Ethical and human rights considerations in public health in low and middle-income countries: an assessment using the case of Uganda’s responses to COVID-19 pandemic

Abstract

Background In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19. Main body We begin by illustrating the value of ethics and human rights considerations for public health measures including during emergencies. We then summarize Uganda’s social and economic circumstances and some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human rights considerations for public health, we reflect upon the ethical propriety of some of Uganda’s responses to COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the spread of COVID-19, the ethics and human rights considerations commonly recommended for public health responses and their importance. Our study found that some of the measures adopted violate ethics and human rights principles. We argue that even though some human rights can sometimes be legitimately derogated and limited to meet public health goals during public health emergencies, measures that infringe on human rights should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least restrictive. We reflect on Uganda’s initial measures to combat the spread of COVID-19 and argue that many of them fell short of these criteria, and potentially limit their effectiveness. Conclusion The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles recommended for public health measures.

Ethical Considerations and Challenges Duringthe COVID-19 Vaccine Deployment: Experiences from an Indian Perspective

“…Consequently, similar to public health responses towards the management of other aspects of the COVID-19 pandemic, governments are likely to escape moral culpability despite failing to ensure adequacy and timeliness of vaccination coverage due to the lack of specific and measurable ethical benchmarks [29]. Evolving a robust ethical framework for assessing government and administrative response towards COVID-19 vaccination applicable in the developing world therefore represents an urgent ethical imperative.…”

COVID-19 and the Law in Uganda: Development and Application of the Public Health Act to Control the Pandemic, 2020-2021

“…Some of the COVID-19 preventive health measures (NPIs) directly restrained human rights such as the right to education (Article 30), the right to practice any religion (Article 29), and right to move freely throughout (Article 29), to enter, leave and return to Uganda. This scenario was prevalent globally and not in Uganda alone (39). Noteworthy, these COVID-19 preventive measures became more stringent as the outbreak evolved with increasing cases and deaths, such as community quarantine or total "lockdown" (40).…”

The Metaphor of War in Political Discourse on COVID-19 in Uganda

“…This was partly due to the excessive use of unnecessary and in some instances lethal force by the Uganda police and the military to enforce COVID-19 containment measures. While in and of themselves, these measures were not harmful to the population, their enforcement edged on infringement and violation of "ethical and human rights principles" (Barugahare et al, 2020). In some instances, enforcement of these measures led to extra-judicial killings and injuries as is, for example, reported in a 2021 report by Amnesty International that "in Uganda, security forces killed at least 12 people, including an 80-year old woman" (Amnesty International Ltd 2021, 20).…”

“…For example, James Nkuubi in his study on how guns govern public health in Uganda asserts that increased militarization of the COVID-19 public health emergency led to a "digression of democratic values, the rule of law and human rights" (Nkuubi 2020, 638). Further, those measures violated the ethics and human rights principles in that they were very restrictive and not necessarily proportionate to the magnitude of the threat nor strictly necessary, effective, reasonable, and equitable (Barugahare et al, 2020).…”