Greg Pence, Ph.D., professor of philosophyWhen the city of Wuhan, China, quarantined 11 million people in January 2020 after the outbreak of a deadly novel coronavirus, Greg Pence knew something big was coming. He told his students as much — in fact, he told them that the SARS-COV-2 virus, which eventually would become known worldwide as COVID-19, likely would be what he described as an “epic” historical event.
“Even a parent I was meeting with asked if I really thought the virus would come to Alabama,” Pence said.
“I said, ‘Yes, it will.’”
And he was right. COVID-19 hit Alabama hard, bringing with it more than 541,000 diagnosed cases and 11,000 deaths to date. But for Pence, a professor in the Department of Philosphy who has studied bioethics since the 1970s, it brought something more — the chance to study what he considers to be the most significant bioethical issue in a century.
Pence compiled his research into his new book “Pandemic Bioethics,” which examines relevant issues such as the fair allocation of scarce medical resources, immunity passports, vaccinations, discrimination against minorities and more. It is available from Broadview Press as an e-book on the Google Play and Amazon Kindle stores and from other vendors in the coming weeks and in print.
The book opens with explorations of historic pandemics such as the 1918 Spanish flu and modern viral pandemics such as HIV and the swine flu outbreaks in 1976 and 2009, then examines SARS2 viruses, containment methods, vaccines, privacy, structural inequality and leadership, plus a look into a future shaped by the COVID-19 pandemic.
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“This virus and how to deal with it — that made everyone a bioethicist. There are tons of philosophical issues in fighting this virus and setting public policy, and I wanted to make sure they were put out there.” |
“A lot of issues in bioethics are esoteric, such as the question, ‘Who gets a heart transplant?’ But this virus and how to deal with it — that made everyone a bioethicist. There are tons of philosophical issues in fighting this virus and setting public policy, and I wanted to make sure they were put out there.”
Some of the most pressing questions posed by COVID-19 that Pence tackles in the book center on its long-term effects on population health, the emergence of viral variants and the effects of American leadership on public health decision-making during the pandemic.
Vaccine development and implementation also pose unique issues, Pence says, from the process of emergency use authorization from the U.S. Food and Drug Administration to mandatory vaccinations, distribution to underserved populations and what he calls “status certificates.”
If 32 million people are known to have been infected with COVID-19, with perhaps an additional 32 million infected, the U.S. has a large pool of citizens with prior exposure, and therefore antibodies; another 160 million have full or partial vaccination status, he says. “Some app or document is going to be needed to cover all these Americans,” he said. “Calling it a vaccination passport or vaccination certificate doesn’t work for the unvaccinated Americans who are exposed but have good antibodies. But those antibodies will fade over time, especially in seniors, and some from vaccines may fade faster than others. Even the term immunity certificate doesn’t work because it won’t be an all-or-nothing thing, but rather a matter of degrees. The term status certificate will be needed to cover all these possibilities.”
Ethical takeaways
Pence says he hopes readers of “Pandemic Bioethics” take away a few key lessons. First, be wary of victim-blaming those who have been or are infected with COVID-19. Discrimination against overweight people of color who contracted COVID-19 is one example he cites. The Centers for Disease Control and Prevention notes that some racial and ethnic minority groups face multiple barriers to health care, such as lack of insurance, transportation, childcare or the ability to take time off work.
“Constantly linking deaths from COVID to their weight, high blood pressure and other things can be code for, ‘Well, they deserve what they get for their unhealthy lifestyle,’” Pence said. “We have to be very careful about that.”
He also hopes people are more aware of what he terms “amplification systems,” or crowded, high-traffic locations such as airports or the mass food-production sites that can magnify the spread of germs.
“We live in a very interconnected world,” Pence said. “We assume that everything is safe and inspected and regulated, but a lot of those systems have fallen apart in the last few decades due to deregulation.”
The third lesson, according to Pence, is that we must begin preparing for pandemics to come, which begins with improving public health systems both in the United States and globally.
“We weren’t ready this time, and we need to be ready next time,” he said.
Changing education
When Pence “puts on his philosopher’s hat,” he says he believes that everyone who lived through the COVID-19 pandemic has been changed fundamentally, from students who realized they prefer an online education experience to people who would rather work remotely than in a traditional office setting. Even something as casual as dating might undergo procedural changes such as discussion of vaccination status before meet-ups, he explains.
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“We weren’t ready this time, and we need to be ready next time.” |
At UAB, students have expressed interest in learning more about pandemics and ways those events may affect the future. This summer, Pence is again teaching PUH 690, “Ethical and Political Issues of Pandemics.” The first iteration was taught during the 2020 summer semester, when the pandemic was fairly new. The course follows a structure similar to “Pandemic Bioethics,” including spending the first third of the course discussing historical pandemics and the issues that arose in ethics, law and public policy.
“With every bioethical issue I write about, I try to present it in historical context, whether its allocating organs to recipients or AIDS,” Pence explained. “We’ve been through all this before with the Spanish flu, with cholera, when we scapegoated the victims of AIDS. Hopefully we can learn from our mistakes — and we did make some big mistakes.”
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