I am not sure the test has been met. Our actions to combat one disease are allowing a whole host of others to flourish and usually among the poorer populations of the world.
You might argue that the methods employed are about gaining time for a vaccine to be developed and about ensuring that one infectious disease is not brought into environments where others already thrive.
The problem is that we have no way of knowing if this approach will ultimately prove correct. This is a difficulty we should not shy away from.
For now, all we have, is at best, a kind of speculative ethical proportionality.
Let us remember that there is still no vaccination against Middle East respiratory syndrome, which is now known to be caused by another form of the coronavirus and which was first reported on September 2012 in Saudi Arabia.
So, what looks proportional now in terms of our response, may soon degrade into brutality if the same approach is still being persisted within 8 years’ time.
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David Mullins is a bioethics commentator. He holds a Masters Degree in Bioethics, with a dissertation on “Ethical Alternatives to Embryonic Stem Cell Research”.
