Ethics-driven policy framework for implementation of movement restrictions in pandemics

Abstract

In the ongoing COVID-19 pandemic, countries across the globe undertook several stringent movement restrictions to prevent the virus spread. In April 2020, around 3.9 billion people in 90 countries were contained in their homes. Discourse on the ethical questions raised by such restrictions while historically rich is absent when it comes to pragmatic policy considerations by the decision-makers. Drawing from the existing literature, we present a unified ethical principles–pragmatic considerations–policy indicators framework flexibly applicable across different countries and contexts to assess the ethical soundness of movement-restricting policies. Our framework consolidates 11 unique but related ethical principles (harm, justifiability, proportionality, least restrictive means, utility efficiency, reciprocity, transparency, relevance, equity, accountability, and cost and feasibility). We mapped each ethical principle to answerable questions or pragmatic considerations to subsequently generate 34 policy indicators. These policy indicators can help policymakers and health practitioners to decide the ethically substantiated initiation of movement restrictions, monitor progress and systematically evaluate the imposed restrictions. As an example, we applied the framework to evaluate the first two phases of the largest lockdown (March–May 2020) implemented nationwide in India for its adherence to ethical principles. The policy indicators revealed ethical lapses in proportionality, utility efficiency and accountability for India’s lockdown that should be focused on in subsequent restrictions. The framework possesses value towards ensuring that movement-restrictive public health interventions across different parts of the world in the ongoing pandemic and possible future outbreaks are ethically sound.

Phase-wise Impact Analysis of the Indian National Lockdown against COVID-19 Outcomes

“…We further observed that there was excess focus on the anticipated efficacy of the interventions rather than to scale up the healthcare resources, and thus preparedness for the impact of the pandemic was lost. This was more of a speculated efficacy, and thus, very short-sighted policy implications with little consideration of societal implications and ethical concerns of the lockdown interventions 31 .…”

Perceived coercion, perceived pressures and procedural justice arising from global lockdowns during the COVID-19 pandemic: A scoping review

“…According to an Indian policy framework by Zadey, Dharmadhikari & Mukuntharaj (2021), where the extent of harm that a potential pathogen poses is unknown, decision-making and guidelines regarding restrictions of human rights must be clearly communicated, equitable and reciprocal. Such decision-making must uphold the use of least restrictive means and, as more information unfolds, decisions must be guided by the principles of preventing harm, justifiability and proportionality [45]. Other authors in Western cultures focused on such restrictions being justified in light of the risk of negative outcomes to others, particularly in the absence of a vaccine [12,19,46].…”

“…Finally, there is some limited debate regarding the ethicality and fairness of lockdown within the literature, particularly in those with fewer economic means and less reliable access to food, water and sanitation [47]. Some authors argued that decision-making regarding lockdown must adopt the least restrictive means possible until clear information on a pathogen and the risks it poses emerge, whilst others argue that lockdown is justified where there is substantial risk of loss of life [12,19,45,46].…”