N S D A N A T I O N A L T O U R N A M E N T T O P I C R E S O L V E D : A P U B L I C H E A L T H E M E R G E N C Y J U S T I F I E S L I M I T I N G C I V I L L I B E R T I E S .
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In Collaboration With DFW Speech & Debate Staff
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Table of Contents
TOPIC ANALYSIS BY: MATT SLENCSAK ...... 8 Resolved: A public health emergency justifies limiting civil liberties...... 8 Introduction & Background ...... 8 Researching The Resolution ...... 10 Implementation ...... 11 History of Public Health Emergencies ...... 11 Ground (And any potential skew…) ...... 12 Framing ...... 12 Conclusion ...... 13 FRAMING ...... 14 It is the obligation of people as global citizens to do as much as possible to protect the most vulnerable and the State to create the circumstances where that is possible ...... 15 The social contract necessitates trading freedom for survival- the key is to allow for emergency powers when necessary, for collective safety ...... 16 Methods to resolve PHEs require a balancing of pragmatic and ethical concerns. Failure to do so only undermines the effectiveness of different tactics ...... 17 The balancing of ethical principles during a PHE means assessing who is burdened by state action and determining if it is truly justified. A PHE does not immediately justify state action ...... 18 Global public health is deeply interconnected - we are only as safe as the most vulnerable person, globally ...... 19 AFFIRMATIVE EVIDENCE ...... 21 Implementation / Solvency ...... 22 Analysis across 58 countries finds that public trust increased compliance with restrictions during the COVID-19 pandemic ...... 22 Taiwanese Policies and infrastructure from the 2003 SARS outbreak allowed for a targeted response to the Covid PHE, proving that governments do not have to default to larger interventions ...... 24 Isolation and distancing can prevent from overwhelming hospitals and spreading to the most vulnerable ...... 25 Outbreaks inevitably stress the medical system- even with all other possible measures in place, distancing is required to prevent deaths 26 Digital health technologies helped with resource allocation, contact tracing, and quarantining for COVID ...... 27 A switch to digital technology allowed better real time prediction and reporting of pandemics ...... 29 Malaria, HIV/AIDS, and foot and mouth disease all serve as successful historical examples of modeling to aid in pandemic response ...... 30 Disease Modeling in China allowed the country to provide crucial warning and analysis of effective mitigation policies ...... 32 South Asia Exemplifies the Success of Using mandatory tracking to contain COVID-19...... 34 Vaccine mandates in Europe increase the proportion of the population getting vaccinated which supersedes any concerns of individual liberty ...... 35 Environmental ...... 37 Pollution within Delhi has reached levels that are literally off the charts. These concentrations increase heart disease, respiratory infections, and other forms of harm ...... 37 PHE can help reframe environmental issues into their health consequences, allowing for them to be better confronted. The restrictions of civil liberties allow for first steps to be put in place as well ...... 38 Air pollution is a global public health emergency ...... 39 Smog standards are critical for public health ...... 40 WASH (water, sanitation, and hygiene) is critical to fight public health crises like COVID-19 ...... 41 Water pollution negatively impacts public health ...... 42 Government policies that reduce pollution protect public health – laundry list ...... 44 After declaring a public health emergency New Delhi has increased environmental focus in the energy, transportation, and agricultural industries ...... 45 The prevalence of air pollution in China has resulted in several positive policy changes in response to the public health crisis ...... 46 Outbreaks...... 47 Outbreaks justify limitations, as the only way for a nation to prevent them is to work ahead of the problem...... 47 COVID-19 Patients are seeing long term neurological, cardiovascular, and pulmonary system complications ...... 48 4 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
Long term economic consequences of pandemics can persist for 20 years ...... 50 Estimates suggest that lockdowns prevented 3.1 million deaths in the EU and 531 million in the US ...... 52 Analysis finds that per-capita mortality was 4 times lower in places with mask mandates than without ...... 53 Imposition of social distancing requirements in the US are estimated to have reduced reported cases by over 600,000 21 days after implementation ...... 54 The South African Government lockdown shows the effectiveness of lockdowns on limiting spread...... 56 Cases spiked in states that lifted lockdowns first ...... 58 Analysis across 18 nations finds that lifting lockdowns too early can lead to deadly spikes in cases...... 60 Contact tracing, mandatory quarantines, travel restrictions, and increased surveillance resulted in the successful containment of SARS in Asia ...... 61 Increased health technology in Sierra Leone improved their Ebola response ...... 63 *Western Exceptionalism ...... 65 The Global South is better at responding to COVID-19, faces the brunt of consequences of the Global North’s unwillingness to act, and is locked out of receiving vaccines due to patent laws ...... 65 Sub-Saharan Africa proves- responsive policy keeps case numbers low...... 67 While the UK and US ignored advice, South Korea kept caseloads low through aggressive contact tracing ...... 68 US guidelines created noncompliance, while South Korean contact tracing allowed for quick and effective responses ...... 69 Appeals to civil liberties have hamstrung the US response at every turn ...... 70 Attempts to profit off of health policy has justified imperialist intervention and catastrophizing...... 72 NGOs like the Gates Foundation use deregulated global health governance to bypass safety measures and turn poorer countries into customers for big pharma ...... 74 Property rights ensure that the current system cannot solve- patent monopolies means that companies prioritize profits over ending the pandemic ...... 75 Even within existing legal loopholes, companies do everything they can to avoid poorer countries accessing treatment...... 76 IP reinscribes existing health access problems and ensures that manufacturers can never meet the necessary global supply, dooming millions in the Global South ...... 77 *Structural Violence ...... 78 Poor and insured Americans saw a greater burden of H1N1, and those trends are continuing with COVID ...... 78 Socioeconomic Status disincentivizes people to seek medical treatment ...... 79 Higher COVID mortality rates are found among impoverished groups ...... 80 COVID-19 pandemic disproportionately impacts communities of color ...... 81 Structural inequities exacerbate public health emergencies ...... 83 Vaccine hesitancy caused by institutional racism ...... 84 White communities get PPP loans easier...... 85 White communities get more vaccinations ...... 86 White communities get more testing sites ...... 87 Lack of health and transportation infrastructure creates vulnerability ...... 89 People of color are impacted by health inequity – discrimination, healthcare, housing, education, criminal justice, finance – CDC evidence ...... 91 AT: Rights ...... 92 Prior Case law shows that more coercive methods such as quarantine and isolation are justified if they promote the general welfare and are proportional ...... 92 Violations of civil liberties such as surveillance and mandatory vaccination and treatment are necessary for global suppression of outbreaks...... 94 This is widely recognized as a necessary governmental tradeoff in order to ensure justice for the least advantaged...... 95 General welfare trumps individual considerations when dealing with public policy ...... 96 Governments empirically under-restrict, not over-restrict, rights ...... 98 Limiting religious exemptions is necessary to protect the public ...... 99 NEGATIVE EVIDENCE ...... 101 *Class ...... 102 Quarantines and travel advisories have historically misused due to a lack of good data and communication. This means that the burden of containment falls increasingly on a few, as opposed to allowing for a greater distribution of the burden ...... 102 Reactions by governments are tainted by class and cultural barriers, resulting in less action when the individuals impacted have lesser class privilege. Those actions which are taken ultimately disempower them further, as they target cultural practices ...... 103 Technological Innovation in disease research will widen health inequality ...... 104
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Low-income individuals are more likely to experience job loss during an outbreak ...... 105 Low-income workers are 6 times less likely to be able to telework, resulting social distancing and lockdowns increasing economic harm on poorer communities ...... 107 Income is related to the ease and extent to which people social distance ...... 108 The benefits of social distancing are significantly lower in poor countries given the economic burden ...... 110 Blanket lockdowns fail in developing countries due to a lack of financial capabilities and the issues within their labor market. Targeted support for vulnerable populations is preferable ...... 111 Lack of digital technology in developing countries limits the effectiveness of digital contact tracing ...... 112 Democracy ...... 113 Open communication and collaboration make democracies more effective at responding to pandemics ...... 113 Even though authoritarian countries imposed more stringent democracies were more successful in enforcing them given that they foster a higher degree of citizen cooperation ...... 115 4 major failings of authoritarian government limit their response to pandemics ...... 116 Authoritarian responses aren’t more effective than democracies. East Asian democracies had some of the best pandemic responses even when compared to countries like China ...... 118 Increased governmental powers both become permanent and immediate, allowing for countries to silent dissidents and set up the future of surveillance of their people ...... 119 Public health emergencies incentivize democratic nations to abuse power and overreach ...... 120 COVID-19 shows governments in over 80 countries are using the pandemic to erode democracy – accelerating rights violations, causing damage that will last beyond the pandemic ...... 121 Empirically states use expansion of emergency powers beyond what is necessary, increasing undo rights violations and accelerating autocratization by 75%...... 123 Rights ...... 125 Public health emergencies have been used to expand governmental power in ways which cannot be reversed post emergency ...... 125 *China has utilized the quarantine and other pandemic fighting techniques to harm the Uighur populations in their country ...... 126 Restricting civil liberties for public health is counterproductive by reacting with punishment, and undercutting public confidence in health officials ...... 127 Civil liberty restrictions on the basis of health become endless – there will always be new diseases ...... 128 *Vaccine passports pose fundamental dangers to mass amounts of human rights – particularly harming the most vulnerable ...... 129 Vaccine passports will become defacto mandatory, violating the right to privacy for basic yet essential services ...... 131 A human rights approach to public health has fostered increased medical attention to marginalized communities and bolstered government accountability for pandemic response ...... 133 Valuing a human-rights based approach to public health policy increases the likelihood of compliance ...... 135 Harm Reduction That Protects Rights ...... 137 Voluntary app measures are able to operate without violating civil liberties, ensuring they aren’t left at home ...... 137 Media campaigns remain an effective measure for large scale social health changes without limiting civil liberties ...... 138 Combining community engagement with low-cost products can work, allowing for communities to change where more coercive actions fail ...... 139 Contact Tracing by Bluetooth instead of GPS could preserve location data of individuals...... 140 Privacy by Design Apps being used in several countries can reduce privacy concerns ...... 141 The slow uptake of contact tracing apps is explained by low public trust ...... 142 Voluntary Contact Tracing Apps have higher support across Europe and the US ...... 143 Voluntary lockdowns coupled with government support are more effective and don’t violate civil liberties ...... 144 Monetary Incentives worked for the influenza vaccine in the 2005-2006 flu season...... 146 Both SARS and subsequent WHO efforts have shown the importance of transparency in early disease detection and compliance with restrictions...... 147 Preparation ...... 149 Across 188 during the 2009 H1N1 pandemic countries that higher levels of pandemic preparedness did better in terms of response ...... 149 Because of early investment in pandemic infrastructure Uganda went from being the site of the largest Ebola outbreak to being able to cope with disease ...... 151 Rwanda’s model of disease emphasized early pandemic investment and increasing healthcare equity...... 152 Economic bills passed do not address long term issues. Investments in the social safety net are crucial moving forward ...... 154 Failure to invest in healthcare infrastructure after SARS hurt our COVID response. The short-term fixes put in by the CARES act do nothing to stop the long-term failure to invest in healthcare ...... 155 Investments in pandemic preparedness are the most important tool against pandemics, yet they often get ignored for short term solutions ...... 156
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Pandemic Preparedness in South Korea allowed them to avoid strict lockdown seen in Europe ...... 158 Comparisons between the 4 Asian polities, Japan, and the US show the importance of pre-pandemic infrastructure in responding to crises ...... 159 *Drug Epidemics ...... 160 Current actions to confront the public health crisis surrounding drug use is increasingly punitive against Black and Latinx drug users, while simultaneously rehabilitating White individuals...... 160 The opioid epidemic has been officially recognized as a public health emergency ...... 162 Decriminalization in countries such as Portugal has helped to reduce the use of drugs in other countries while also improving public health more broadly. Non-coercive means operate as a bridge towards these health improvements...... 163 Decriminalization and/or legalization is necessary in order to decrease the dangers of addiction while also being a part of a cultural shift which does not demonize those who use drugs, increasing the ability to provide rehabilitation...... 165 We must rethink our approach to drug use - criminalization has led to mass incarceration, long lasting impacts on the lives of individuals, but has produced no change in drug usage ...... 167 White use illicit drugs at equally or greater rates than Black individuals, and yet Black adults are eleven times more likely to be arrested for drug possession, reflecting the bias within the criminal justice system...... 169 The War on Drugs has is routinely used to justify violations of privacy, body autonomous, impose financial burdens, as well as jail time – disproportionately impacting low income and racial minorities ...... 170 An ethical approach to drug epidemics must be based in a methodology other than criminalization. Even best practices cannot operate within a system that stigmatizes and prevents individuals from accessing the broader medical and social communities they need ...... 172 AT: Environment - (Non-PHE Responses) ...... 173 Pollution taxes are historically successful - precedent ...... 173 US air pollution policies work – satellite data ...... 174 Governments must implement clean air policies ...... 175 AT: PHE Efforts Solve / Work ...... 177 *Government collaboration is insufficient, as each level attempts to deflect blame to another and scapegoat ...... 177 Overly coercive measures can undermine government trust ...... 178 Rising political mistrust in England is increasing the prevalence of conspiracy theories which in turn lower COVID restriction compliance and vaccine uptake...... 179 Governments use health emergencies for political advantages, thereby reducing public trust and making it harder to solve the problem 181 Restricting civil liberties and undermining rights fails to produce benefits. People avoid testing and other measures instead of complying ...... 182
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Topic Analysis By: Matt Slencsak
Matthew Slencsak has been involved in Speech and Debate for over 10 years. He graduated from Howland HS in 2013, after competing in Lincoln Douglas debate for 4 years. After High School, Matt obtained a degree in IT. Matt has coached at multiple schools, building several LD debate programs from scratch including South Range High School and Liberty High School. Matt has coached students to making stage at both the state level and national level. He has had multiple state and national quarterfinalists, even coaching students to finals at the OSDA State Tournament and NSDA National Tournament. Matt co-founded Triumph Debate with the goal of creating a more equitable space. Resolved: A public health emergency justifies limiting civil liberties. Introduction & Background Like the NCFL Grand National Tournament topic we released a brief on last month, this resolution is very important to many debaters. The NSDA National Tournament is the largest national tournament in the United States, and for many debaters (especially local debaters or traditional LDers), it is the most important and significant tournament in their debate career. Though, like with the NCFL topic, this resolution will really only be used at one major tournament, it is important to take the time to understand the topic literature, and show up to NSDAs prepared.
As always, it may be worth debaters exploring previous topics that are similar and can provide ideas or resources that can be a starting point for many. Recognizing this trend is important because a.) it can help you analyze the resolution in a consistent way and b.) it grants you the opportunity to utilize framing techniques, cards and argumentation from previous (but relevant) topics. A few examples of similar NSDA resolutions from previous years include:
(LD) Nationals 2017 – Resolved: A just government ought to prioritize civil liberties over national security.
(LD) Nationals 2011– Resolved: When forced to choose, a just government ought to prioritize universal human rights over its national interest.
(LD) September/October 2005 – Resolved: individual claims of privacy ought to be valued above competing claims of societal welfare. Definitions & Topicality
In terms of definitions, I think there is a little bit of disagreement on key areas. For this reason, debaters should prepare interpretations of what constitutes both a “public health emergency” as well as “civil liberties”. Importantly, I would recommend that debaters stray away from utilizing definitions specific to one country, as broader definitions will have better historical precedent and greater relevance in a round where the debate is not about any one country. Instead, opt for definitions presented by international organizations or used in particular literature pieces. With that, let’s break down each term/phrase in the resolution, and what it means for all competitors.
The first, and likely the most important, is “public health emergency”, or PHE.
What constitutes a public health emergency, on face, may seem intuitive. In fact, you may already have thoughts and opinions on various emergencies and health crisis. However, there is some disagreement on what is categorizes as a public health emergency. This is largely because each nation has their own interpretation, as well as the international community and various authors on the topic. In short, there are a lot of agents at play who may disagree on how big the PHE umbrella is. 8 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
Many definitions contextualize PHE as a larger threat to international health. It is usually noted as a catastrophic event that requires significant health services. Where debaters may disagree is what exactly is included in those “catastrophic events”. Some states (and by consequence, papers in the literature) include scenarios such as environmental disasters, specific health crises that are not necessarily transmittable (i.e., opioid epidemic), bioterrorism, and more. Other nations or organizations define PHE more tightly, limiting it to disease specifically. Both interpretations are fair, and in fact, reflective of the literature. This is likely because the United States Department of Health and Human Services has a far broader definition, so much of the US-specific research or research conducted by Americans focuses on this interpretation.
The World Health Organization provides a definition of PHE: https://www.who.int/hac/about/definitions/en/
A public health emergency (the condition that requires the governor to declare a state of public health emergency) is defined as "an occurrence or imminent threat of an illness or health condition, caused by bio terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human facilities or incidents or permanent or long-term disability (WHO/DCD, 2001). The declaration of a state of public health emergency permits the governor to suspend state regulations, change the functions of state agencies. This definition is ideal to use if you are looking to include a wide array of topic areas, because it specifically includes epidemic causes.
A more specific definition focused exclusively on disease control comes from the IHR in 2005, where they define Public Health Emergency of International Concern as: https://www.who.int/ihr/procedures/pheic/en/
“an extraordinary event which is determined, as provided in these Regulations: to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response”. This definition implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action. In my opinion, because of the amount of literature on disease response and prevention, the second definition would probably be better for a more predictable debate with smaller ground distribution, that is more balanced.
However, the first definition allows for more creativity and expands the scope of the topic to encourage additional research. Another added benefit of the first definition is that it allows debaters to argue outside of COVID-19. Since the coronavirus has been present for over a year, much of the most recent literature discusses that event specifically. Unfortunately, for many debaters, coaches, and judges, debating COVID-19 can be extremely upsetting. Keep in mind that there are millions of people who have lost loved ones due to the virus. Given these circumstances, I think having a more expansive topic definition seems like a fair tradeoff so more folks can meaningfully engage with the activity.
The next term that is important for debaters to think about (though not really to define) is the term justify. And this is really just because this term is sort of the crux of the debate; how is something justified? The answer comes in the form of framework. If a debater has a framework on the negative of, say, maximizing individual rights, then limiting or violating civil liberties is far less justified under this framework. In other words, your framework will give you a bright line or standard to indicate when something is or isn’t justified. After all, the point of philosophy, in large part, is to answer these kinds of questions regarding what action/policy is the most just/best. So, I think it is important for debaters to cognitively recognize how this plays out in their debate rounds, to be able to draw lines in the sand or answer questions in cross examination sufficiently.
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The third term that debaters are going to have to have to grapple with is “limiting”. I think it is fairly obvious what the definition of limiting is – that is not the issue. Instead, debaters need to think about (and prepare answers to) how much we limit civil liberties. I think to assume either side is all or nothing is inaccurate and unfair. It is unreasonable to force the negative into defending never being able to do any limit. Otherwise, affirmatives could point out just how unreasonable that negative interpretation is by conjuring up high magnitude examples on their side, with very slight violations of civil liberties.
For example, it would probably be incredibly unreasonable for the negative to be in opposition of temperature checks when someone walks into a public establishment on the grounds that it violates civil liberties (i.e. privacy), in so far as those temperature checks could save thousands of lives and are such a small violation.
For this reason, I think debaters should interpret the resolution as more of an “on balance” statement. Stray away from fuzzy examples of minor violations / benefits in attempts to make your opponent look absurd. Instead, opt for a debate with equal severity. This will be a better, fairer debate with more quality literature.
The final phrase to consider is “civil liberties”. I wouldn’t bother providing a definition in case, but I do think it is worth understanding how different authors/institutions define civil liberties. This may only become an issue at the NSDA National tournament in the case that someone on the affirmative tries to argue that the negatives example(s) of civil liberties being violated aren’t topical, because they aren’t actually civil liberties according to their definition. I think, unless the negative is blatantly contextualizing something as a civil liberty that is obviously not one, this debate seems less important, and will likely be really unenjoyable for your judges, too.
Overall, this topic should be relatively straightforward for most debaters, and I think most debaters should just be aware of interpretations and how these affect ground distribution to inform their argumentation and prepare for their rounds. Researching The Resolution Now that we have discussed what terms included in the resolution are and mean, it is important you know key terms while researching. Doing a quick Google search of a public health emergency (PHE) and civil liberties will yield you some results. But you can maximize your research output by including key terms that the literature base uses, including:
• Public Health Emergency of International Concern • Public Health Disasters • Health Crisis • Health Emergency • Health Emergency Response • Health Emergency Declaration • Health Emergency Preparedness • Health specific terms, such as social distancing, quarantine, contract tracing, lockdowns • Disaster Preparedness • Outbreak Modeling • Herd Immunity • Healthcare Access
This list is a really roundabout way of searching different ways that the literature base on this topic defines or characterizes public health emergencies / civil liberties. Of course, what you search with these terms is entirely up to you!
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Implementation This topic really does not have much of an implication for implementation, because it is more of a statement of values than it is a policy proposal. Of course, there are a plethora of specific ways that nations can implement PHE preparedness/response mechanism. These include lockdowns, quarantines, self-isolation measures, social distancing, temperature checkpoints, mandated reporting for policy violations, testing, contract tracing, vaccines, and so much more. Debate over these specific implementation measures will more so focus on whether they work or how severely they may violate civil liberties.
It is important that this debate focuses on solvency. In fact, after diving deep into a lot of the literature on either side, I think issues of who solves the emergency best are going to be incredibly important. Both sides have clear claims to solving better, and there is a substantial amount of research with various links/unique warrants to allow debaters to have that discussion in round.
Finally, I think debaters must consider the different health models that have been proposed by researchers and institutions. We include many pieces of evidence of these in our “Framing” section. These models provide ways to view public health emergencies, best approaches, and directly impact how a government would approach PHE/civil liberties.
All in all, there isn’t too much to focus on in terms of implementation or understanding policy proposals. Instead, more debates will center on framing and solvency. Debaters should gain a strong understanding of various methods that have been used by governments to enact PHE safety measures. History of Public Health Emergencies The history of public health emergencies is largely defined or contextualized by what debaters will count as a PHE. If folks consider, for example, bio terrorism or environmental disasters as part of PHEs (which are likely topical), then the history of these various emergencies will be never ending. Because of this, I highly recommend debaters do their own research and truly understand the depth of the arguments they are presenting in round. In light of this, I’ll offer a brief overview of disease focused PHEs that students should be aware of.
First, of course, is COVID-19. Given that we are on the tail end of a global pandemic, many students, coaches and judges may immediately think of and focus on COVID-19 as the most prominent example of a PHE. This is exacerbated by the fact that most recent literature does the same. Avoid falling into this trap. Moreover, most debaters may have a strong understanding of COVID-19, so we’ll gloss over the main points before diving into less known PHEs.
The origins of COVID-19 are largely unknown, and publications from as recent as yesterday have scientists calling for extensive research into this area. World Health Organization backed investigations concluded that one of the most likely causes is based on the intermediary host theory, where the virus was transmitted from an original animal host to an intermediate host, and then directly infected humans through contact. This is still uncertain, however. What we do know is that the virus was found to be genetically related to the SARS outbreak of 2003. Originally, experts believed the first case of COVID-19 to be reported from Wuhan, China in December of 2019. But some research indicates that COVID- 19 likely can be traced back even further.
COVID-19, or coronavirus-2 (SARS-CoV-2), emerged in 2019 and was officially declared a pandemic by the World Health Organization on March 11th, 2020. This was in large part due to the rapid speed at which the virus spread. Transmission rate is a really important consideration when nations or agencies declare public health emergencies. Recent data from just a week ago published by IHME estimates nearly 7,000,000 deaths globally as a result of COVID-19. Nearly every nation went into lockdown, implemented safety measures like social distancing, self-isolation, and mask requirements. Data also estimates over 160 million cases of COVID-19 have spread across the globe in the last two years. As I am writing this, just yesterday data showed over a billion shots for COVID-19 vaccines have been distributed.
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In terms of other health emergencies, I want to start off by saying that this list is significantly limited by timeframe. Any event prior to the 1900s is incredibly outdated. Modern medicine, medical technology, and science (and our ability to track, predict, and test disease) all mean that the more recent your case example, the more applicable it is right now.
One of the largest and most notable public health emergencies include the influenza pandemic of 1918. It is estimated that 25-50 million people died worldwide. In modern history, there are a few key cases to be aware of. The first is the H1N1 virus. A novel gene of the H1N1 virus emerged in 2009, first detected in the US and spread across the globe. According to CDC estimates, from April 2009 to 2010, there were over 60 million cases, nearly 300,000 hospitalizations, and over 12,000 deaths in the US alone. In May of 2014, the poliovirus was declared a Public Health Emergency of International Concern (PHEIC) under IHR 2005, as cases significantly spiked. The 2014-2015 Ebola virus outbreak in West Africa was considered one of the most severe virus outbreaks, with fatality rates ranging from 25 – 90%. Between 2013 – 2016, the virus killed over 11,000 people. In February of 2016, the World Health Organization declared a PHEIC for the Zika virus, as the fever spread from Brazil to other parts of South and North America. Thousands of cases were reported.
There are surely dozens of other major public health events that could be included in this rundown, but I wanted to give a substantial overview for students to understand some of the history of disease outbreak, and where the WHO has stepped in to declare emergencies. A great starting point in trying to understand this history is taking a look at when agencies like the CDC or WHO have made public health declarations. Ground (And any potential skew…) In my opinion, this topic has no substantial skew. There is some decent deontic ground for the negative that I think can be utilized nicely, especially in regard to rights frameworks or tautology. The affirmative has access to maybe some larger impact scenarios, especially with environmental arguments.
The tough part about the literature that I think a lot of students may realize as they dive in is that most of the evidence does not take a hard stance either way. Instead, they advocate for trying to balance both concerns, or even argue that they’re not directly in opposition. While in academia this might be fine, in a debate round this sort of advice is less helpful because the resolution is directly putting both sides at odds. For this reason, I would keep in mind the authors intent of their article and acknowledge their perspective on health modeling.
One thing to note on this topic is that the topic area itself is quite large, especially depending on the specific definition used in each round. As a result, debaters may find themselves in rounds where their opponents are running arguments / evidence they hadn’t even considered or discovered themselves. Don’t be afraid if this happens. The element of surprise or out-there arguments shouldn’t be the reason you drop a ballot. Instead, collect yourself and refute it as you would any other argument at any other tournament. You’ve got this! Framing As far as framing goes, both sides have access to the typical framing mechanisms, such as consequentialism / utilitarianism, pragmatism, structural violence, contractarian standards, and more. This topic can really be broken down to collectivism vs individualism. For this reason, I think affirmatives can create incredibly strong cases utilizing communitarianism as a framework. Likewise, I think negatives get clean access to any sort of rights-based / liberty framework. If you are curious what these may be like, I encourage you to take a look at the Triumph Debate Framework Vault for example frameworks/evidence.
Aside from generic framing, though, I think this topic is fantastic because there are a lot of public health specific frameworks that debaters can use. I would encourage students to do research on public health / health / emergency and philosophy/ethical concerns to discover some of the literature that exists. Of course, we have cut and included some of that evidence in our “Framing” section, and I would recommend debaters check that out.
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All in all, debaters can utilize more stock framing that we see topic to topic, with options that work really well on this topic, or they can opt for a more topic-specific framework relating to health/emergencies. Because debaters have so many options, I think this topic is fairly good for framing! Conclusion As usual, this analysis was a bit lengthy, I know. But we try to be extensive by providing one comprehensive overview of the topic, so that debaters do not have to read a dozen topic essays to get a holistic view of the topic.
In summary, I recommend doing a lot of deep research, strategically utilizing key search terms, coming prepared with your own definitions and interpretations, and recognizing (as well as appropriately accounting for) the potential literature skew that exists, and giving both sides the time necessary to produce good quality arguments. Often times, debaters will actually under-prep the side of the resolution that comes more naturally to them or is more present in the topic literature, because they’re more focused on strengthening their more difficult positions. Be aware of this common issue, and don’t fall into this trap. Take the time to develop strong positions on both sides – and I hope that the evidence presented in this brief helps get you started in doing so.
Lastly, if you have any questions about the evidence presented in this brief, or about our topic analysis, feel free to reach out to us at [email protected] and we would be happy to discuss further. Good luck to all those competing at the NSDA National Tournament, congratulations to every qualifier, and happy debating!
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Framing
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It is the obligation of people as global citizens to do as much as possible to protect the most vulnerable and the State to create the circumstances where that is possible Casla 20 [Koldo Casla, Law @ University of Essex, “Rights and Responsibilities: Protecting and Fulfilling Economic and Social Rights in Times of Public Health Emergency,” Essex Dialogues, http://repository.essex.ac.uk/28006/1/003.pdf] /Triumph Debate
The 1998 UN Declaration on Rights and Responsibilities of Individuals loosely talks about an individual responsibility to safeguard and promote democracy, human rights and a social and international order where human rights can be materialised.7 The wording of the UN declaration echoes the way many human rights defenders take injustice personally. Their commitment is commendable, particularly when they work in very difficult circumstances putting their lives at risk. But my idea of responsibility is slightly different. I am not saying we should all become human rights activists, as desirable as that would be. I am arguing that we should become citizens (members of a political community irrespective of nationality, migration status or any other personal circumstances) and accept and embrace the rights and responsibilities that come with it. This broad idea of citizenship is helpful to make sense of the difference between a legal duty and the civic duty presented here. As individuals, we are legally entitled to certain rights and obliged to respect the rule of law, also when the law limits our rights because it is necessary and proportionate to do so. We are not legally obliged to be virtuous citizens, neither should we be in exchange for human rights. The risks of a totalitarian turn if this requirement existed would be unendurable.8 However, above and beyond the realm of individual legal responsibility and duties, there is room to make for civic duty, interpreted as a meaningful contribution so other members of the political community can see their rights fulfilled. Reason and freedom from the yoke of religion and tradition were significant advances in history, but modernity’s liberal orthodoxy is not enough to ensure human rights for everyone: We need the State.9 One of the civic duties must be to sustain and defend resourceful and universal public services that prioritise the attention of most vulnerable individuals in a more equal and caring society. Our personal and economic fortune depends on others. This proposition is anchored in the tradition of civic republicanism. It can be found in Rousseau, ‘No citizen be so very rich that he can buy another, and none so poor that he is compelled to sell himself’. 10 Within this tradition, Thomas Paine pointed out, personal property is the effect of society; and it is as impossible for an individual to acquire personal property without the aid of society, as it is for him to make land originally… All accumulation, therefore, of personal property, beyond what a man’s hands produce, is derived to him by living in society; and he owes on every principle of justice, of gratitude, and of civilization, a part of that accumulation back to society from whence the whole came.11 Civic republicanism is looking for a non-individualistic version of rights, in line with T. H. Marshall’s notion of social citizenship. 12 Marshall understood social rights as essential ingredients of citizenship and advocated an egalitarian form of welfare that required reciprocal responsibilities between members of society in a precise historical and cultural context.13 As a matter of responsibility and social citizenship, I think those of us who believe in human rights can do more to advance meaningfully towards a society where justice is distributed in such way that there is real freedom for all. And with the adjective real I mean a democratic commitment to non-domination, beyond negative liberty,14 and I mean in particular the material conditions to be free, for which socio-economic rights are essential. When the International Covenant on Economic, Social and Cultural Rights (ICESCR) was drafted in the 1960s, the promotion of “general welfare in a democratic society” was presented as a potential “limitation” to these rights.15 I would argue, however, that embracing both rights and responsibilities would not see “general welfare”, as such, as a limitation of rights, but rather as one of the goals of enhancing socio-economic rights in law and policy. This does not mean that there would no longer be conflicts between individual rights and collective interests. It would be foolish to believe that social citizenship would simply overcome a 200-year tension between individual liberalism and utilitarianism. But it can help us to identify a holistic response that takes rights and responsibilities as the two sides of a single coin, as opposed to rights versus responsibility, or individual interests versus collective needs.
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The social contract necessitates trading freedom for survival- the key is to allow for emergency powers when necessary, for collective safety Li 20 [Neville Chi Hang Li, Political Science @ University of Bath, “How to construct COVID-19 as a national security threat in public discourse?” Viral Discourse, https://www.researchgate.net/profile/Chi-Hang- Li/publication/344649104_How_to_construct_COVID- 19_as_a_national_security_threat_in_public_discourse/links/5f86d1b9299bf1b53e263f66/How-to-construct-COVID-19- as-a-national-security-threat-in-public-discourse.pdf] /Triumph Debate
There are countries such as the UK that are sensitive to the concerns of human rights 6 and therefore have engaged in lengthy legislative processes in the Parliament to gain emergency powers without declaring a state of emergency. Historically there are plenty of cases of leaders exploiting the declaration of national emergency to stay in power, yet there are also cases where the use of emergency power has contributed to constitutional transformation (de Wilde 2015). For better or the worse, politics is often about a trade-off between personal liberty and collective safety. If we believe in the social contract to forgo some of our freedom to the government for survival as Hobbes suggested, we need to follow the emergency measures like the lockdown and social distancing. We may further discuss the room for improvement in the social contract and the security measures once the pandemic is dealt with, just like the constitutional transformations noted by de Wilde. Some countries such as Spain and Japan have already de-securitized the issue by ending the state of emergency. It would be interesting to conduct a comparative study on the discursive de-construction COVID-19 as a national security threat – I hope that day will come soon.
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Methods to resolve PHEs require a balancing of pragmatic and ethical concerns. Failure to do so only undermines the effectiveness of different tactics Barugahare et al. 20 [John Barugahare, Phd from University of Bergen focused on allocating and financing global health resources, Fredrick Nelson Nakwagala, Department of Epidemiology and Biostatistics, Erisa Mwaka Sabakaki, Senior lecturer and chair of Biomedical Sciences Higher Degrees and Research Ethics Committee, PhD from Fukui University, Joseph Ochieng, Associate Professor of Anatomy at Makerere University in Kampala, Nelson K Sewankambo, Professor of Medicine at Makerere University in Kampala, 2020, “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”, BMC Medical Ethics, https://doi.org/10.1186/s12910-020-00523-0] /Triumph Debate
The case for explicitly integrating ethical considerations in public health policy and program evaluation has been articulated as a complement to traditional ‘evidence’. The motivating concern for this view is that the traditional concept of ‘evidence’ exclusively focuses on the potential effectiveness of alternative policy measures without reflecting on how the ensuing actions will impact ethical-related goals of public health. Hence, this position is based on the need to capture some of the common but mostly implicit ethical goals of public health – ‘doing good’, ‘avoidance of harm’, ‘preventing or reducing avoidable health disparities (health equity), among others. This suggests a need for going beyond the traditional and mechanistic approach to health policy evaluation that relies on ‘evidence’ per se, to a more holistic one that captures the ethical-related goals of public health [20]. It is important to appreciate that in uncertain situations where there are overwhelming burdens on health systems such as those presented by the COVID-19 pandemic, it is extremely difficult to implement public health measures that are free of ethical controversy [18]. This is even more difficult in severely resource-limited countries like Uganda. This is so because, as it has been cautioned in reference to responses to the H1N1 influenza pandemic, in similar circumstances, minimalist measures are likely to be ineffective, while maximalist, disproportionate ones pose potential long-lasting negative effects on community trust, public services, social order, and the economy [29]. Generally, ethical controversies about public health measures can result from perceived deception in the form of deliberate under-reporting of statistics of the pandemic [30] or exaggeration of the same statistics; compulsory institutional quarantines at one’s own cost [7,8,9], or judicial detention of potentially infectious patients who are uncooperative [31]. It should be noted that some ethically controversial measures usually come with seemingly robust pragmatic justifications. However, their failure to satisfy ethics and human rights criteria will jeopardize their effectiveness. For example, deception in the form of deliberate under-reporting of the magnitude of the pandemic may be justified by the goal of staving off the devastating psychological impact of truthful reporting on the economy. On the other hand, such deception will lead to false low-risk perceptions among the public, which directly compromise public’s voluntary compliance with highly restrictive safety measures or complicate their enforcement. Such measures will be wrongly perceived as disproportionate, unnecessary and unreasonable in the circumstances; therefore, they will increase the spread of the infection. The reverse is true for deception in the form of exaggeration of the statistics – unnecessary speculations may devastate the economy and lead to the adoption of highly restrictive measures, thus unnecessarily limiting and derogating human rights. Furthermore, it is natural that perceptions of discrimination in the form of privilege-like exemptions for some people from compliance with highly burdensome measures such as institutional quarantine – inequitable imposition of burdens – will generally weaken a sense of obligation for voluntary compliance among the public and even make enforcement largely unsuccessful, or unnecessarily violate people’s rights. The emerging insight is that the importance of explicitly integrating ethics and human rights considerations into the choice of effective policies and measures cannot be overstated. Our contention is that public health policies and measures chosen following a more holistic approach that combines ‘evidence’ and ‘ethics and human rights considerations’ as its criteria has better chances of success than a mechanistic one which relies on ‘evidence’ alone. Hence, if ‘evidence’ is the only input for such decisions, then there is a strong case for revisiting the traditional concept of ‘evidence’ as it applies to public health, to include the potential ethical and human rights impact of alternative policies, programs and measures.
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The balancing of ethical principles during a PHE means assessing who is burdened by state action and determining if it is truly justified. A PHE does not immediately justify state action Barugahare et al. 20 [John Barugahare, Phd from University of Bergen focused on allocating and financing global health resources, Fredrick Nelson Nakwagala, Department of Epidemiology and Biostatistics, Erisa Mwaka Sabakaki, Senior lecturer and chair of Biomedical Sciences Higher Degrees and Research Ethics Committee, PhD from Fukui University, Joseph Ochieng, Associate Professor of Anatomy at Makerere University in Kampala, Nelson K Sewankambo, Professor of Medicine at Makerere University in Kampala, 2020, “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”, BMC Medical Ethics, https://doi.org/10.1186/s12910-020-00523-0] /Triumph Debate
Nancy Kass’ “An ethics framework for public health” [53] provides a significant framework to guide the integration of ethics considerations in the design and implementation of public health programs. According to this framework, the analysis in the process of choosing appropriate public health policies, programs and measures it is important, primarily, to identify the policy or measures’ goals to be achieved. After listing alternative policies, programs or measures, it is important to evaluate each of them for their potential efficacy in achieving the target goal(s). In addition, it is important to estimate the burdens each of the measures will impose on the public, and then find the means of mitigating such burdens in the course of implementing the chosen measures. In addition, in case certain public health policies, programs or measures are judged burdensome and restrictive, Kass recommends that efforts should be made to identify alternative measures, which are equally effective but less burdensome. Further, since it is very difficult to entirely eliminate burdens from public health measures, especially those adopted during PHEs, justice demands that these burdens be equitably distributed among the population, as opposed to being shouldered by a few. Finally, effort should be made to ensure a fair balance between the benefits and burdens of the adopted public health programs or measures [53]. The ethical insights in these questions have been reflected in several related scholarly views [24, 28, 51, 52, 56, 29, 57, 19]. Furthermore, learning from the experience of the ethical gaps in response to previous pandemics, the WHO developed a set of ethical considerations to guide the development of public health responses to future influenza pandemics [16]. Even though these guidelines are intended to be used in preemptive public ethical deliberations, they still provide insights into the manner of managing ethical issues that arise during PHEs. Key considerations in these guidelines pertain to balancing rights, interests and values of societies, communities and individuals, and the clear definition of obligations of all categories of stakeholders [16] (emphasis added). This balancing act can be facilitated by referring to ethical principles. In the field of bioethics, the traditional ethical principles have been those proposed by Tom Beauchamp and James Childress – Respect for autonomy, Beneficence (doing ‘good’), Justice and Non-maleficence (avoidance of harm) [58]. Even though these principles have been largely applied in clinical medicine and health research, they have been said to be key principles in public health as well [20]. Other official ethical guidelines for designing and implementing public health measures have in several ways reiterated similar criteria [50, 18, 14, 15]. Of special interest are the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights [11] and General Comment No. 14 on Article 12 of the Covenant on Economic Social and Cultural Rights [55]. Clause 25 of the Siracusa Principles states, “Public health may be invoked as a ground for limiting certain rights in order to allow a state to take measures dealing with a serious threat to the health of the population or individual members of the population.” However, other clauses demand that state authorities do not act arbitrarily to unnecessarily violate human rights or impose unreasonable or extremely burdensome measures, which may not be strictly required to achieve public health goals in the prevailing circumstances. For example, “The severity, duration, and geographic scope of any derogation measure shall be such only as are strictly necessary to deal with the threat to the life of the nation and are proportionate to its nature and extent” [11]. Furthermore, “Whenever a limitation is required in the terms of the Covenant, to be “necessary,” this term implies that the limitation: (a) is based on one of the grounds justifying limitations recognized by the relevant article of the Covenant; (b) responds to a pressing public or social need; (c) pursues a legitimate aim; and (d) is proportionate to that aim” [11]. Similar constraints and the burden of proof being placed on governments are found in paragraphs 28 and 29 of CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12) [55].
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Global public health is deeply interconnected - we are only as safe as the most vulnerable person, globally Murphy & Whitty 09 [Therese Murphy, Law @ Queen’s University Belfast, and Noel Whitty, Law @ Keele University, “IS HUMAN RIGHTS PREPARED? RISK, RIGHTS AND PUBLIC HEALTH EMERGENCIES,” Medical Law Review, (Ellipses in source), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697855/] /Triumph Debate
The SARS outbreak and its containment produced a range of responses.20 China, for example, was criticised for its delay in reporting cases and an initial lack of cooperation with WHO. WHO was criticised by Canada for its unilateral issuance of travel advice to persons proposing to travel to Toronto, the city outside Asia worst affected by the outbreak.21 Meanwhile, in Canada, delays and wrangling between the Ontario government and the federal government over funding to provide compensation for individuals may have undermined the quarantine scheme by leaving people with financial incentives to break quarantine.22 As part of quarantine and isolation measures, some jurisdictions, including Canada, adopted policies involving heavy limitations on individual rights.23 WHO has said that these control schemes were responsible for the interruption of transmission of the disease within four months of the announcement of the outbreak, but the use of measures that severely restricted individual freedoms was deeply controversial. The year 2003 is, however, notable for more than the SARS outbreak and its containment. It was also the year in which the Commission on Human Security, co-chaired by Sadako Ogata and Amartya Sen, issued its final report.24 The Commission labelled illness, disability and avoidable death as ‘critical pervasive threats’ to human security; more generally, it harnessed the language of security to highlight the ongoing neglect of social and economic rights. One year on, in 2004, ‘comprehensive collective security’—described as a ‘new and broader understanding’ of international security—provided the overall vision behind the report of the UN Secretary General’s High-Level Panel on Threats, Challenges and Change.25 The Panel prescribed an improvement in public health systems, arguing that: emergence of new infectious diseases, a resurgence of older diseases and a spread of resistance to a growing number of mainstay antibiotic drugs ... signify a dramatic decay in local and global public health capacity.26 It also warned that ‘the security of the most affluent State can be held hostage to the ability of the poorest State to contain an emerging disease’.27 And, controversially, it suggested a new role for the UN Security Council: in its view, in ‘extreme cases of threat posed by a new emerging infectious disease or international release of an infectious agent’,28 it would be appropriate for the Security Council to help with the implementation of control measures. The threat of biological terrorism was also invoked by Kofi Annan, then Secretary General of the United Nations, in his 2005 UN reform strategy, In Larger Freedom. In his view, ‘[o]ur best defence against this danger lies in strengthening public health’ and he seemed to indicate that he supported an expanded role for the Security Council in the event of an ‘overwhelming outbreak of infectious disease that threatens international peace and security’.29
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20 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
Affirmative Evidence
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Implementation / Solvency Analysis across 58 countries finds that public trust increased compliance with restrictions during the COVID-19 pandemic Pak, et al 21 [Anton Pak- Research Fellow in Applied Economics and Data Science at the Australian Institute of Tropical Health and Medicine, James Cook University Emma McBryde- Professorial Research Fellow - Infectious Disease and Epidemiology Australian Institute of Tropical Health & Medicine Oyelola A Adegboye- biostatistician, an experienced teacher and public health researcher. He completed his PhD at the University of Western Cape, South Africa in 2014, January 2021, “Does High Public Trust Amplify Compliance with Stringent COVID-19 Government Health Guidelines? A Multi-Country Analysis Using Data from 102,627 Individuals,” Risk Management and Healthcare Policy, vol. Volume 14, pp. 293–302. DOI.org (Crossref), doi:10.2147/RMHP.S278774.] /Triumph Debate
Discussion The high burden associated with the highly contagious COVID-19 disease cannot be overemphasized; there is a benefit when the public complies with public health guidelines. However, policy compliance is not without cost. Stringent restrictions, such as lockdown orders and school closures, may bring not only work but also social life disruptions that affect people’s mental health17–19 and negative economic and financial consequences on micro and macro levels.20,21 Previous studies have shown the importance of public trust on the effectiveness of government restrictions.22 We contribute to the literature by providing empirical evidence that an increase in public trust during the onset of COVID- 19 pandemic significantly amplifies citizen’s compliance with an increased level of government stringent public health policies. The impact of strict measures on compliance is twice as large for individuals with high trust in government than for those with low trust; however, when governments measures are less restrictive, individuals with lower trust level are more likely to comply. We posit that this asymmetry in response could be influenced by the way individuals view the merits of the restrictions conditional on their underlying trust attitudes towards government and its institutions. In the situation of high uncertainty, especially during the onset of COVID-19 pandemic, the higher the predicted compliance at low levels of restrictions by people with low trust is not surprising. This can be potentially viewed as a self-protective behavior in response to the perception that the government is not implementing a suitable level of restrictions or has not been truthful with them about COVID-19. Conversely, if an individual generally believes that the government acts in the best interests of the people, the compliance to the restrictions is likely to be positively reinforced. Public distrust in government may lead to a lower level of compliance with government measures and thus, unsuccessful public health interventions.3,5,11,23 For example, Goldstein and Wiedemann5 reported that higher political and social trust measures are associated with improvements in compliance with stay-at-home orders in the US. The authors underscored the importance of trust in state capacity and the different levels of trust resulting in asymmetrical compliance, compounded by partisanship behavior. 5 In Nigeria, large-scale political distrust due to corruption was said to undermine public adherence to government COVID-19 policies.23 A study by Lalot et al revealed that absence of concern and trust significantly reduce people’s compliance with restrictive government measures put in place in Italian and French cities.24 This is also consistent with the findings among young Swiss adults.25 Furthermore, in situations when the majority of the population comply with government restrictions and public health advice, the created public good and incentives will extend to free-riders as well. In other words, some individuals (noncompliers) enjoy the benefits of public health practices without respecting them. As in other free-riding problems, the prolonged noncompliance reduces the benefits of cooperative behaviors of the compliers, and in the case of epidemics, leads to a spike in new infections. To mitigate this problem, governments can penalise noncompliers, thus making the incentive to free-riders smaller. However, enforcement of the penalties may be costly and problematic if the number of noncomplying individuals is considerable. A better public policy approach is through education and transparent communication about the public health crisis aiming to reinforce good behavior. This also underscores the value of political and social trust in achieving the goal of high compliance. Our analysis also revealed that compliance is higher for females, elderly and people with higher income and in better health. Previous research on people’s compliance with government restrictions during epidemics showed that females and elderly respected preventative measures more than other groups.3,11,26 Perhaps the fear of being infected incentivizes individuals, especially those who are vulnerable, to change their behavior and comply with public health advice.1,2 As the risk for severe illness from COVID-19 is the highest for older adults,27,28 it is not surprising to find that this group has been associated with greater compliance and the incremental increase in compliance across a broad age range mirrors the evidence that the risk for severe illness and mortality from COVID19 increases with age. Our results are consistent with findings from an ongoing longitudinal cohort study of young adults conducted during the early stage of the COVID-19 pandemic in Switzerland revealed that younger adults were less likely to comply with Swiss government public health guidelines.25 We also found these dynamics between public trust, the stringency of restrictions, and policy compliance to be heterogeneous between political regimes. In democracies, people who have high trust in the government have lower infection avoidance behavior when the government does not call for it, whereas they have higher infection avoidance behavior when the government does call for it. This is not true in autocracies or anocracies, in which government-trusting individuals always tend to have higher infection avoidance behaviors. Perhaps this suggests greater reliance and trust in both low-risk messages and highrisk messages from the government in democracies. This study has a number of limitations. Firstly, it was based on survey data sets conducted during the onset of the COVID-19 pandemic, and there could be an overrepresentation of individuals who were likely more concerned with the spread of the disease. Secondly, there are response bias concerns, particularly 22 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
social desirability bias, which might have led to the underreporting of noncompliance behavior. However, this might be less of a problem as individuals self- completed the questionnaire anonymously and via an online channel which helps to elicit true preferences and answers.29 In summary, we have shown how important it is for a government to build and maintain public trust and citizens’ cooperation in managing public health response. The COVID-19 pandemic has not only brought significant health and economic challenges around the world, but also provided an opportunity for governments to restore and strengthen trust at a time when it is most needed. Moreover, as the number of new infections stabilizes, public trust will be among the crucial factors for recovery on the other side. Our findings indicate that public trust is strongly associated with compliance and amplifies the impact of the government preventative measures. Yet, the dynamics of this amplification differs among political regimes.
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Taiwanese Policies and infrastructure from the 2003 SARS outbreak allowed for a targeted response to the Covid PHE, proving that governments do not have to default to larger interventions Lin et al 20 [Cheryl Lin- Co-Director, The Policy & Organizational Management Program at Duke University, Wendy E. Braund - University of Pittsburgh, John Auerbach- Trust for America’s Health, Jih-Haw Chou,- Taiwan Centers for Disease Control, Ju-Hsiu Teng- Taiwan Centers for Disease Contro, Pikuei Tu- Duke University, and Jewel Mullen- University of Texas, July 2020, “Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan,” Emerging Infectious Diseases Journal , Volume 26, Number 7, CDC. wwwnc.cdc.gov, doi:10.3201/eid2607.200574.] /Triumph Debate
Informed by lessons from the 2003 SARS outbreak, Taiwan had systems in place to fight the potential new epidemic. The country has a robust nationwide public health network, comprehensive universal healthcare for all citizens, vibrant medical research and pharmaceutical industries, and improved infection control practices. We delineate and analyze the critical policy decisions and cross-departmental collaborations in the Taiwan government and Taiwan Centers for Disease Control (Taiwan CDC) during the first 50 days of the COVID-19 epidemic. Of note, the centralized, real-time database of the country’s National Health Insurance (NHI) helped support disease surveillance and case detection. Taiwan CDC’s comprehensive response and innovative use of the NHI database effectively delayed and contained community transmission in the country, even as the number of confirmed cases surged in neighboring countries in Asia starting in mid-February. Devising and Updating Travel and Disease Control Policies While most of the world was preparing for the 2020 New Year, Taiwan CDC began health screening of passengers on flights arriving from Wuhan. Within a week, the government assembled a cross-departmental taskforce and an expert team of leaders in infectious diseases, public health, and laboratory sciences. The government raised the travel advisory to Wuhan to level I–watch and alerted the healthcare community to report to Taiwan CDC on patients with respiratory symptoms and fever or presumptive pneumonia who had recently traveled to Wuhan. At the same time, the Taiwan CDC epidemiology laboratory started developing and producing test kits adapted from existing diagnostic modalities for pneumonia of unknown etiology. As Taiwan CDC took the lead, public and private healthcare providers, local governments, and health departments looked to the central government for guidance regarding preparedness and response. The country quickly updated infection control practices and strategies established during the 2003 SARS epidemic, such as installation of infrared temperature checkpoints and border quarantine at airports and seaports. Following Taiwan CDC’s outbreak prevention guidelines, hospitals swiftly instituted screening booths to monitor the temperature of persons entering the facility, offer hand sanitizer, and separate persons with fever or related ailments. In addition, Taiwan increased stockpiles of personal protective equipment (PPE) for healthcare workers, predesignated potential isolation wings and hospitals, and created a daily nationwide inventory of available intensive care and negative-pressure isolation rooms, including the number that could be refitted when needed. Thumbnail of Timeline of policy decisions during the first 50 days of COVID-19, Taiwan. Blue text indicates cases in Taiwan. Information collected from Taiwan CDC, CDC, and WHO. Because of differences in global time zones, some events might be recorded or announced with 1-day discrepancy in different reports, news, and publications. CDC, US Centers for Disease Control and Prevention; CECC, Central Epidemic Command Center; COVID-19, 2019 novel coronavirus disease; NHI, National Health Insurance; Figure. Timeline of policy decisions during the first 50 days of COVID-19, Taiwan. Blue text indicates cases in Taiwan. Information collected from Taiwan CDC, CDC, and WHO. Because of differences in global... On January 15, 2020, Taiwan CDC classified the novel coronavirus as a class-V communicable disease, which institutes legal measures, including mandated reporting and quarantine. For instance, under class-V, healthcare providers are required by law to report suspected cases to Taiwan CDC within 24 hours, and the government can isolate or quarantine persons confirmed or suspected to be infected at designated sites. The Wuhan travel advisory was elevated to level II–alert the next day and later to level III–warning (Figure; Appendix Table). Reporting criteria were broadened to include persons showing symptoms who had not traveled to China recently but had close contact with persons who had confirmed or suspected cases. In addition, specimen testing parameters were expanded. On January 20, Taiwan activated its Central Epidemic Command Center (CECC), which is equivalent to an Emergency Operations Center in the United States.
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Isolation and distancing can prevent from overwhelming hospitals and spreading to the most vulnerable Gostin et al 20 [Lawrence Gostin, Law @ Georgetown, Eric Friedman, Law @ Georgetown, and Sarah Wetter, Law @ Georgetown, “Responding to Covid-19: How to Navigate a Public Health Emergency Legally and Ethically,” Hastings Center Report, https://onlinelibrary.wiley.com/doi/pdf/10.1002/hast.1090] /Triumph Debate
Compulsory orders for quarantine, isolation, and cordon sanitaire bring enormous legal, ethical, and logistical challenges and should be used only as a last resort. Self- isolation or self-quarantine are preferable and generally effective. When properly informed, most people will follow their instincts to stay safe and will shelter in place at home. Self-isolation has another benefit besides limiting infringement on people’s civil liberties: if hospitals become overwhelmed, as in South Korea and Italy, self-isolation for people with mild symptoms can help make more hospital beds available for sicker patients. Where voluntary compliance is not an option, governments may need to enforce containment orders in the interest of public health, but how far should they go? It may be relatively easy to enforce isolation and quarantine orders against individuals who pose a known danger. Yet we are witnessing large-scale quarantines imposed without any individualized risk assessment. Elderly persons, for example, face such a high risk of death if they contract Covid-19 that many nursing homes have gone on “lockdown” mode, forbidding residents to leave or visitors to enter the facility. As described above, these orders must follow rigorous safeguards, including opting for the least restrictive alternative, depending on scientific assessment of risk and effectiveness, ensuring procedural due process, and providing a safe and habitable environment. Difficult questions will still arise, though. For example, are complete lockdowns necessary, or may an eighty-year-old without underlying conditions go for a short walk outside while practicing physical distancing? Further, monitoring and enforcement through surveillance modes, including thermal scanners, electronic bracelets, and web cameras such as those used during the SARS outbreak,19 implicate privacy interests. Enlisting armed police and citizen informers to control large populations in cities like New York or Chicago seems so contrary to American values and the rule of law that it is difficult to conceive opting for that route in the days and weeks ahead. But San Francisco has already ordered its population to shelter in place for three weeks, with people directed to stay inside and avoid contact with others, though with numerous exceptions. People can leave their homes without government permission, but law enforcement has been asked to ensure compliance. At a time of vast inequities, we are all only as safe as the most vulnerable among us—both in the United States and globally. If poor or disadvantaged members of our community cannot practice physical distancing or access health services, then we will all be at greater risk. Conversely, those who are better off should take measures to protect themselves from infection, both for their own health and in order to protect everybody else. Equity and public health go hand in hand. We are in uncharted territory, where vital human connections and economic activity are disrupted in ways not seen in generations. If we want to safeguard the public’s health while being faithful to our most fundamental values, then we must ensure that our response is effective, ethical, and equitable.
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Outbreaks inevitably stress the medical system- even with all other possible measures in place, distancing is required to prevent deaths Gostin et al 20 [Lawrence Gostin, Law @ Georgetown, Eric Friedman, Law @ Georgetown, and Sarah Wetter, Law @ Georgetown, “Responding to Covid-19: How to Navigate a Public Health Emergency Legally and Ethically,” Hastings Center Report, https://onlinelibrary.wiley.com/doi/pdf/10.1002/hast.1090] /Triumph Debate
A surge of individuals exhibiting flu-like symptoms, along with the “worried well,” will undoubtedly stress the health system. Health facilities do not have the capacity to cope with the expected patient numbers: they lack enough critical care beds, ventilators, essential medicines, and personal protective equipment for health workers. N95 masks, a key tool to prevent respiratory infections, are in short supply. Scarcity of health resources not only places Covid-19 patients at risk but will also delay care for patients with urgent needs such as for cancer, diabetes, and heart disease—and even affect safe delivery for pregnant women. Disruptions to the health system will likely cause more deaths of persons with a variety of urgent health needs than of patients diagnosed with Covid-19.2 In times of crisis and with health systems facing scarcity, hospitals, with guidance from public authorities and professional bodies, must make hard decisions to best ensure optimal health outcomes and fair distribution. How can we avoid the scarcity dilemma? Where possible, every effort should be made to avoid the scarcity dilemma altogether. We are already trying to do that through strict physical distancing, which could flatten the epidemic curve and moderate demand on the health system. But since the United States is so late in its mitigation efforts, scarcity is likely to become a reality. What should we do? A World War II-type mobilization could ramp up the production of personal protective equipment, ventilators, and other essential supplies and equipment that could become scarce. The president should exercise his full authority under the Defense Production Act to mobilize industry to provide urgently needed resources. Regions experiencing limited levels of Covid-19 could lend equipment, and deploy first responders, to regions where health system capacity is strained. Retired health workers or trained health workers not presently practicing could return to service. With ample funding, leadership, and coordination, scarcity can be, if not entirely avoided, then at least mitigated. The president or governors could also call in the military, National Guard, or Army Corps of Engineers for assistance with logistics, supply chains, and even building clinics. How can we ethically balance physicians’ duties to patients and to the wider community? Standards of care ordinarily require physicians to meet the specific medical needs of their patients. But in a crisis, we may have to shift the standard of care to emphasize the needs of the community,3 while still providing the best possible individual-level care. This concept was encapsulated by the National Academy of Medicine as “crisis standards of care,” defined as the “optimal level of care that can be delivered during a catastrophic event, requiring substantial change in usual health care operations.”4 In jurisdictions with declared public health emergencies,5 crisis standards of care provide a mechanism for reallocating staff, facilities, and supplies to meet population needs. To free up scarce medical resources, for example, hospitals could postpone nonemergency tests and procedures. In the areas hardest hit so far, like Seattle and New York, hospital administrators have been canceling or postponing elective— and even some more serious6 —surgeries. To avoid harm, health agencies and organizations must plan now to implement crisis standards of care; they should not wait until the disease is widely detected in the community. Implementing crisis standards must be part of a systemwide approach in which all stakeholders, including health professionals and the public, participate in transparent decision-making.7 How can we ethically allocate scarce resources? Even with increased production and measures like postponing nonurgent medical procedures, there might still be too few health workers and critical care beds and not enough supplies and equipment. These resources must be allocated ethically. First and foremost is the need to protect health workers delivering care in the midst of the crisis, for without them and their extraordinary efforts, the entire health system would collapse. Along with ensuring that health workers are adequately trained in infection control, supplied with protective equipment, and provided vaccines once available, the health system should designate health workers a top priority for receiving scarce resources that are vital for their own protection, care, and treatment. Second, beyond health workers, decisions about who is tested or who receives treatment must center on prevention of SARS-CoV-2 transmission (public health), protection of individuals at highest risk, meeting societal needs, and promoting social justice. Protecting public health may mean prioritizing resources for people in confined settings (such as homeless shelters, prisons, and nursing homes), where the virus can spread rapidly from person to person. Resources may need to be targeted to areas experiencing localized outbreaks to curb transmission and prevent hospitalizations. Groups at highest risks, such as older adults, people with compromised immune systems, and people with underlying conditions (such as heart or lung disease or diabetes) are another priority, as they are most likely to become seriously ill and die. Meeting societal necessity means protecting critical services, like public safety, fire protection, and sanitation, as well as producers and suppliers of essential goods and services, like food and medicine, as well as people who carry out critical public health functions. Even with mass closures during Covid-19, these services must continue, and people working in these areas should be priorities as well. Finally, social justice demands that needed supplies and countermeasures are distributed equitably, with steps to ensure that poorer and marginalized populations— segments of the population traditionally left behind, like people with disabilities and people of color—receive a fair distribution of scarce resources.
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Digital health technologies helped with resource allocation, contact tracing, and quarantining for COVID Whitelaw et al 20 [Sera Whitelaw- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada, Prof Mamas A Mamas, DPhil- Institute of Population Health, University of Manchester, Manchester, UK, Prof Eric Topol, MD- Scripps Research Translational Institute, La Jolla, CA, USA, Harriette G C Van Spall, MD- Population Health Research Institute, August 2020, “Applications of Digital Technology in COVID-19 Pandemic Planning and Response,” The Lancet Digital Health, vol. 2, no. 8, pp. 435–40, www.thelancet.com, doi:10.1016/S2589-7500(20)30142-4.]/ Triumph Debate
Digital health technology can facilitate pandemic strategy and response in ways that are difficult to achieve manually (figure).2 Countries such as South Korea have integrated digital technology into government-coordinated containment and mitigation processes—including surveillance, testing, contact tracing, and strict quarantine—which could be associated with the early flattening of their incidence curves.3 Although South Korea has incurred only 0·5 COVID-19 deaths per 100 000 people,3, 4 the USA, with three times as many intensive care unit beds per 100 000 people and ranked number one in pandemic preparedness before the COVID-19 pandemic, has sustained ten times as many deaths per capita This Viewpoint provides a framework for the application of digital technologies in pandemic management and response, highlighting ways in which successful countries have adopted and integrated digital technologies for pandemic planning, surveillance, testing, contact tracing, quarantine, and health care (table). The panel provides a brief glossary explaining some of these concepts Big data and artificial intelligence (AI) have helped facilitate COVID-19 preparedness and the tracking of people, and so the spread of infection, in several countries. Tools such as migration maps, which use mobile phones, mobile payment applications, and social media to collect real-time data on the location of people, allowed Chinese authorities to track the movement of people who had visited the Wuhan market, the pandemic's epicentre.5, 6 With these data, machine learning models were developed to forecast the regional transmission dynamics of SARS-CoV-2 and guide border checks and surveillance.6, 7 As soon as China reported the outbreak, Taiwan initiated health checks for airline travellers from Wuhan, integrating data from immigration records with its centralised, real-time national health insurance database.8 This integration allowed health-care facilities to access patients' travel histories and identify individuals for SARS-CoV-2 testing and tracking.8 Taiwan's proximity to Wuhan, China, made the region particularly susceptible to COVID-19, but its efficient use of big data is credited for the low number of cases and deaths.4, 8 Swedish Health Services, a USA-based health-care organisation, has developed a platform for health-care workers to report real-time data on volumes of patients with COVID-19, personal protective equipment, staffing, ventilator usage, and other resource information.9 This information has been shared across its hospitals to track the status of facilities, allocate health- care resources, and increase hospital bed capacity.9 The need to track COVID-19 has fuelled the innovation of data dashboards that visually display disease burden. UpCode uses data provided by the Singapore Ministry of Health to depict infection trends across age, sex, and location, and to plot the recovery time of infected individuals.10 The Johns Hopkins University (MD, USA) coronavirus dashboard and the web-based platform HealthMap provide up-to-date visuals of COVID-19 cases and deaths around the globe.4 AI algorithms allow the effect of the climate to be incorporated into the projections.11 AI is not without limitations and requires training with COVID-19 datasets. Most of the AI predictive models so far have used Chinese samples, which might not be generalisable.12 In addition to the absence of historical training data, social media and other online traffic have created noise in big-data sets, potentially producing overfitted or so-called lucky good fit models.12, 13, 14 This noise must be filtered before accurate trends and predictions can be discerned. The accuracy, validity, and reliability of each AI forecast should be assessed when interpreting projections.12, 15 Screening for infection China uses free, web-based and cloud-based tools to screen and direct individuals to appropriate resources.7 High-performance infrared thermal cameras set up in Taiwanese airports are used to capture thermal images of people in real time, rapidly detecting individuals with a fever.8 In Singapore, people have their temperature measured at the entries of workplaces, schools, and public transport. The data from the thermometers is tracked and used to identify emerging hot spots and clusters of infection where testing could be initiated.10 Unlike most other countries, Iceland has launched widespread testing of asymptomatic individuals.16 Using mobile technology, Iceland collects data on patient-reported symptoms and combines these data with other datasets such as clinical and genomic sequencing data to reveal information about the pathology and spread of the virus.16 This approach has added to the knowledge base regarding the prevalence and transmission of asymptomatic COVID- 19. To date, Iceland has had the highest per-capita testing rate and among the lowest per-capita COVID-19 mortality 27 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
rate.16 Other countries offering widespread testing include Germany and South Korea.17, 18 In the USA, a private company has used digital thermometers to collect real-time data on clusters of febrile illness,19 and a national study is capturing resting heart rate with a smartwatch application, which could be able to identify COVID-19 emerging outbreaks.20 These initiatives are either enterprise-driven or investigational and are not integrated into policy and practice. Systematic screening technologies are expensive and require trained personnel, restricting their uptake in many countries.21 The incubation period and the relatively high prevalence of asymptomatic infection compared with other infectious diseases limits the effectiveness of digital systems that screen vital signs or self-reporting of symptoms.21, 22 Researchers at the European Centre for Disease Prevention and Control estimate that a majority of passengers from Chinese cities would not be detected by screening because of these factors.23 Contact tracing South Korea has implemented tools for aggressive contact tracing, using security camera footage, facial recognition technology, bank card records, and global positioning system (GPS) data from vehicles and mobile phones to provide real-time data and detailed timelines of people's travel.18 South Koreans receive emergency text alerts about new COVID-19 cases in their region, and people who could have been in contact with infected individuals are instructed to report to testing centres and self- isolate.14 By identifying and isolating infections early, South Korea has maintained among the lowest per-capita mortality rates in the world.4, 18 Singapore has launched a mobile phone application that exchanges short-distance Bluetooth signals when individuals are in proximity to each other. The application records these encounters and stores them in their respective mobile phones for 21 days. If an individual is diagnosed with COVID-19, Singapore's Ministry of Health accesses the data to identify contacts of the infected person.10 Like South Korea, Singapore has maintained one of the lowest per-capita COVID-19 mortality rates in the world.4, 10 Germany has launched a smartwatch application that collects pulse, temperature, and sleep pattern data to screen for signs of viral illness.17 Data from the application are presented on an online, interactive map in which authorities can assess the likelihood of COVID-19 incidence across the nation.17 With widespread testing and digital health interventions, Germany has maintained a low per-capita mortality rate, relative to other countries, despite a high prevalence of cases.4, 17 Contact tracing applications are not without pitfalls.24 Not all exposure requires quarantine, such as when the exposed individuals are wearing personal protective equipment or are separated by thin walls penetrable by mobile phone signals.24 On the other hand, relevant exposure could be missed when individuals do not carry their mobile phones or are without mobile service.24 In addition, researchers at Oxford University (UK) have suggested that 60% of a country's population would need to use a contact tracing application for it to be an effective mitigation strategy.25 Quarantine and self-isolation The indiscriminate lockdowns for infection control in several countries have had severe socioeconomic consequences. With digital technology, quarantine can be implemented in individuals who have been exposed to or infected with the virus, with less strict restrictions imposed on other citizens. China's quick response (QR) code system, in which individuals are required to fill out a symptom survey and record their temperature, allows authorities to monitor health and control movement.7 The QR code serves as a COVID-19 health status certificate and travel pass, with colour codes representing low, medium, and high risk; individuals with green codes are permitted to travel unrestricted, whereas individuals with red codes are required to self-isolate for 14 days. China also uses AI-powered surveillance cameras, drone-borne cameras, and portable digital recorders to monitor and restrict the gathering of people in public.7 In Australia, international travellers were quarantined in hotels on arrival, with travellers from Wuhan quarantined off the Australian mainland. In new legislation, individuals breaching quarantine will be forced to wear tracking devices, with fines levied for further instances of breaking the restrictions.26 In Taiwan, electronic monitoring of home-quarantined individuals is facilitated through government-issued mobile phones tracked by GPS;8 in the event of a breach in quarantine, this so-called digital fence triggers messages to the individual and levies fines.8 In South Korea, individuals in self-isolation are instructed to download a mobile phone application that alerts authorities if they leave their place of isolation.18 In Hong Kong, people in self-isolation are required to wear a wristband linked through cloud technology to a database that alerts authorities if quarantine is breached.7 Iceland has launched a mobile phone solution to monitor individuals with COVID-19 and ensure that they remain in self-isolation.16 Mobile phone solutions for quarantine enforcement can be bypassed if individuals leave their quarantine location without their devices.27 Self-reported surveys such as those used in QR code systems only work when individuals are symptomatic and report their symptoms accurately.24 However, such technological innovations could provide benefits when used in combination with other strategies.22
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A switch to digital technology allowed better real time prediction and reporting of pandemics CSIS 19 [Center for Strategic and International Studies, October 2019, “Can Digital Health Help Stop the Next Epidemic?” https://www.csis.org/analysis/can-digital-health-help-stop-next-epidemic.] /Triumph Debate
BUILDING ON RECENT PROGRESS IN DIGITAL HEALTH Harnessing the capabilities of digital technologies, big data, machine learning, and artificial intelligence (AI) could help strengthen prevention measures by predicting potential future epidemic outbreaks and targeting communications for behavior change. With this information, officials would have the capability to strengthen efforts to prevent outbreaks before they occur. More timely and accurate collection and sharing of high- quality data at all levels, through enhanced surveillance and laboratory tools, could help rapidly detect cases before outbreaks become epidemics. Interoperability, designed and implemented effectively, could increase the speed and accuracy of confirming suspected cases. Harnessing mobile technology to enable faster collection and sharing of data accelerates early detection even at the front line. Easier and more efficient data flow in times of crisis, such as using digital tools to track and manage commodity supply chains in real time, speed response and can spell the difference between an epidemic and a pandemic. EXAMPLES OF IMPACT Artificial Intelligence in Medical Epidemiology (AIME) is an AI-enabled platform supported by USAID that uses a variety of physical and environmental factors to predict future outbreaks of diseases like Zika and dengue months in advance. This technology has been used in Rio de Janeiro, Singapore, and Malaysia, leading the countries to accurately predict dengue outbreaks within 400 meters and up to three months in advance, with 88.7 percent accuracy.10 The electronic Integrated Disease Surveillance and Response (eIDSR) system, supported by USAID and other donors, is used to improve and customize the flow of information within health programs, building on the existing DHIS2 platforms in many countries. In Sierra Leone and Tanzania, all districts electronically report their IDSR data to the national level, reducing the number of data entry errors by half and capturing and verifying data 60 percent faster than the paper- based IDSR system.11 In Vietnam, a CDC electronic surveillance platform is now functional for 44 communicable diseases and syndromes in all 63 provinces and 711 districts, allowing real-time reporting and information sharing between the clinical and preventive medicine sectors.12 Some of these benefits are already being realized. In the last five years, investments in data and digitization have contributed substantially to increasing the capabilities of countries to improve epidemic preparedness and response. The U.S. government should maintain and build upon these recent successes to realize the full potential of digital health in preventing, detecting, and responding to outbreaks.
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Malaria, HIV/AIDS, and foot and mouth disease all serve as successful historical examples of modeling to aid in pandemic response Becker et al 21 [Alexander D Becker- Department of Biology, Stanford University, Kyra H Grantz, BA †- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Sonia T Hegde, PhD- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Sophie Bérubé, BA- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health Derek A T Cummings, PhD- Department of Biology, University of Florida Amy Wesolowski, PhD- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, January 2021, “Development and Dissemination of Infectious Disease Dynamic Transmission Models during the COVID-19 Pandemic: What Can We Learn from Other Pathogens and How Can We Move Forward?” The Lancet Digital Health, vol. 3, no. 1, pp. e41–50. www.thelancet.com, doi:10.1016/S2589-7500(20)30268-5.] /Triumph Debate
What makes modelling efforts successful: past examples In this section, we outline briefly the history and features of several successful and less successful efforts where models were developed and investigated to inform a public health response.2, 8 These efforts span multiple pathogens, hosts, routes of transmission, and transmission settings (emerging, endemic, or nearing elimination). Although no two outbreaks or transmission scenarios are alike, a common thread in the examples discussed here is the use of models in real time to develop policy decisions. Shared in the examples below of key public health questions that have been addressed through modelling, and mirrored in the ongoing COVID-19 outbreak, are the problems of: few and possibly unreliable data, potentially uncertain transmission routes and model structures, and developing and communicating actionable modelling results. Comparing and analysing previous outbreaks across a range of settings allows for a holistic view of best practices and potential pitfalls for disease modellers. Malaria: how effective does vector control need to be? Models of malaria transmission were some of the first mechanistic models used to assess public health interventions. Between 1908 and 1921, Ross developed a series of mathematical formulations of malaria transmission following an unsuccessful mosquito larval control trial.30, 31 At the time, the long-standing scientific belief was that mosquito populations should be completely eliminated to eradicate malaria, an unattainable goal. However, with the use of a theoretical framework based on the mosquito-human transmission process and the mosquito lifecycle, Ross provided evidence that malaria transmission could be contained with only the partial control, rather than the extinction, of mosquito populations. This early work laid the foundation for particular metrics to monitor transmission that are still used, such as the prevalence rate and entomological inoculation rate. Following this work, Macdonald extended Ross's model to inform control strategies for the WHO Global Malaria Eradication Programme.30, 31 Importantly, this work evaluated the usefulness of additional vector control measures, like insecticides, and their overall effectiveness in reducing malaria transmission in high transmission regions of sub-Saharan Africa. These early models were highly successful in four areas: first, illustrating the benefit of developing biologically realistic theoretical formulations; second, identifying key epidemiological values, and outlining the necessary data to estimate them; third, outlining and addressing clear questions with precise communication, integration, and motivation from the eradication programmes; and finally, restricting analyses to evaluating the effectiveness of different interventions as opposed to directly forecasting the burden, which was not yet an attainable goal with the available knowledge of malaria transmission and computational methods. HIV and AIDS: what is the effectiveness of different testing and treatment policies? Models of HIV and AIDS, including models of population-level transmission and within-host viral dynamics, have been used to identify patterns of transmission and risk structure, the effect of treatment and individual changes in the immune response with antiretroviral therapy, and the emergence and propagation of drug-resistant variants.32, 33 Arguably the most successful use of population-level (as opposed to within-host) models has been in producing and evaluating estimates for the intensity and frequency of various treatment and prevention measures needed to reach control targets in forward simulations of incidence and prevalence.34, 35, 36, 37, 38, 39 As with many emerging pathogens, back-calculation methods were also commonly used to estimate relevant transmission parameters (eg, the incubation period) and historical infection incidence from AIDS incidence data.40 Importantly, these methods also provided a scientifically supported approach to project AIDS incidence at various stages of disease progression with surprising simplicity and without the need for more complex model structures or data that were not readily available early on in the global pandemic.40 Increasingly, more realistic formulations of projection models have been developed to add social, demographic, and biological realism to the population risk structure, with a particular focus on burden within key populations and the role of heterogeneous sexual networks.41, 42, 43 The understanding that preferred or assortative mixing, concurrency in sexual partnerships, and scale-free contact networks might lead to greater disease burden and faster growth than expected under proportionate mixing assumptions was developed largely from models of HIV transmission.42, 43, 44, 45 In addition to these theoretical advances in infectious disease dynamics, important public health decisions have been guided by the long-term projections of HIV incidence estimated with the use of mathematical transmission models, including the adoption or recommendations to scale-up antiretroviral therapy, universal test and treatment, and treatment as prevention.39, 46, 47 Several of the most successful modelling efforts were integrated with long-running cohort studies or clinical trials, which provided crucial data on intervention effectiveness to modellers, and enabled the integration of modelling results into policy decisions and on-the-ground public health activities.47, 48 But variability in model structure, complexity, and variable 30 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
choice might be amplified over the decades-long timescale for which projections of HIV are often made, considering the innate complexity of HIV transmission. Sensitivity analyses and model comparisons, often done by formalised working groups, have been crucial to identifying a general consensus (eg, that antiretroviral therapy has the potential to substantially reduce infections, if access and adherence to it are high)34, 47 and exploring possible uncertainties and variability in modelling results.49 At present, modelling is widely used to guide national and international programmes; for example, the Spectrum/AIDS impact model is used in more than 170 countries to estimate key HIV transmission and control indicators.50 Measles: how should vaccinations be deployed? Measles is one of the earliest pathogens to be modelled, with transmission models dating back to at least the late 1800s.8 Since the wide-scale deployment of a safe and effective vaccine, transmission models have informed and guided international, national, and local immunisation programmes.8, 51 By providing a clear way to estimate spatial, seasonal, and age- specific transmission rates, dynamic compartmental models have been used to evaluate the effect of novel interventions, control strategies, and elimination strategies. In addition, an array of theoretical and applied work based on long-term mortality and morbidity data has informed current understanding of the relative effect of birth rates, seasonal forcing, recolonisation, and extinction events, and age-specific mixing rates on producing variable epidemic patterns.52, 53, 54, 55, 56, 57 Importantly, models have been used to understand the effectiveness of various vaccination campaign designs on local and global measles elimination in both low- income and high-income settings. The balance between applied and basic science has formed robust literature focusing on measles dynamics. For example, the WHO Strategic Group of Experts includes models as a key tool for the successful control and hopeful elimination of the disease.58 The successes of integrated modelling- public health efforts have largely relied on a foundation of clear, applied questions, along with an abundance of long time series data and multiple model fitting approaches. When coupled with the pathogen's simple life history, models can readily address frequently applied questions such as: where are the areas of the population that routine vaccination coverage is not reaching, what is the likelihood of transmission in susceptible populations, and how to best design effective additional vaccination campaigns. Measles dynamics highlight the success associated with the use of extensive epidemiological data across a wide range of geographical, population and demographic settings to inform model structure, estimate variables, and test model validity. Additionally, the history of measles modelling shows the benefits of a goal-oriented approach for establishing modelling priorities and of rigorous model evaluation by multiple research groups over time. Rubella: what is the effect of vaccination strategies on congenital rubella syndrome burden? Routine vaccination for rubella has additional complications compared with those for the measles vaccination, in that insufficient vaccine coverage can increase overall disease burden by increasing the average age of infection and subsequently the risk of congenital rubella syndrome among pregnant women, relative to the more mild form of the disease that occurs in early childhood.51, 59, 60, 61 As a result, those leading vaccination programmes should weigh the risk of increased congenital rubella syndrome burden against the benefits of an overall reduction in rubella infections when considering introducing rubella vaccine into their routine programme. This calculation depends on the demographic characteristics of the population, the risk of an outbreak, and the probable vaccination coverage. Infectious disease transmission models have been used to clearly identify the risks and benefits of introducing rubella to a vaccine programme and therefore have been an integral part of guidance policies for routine vaccination requirements in various countries. The success of rubella modelling in addressing what the appropriate circumstances are for introducing a rubella vaccine into a population relies on three components. First, the ability to build off of the substantial history of measles transmission modelling (with the use of common terminology and validated models); second, clear policy questions and guidance; and third, subsequent model refinements to the structure of the model following the identification of possible vaccination strategies.4, 61 Foot and mouth disease: how should the epidemic be controlled? During the 2001 foot and mouth disease outbreak in the UK, multiple models were used to predict the disease dynamics and inform control measures.62 This situation was one of the first instances when models were used during an epidemic to support the decision making process. Models were used both to predict the epidemic trajectory (with stochasticity) as it was occurring, and to compare different control measures.62 Models used during this time were able to capture the number of cases at a moment in time, approximate the spatial concentration of cases, and roughly estimate the overall magnitude of the outbreak.63, 64, 65, 66 Direct communication between modellers, veterinarians, and policy makers, as models were being developed and as more epidemiological data were becoming available, was facilitated via a centralised working group.67 Therefore, this outbreak served as the first example of the regular integration of emerging data into modelling efforts during an ongoing outbreak to inform decision making (in this situation, the recommendation was to cull infected animals and potentially exposed animals in nearby facilities).68 That multiple models were developed allowed for model comparison to identify robust results, and helped to support the notion that modelling results were not biased by model structure or complexity. These efforts were not without controversy, though; some contend that the few models used to justify large-scale animal culling were unverified, based largely on the same data and assumptions about transmission, and that the policies they informed were too rigid.62, 67, 69 There was concern that model estimates were presented as inappropriately precise, and that models geared towards understanding a national outbreak were not sufficiently capturing the local context.62, ‘
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Disease Modeling in China allowed the country to provide crucial warning and analysis of effective mitigation policies Poletto et al 20 [Chiara Poletto- researcher at Pierre Louis Institute of Epidemiology and Public Health Samuel V Scarpino- Assistant Professor of Marine & Environmental Sciences and Physics in the College of Science Erik M Volz- Senior Lecturer at MRC Centre for Global Infectious Disease Analysis and Department of Infectious Disease Epidemiology, Imperial College London, London, October 2020, “Applications of Predictive Modelling Early in the COVID- 19 Epidemic.” The Lancet Digital Health, vol. 2, no. 10, pp. e498–99. www.thelancet.com, doi:10.1016/S2589- 7500(20)30196-5.] /Triumph Debate
On Jan 30, 2020, WHO declared a Public Health Emergency of International Concern, a month after COVID-19 was identified in Wuhan, China. By this point, several mathematical and computational models had already raised the alarm about the potential for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to cause a global pandemic and the dire consequences for public health should drastic action not be taken. During the emergence of a novel pandemic, predictive modelling is important in public health planning and response. Relating models to data provides a view into unseen variables, such as the occurrence of cryptic transmission and the prevalence of infection, and these models allow exploration of counterfactuals and hypothetical interventions. However, although there have been tremendous advances in mathematical epidemiology, prognostications about epidemic outcomes are inherently prone to errors. Predictive modelling is valuable when assumptions are related, the variables to be estimated are clearly defined, and researchers or policy makers who use the model outputs have a clear understanding of what can and cannot be achieved by this method. Indeed, calls for national disease-forecasting centres have arisen from the crucial need to educate policy makers at all levels on how to integrate predictive modelling into decision-making processes. Deriving insights with predictive modelling requires diverse datasets, which are often imperfect, particularly in the crucial period of epidemic emergence when surveillance is imprecise and little is known about the epidemiology or the clinical features of the disease. For example, extensive clinical case counts and genomic data were combined with large-scale records of human mobility and behaviour using predictive modelling, owing in part to the massive deployment of digital information sources. In this Comment, we highlight several important discoveries resulting from the application of predictive modelling to diverse data sources that affected clinical and policy decisions. • View related content for this article In the weeks following the first report of COVID-19, predictive models anticipated the pattern of international spread but also quantified the extent of the epidemic in China. Specifically, a predictive model by Imai and colleagues1 used travel volumes from Wuhan and the dates when imported cases first arrived in cities within China and globally to forecast the size of the epidemic in Wuhan. The results of this study suggested that substantially more cases were present in Wuhan than were reported in the official statistics.1 Identifying the potential discrepancy between reported cases and true disease burden provided a crucial early warning to the international community. Next, statistical modelling and data-driven computer simulations provided accurate projections of global epidemic dispersal, quantifying the role of physical distancing in China and reductions in international travel on the spatiotemporal pattern of spread of COVID-19.2, 3 These predictive models showed that the cordon sanitaire around Wuhan reduced the growth rate of exported cases but came too late to prevent national and international seeding. Control of the epidemic in countries outside China failed because of the difficulty in detecting and isolating infected travellers. Mechanistic modelling of the natural history and transmission of COVID-19 anticipated this difficulty.4 A predictive model provided the first evidence for the hypothesis, now widely accepted, that presymptomatic and asymptomatic infected individuals fuel local epidemics. Consequently, the majority of imported cases went undetected, generating extensive chains of local transmission.3 Owing to the difficulties of syndromic surveillance and incomplete testing, COVID-19 mortality has often been the most easily measured, widely available, and easily compared metric for epidemic progression. Estimates of infection fatality rates generated by early studies of expatriated travellers paved the way for later efforts to characterise unknown epidemic burden using various modelling approaches that relate mortality to unknown epidemic prevalence.5 The unprecedented scale of non-pharmaceutical measures implemented in China and later in many countries around the world resulted in a strong variation in human behaviour. Lockdowns and physical distancing measures profoundly altered human mobility and encounters. Measuring changes in human mobility under these restrictions was essential to quantify the effect of public health measures on the amount of human contact and geographical extent of travel. Aggregated data from mobile phone and internet service records provided an accurate and near real-time information source. By leveraging these data, predictive modelling allowed for the assessment of mobility restrictions on the propagation of the epidemic and showed how control measures implemented in China substantially mitigated the spread of COVID-19.6, 7 As the pandemic progressed and lockdowns were implemented in many countries, analyses based on mobile phone records provided essential support to public health assessments across the different stages of lockdown implementation and release.8 According to Google Scholar, there have been well over 30 000 academic publications with COVID-19 in the title. Of these 30 000 papers, less than 2% indicate from the title that they use predictive modelling. Nevertheless, nearly every business, hospital, city, state, and national government has been provided with COVID-19 forecasts. This disconnect between the small but rapidly growing science around outbreak forecasting and its now widespread application creates a complex situation for researchers, clinicians, and policy makers. As a result, we echo calls for disease-forecasting centres at the national level that provide not only predictive models but also expert guidance to policy makers and the public around the interpretation of the models. We conclude that predictive modelling is not a monolithic 32 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
framework nor a single methodology but rather encompasses a wide variety of statistical and mathematical models applied to diverse data to address different inference and prediction goals. How can we assess the performance of predictive modelling in guiding the global response to COVID-19? Regarding the most important application of these models, there has been notable success: predictive modelling correctly predicted that a global pandemic was probable and that there would be severe consequences for human health in the absence of strong public health measures to restrict human contact.
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South Asia Exemplifies the Success of Using mandatory tracking to contain COVID-19 Hunag 20 [Huang, Yasheng, professor of political economy and international management and holds International Program Professorship in Chinese Econom, Sun, Mericen, PhD student of international relations and political economy at Massachusetts Institute of Technology, and Sui, Yuze, correspondent for Harvard Business Review, April 15 2020, “How Digital Contact Tracing Slowed Covid-19 in East Asia,” Harvard Business Review, https://hbr.org/2020/04/how-digital- contact-tracing-slowed-covid-19-in-east-asia] /Triumph Debate
Clearly, applying technology in these ways can be an important tool in containing the pandemic. But this use of technology raises sobering policy questions about data sovereignty and privacy, issues that are more contentious in Western democracies than in the more collectivist societies of East Asia. The most effective deployment of technology for tracking individuals’ infection status, movements, and contacts hinges on three critical conditions that might each present difficult dilemmas for Western democracies: The adoption of the needed technologies (whether they are just strongly encouraged or made mandatory); a digital infrastructure enabled and activated by the government; and seamless data sharing between government and business that may afford few privacy protections. Let’s look at each in detail. Technology adoption Drawing on the experience of countries that are effectively using technology for contact tracing, the first step — and a requirement — is to encourage, or, better yet, mandate, the installation of tracking apps on phones. In East Asian countries, this has been more mandatory than voluntary. In Singapore, a country known for its efficiency and no-nonsense government, citizens are encouraged by the government to install TraceTogether, which exchanges Bluetooth signals between mobile phones in close proximity. This is a modern counterpart to the traditional and time-consuming contact-tracing method, which relies on fallible human memory. A government poll reported in Nikkei Asian Review found that more than 70% of respondents supported this move. Hong Kong, which has also seen effective containment, recently implemented a mandatory 14-day quarantine upon entry for all overseas arrivals. To enforce this, the Hong Kong government required each new arrival to download the StayHomeSafe app and gave them a paired wristband that uses geofencing technology to help catch violators, and, as reported in Quartz, warned anyone violating the quarantine that they could face up to six months in prison and a
$3,200 fine. The more striking case of curve-flattening is South Korea, where The Washington Post reports that private developers took it upon themselves to develop apps that supplement official government contact tracing efforts, which many find insufficient. Corona 100m, which, according to MarketWatch, South Koreans downloaded over one million times in just a few weeks with “overwhelmingly positive reviews,” collects data from public government sources that alert users of any diagnosed Covid-19 patient within a 100-meter radius along with the patient’s diagnosis date, nationality, age, gender, and prior locationsCorona Map similarly plots locations of diagnosed patients to help those who want to avoid these areas and, as Business Insider reports, was the second-most-downloaded app in Korea. A vibrant democracy that has also won praise for its Covid-19 containment, Taiwan is believed to be the first to have use mobile phone tracking to enforce quarantines, which the government reportedly reinforces by calling those in quarantine twice a day to ensure they do not evade tracking by leaving their phones at home. While mobile tracking of infectious disease has been available for at least a decade — Cambridge University’s voluntary FluPhone app developed in 2011 is an early example — the adoption rate varies dramatically across regions. Wired reports that fewer than 1% of the people in Cambridge signed up for FluPhone, for example, compared to the widespread adoption of mobile contact tracing we’re now seeing in East Asian countries. Concerns in Western democracies about privacy and civil liberty could create substantial impediments to rolling out such technologies in these countries and may have contributed to FluPhone’s low penetration . Even within democracies, there are clear cross-national differences in the degree of voluntary adoption of contact-tracing technologies. But without widespread adoption, such contact tracing efforts will fail. South Korea’s aggressive response to Covid-19 appears to have been enabled by its recent experience in handling epidemics. In 2015, the MERS outbreak there infected 186 and killed 36. Some consider the country’s aggressive data-sharing on Covid-19 to be a correction for the government’s reportedly opaque approach that marred its MERS response. A survey of 1,000 South Koreans found that most supported the government’s transparency in sharing travel details of Covid-19 patients and that most “preferred the public good to individual rights.” Similarly, Taiwan was among the hardest hit during the 2003 SARS outbreak. It subsequently established a disaster- management system that enabled its rapid response to Covid-19, both technologically and institutionally: In one day, relevant institutions integrated infected patients’ past 14-day travel history with their identification data, which then facilitated ongoing mobile tracking. Later, Taiwan launched the Entry Quarantine System that sought to expedite entry by providing passengers with a health declaration pass via SMS, with all hospitals, clinics, and pharmacies gaining access to patients’ travel histories shortly after. In an epidemic, timing is everything. South Korea’s and Taiwan’s experience indicate that the extra time gained from having a system of disaster-response infrastructure in place ready to be deployed proved critical in shaping the pandemic’s trajectory. The same lesson can be gleaned from China’s Covid-19 management, although China didn’t leverage an existing epidemic-response capability but rather repurposed its vast existing system of digital surveillance for Covid-19 tracking, The Economist reports. This approach has afforded the Chinese authorities a “more tailored approach” by “allowing most people to resume their normal lives while monitoring those who might be infected.” As research by two of us (Yasheng and Meicen) with MIT’s Work of the Future Task Force has shown, China’s repurposing of existing digital technology in addressing Covid-19 is not limited to contact tracing. The Chinese high-tech firms, SenseTime and Megvii, for example, both known for their facial recognition technology, have developed and deployed AI-based contactless temperature detection software. SenseTime has also developed and deployed a “Smart AI Epidemic Prevention Solution” which, by integrating AI algorithms with infrared thermal technology, detects a fever within 0.3
C accuracy and identifies individuals not wearing a face mask with over a 99% success rate .
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Vaccine mandates in Europe increase the proportion of the population getting vaccinated which supersedes any concerns of individual liberty Drew 19 [Liam Drew, science and meical correspondant for Nature; PhD in Philosophy BS in Neuroscience, , Nov. 2019, “The Case for Mandatory Vaccination,” Nature, vol. 575, no. 7784, pp. S58–60. www.nature.com, doi:10.1038/d41586- 019-03642-w] /Triumph Debate
In 2015, the World Health Organization (WHO) declared that the United Kingdom had eradicated the infectious viral disease rubella. The following year, it similarly designated the country as measles-free after confirmed cases numbered fewer than 125 for the second consecutive year. Immunization rates in UK children were high at that time. They had slumped to a nadir in the mid-2000s following the false assertion in 1998 that the measles, mumps and rubella (MMR) vaccine was linked to autism. But by 2016, more than 95% of the country’s 5-year-olds had received one dose of MMR, and roughly 85% had received the pre-school booster that maximizes immunity. When 95% of a population is immune to measles, the disease cannot spread. This is known as herd immunity, and it is the cornerstone of the WHO’s long-held plan to eradicate measles globally. Achieving this would rid the world of a very serious disease, for which 1 in 1,000 cases is fatal. In 2010, eradication was considered achievable by 2020. But that time is almost here, and the disease is not close to being eradicated. In fact, it is on the rise. Part of Nature Outlook: Vaccines During the first half of this year, Europe had 90,000 cases of measles — more than 17 times the number reported in the whole of 2016. In August, the United Kingdom lost its measles-free status (as did Albania, Greece and the Czech Republic). The United States, which is currently experiencing the highest number of measles cases since 1992, is also at risk of losing the measles-free standing that it has held since 2000. The resurgence of measles is a symptom of falling rates of immunization against infectious disease. “When immunization rates drop and herd immunity frays, it’s always measles that comes back first,” says Paul Offit, a paediatrician specializing in infectious disease at the Children’s Hospital of Philadelphia, Pennsylvania. “Measles is the canary in the coal mine.” Earlier this year, the WHO named hesitancy to vaccinate as one the ten gravest threats to global health. As a result, governments around the world are considering policies that would make vaccinations mandatory. Over the past 5 years, legislators in Australia, France and Italy have restricted school access for children who haven’t received the country’s recommended panel of vaccinations, including MMR. Some US states are doubling down on existing vaccination requirements for schoolchildren by removing the ability for parents to legally refuse vaccines for non-medical reasons. And in September, the UK health secretary Matt Hancock responded to pressure — including a letter from four prominent London doctors calling for action to address the United Kingdom’s falling immunization rates — with the announcement that the government had taken legal advice on how it might make vaccinations compulsory. This is a common reaction among politicians, says Noni MacDonald, a paediatrician at Dalhousie University in Halifax, Canada, and a founding member of the WHO’s Global Advisory Committee on Vaccine Safety. But mandates are not as clean a solution as policymakers might hope. A variety of incentives and penalties have been employed, with differing levels of enforcement, and the effectiveness of each approach is not clear cut. Because the factors driving low immunization rates are not the same everywhere in the world, MacDonald says that governments should frame their policy-making decisions around two questions: “What problem are you trying to fix? And is a mandate the way to fix it?” A pressing need “In a better world, we wouldn’t need mandates,” says Offit. “People would educate themselves about vaccines and make the best decision for their children and for themselves. Assuming there’s not a medical contraindication, they’d get vaccinated every time.” Evidence of vaccination’s effectiveness is resounding. Government agency Public Health England estimates that the measles vaccine, first introduced in the United Kingdom in 1968 and combined with mumps and rubella vaccines in 1988, has prevented 20 million cases of measles and saved 4,500 lives. Widely used vaccines have excellent safety records. In terms of improving public health, vaccination is second only to providing clean drinking water. Despite this, countries around the world are failing, to varying extents, to reach levels of coverage required to achieve herd immunity — especially for MMR. Misinformation is a major problem, according to Offit. “There’s a lot of bad information out there,” he says. “It scares people — begs them to make bad decisions.” Other researchers say that vaccines are victims of their own success. A worldwide survey published by the London-based charitable foundation Wellcome (see go.nature.com/2qg0mnp) this year showed that vaccine hesitancy is a problem mainly in high- income countries, where widespread immunization has made outbreaks of infectious disease much less common. As cases become rarer, the number of people with first-hand experience of the seriousness of the diseases diminishes. Belief in the need for vaccinations weakens, as more people calculate that the safer course is to go without them, says Helen Bedford, a children’s health specialist at Great Ormond Street Institute of Child Health, London. “When the disease isn’t around,” she says, “half the equation has been removed — all the risk is focused on the vaccine.” It is against this backdrop that the idea of enforcing vaccination is raised. Proponents of mandatory vaccination argue that despite what is arguably a removal of individual freedom, the ethical justification for intervention is twofold. The first argument is that the state is acting to prevent parents from making decisions on behalf of their children that unnecessarily expose them to the risk of infectious disease. Through this lens, mandating vaccination is akin to legally requiring that young children are secured in an appropriate car seat. The second argument is that failure to vaccinate not only puts the unvaccinated individual at risk, but also anyone they come into contact with — including those too young to be immunized and people who, for medical reasons, cannot be vaccinated. “The libertarian argument
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falls apart,” Offit says. “If you’ve made the choice to put your child in harm’s way, and to put those who they come into contact with in harm’s way, then you’ve done harm.” His opinion echoes that of the US Supreme Court of 1905, which upheld the legality of an 1809 mandate for smallpox vaccination in Massachusetts, stating “There are manifold restraints to which every person is necessarily subject for the common good.” Making a mandate Governments can never force someone to get themselves or their child vaccinated — it is a foundational principle of medical ethics that consent must be given for any procedure. The decision to make vaccination mandatory is therefore a decision to impose some form of penalty on those who do not follow the law. A common penalty is to exclude unvaccinated children from school, because these are hotspots for disease outbreaks. This has long been the case in the United States — since 1980, all 50 states have formally linked vaccination to school entry. Australia, France and Italy have taken similar action. Australia also has legislation that withholds financial child support from the parents of unvaccinated children without medical exemptions. In Italy, fines are also levied on parents. But penalties can be considerably softer. Josephine Sauvage, one of the London doctors who wrote to the UK health secretary, suggests that a mandate could record children’s vaccination status at school entry, and require anyone who declines immunizations to register a conscientious objection. It would be the first such UK mandate since one was implemented for smallpox more than 100 years ago. A measles outbreak in April led to the New York mayor declaring a public-health emergency.Credit: Erik Pendzich/Alamy Although mandatory vaccination has existed in various forms for more than 200 years, there is a paucity of good epidemiological studies of the effects of different mandates, MacDonald says. The introduction of new laws is often accompanied by increased publicity about vaccination, which makes it harder to identify the specific effects of legislation. The social contexts in which mandates are applied also vary from place to place and are continually shifting. In the United States, which recommends a panel of vaccinations, the number of states with specific mandates proliferated from 20 in 1963 to all 50 (plus the District of Columbia) in 1980. That expansion was backed by nationwide surveys in the 1970s showing that the incidence of measles was higher in states without mandates, and lowest in states where mandates were strictly enforced. Early evidence from Italy and France shows that immunization coverage has risen with the introduction of mandates. And the No Jab, No Pay legislation withholding state benefits that was introduced in Australia in 2015 coincided with full immunization rates rising by around 3%. Nationwide coverage is now nearly 95%. Several US states have taken steps to restrict people’s ability to opt out for non-medical reasons. In 2016, after a well-publicized outbreak of measles at Disneyland in California, the state made it impossible for people to legally opt out of immunization on anything other than medical grounds. Legislators in New York took the same action this year after a measles outbreak in Brooklyn, as did the state of Maine. There is evidence that the California legislation has worked — between 2013 and 2017 the proportion of children attending kindergarten who were not up to date on their vaccinations halved, to 4.9%. But this might not tell the whole story. Daniel Salmon, director of the Johns Hopkins Institute for Vaccine Safety in Baltimore, Maryland, points out that the number of unvaccinated children being educated at home in California almost quadrupled between the 2016–17 and 2018–19 school years. Salmon also contends that increases in immunization rates have been largely offset by a spike in the number of medical exemptions awarded since the 2016 legislation came in. There is evidence of physicians listing conditions not typically viewed as contraindications for vaccination. A further round of legislation, introduced in California in September, will see the reasons physicians give for medical exemptions monitored and controlled more closely.
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Environmental Pollution within Delhi has reached levels that are literally off the charts. These concentrations increase heart disease, respiratory infections, and other forms of harm McHardy et al., 20 [Juliette Simpson McHardy, former intern at the WHO, worked on global health law as a research assistant for the O’Neil Institute, the Food and Agriculture Organization, and Australian health Practitioners Regulation Agency, Kashish Aneja, practicing lawyer at Delhi High Court and Supreme Court of India and has a masters in in global health law from Georgetown, Marherita Marianna Ciná, fellow at the O’Neill Institute of National and Global Health Law at Georgetown University Law Center, Lawrence O. Gostin, O’Neill Professor of Global Health Law and director of the WHO Collaborating Center on National and Global Health Law, February 5, 2020, “Delhi in a Chokehold: Air Pollution as a Public Health Emergency”, HealthAffairs, https://www.healthaffairs.org/do/10.1377/hblog20200130.710866/full/] /Triumph Debate
Delhi is in pollution’s ever tightening chokehold, causing catastrophic health harms. India ranks as the second most populated country in the world, and the first in air pollution. Of the World Health Organization’s (WHO’s) top 10 most polluted cities, all but one (Bamenda, Cameroon) are in India. Consider the sheer number of people breathing toxic air. On November 1, 2019, Delhi’s Environment Pollution (Prevention and Control) Authority (EPCA) declared air pollution a public health emergency. The declaration acknowledged the severe impact of pollution on health. Although it provided for specific measures to ameliorate pollutant levels and to prevent undue human exposure, it did not specifically define “public health emergency,” specify duration, or provide for long-term systemic changes. While the ongoing crisis in Delhi was born of the externalities of rapid urban and economic development in the context of a shifting climate, it has been abetted by profound failure in political will and coordination within a federal system of divided responsibilities ill-suited to regulating air pollutants. Against this murky backdrop of failed public health and environmental governance, the EPCA has proven to be a bright beacon shining amidst the fog. Air Pollution And Health Ambient air pollution is a key risk factor for preventable noncommunicable diseases (NCDs): It kills more than four million people every year globally. Worldwide, air pollution is responsible for 29 percent of all deaths and disease from lung cancer, 17 percent from acute lower respiratory infection, 25 percent from ischaemic heart disease, 43 percent from chronic obstructive pulmonary disease, and 24 percent of all deaths from stroke. In addition to these direct impacts on individual health outcomes, air pollution causes indirect health harms on other key determinants of individual health. For example, with dangerously high levels of air pollution, people cannot go outside to exercise or cannot perform work during business hours. Every aspect of an individual’s health is affected. In Delhi, (see exhibit 1), NCDs attributable to ambient air pollution far exceed the global average, with hundreds of thousands of premature deaths resulting annually across India. The major factors contributing to Delhi’s particulate matter (PM) levels include unpaved roads, ill-regulated industry, an ever-increasing number of road vehicles, the burning of stubble (an unwanted but burdensome remainder of harvest) in the adjacent states of Punjab and Haryana, and firecracker use accompanying annual Diwali celebrations. These activities release PM, the most harmful form of pollutant, in its two major forms: PM10 (the largest, albeit still microscopic), and PM2.5 (smaller but harmful when inhaled). To give a sense of the catastrophe that gripped Delhi in early November, ambient PM was recorded in excess not only of what may be considered safe for inhalation, but also, at times, the very scale used to record its presence. PM10 has been measured at 999 out of a maximum possible 999 micrograms per cubic meter (mpcm) in parts of the Delhi metropolis with, for example, 24-hour averages hovering at 693 mpcm and 288 mpcm for PM10 and PM2.5 on November 2. (In the United States and many other countries, the scale ends at 500). Per the WHO, safe levels of mean PM10 and PM2.5 exposure over 24 hours are, respectively, 50 mpcm, and 25 mpcm.
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PHE can help reframe environmental issues into their health consequences, allowing for them to be better confronted. The restrictions of civil liberties allow for first steps to be put in place as well McHardy et al., 20 [Juliette Simpson McHardy, former intern at the WHO, worked on global health law as a research assistant for the O’Neil Institute, the Food and Agriculture Organization, and Australian health Practitioners Regulation Agency, Kashish Aneja, practicing lawyer at Delhi High Court and Supreme Court of India and has a masters in in global health law from Georgetown, Marherita Marianna Ciná, fellow at the O’Neill Institute of National and Global Health Law at Georgetown University Law Center, Lawrence O. Gostin, O’Neill Professor of Global Health Law and director of the WHO Collaborating Center on National and Global Health Law, February 5, 2020, “Delhi in a Chokehold: Air Pollution as a Public Health Emergency”, HealthAffairs, https://www.healthaffairs.org/do/10.1377/hblog20200130.710866/full/] /Triumph Debate
The public health emergency declaration, while necessary to address immediate issues and provide impetus for further action, is not sufficient on its own to address this environmental and health catastrophe. First, the full potential of the law is released only with considered legislative and executive action, taken on the basis of detailed scientific advice and extensive public consultation. EPCA actions are, by contrast, reactive and aimed at sources most susceptible to prevention for the immediate protection of public health. For example, the EPCA’s recommendation that people stay indoors and the subsequent closure of schools benefit those middle-class people who live in homes with well-maintained air purifiers. Similarly, an India Supreme Court order, issued in response to the declaration, aimed at causing stubble burning’s immediate cessation was admirable but did not address the economic burden such a ban would impose on farmers or provide for their compensation. Second, there are also procedural concerns about the representation of affected individuals, in particular those without economic heft, in the formulation of these emergency decrees. Action taken to address a public health emergency is, therefore, best seen as the beginning of a longer process in structural change. It should not become a crutch relied on to avoid hard decisions and a contentious debate. Third, placing human health at the forefront of an environmental catastrophe has rhetorical advantages. This potential advantage can be seen in India’s recent response to its ongoing pollution problems, in which public health became the principal media frame in the ongoing and contentious air pollution debate. While it is common for matters of environmental health to be framed by economic interests or as an abstract concern for the environment, this declaration shows that shifting the debate onto the terrain of public health centers the problem on human lives, thereby creating a compelling basis for action. This personalization of the political is an important precedent for bridging the silos of environment and health. A related question: Would climate emergency declarations have greater salience if framed as public health emergencies? Finally, given the increasingly complex interactions among pollution, climate change, and human health, there is growing potential for judicial involvement in preventing immediate harm and overcoming political paralysis. Those pursuing strategic advocacy in response to the harms of pollution, or the effects of environment on human health more generally, can use this public health emergency declaration as precedent in how the judicial and administrative powers may be leveraged through litigation.
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Air pollution is a global public health emergency Bolton 16 [Doug Bolton, Tech/science reporter, 1-19-2016, "Air pollution in cities is now a global 'public health emergency'," https://www.independent.co.uk/climate-change/news/air-pollution-public-health-emergency-who-world- health-organisation-a6821256.html] /Triumph Debate
The World Health Organisation (WHO) has said that air pollution is now a "public health emergency" across the globe, in a stark warning about the dangers of unclean air in our cities. The warning comes at a time when air pollution is high on the agenda - in December, Chinese authorities issued a pollution 'red alert' in Beijing, forcing schools and businesses to close down and urging people to stay indoors in order to protect them from the deadly smog. And just eight days into 2016, London breached its own legal limit on air pollution for the entire year. Under EU regulations, pollution levels in London are allowed to exceed the maximum safe limit for 18 hours a year - this allowance had been burned through completely by Friday 8 January. Speaking to The Guardian, Maria Neira, the head of public health at the WHO, said: "We have a public health emergency in many countries from pollution." "It's dramatic, one of the biggest problems we are facing globally, with horrible future costs to society." Neira told the paper that although the short-term effects of pollution on city-dwellers' health can be severe, consistently high levels could be creating a ticking time bomb of public health problems. Exposure to air pollution can cause health issues like asthma, heart disease and potentially even dementia, conditions which require medical attention and hospital beds. If air pollution levels stay high, Neira believes global health services in the future could be put under even more strain than they are now. According to the UN, 3.3 million people around the world die prematurely due to the effects of air pollution every year. Most of these deaths occur in China, India and Pakistan, but the UK is badly affected too. According to a estimates made by researchers from King's College London, almost 9,500 people in London alone died prematurely in 2010 due to pollution - 3,537 from the effects of nitrogen dioxide (NO2), which is expelled by engines and power stations, and 5,879 from PM2.5, the name given to the smallest particles of pollution which can penetrate deep into the lungs and cause respiratory problems. Across the UK, the number of early deaths that can be blamed on pollution could be as high as 60,000 a year, according to a report from official advisory body the Committee on the Medical Effects of Air Pollutants, which was reported by The Sunday Times. The Government is now being put under pressure to take swift action on the issue, having been accused in the past of wilfully ignoring air pollution reduction targets. This pressure will likely increase with the WHO's release of pollution figures next month, which are expected to show that air quality has continued to decline across the world in the past year.
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Smog standards are critical for public health EDF, No Date [Environmental Defense Fund, Environmental Defense Fund or EDF (formerly known as Environmental Defense) is a United States-based nonprofit environmental advocacy group. The group is known for its work on issues including global warming, ecosystem restoration, oceans, and human health, and advocates using sound science, economics and law to find environmental solutions that work. It is nonpartisan, and its work often advocates market- based solutions to environmental problems., xx-xx-xxxx, "Why smog standards are important for our health," https://www.edf.org/health/why-smog-standards-are-important-our-health] /Triumph Debate
Nearly 40 percent of Americans live in areas with unhealthy levels of smog pollution. What is smog? Across many major cities, a hazy brown soup of pollution hangs over the skyline, especially in the warmer months. This is smog, known more specifically as ground-level ozone. Smog is formed when industrial emissions from power plants, factories, cars, and other sources react with heat and sunlight in the atmosphere. Why is it harmful? When inhaled, smog irritates our airways, increasing our risk of serious heart and lung diseases. These health risks are why many cities monitor smog levels. On a high ozone-alert day, for example, your eyes and throat may burn, and you may cough and wheeze. Reducing smog will protect all Americans — especially our kids, older adults and people active outdoors. How can you help fix it? Every five years, the EPA reviews air quality standards in light of any new medical evidence, and makes updates, if appropriate. A 2015 review lowered the nation's air quality standard for smog pollution from 75 parts per billion (ppb) to 70 ppb. The science on ozone's health effects is rock solid. Elena Craft, Senior Health Scientist EDF fought to get those standards implemented. Now there is strong evidence that we need a more stringent standard to protect public health. We will fight for those too — but we need your help.
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WASH (water, sanitation, and hygiene) is critical to fight public health crises like COVID-19 Lal 2020 [Aparna Lal, Robyn M. Lucas, Anthony Slatyer, BSc (Hons) Zoology, MSc (Wildlife Science), PhD (Public Health) Fellow, Environment, Climate and Health, Research School of Population Health, College of Health & Medicine, I have an undergraduate degree in Zoology and then went on to do a Postgraduate Diploma in Wildlife Management in New Zealand and a Master’s degree in Wildlife Science in India when I spent 6 months following chasing green turtles and setting up grazing experiments in the Indian Ocean. Interviewing villagers living on the edge of India’s protected Tiger Reserves made me start thinking about disease transmission between wild animals, livestock and humans who live in close proximity to animals. This led me to do my PhD at the Department of Public Health at the University of Otago (New Zealand), graduating in 2014. I then moved to the ANU, where I am now a Fellow working with the Environment, Climate and Health group in the National Centre for Epidemiology and Population Health., 7-24-2020, "Water access as a required public health intervention to fight COVID-19 in the Pacific Islands," Lancet Regional Health – Western Pacific, https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065%2820%2930006-7/fulltext] /Triumph Debate
In 2015, 193 United Nations (UN) member countries adopted Agenda 2030 as an agreed framework for sustainable development to 2030 [[1]], with seventeen sustainable development goals (SDGs). For health, water and sanitation, the relevant goals are SDG 3, to “ensure healthy lives and promote well- being for all at all ages”, and SDG 6, to “ensure availability and sustainable management of water and sanitation for all” [[1]]. Water, sanitation, and hygiene (WASH) interventions, including handwashing services, are often considered independently to public health. Yet, in the COVID-19 global pandemic, good hygiene and regular, thorough handwashing are cornerstones of the public health response. WASH services are critical to interrupting transmission of SARS-CoV-2, and thus the public's health. Concomitant access to soap and hand-hygiene related skills and knowledge [[2]] are also essential. • View related content for this article In the Pacific Islands, WASH interventions to improve public health are limited. In Suva, Fiji, health and sanitation systems have been strengthened to protect communities from COVID-19 [[3]]; most other Pacific Island nations lack sufficient WASH, including handwashing services, to enable effective containment of COVID-19. We used the most recent data from the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (www.washdata.org) to assess potential access to WASH services across 21 Pacific Island nations (excluding Australia and New Zealand). All nations reported national-level estimates of household-level drinking water and sanitation coverage; only 62% of countries provided data separately for urban and rural regions (Fig. 1A). Only 4 (19%) nations (Republic of the Marshall Islands (RMI), Solomon Islands, Vanuatu, and Federated States of Micronesia (estimates from 2005)) had data on household handwashing and hygiene facilities (Fig. 1A). Rural areas in RMI, Solomon Islands and Vanuatu had a higher percentage of households with no facilities for water and soap, and a lower percentage of households with basic facilities for water and soap, compared to urban areas. These are immediate data gaps that must be addressed to evaluate the risk of SARS-CoV-2 transmission. Fig 1 Fig. 1Data availability () and gaps () for WASH related information in (A) Households (B) Schools and (C) Healthcare facilities in 21 Pacific Island countries (data based on 2019 JMP). View Large ImageFigure ViewerDownload (PPT) There are very limited data from Pacific Island countries on available drinking water, sanitation or handwashing facilities in schools and healthcare facilities (Fig. 1B and C). For schools, only 43% of Pacific Island nations reported drinking water and sanitation data, while only 29% had data on hygiene and handwashing facilities (Fig. 1B). Education and messaging on adequate hygiene needs to be developed that is age-appropriate [[4]] and gender-specific, with hand-hygiene facilities available on-site. For healthcare facilities, only three Pacific Island nations reported data on drinking water and sanitation (Fig. 1C). In a 2017 census in Fiji, 13% of healthcare facilities did not have handwashing stations at points-of-care or within 5 m of toilets. In this setting, regular handwashing and disinfection practices, and safely managing health care waste, are essential for infection control [[5]]. Data on waste management facilities were reported for 57% of Pacific Island nations, largely restricted to hospitals, with no information available for primary care facilities. Functional hand-hygiene services should be available to all those working or visiting healthcare facilities. The COVID-19 pandemic is an appropriate time to expand the coverage of WASH in Pacific Island countries to increase coverage for households, schools and healthcare facilities. Increased education and active community engagement alongside this expansion is critical to its success for public health. Enhancing existing initiatives, such as the Healthy Islands monitoring framework and the principles of Universal Health Coverage (UHC) adopted by Pacific Health Ministers in 2015, can reduce data gaps on indicators, and improve reporting on the efficiency, uptake and sustainability of services across urban and rural areas [[6]]. Cultural knowledge and practices for WASH remain a knowledge gap for Pacific Island countries [[7]]. Many countries are not on track to achieve their SDG commitments by 2030 and some are going backwards [[8]]. The 2018 UN Economic and Social Council global estimates [[9]] indicate that: • Three billion people do not have basic handwashing facilities at home; • One third of primary schools lack basic drinking water, sanitation and hygiene services; • 12% of healthcare facilities have no water service, obtaining this from >500 m away, or from an unimproved source. The COVID- 19 pandemic will have a disproportionate impact on communities without access to suitable quality water, soap, and knowledge about handwashing for personal hygiene. This and other socio-economic inequalities will reduce the effectiveness of response measures and increase health risks to wider populations [[10]]. Successive waves of outbreaks will worsen social conditions, placing additional strain on public health infrastructure. Actioning the Agenda 2030 commitment by prioritising access to WASH services as a public health intervention for COVID-19, alongside scaling-up of locally successful solutions, experience sharing, and education is now essential.
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Water pollution negatively impacts public health Cassoobhoy 2020 [Arefa Cassoobhoy, Dr. Arefa Cassoobhoy is a board certified internal medicine doctor with expertise in health communications and a background in public health. She trained at Emory University and was a senior medical director at WebMD and Medscape. She sees patients in person and by telemedicine in Georgia. 11-22-2020, "How does water pollution affect human health?," https://www.medicalnewstoday.com/articles/water-pollution-and- human-health#water-pollution] /Triumph Debate
Water pollution occurs when a body of water becomes contaminated, usually by chemicals or microorganisms. Water pollution can cause water to become toxic to humans and the environment. Water is an essential resource for all life on Earth. If a water source becomes contaminated due to pollution, it can lead to health issues in humans, such as cancer or cardiovascular conditions. This article explores the causes of water pollution, how it can affect human health, and what people can do to help prevent it. Water pollution Image credit: JEAN AURELIO PRUDENCE/L’Express Maurice/AFP via Getty Images Water is a natural resource that all living creatures require. Clean water is also used in manufacturing and for social and economic development. However, according to the United Nations (UN), 2.2 billion people lack access to safe drinking water services. The UN and the World Health Organization (WHO)Trusted Source list the following statistics on water pollution: Over half the global population do not have safely managed sanitation services. Around 2 billion people live in countries with high levels of water stress, meaning the amount of water available is less than the amount required. Experts estimate that by 2025, half the world’s population will live in a water-stressed environment. Around 785 million people do not have basic drinking-water services. Since the 1990s, water pollution has worsened in almost all rivers in Asia, Latin America, and Africa. Sources of water pollution Water is sometimes referred to as the universal solvent, as it dissolves more substances than any other liquid. However, this ability means that water is easily prone to pollution. Below are just some of the many ways that water pollution can occur. Sewage and wastewater After being used, water becomes wastewater. Wastewater can be domestic, such as water from toilets, sinks, or showers, or from commercial, agricultural, or industrial use. Wastewater also refers to rainwater that washes oil, grease, road salt, debris, or chemicals from the ground into waterways. The UN estimates that 80% of wastewater returns to the ecosystem without being treated or reused. In 2017, the UN found that 2 billion people worldwide did not have access to facilities such as toilets or latrines. The organization also discovered that 673 million people openly defecate outside. Agriculture The agriculture industry is one of the biggest consumers of fresh water. In the U.S., it is responsible for around 80% of the nation’s water consumption. Agriculture is also the main source of pollution in rivers and streams in the U.S. One way that agriculture causes water pollution is through rainwater. When it rains, pollutants, such as fertilizers, animal waste, and pesticides get washed from farms into waterways, contaminating the water. Contaminates from agriculture usually contain high amounts of phosphorous and nitrogen, which encourage the growth of algal blooms. These blooms produce toxins that kill fish, seabirds, and marine mammals, as well as harming humans. Additionally, when these algal blooms die, bacteria produced as the algae decompose use up oxygen in the water. This lack of oxygen causes “dead zones” in the water where fish cannot live. The United Nations Educational, Scientific and Cultural Organization (UNESCO) estimate that there are roughly 245,000 square kilometers of dead zones globally. Plastics and garbage Approximately we produce 1.4 billion tonsTrusted Source of waste each year. Of this annual waste, 10% comprise plastics. Due to the widespread use of plastics, experts estimate that 4.8– 12.7 million tons of waste enter the ocean each year. Plastic and garbage can enter the water in many ways: debris falling off ships trash blowing into the ocean from landfills garbage swept into the sea via rivers from people discarding used items such as food packages people throwing their trash on to the beach Once in the water, plastic and garbage can harm marine life and human health. Fish may eat trash, mistaking it for food, and end up dying. As plastic slowly breaks apart, microplastics form. These are small fragments of plastic that are less than 5 millimeters in size. Fish may consume these microplastics, which may then be eaten by humans. The UN state that plastic debris in the ocean causes the deaths of over a million seabirds each year. Plastic debris is also responsible for the deaths of more than 100,000 marine mammals annually. Oil Oil pollution can occur when oil tankers spill their cargo. However, oil can also enter the sea via factories, farms, and cities, as well as via the shipping industry. Radioactive waste Radioactive waste can endure in the environment for thousands of years, making safe disposal difficult. If improperly disposed of, it can enter the water, making it hazardous to humans, marine life, and the environment. Fracking Fracking is the process of extracting oil or natural gas from rock. The technique uses large amounts of water and chemicals at high pressure to crack the rock. The fluid created by fracking contains contaminants that can pollute underground water supplies. powered by Rubicon Project ADVERTISEMENT Check your vitamin levels with an at-home micronutrient test This micronutrient test checks for vitamin B12, D, E, Magnesium, Copper, Selenium & Zinc. Get your results in 2-5 days from an accredited laboratory with free shipping, Order today for 30% off. Water pollution and human health The following are some negatives ways that water pollution can directly affect human health. Ingesting microplastics A person may ingest microplastics via drinking water or through eating contaminated seafood. At Tokyo Bay in 2016, scientists examined 64 anchovies for microplastic consumption — 77%Trusted Source had microplastics in their digestive systems. People have also discovered them within salt, beer, and 42 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
other food items. Studies show microplastics may cause oxidative stress, inflammatory reactions, and metabolic disorders in humans. However, further research is needed to confirm these effects. Consuming water contaminated by sewage The WHO note that, globally, around 2 billionTrusted Source people use a drinking water source with fecal contaminants. Contaminated water can harbor bacteria, such as those responsible for diarrhea, cholera, dysentery, typhoid, hepatitis A, and polio. According to the UN, every year, approximately 297,000 children under five die from diseases linked to poor sanitation, poor hygiene, or unsafe drinking water. Drinking water containing chemical waste Chemical pollutants, such as pesticides, fertilizers, and heavy metals can cause serious health problems if ingested. In 2014, residents in Flint, Michigan, experienced water contamination due to inadequate testing and treatment of their water supply. The contaminated water caused rashes, hair loss, and itchy skin. Lead levels in the bloodstream of children who drank the water doubled. A person who ingests chemical toxins in their water can be at risk of: cancer hormone disruption altered brain function damage to immune and reproductive systems cardiovascular and kidney problems Swimming in contaminated water can also trigger: rashes pink eye respiratory infections hepatitis MEDICAL NEWS TODAY NEWSLETTER Knowledge is power. Get our free daily newsletter. Dig deeper into the health topics you care about most. Subscribe to our facts-first newsletter today. Enter your email Your privacy is important to us Combatting water pollution A person who wishes to reduce water pollution can help by: reducing plastic usage and recycling plastics when possible disposing of household chemicals properly keeping up with the maintenance of their vehicle to ensure it is not leaking harmful substances avoiding using pesticides making sure to clean up dog waste making sustainable choices regarding food and drinks considering going vegan or vegetarian Summary Water pollution is a serious environmental issue that can be caused by many contaminants. Human health can be affected by consuming, entering, or washing in polluted water. There are various ways to help to limit water pollution. If a person experiences any effects of water pollution, they should speak to their doctor.
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Government policies that reduce pollution protect public health – laundry list EDF 2020 [Environmental Defense Fund, Environmental Defense Fund or EDF (formerly known as Environmental Defense) is a United States-based nonprofit environmental advocacy group. The group is known for its work on issues including global warming, ecosystem restoration, oceans, and human health, and advocates using sound science, economics and law to find environmental solutions that work. It is nonpartisan, and its work often advocates market- based solutions to environmental problems., 1-20-2020, "Policies to reduce pollution and protect health," https://www.edf.org/airqualitymaps/oakland/policies-reduce-pollution-and-protect-health] /Triumph Debate
Emissions from cars, trucks and other engines are a primary source of harmful pollution. Diesel exhaust from goods movement — specifically trucks, trains and marine sources — is of particular concern. The World Health Organization classifies diesel engine exhaust as carcinogenic to humans [PDF], and the U.S. Environmental Protection Agency (EPA) has found that diesel emissions contribute to health problems, including premature mortality, aggravated heart and lung disease, and increased respiratory symptoms, particularly for children, the elderly, outdoor workers and other sensitive populations. Protections at the federal, state and local levels, as well as private-sector mitigation, can make an enormous difference in protecting health. Federal standards: Bedrock protections for all Since the 1970s, the federal government has limited pollution from a range of sources, including power plants, industrial facilities, cars, trucks and off-road engines. Health and quality of life benefits from these protections have been substantial. For example, a 2011 analysis [PDF] estimates that the Clean Air Act provides $30 worth of health benefits for every dollar spent. All vehicles and engines operating in the United States must comply with emissions standards for specific pollutants, including smog, soot and greenhouse gases. These requirements have been a powerful tool for improving fuel efficiency and reducing emissions in newer vehicles. Standards adopted for heavy-duty trucks in 2016 would cut over a billion tons of climate pollution and save hundreds of millions of dollars by 2035, while also benefiting public health by reducing emissions of particulate matter and smog-precursor pollutants. The new standards are supported by a broad range of stakeholders, including leading public health organizations, large companies that depend on reliable and efficient freight, and consumers. Voluntary programs also play a major role in reducing emissions and promoting cleaner air. For example, EPA's SmartWay program has empowered companies to move goods in the cleanest, most energy-efficient way possible (and to save $27.8 billion in fuel costs) since 2004. SmartWay's clean air achievements (84 million metric tons of carbon dioxide, 1,694,000 tons of nitrogen oxides and 70,000 tons of particulate matter emissions avoided) are also a boon to public health. EPA's SmartWay program has empowered companies to move goods in the cleanest, most energy-efficient way. Since 2004, SmartWay has saved 170.3 million barrels of oil — the equivalent of eliminating the annual energy use of more than 6 million homes. SmartWay's clean air achievements are also a boon to public health, with 72.8 million metric tons of carbon dioxide, 1,458,000 tons of nitrogen oxides and 59,000 tons of particulate matter emissions avoided. Companies affiliated with the SmartWay Program have also saved up to $24.9 billion in fuel costs to date. Meanwhile, the Diesel Emissions Reduction Act (DERA), which provides funding for owners to replace their diesel equipment sooner than legally required, cut 335,200 tons of NOx pollution and 14,700 tons of particulate matter (PM2.5) since 2008. Officials estimate health benefits of $12.6 billion and up to 1,700 fewer premature deaths. State initiatives: California's freight plan With an increasingly uncertain outlook for national clean air protections, states are leading a transition to cleaner technologies. California is tackling freight-related transportation emissions with its California Sustainable Freight Action Plan, which sets a goal of using zero- or near-zero emissions equipment to transport freight everywhere feasible. This ambitious vision puts California on the right path, but the plan's ability to achieve its goals will require robust support from the public and follow-through from California legislators Reducing exposure through city planning The Oakland air quality maps show that air pollution levels can vary significantly by location. Cities can use air quality information and emissions data to guide planning decisions in ways that reduce residents' exposure to air pollution, for example, by building schools, hospitals or housing developments farther away from major sources of pollution like freeways. Likewise, local and regional governments can use air pollution data to guide transportation planning, and companies can incorporate this information in freight management. Similarly, local governments, companies or individuals can provide funding to install air filtration systems in areas with high levels of pollution to assist in reducing exposure to harmful toxic air. Reducing exposure to air pollution has important benefits, but cutting emissions at the source is the most powerful tool for protecting people's health over the long term. And reducing tailpipe emissions also reduces greenhouse gas emissions that contribute to climate change. Speak up where you live If you live in Oakland, connect with local groups like the West Oakland Environmental Indicators Project (WOEIP), who can help you take action on issues that affect Oakland air quality. If you live elsewhere, find a group working near you. For example, Moms Clean Air Force, a national group of more than a million parents, organizes communities to protect clean air and our kids' health in 20 states.
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After declaring a public health emergency New Delhi has increased environmental focus in the energy, transportation, and agricultural industries Thomas and Tiwari 20 [Vinod Thomas, visiting professor at the National University of Singapore and at the Asian Institute of Management, Manila and Chitranjali Tiwari, associate fellow at JK Lakshmipat University, Jaipur, 25 Nov. 2020, “Delhi, the World’s Most Air Polluted Capital Fights Back.” Brookings, https://www.brookings.edu/blog/future- development/2020/11/25/delhi-the-worlds-most-air-polluted-capital-fights-back/] /Triumph Debate
The main sources of Delhi’s particulate emissions are, in equal measure, particles from large power plants and refineries, vehicles, and stubble burning. The experiences of Bangkok, Beijing, and Singapore suggest that an ambitious but feasible goal is to cut air pollution by one-third by 2025, which, if sustained, could extend people’s lives by two to three years. The current effort is designed to confront all three sources, but strong implementation is needed. Delhi is moving simultaneously on three fronts: energy, transport, and agriculture. In each case, East Asia offers valuable lessons. Coal- fired plants. Delhi’s environment minister has called for the closure of 11 coal-fired power plants operating within 300 kilometers of Delhi. But policy implementation must improve: All the plants have missed two deadlines to install flue-gas desulfurization units to reduce sulfur dioxide emissions. Last year, 10 coal-fired power plants missed a December deadline to install pollution control devices. Beijing provides valuable lessons in cutting concentrations of PM2.5 more than 40 percent since 2013. Beijing substituted its four major coal- fired stations with natural gas plants. The city government ordered 1,200 factories to shut with stricter controls and inspections of emitters. Bangkok had success with its inspection and maintenance program. Cleaner transport. Delhi has tried pollution checking of vehicles by mobile enforcement teams, public awareness campaigns, investment in mass rapid transport systems, and phasing out old commercial vehicles. The Delhi government’s recent push for electric vehicles shows promise, while the response of industry and the buy-in from customers will be key. Overall results in cutting pollution have been weak because of poor governance at every level. Better outcomes will be predicated on investment in public transportation, including integration of transport modes and last-mile connectivity. Unfortunately, Delhi Transport Corporation’s fleet shrank from 6,204 buses in 2013 to 3,796 buses in 2019, with most of the bus fleet aging. Delhi should look at Singapore’s regulation on car ownership and use; its improved transit systems; and promotion of pedestrian traffic and nonmotorized transport. Better farming practices. Burning of crop stubble in Delhi’s neighboring states has become a serious source of pollution in the past decade. In 2019, India’s Supreme Court ordered a complete halt to the practice of stubble burning and reprimanded authorities in two of these states, Punjab and Haryana, for allowing this illegal practice to continue. Needed is the political will to act, as poor farmers complain that they receive no financial support to dispose of post-harvest stubble properly. Delhi’s “Green War Room” signaling the fight against the smog, is analyzing satellite data on farm fires from Punjab and Haryana to identify and deal with the culprits. The Indian Agricultural Research Institute has proposed a low-cost way to deal with the problem of stubble burning by spraying a chemical solution to decompose the crop residue and turn it into manure. Better coordination is needed. In 2013, when Singapore faced a record-breaking haze due to agricultural waste burning in neighboring countries, the Environment Agency and ministries of education and manpower together issued guidelines based on a Pollution Standards Index to minimize the health impacts of haze. Stubble burning has been banned or discouraged in China, the United Kingdom, and Australia. Delhi, projected to be the world’s most populous city by 2030, is motivated by a sense of urgency. Facing a growing environmental and health calamity, antipollution efforts are being strengthened. But to succeed, the different levels of government must harness the political will to invest more, coordinate across boundaries, and motivate businesses and residents to do their bit.
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The prevalence of air pollution in China has resulted in several positive policy changes in response to the public health crisis Leung 19 [Felix Leung, postdoctoral researcher and a scientist at the Chinese University of Hong Kong, 14 Aug. 2019, “How China Is Winning Its Battle Against Air Pollution,” Earth.org, https://earth.org/how-china-is-winning-its-battle- against-air-pollution/] /Triumph Debate
China has lifted millions out of poverty like no other country on the planet. The price of that economic progress is demonstrated in the air pollution that has caused a public health crisis, killing more than 1.1 million people every year. It has also proved costly for the nation as the economy suffers an annual loss of $37 billion due to pollution-induced crop failure. China Air Pollution Solutions After Beijing’s ‘airpocalypse’ sparked a mass outpouring of anger and frustration among citizens, China set out to clean up the air quality of its cities. The government prohibited new coal-fired power plants and shut down a number of old plants in the most polluted regions including city clusters of Beijing-Tianjin-Hebei and the Pearl and Yangtze Deltas. Large cities like Shanghai, Shenzhen, and Guangzhou restricted the number of cars on the road and started introducing all-electric bus fleets. The country reduced its iron-and steel-making capacity and shut down coal mines. The government also introduced aggressive afforestation and reforestation programmes like the Great Green Wall and planted more than 35 billion trees across 12 provinces. With investments of over $100 billion in such programmes, China’s forestry expenditure per hectare exceeded that of the US and Europe and became three times higher than the global average. The Air Pollution Action Plan released in September 2013 became China’s most influential environmental policy. It helped the nation to make significant improvements in its air quality between 2013 and 2017, reducing PM2.5 levels (atmospheric particulate matter) by 33% in Beijing and 15% in the Pearl River Delta. In Beijing, this meant reducing PM2.5 levels from 89.5µg/m³ (micrograms per cubic metre) down to 60. The city achieved an annual average PM2.5 level of 58µg/m³– a drop of 35%. But even so, no cities reached the World Health Organization’s recommended annual average PM2.5 level of 10µg/m³. And as of the end of 2017, only 107 of China’s 338 cities of prefectural level or higher had reached the WHO’s interim standard of 35µg/m³. You might also like: Asia’s Battle Against Plastic Waste China air pollution China declared war on smog and launched a five-year national air quality action plan in 2013. As part of the second phase of its battle against air pollution, in 2018, China introduced its Three-year Action Plan for Winning the Blue Sky War. While the 2013 Action Plan only set PM2.5 level targets for the city clusters of Beijing-Tianjin-Hebei and the Pearl and Yangtze Deltas, the new three-year Action Plan applies to all the cities in China. It mandates at least an 18% reduction in PM2.5 levels on a 2015 baseline in as many as 231 cities that have not yet reached the government standard- an average of 35µg/m³. The previous plan had not addressed a primary pollutant that made the air deadly in many cities: ground-level ozone- highly irritating gas created by volatile organic compounds (VOCs) reacting with nitrogen oxides released from vehicles. Although ozone in the upper atmosphere protects the Earth by blocking solar radiation, it is extremely toxic in the troposphere and could cause asthma and respiratory tract infections among residents. The new action plan focuses more on ozone pollution as it adds targets for both VOCs and nitrogen oxides: emissions reductions of 10% and 15%, respectively, by 2020. The air quality over major Chinese cities has improved as of the beginning of 2020, a byproduct of the Covid-19 pandemic that originated in Wuhan in the Hubei Province that saw the nation embark on the largest lockdown measures in the world. A drop in industrial and economic activities resulted in reduced greenhouse gas emissions and improved air quality in Wuhan over the Chinese New Year, as well as Beijing, Shanghai and the Yangtze River Delta region. However, emissions will no doubt rise again once the pandemic subsides. Air pollution levels in major cities in China at the turn of this century were almost exactly at the level of London at the height of the Industrial Revolution in 1890. But China cleaned up its air twice as fast as the United Kingdom did after the Great Smog of postwar London killed 8 000 people. Recent research suggests that China’s fight against air pollution has laid the foundations for extraordinary gains in the country’s life expectancy. The average citizen can now expect to live 2.4 years longer on average if the declines in air pollution persist.
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Outbreaks Outbreaks justify limitations, as the only way for a nation to prevent them is to work ahead of the problem Stratton 20 [Samuel J. Stratton, Public Health @ UCLA, “COVID-19: Not a Simple Public Health Emergency,” Prehospital and Disaster Medicine, https://www.cambridge.org/core/services/aop-cambridge- core/content/view/2425C669F59CF3B5F07DA33F78DC20E8/S1049023X2000031Xa.pdf/covid19_not_a_simple_public_h ealth_emergency.pdf] /Triumph Debate
As with centuries of experience with infectious disease outbreaks, COVID-19 cannot be contained due to world-wide travel by humans before the initial outbreak is detected or admitted to be occurring. Logical for containment of infectious outbreaks are advanced public health measures of monitoring and limiting close human contact for those who have been exposed to the contagion. Most readers of Prehospital and Disaster Medicine are familiar with the health and medical aspects of disease outbreaks as discussed in the paragraphs above. Important also are global political, economic, and social impacts of disease outbreaks, such as COVID-19. Politically, such outbreaks are extremely threatening for governments of the local region and country of origin for the new disease. Emergency public health emergencies are difficult for governmental organizations to recognize and manage. Organized and effective governments generally prepare, plan, and anticipate natural disasters that are characterized by being of sudden impact, such as floods, storms, and earthquake-tsunamis. Infectious disease outbreaks are difficult for government agencies to recognize due to gradual onset and lack of damage to infrastructure (buildings and roads). Importantly, disease outbreaks require that governments support health agencies to affect and adjust human behavior as opposed to finance repair of infrastructure and provide economic relief. Rebuilding a road or funding a shelter is much easier for a government than convincing a population to change basic behavior to limit the spread of disease. This aspect of infectious disease outbreaks and government challenges supports the Chinese government efforts and timing of action for the current COVID-19 outbreak as opposed to the frequent criticisms being delivered by media “experts.” The global economic impact of the COVID-19 outbreak has been obvious. China trade has been restricted throughout the world with heavy impact for China and those nations that economically interact with China. Chinese manufacturing has suffered with limits to labor force interaction at work to contain the contagion and decreased world demand for goods due to fear of spread of the disease. Human travel for business and pleasure to and from China has decreased to the point of relative nonexistence. Supporting the assertion for the global economic impact of COVID-19, note that world stock exchanges have fluctuated wildly as news of the outbreak is released. The anticipated threat to a national economy adds to the stress for a national government when confronted with a potential new disease outbreak, leading to hesitation in publicly reacting to initial reports and informing the outside world. Both immediate and long-term social challenges are a major difficulty in controlling the current COVID-19 outbreak and potential future outbreaks. First, limiting the movement of those with known infection exposure to avoid disease spread requires the participation of the restricted individuals. While many will understand the need for restricted interaction with the community, many others will consider the restriction a violation of their human rights. Effective public health messaging to a community is essential for success in obtaining social support for disease containment strategies. Yet, effective public health messaging, particularly to convince a population to limit their activities, must be culturally and socially competent as well as compelling without overstating known evidence. In essence, public health messaging regarding a disease outbreak such as COVID-19 is difficult, particularly in multicultural populations. Further, public health agencies are most often staffed for daily operations and do not have the staffing capacity for close monitoring of exposures. This staffing problem for public health agencies leads to a requirement that those in a community voluntarily act to contain infection outbreaks. The COVID-19 outbreak has the potential to become a global pandemic. Containment of the outbreak requires the best of public health actions and skills. Missteps will occur because of the human nature of both those infected and the health responders themselves. Important for all who are providing health and medical services during this event is to recognize the broad impact of such a disease outbreak. It is necessary to understand the concerns of those who must support the efforts to contain the outbreak, including the political, economic, and social impacts of each action taken in the overall effort to support global security in relation to COVID-19.
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COVID-19 Patients are seeing long term neurological, cardiovascular, and pulmonary system complications Brigham and Women’s Hospital 2021 [Brigham Health. Brigham and Women’s Hospital, 2021, “Understanding the Long-Term Effects of COVID-19,” Harvard Medical School Teaching Hospital. Mass Genn https://www.brighamandwomens.org/campaigns/physicians/understanding-long-term-effects-of-covid-19] /Triumph Debate
A multidisciplinary team of clinicians and researchers at Brigham and Women’s Hospital is leading clinical initiatives and research to better understand why some patients who recover from COVID-19 experience long-term health complications. While it’s still unclear how many patients experience long- term symptoms, such as persistent flu-like symptoms, chronic fatigue and brain fog, following COVID-19 illness, some studies estimate that 10 percent of patients in the U.S. have ongoing symptoms. “The Brigham is leading a number of clinical trials and research efforts to try and understand exactly what’s causing these long-term effects in some COVID-19 patients,” said Jean Marie Connors, MD, a hematologist at the Brigham. “The Brigham has the depth of clinical expertise, the scientific knowledge and expert, multidisciplinary teams to help solve this difficult problem.” Read Next: Transforming the Health of Women Through Research Long-Term Neurological Complications of COVID-19 A variety of neurological health complications have been shown to persist in some patients who recover from COVID-19. Some patients who recover from their illness may continue to experience neuropsychiatric issues, including fatigue, ‘fuzzy brain,’ or confusion. “In the current absence of direct therapies to treat long-term effects of COVID-19, we can offer the most up-to-date, evidenced-based care to manage patients’ symptoms,” said Shamik Bhattacharyya, MD, MS, a Brigham neurologist. “For neurological symptoms, this may include prescribing a medication for mental fog, physical therapy for mobility problems, or psychotherapy for individuals with psychiatric issues, such as anxiety or depression.” To understand the long-term neurological complications of COVID-19, Dr. Bhattacharyya is launching a study that will use advanced imaging to examine the brains of patients who’ve recovered from COVID-19. The study will use the Brigham’s 7 Tesla (7T) magnetic resonance imaging (MRI) scanner—one of only a few in the country to be approved for clinical use—and functional MRI (fMRI) to examine functioning and connectivity in the brain. The research could pinpoint differences in the brains of patients who develop long-term symptoms. “We might discover a ‘danger signal’ that is being sent to the brain in these patients who haven’t fully recovered from COVID-19,” said Dr. Bhattacharyya. “If we can find regions in the brain that are making these patients feel unwell, we might uncover ways to modulate these brain areas that could help these individuals feel better again.” Additionally, Brigham neurologists Tanuja Chitnis, MD, and Maria Houtchens, MD, have launched a trial to examine how COVID- 19 influences the immune system in patients with multiple sclerosis (MS). The trial assesses the short and long-term outcomes of COVID-19 infection in MS patients and how certain immunotherapeutic treatments used to treat MS impact COVID-19 outcomes. Prolonged Cardiovascular Effects After COVID-19 At the Brigham’s Division of Cardiovascular Medicine, several teams are leading trials that could answer pressing questions about the long-term effects of COVID-19 on the heart. “About a third of patients who are hospitalized for COVID-19 have evidence in their blood tests of injury to their hearts,” said Peter Libby, MD, a cardiologist at the Brigham. “We understand from research at the Brigham that this damage isn’t the result of the coronavirus directly infecting the heart. Rather, the heart damage is caused by the inflammation the virus triggers. This can then cause long-term heart problems, such as abnormal heart rhythms or heart attacks.” Currently, Dr. Libby is collaborating on a study investigating how COVID-19 affects the endothelial cells in the large and small blood vessels. He recently published a paper in the European Heart Journal proposing that the major complications associated with COVID-19 likely involve altered endothelium functioning. Long-Term Pulmonary Complications of COVID-19 Some patients who recover from COVID-19 experience various long-term complications of the lungs. These individuals may have ongoing pulmonary dysfunction, like difficulty breathing and shortness of breath. Others never regain normal lung function. “Studies have shown that many patients with COVID-19 have increased clotting activity that is driven by inflammation,” said Dr. Connors. “In COVID-19 patients, these blood clots can appear in the small vessels inside the lungs and heart as well as in the bigger pulmonary arteries and large veins in the legs. The clots can lead to scarring in the lungs, which can impair blood flow and reduce the capacity of the lungs.” Daniela J. Lamas, MD, a pulmonologist and critical care physician at the Brigham, notes that most blood clotting can be resolved through the rapid use of anticoagulants. However, some major clotting events may lead to long-term pulmonary complications, like chronic shortness of breath, or even a pulmonary embolism, which can be fatal in some cases. “There are some long-term effects that might result in patients who experienced low oxygen levels due to a severe case of COVID-19,” said Dr. Lamas. “Some long-term effects may also result from advanced treatment options, like being on a ventilator for weeks or months.” Recovering Sense of Smell in COVID-19 Patients For patients with long-term smell disturbances, Brigham otolaryngologists Regan W. Bergmark, MD, and Alice Z. Maxfield, MD, have recommended “olfactory training” to some patients. This technique has been used in other types of virus-associated smell loss. For several months, patients smell different odors (e.g., cinnamon, lemon) for five minutes in the morning and evening. The therapy aims to stimulate olfactory nerves and get them to regenerate. “In previous research on smell loss from other cold viruses, patients are more likely to improve with olfactory training,” said Dr. Bergmark. “We need to study these patients further to understand whether olfactory training is an effective treatment for long-term smell loss. We’re currently doing that by collecting data on these patients and tracking them over time.” What’s Causing the Long-Term Effects of COVID-19? It’s not clear why long-term complications persist in some patients who recover from COVID-19. However, most experts agree that the long-term effects of COVID-19 are associated with the coronavirus’ ability to trigger a massive inflammatory response in some individuals. “This inflammation, which results in blood clotting in blood vessels in the lungs, heart, brain, kidneys, and even legs,” said Dr. Connors. “This clotting can injure blood vessels, leading to scarring of these vessels and a wide range of long-term health complications.” Some research shows that people who have long- term effects had a moderate or severe case of COVID-19, whereas those who were asymptomatic or had a mild case didn’t develop long-term symptoms. That said, 48 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
the opposite has also been observed. “I’ve taken care of COVID-19 patients who were catastrophically sick in the ICU and have had remarkable recoveries, versus other patients who had a mild case, were never hospitalized, and are now dealing with ongoing, debilitating health problems,” said Dr. Lamas. “We don’t yet have an explanation for these observations.”
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Long term economic consequences of pandemics can persist for 20 years Jorda et al 2020 [ÒSCAR JORDÀ is senior policy advisor at the Federal Reserve Bank of San Francisco and professor of economics at the University of California, Davis. SANJAY R. SINGH is an assistant professor of economics at the University of California, Davis. ALAN M. TAYLOR is a professor of economics and finance at the University of California, Davis, June 2020, “The Long Economic Hangover of Pandemics.” International Monetary Fund, https://www.imf.org/external/pubs/ft/fandd/2020/06/long-term-economic-impact-of-pandemics-jorda.htm]/ Triumph Debate
The COVID-19 pandemic’s toll on economic activity in recent months is only the beginning of the story. While the rapid and unprecedented collapse of production, trade, and employment may be reversed as the pandemic eases, historical data suggest that long-term economic consequences could persist for a generation or more. Among these are a prolonged period of depressed real interest rates—akin to secular stagnation—that may linger for two decades or more. Still, one piece of good news is that these sustained periods of low borrowing costs are associated with higher real wages and create ample room for governments to finance stimulus measures to counteract economic damage caused by the pandemic. Research on the economic fallout of the ongoing COVID-19 pandemic has so far naturally focused on the short-term impacts from mitigation and containment strategies. However, as governments engage in large-scale counter-pandemic fiscal programs, it is important to understand what the economic landscape will look like in the years and decades to come. That landscape will shape monetary and fiscal policy in ways that are not yet fully understood. A look at previous pandemics, going back to the Black Death in the 1300s, can help fill this gap by shedding light on their medium- to long-term economic effects. In extrapolating from historical trends, though, it’s important to note one crucial distinction. Past pandemics such as the Black Death occurred at times when virtually no one survived to old age. With today’s longer life spans, perhaps this time may be different: COVID-19 mortality appears to disproportionately affect the elderly, who typically no longer participate in the labor force and tend to save more than the young. Pandemics and macroeconomics Historical studies have typically focused on one event, in one country or region, and have traced local outcomes a decade at most. But in large-scale pandemics, effects will be felt across whole economies, or across wider regions, for two reasons: either because the infection itself is widespread or because trade and market integration eventually propagate the economic shock across the map. In a new paper, Jordà, Singh, and Taylor (2020), we take a global view of the macroeconomic consequences of pandemics across a number of European economies. We focus on the aftermath of 15 large pandemic events with at least 100,000 deaths, which are listed in the table. Using newly available data on yields of long-term sovereign debt stretching back to the 14th century (Schmelzing 2020), we estimate the response of a so-called real (after-inflation) natural rate of interest in Europe following a major pandemic. In what follows, we refer simply to the “natural rate.” Economists speak of the natural, or neutral, rate of interest as the equilibrium level that would keep the economy growing at its potential rate with stable inflation. In the long run, the relative demand and supply of loanable funds by savers and borrowers determine the natural rate. The natural rate is an important economic barometer. For example, as populations become more frugal, the relative supply of savings increases; when the underlying pace of growth wanes, investment becomes less attractive—in both cases, the natural rate declines to restore equilibrium. As shown in Chart 1, pandemics have long- lasting effects on interest rates. Following a pandemic, the response of the natural rate of interest is tilted down by nearly 1.5 percentage points about 20 years later. For perspective, that decline is comparable to what we have experienced from the mid-1980s to today. We also find that it takes an additional 20 years for the natural rate to return to its original level. Staggering findings These results are staggering and speak to the large economic effects pandemics have had over the centuries. It is well known that after major recessions caused by financial crises, real safe rates—which are closely tied to the natural rate—can be depressed for 5 to 10 years (Jordà, Schularick, and Taylor 2013), but the persistence of the responses here is even more pronounced. The evidence presented in Chart 1 is consistent with the well-known neoclassical growth model. Loss of labor without parallel destruction of capital leads to a rebalancing of the relative returns to labor and capital. The resulting drop in interest rates may also be amplified by increased saving by pandemic survivors—they may simply wish to rebuild their wealth or may just be more frugal out of caution. If this explanation is correct, we should see a very different pattern following a quite different type of historical event that also leads to massive loss of life: war. Unlike pandemics, major armed conflicts also result in destruction of crops, land, structures, and machinery: in other words, the loss of capital. To explore further, we extended our initial estimates to include major wars that resulted in large loss of life (and large loss of land, structures, and other traditional forms of capital). The results could not be clearer. In wars, the relative loss of capital to labor tilts the interest rate response up, not down, as Chart 1 also shows. Wars tend to leave real interest rates elevated for 30 to 40 years, and in an economically (and statistically) significant way. If the neoclassical mechanism is correct, there is another dimension where the effects of pandemics should be visible. As the labor-to-capital ratio declines, the natural rate should decline but real wages should increase. Chart 2 shows the response of the real wage to pandemics; it rises gradually so that, 40 years out, the real wage is about 10 percent higher. This pattern is thus consistent with the logic of the neoclassical growth model. Net result The great historical pandemics of the past millennium have typically been associated with subsequent low returns on assets. Measured by deviations in the natural rate of interest, these responses indicate that pandemics are followed by sustained periods—over multiple decades—with depressed real interest rates. This may reflect a lack of needed investment (because of excess capital per unit of surviving labor), an increased desire to save (out of caution, greater uncertainty, or a desire to rebuild depleted wealth), or both. If the historical trends we have highlighted play out similarly in the wake of COVID-19, then secular stagnation (Summers 2014) would be a concern for monetary and fiscal stabilization policy for the next two decades or more. But should we expect declines of 1.5 percent 50 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
to 2 percent in the natural rate this time? There are at least three factors that will likely attenuate the decline of the natural rate. First, the death toll of COVID-19 relative to the total population could be smaller than that of some of the major pandemics of the past, if modern medical care and public health measures are more effective. Second, COVID-19 affects primarily the elderly, who are no longer in the labor force and tend to save relatively more than the young—a big difference from past centuries, when people had shorter life expectancies. Third, aggressive counter-pandemic fiscal expansion will further boost public debt, reducing the national saving rate and possibly putting upward pressure on real interest rates. On net, we still expect a sustained period of low real interest rates (though attenuated by the factors we discussed). Low real rates should then provide welcome fiscal space for governments to aggressively mitigate the consequences of the pandemic.
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Estimates suggest that lockdowns prevented 3.1 million deaths in the EU and 531 million in the US Machemer 20 [Theresa Machemer- freelance writer based in Washington DC, June 15 2020, “Studies Estimate That Lockdowns Slowed COVID-19 Spread and Saved Lives,” The Smithsonian Magazine, https://www.smithsonianmag.com/smart-news/studies-estimate-lockdowns-slowed-covid-19-spread-and-saved-lives- 180975089/] /Triumph Debate
One study conducted by researchers at the University of California, Berkeley examined interventions taken by six countries and found that about 531 million cases of COVID-19 were prevented or delayed. And the other study, conducted by Imperial College London, found that in 11 European countries, the virus transmission was extremely reduced and about 3.1 million lives were saved. But the researchers note that the pandemic is still ongoing, so these successes are contingent on people continuing to be careful. The findings suggest that “these control measures have worked,” North Carolina State University mathematical epidemiologist Alun Lloyd tells Science News’ Erin Garcia de Jesus. Lloyd, who wasn’t involved in either study, adds that lockdowns “have saved or delayed many infections and deaths.” The first article from UC Berkeley analyzes data from China, Iran, South Korea, Italy, France and the United States for about a month and a half each. The earliest data came from mid-January in China, and none of the data analyzed was collected later than April 6. Based on epidemiological modeling, the team found that in the United States, about 60 million cases of COVID-19 were averted by lockdown and social distancing measures, per a statement. The team also tried to tease out the specific measures that had the greatest impact on reducing transmission of the coronavirus. The models did not give strong evidence that school closures made a sizeable difference, but “in some contexts, schools were actually closed already during the period when we started analyzing the data,” UC Berkeley data scientist Solomon Hsiang tells Science News. That makes it difficult to tell how infections would have spread if schools had stayed open. But they found that home isolation, business closures and regional lockdowns did the most to slow the pandemic’s spread. “The risk of a second wave happening if all interventions and all precautions are abandoned is very real,” Samir Bhatt, who co-led the study of European countries done at Imperial College London, told reporters during a briefing, per Reuters’ Kate Kelland. In the study of 11 European countries, researchers estimate that more than 3 million deaths were averted by lockdown measures. Per the Guardian’s Ian Sample, this estimate is based on the fact that people sick with COVID-19 infected 81 percent fewer people than they would have if business had continued as usual. The researchers also found that under lockdown measures, the transmission of COVID-19 was reduced so much that people carrying the virus don’t always pass it to others. However, the virus has also not infected enough people to create a natural herd immunity that can protect the population. That would require more than 70 percent of the population to have immunity to the virus, but the researchers found that the country with the most infections per capita, Belgium, was at only eight percent. Less than one percent of people in Norway and Germany have been infected with the novel coronavirus, and about five percent of people in the U.K. have. Lloyd tells Science News that because a variety of public health measures were taken at the same time, it is difficult to disentangle exactly how helpful each individual measure was. But to Hsiang, it is clear that they helped.
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Analysis finds that per-capita mortality was 4 times lower in places with mask mandates than without Peeples 20 [Lynne Peeples- MA in science journalism from New York University and an MS in biostatistics from Harvard University, Oct 2020, “Face Masks: What the Data Say,” Nature, vol. 586, no. 7828, , pp. 186–89, DOI.org (Crossref), doi:10.1038/d41586-020-02801-8.] /Triumph Debate
To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease. But being more definitive about how well they work or when to use them gets complicated. There are many types of mask, worn in a variety of environments. There are questions about people’s willingness to wear them, or wear them properly. Even the question of what kinds of study would provide definitive proof that they work is hard to answer. “How good does the evidence need to be?” asks Fischhoff. “It’s a vital question.” Beyond gold standards At the beginning of the pandemic, medical experts lacked good evidence on how SARS-CoV-2 spreads, and they didn’t know enough to make strong public-health recommendations about masks. The standard mask for use in health-care settings is the N95 respirator, which is designed to protect the wearer by filtering out 95% of airborne particles that measure 0.3 micrometres (µm) and larger. As the pandemic ramped up, these respirators quickly fell into short supply. That raised the now contentious question: should members of the public bother wearing basic surgical masks or cloth masks? If so, under what conditions? “Those are the things we normally [sort out] in clinical trials,” says Kate Grabowski, an infectious-disease epidemiologist at Johns Hopkins School of Medicine in Baltimore, Maryland. “But we just didn’t have time for that.” So, scientists have relied on observational and laboratory studies. There is also indirect evidence from other infectious diseases. “If you look at any one paper — it’s not a slam dunk. But, taken all together, I’m convinced that they are working,” says Grabowski. Mounting evidence suggests coronavirus is airborne — but health advice has not caught up Confidence in masks grew in June with news about two hair stylists in Missouri who tested positive for COVID-191. Both wore a double-layered cotton face covering or surgical mask while working. And although they passed on the infection to members of their households, their clients seem to have been spared (more than half reportedly declined free tests). Other hints of effectiveness emerged from mass gatherings. At Black Lives Matter protests in US cities, most attendees wore masks. The events did not seem to trigger spikes in infections2, yet the virus ran rampant in late June at a Georgia summer camp, where children who attended were not required to wear face coverings3. Caveats abound: the protests were outdoors, which poses a lower risk of COVID-19 spread, whereas the campers shared cabins at night, for example. And because many non- protesters stayed in their homes during the gatherings, that might have reduced virus transmission in the community. Nevertheless, the anecdotal evidence “builds up the picture”, says Theo Vos, a health-policy researcher at the University of Washington in Seattle. More-rigorous analyses added direct evidence. A preprint study4 posted in early August (and not yet peer reviewed), found that weekly increases in per-capita mortality were four times lower in places where masks were the norm or recommended by the government, compared with other regions. Researchers looked at 200 countries, including Mongolia, which adopted mask use in January and, as of May, had recorded no deaths related to COVID-19. Another study5 looked at the effects of US state-government mandates for mask use in April and May. Researchers estimated that those reduced the growth of COVID-19 cases by up to 2 percentage points per day. They cautiously suggest that mandates might have averted as many as 450,000 cases, after controlling for other mitigation measures, such as physical distancing. “You don’t have to do much math to say this is obviously a good idea,” says Jeremy Howard, a research scientist at the University of San Francisco in California, who is part of a team that reviewed the evidence for wearing face masks in a preprint article that has been widely circulated6. But such studies do rely on assumptions that mask mandates are being enforced and that people are wearing them correctly. Furthermore, mask use often coincides with other changes, such as limits on gatherings. As restrictions lift, further observational studies might begin to separate the impact of masks from those of other interventions, suggests Grabowski. “It will become easier to see what is doing what,” she says. Although scientists can’t control many confounding variables in human populations, they can in animal studies. Researchers led by microbiologist Kwok-Yung Yuen at the University of Hong Kong housed infected and healthy hamsters in adjoining cages, with surgical-mask partitions separating some of the animals. Without a barrier, about two-thirds of the uninfected animals caught SARS-CoV-2, according to the paper7 published in May. But only about 25% of the animals protected by mask material got infected, and those that did were less sick than their mask-free neighbours (as measured by clinical scores and tissue changes). The findings provide justification for the emerging consensus that mask use protects the wearer as well as other people. The work also points to another potentially game-changing idea: “Masking may not only protect you from infection but also from severe illness,” says Monica Gandhi, an infectious-disease physician at the University of California, San Francisco. COVID has killed more than one million people. How many more will die? Gandhi co-authored a paper8 published in late July suggesting that masking reduces the dose of virus a wearer might receive, resulting in infections that are milder or even asymptomatic. A larger viral dose results in a more aggressive inflammatory response, she suggests. She and her colleagues are currently analysing hospitalization rates for COVID-19 before and after mask mandates in 1,000 US counties, to determine whether the severity of disease decreased after public masking guidelines were brought in. The idea that exposure to more virus results in a worse infection makes “absolute sense”, says Paul Digard, a virologist at the University of Edinburgh, UK, who was not involved in the research. “It’s another argument for masks.” Gandhi suggests another possible benefit: if more people get mild cases, that might help to enhance immunity at the population level without increasing the burden of severe illness and death. “As we’re awaiting a vaccine, 53 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
Imposition of social distancing requirements in the US are estimated to have reduced reported cases by over 600,000 21 days after implementation Siedner et al. 20 [Mark J. Siedner- Associate Professor of Medicine at Massachusetts General Hospital, Guy Harling- Senior Research Associate in the Institute for Global Health at University College London, Zahra Reynolds- Public Health Research Manager at Massachusetts General Hospital, Rebecca F. Gilbert- Project Coordinator at Massachusetts General Hospital, Center for Global Health, Sebastien Haneuse- Member of the Harvard-MIT Health Sciences and Technology Faculty. Health Sciences and Technology, Atheendar S. Venkataramani- Assistant Professor, Medical Ethics and Health Policy, Perelman School of Medicine Director, Opportunity for Health Lab, Alexander C. Tsai- PhD, is a board-certified staff psychiatrist at Massachusetts General Hospital, August 2020, “Social Distancing to Slow the US COVID-19 Epidemic: Longitudinal Pretest–Posttest Comparison Group Study,” PLOS Medicine, vol. 17, no. 8, p. e1003244. PLoS Journals, doi:10.1371/journal.pmed.1003244.] /Triumph Debate
A complete list of dates of statewide social distancing measures, by type of measure and state, is contained in Table A in S1 Text. During March 10–25, all 50 states and the District of Columbia implemented at least 1 statewide social distancing measure (Fig A in S1 Text). The most widely enacted measures on the first date of implementation were cancellations of public events (34/51 [67%]) and closures of schools (26/51 [51%]). The first social distancing measures were implemented when the median statewide epidemic size was 35 cases (interquartile range [IQR] 17–72). Fig 1A shows the mean daily COVID-19 case growth rate mapped against the date of the first statewide social distancing measures. At the date of implementation of the first social distancing measure, states had a mean daily case growth rate of 30.8% (95% CI 29.1–32.6; Table 1), corresponding to a doubling of total cases every 3.3 days. From 14 days prior to, and through 3 days after, implementation of the first social distancing measure, the mean daily case growth rate did not change (−0.2% per day; 95% CI −0.6% to 0.3%; P = 0.51). Beginning 4 days after implementation of the first statewide social distancing measure, the mean daily case growth rate decreased by an additional 0.9% per day (95% CI −0.4% to −1.4%; P < 0.001). This estimate corresponds to a mean daily case growth rate that had declined to 26.5% (doubling of total cases every 3.8 days) by day 7 after enactment of the first statewide social distancing measures, to 19.6% (doubling time of 5.1 days) by day 14, and to 12.7% (doubling time of 7.9 days) by day 21. As of May 1, nearly all (45 [90%]) states had implemented statewide restrictions on internal movement. These restrictions on internal movement were implemented a median of 11 days (IQR 8–15) after the first statewide social distancing measure was implemented in the respective states, when the median statewide epidemic size was 937 cases (IQR 225–1,414). The mean daily case growth rate was already declining, at a mean rate of −0.8% per day, during the 14 days prior to implementation of statewide restrictions on internal movement (95% CI −0.9% to −0.7%; P < 0.001) (Table 1; Fig 1B). There was a drop detected 3 days after statewide restrictions on internal movement were implemented (−3.1%; 95% CI −4.7% to −1.5%; P < 0.001), but no statistically significant difference in the rate of change before versus after implementation (0.1% per day; 95% CI −0.04% to 0.3%; P = 0.14). As discussed in more detail below, there is substantial difficulty in disentangling the unique associations with statewide restrictions on internal movement from the unique associations with the first social distancing measures. In the analysis of the secondary outcome, change in daily COVID-19-attributed deaths, given the uncertainty in the hypothesized lag between implementation of social distancing and observed changes (if any) in daily COVID-19-attributed deaths, we explored a range of lag times. As shown in Table 2, by 7 days after implementation of the first statewide social distancing measure, the mean daily growth rate in COVID-19-attributed deaths decreased by 2.0% per day (95% CI −3.0% to −0.9%; P < 0.001). By 14 days, the estimated association was no longer statistically significant (−1.0% per day; 95% CI −0.2% to 0.1%; P = 0.09). No additional statistically significant benefit was found after 7 days after implementation of statewide restrictions on internal movement. Sensitivity analyses suggested our estimates were not sensitive to inclusion of additional covariates, did not differ by the size of the epidemic at implementation, and were consistent with the known incubation period (Tables B, C, and D in S1 Text). In the event study specification, mean daily case growth was negative by day 4, and the estimates were statistically significant by day 8, consistent with the primary analysis (Fig B in S1 Text). The event study analysis for change in daily COVID-19-attributed deaths also produced estimates qualitatively similar to the primary analysis, although with slightly larger CIs given the smaller number of events (Fig C in S1 Text). Discussion In this longitudinal pretest–posttest comparison group study, we found that implementation of social distancing measures was associated with a reduction in the mean daily growth rate of COVID-19 cases and in the mean daily growth rate of COVID-19-attributed deaths. Our estimates imply a more than doubling in the doubling time (from 3.8 days to 8.0 days) by 3 weeks following the implementation of social distancing measures. Assuming a cumulative epidemic size of 4,125 reported cases (equivalent to the cumulative number of cases in the US at the time of implementation in each state), the reduction in growth rate we estimated corresponds to a difference between 26,281 reported cases with no social distancing versus 24,625 reported cases with social distancing, at 7 days after implementation; a difference between 158,518 reported cases with no social distancing versus 102,223 reported cases with social distancing, at 14 days after implementation; and a difference between 904,773 reported cases with no social distancing versus 283,161 reported cases with social distancing, at 21 days after implementation. Stated differently, our model implies that social distancing reduced the total number of reported COVID-19 cases by approximately 1,600 cases at 7 days after implementation, by approximately 56,000 reported cases at 14 days after implementation, and by approximately 621,000 reported cases at 21 days after implementation. It can be inferred that earlier implementation of social distancing measures would likely have reduced morbidity and mortality even further. These results are consistent with both the theoretical 54 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
effect of social distancing on epidemic spread [6] and the historical benefit observed with the implementation of such interventions during prior epidemics of communicable diseases [28]. They also are largely in keeping with recent data on the impacts of social distancing measures in the US on both mobility [7,8] and case growth rates [9–11], with generally similar effect sizes. Our study extends this literature by further examining COVID-19-attributed mortality as an outcome. The association between social distancing and case growth rate was most apparent at the lower bound of the incubation period that has been estimated based on publicly available data, with some evidence that the change in growth rate may have started even earlier. We suspect that this observation may have resulted from self-imposed social distancing, which reportedly occurred prior to government-issued mandates [33].
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The South African Government lockdown shows the effectiveness of lockdowns on limiting spread Stiegler and Bouchard 2020 [Nancy Stiegler- Statistic and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape and Jean-Pierre Bouchard- Institut Psycho-Judiciaire et de Psychopathologie (IPJP)/Institute of Forensic Psychology and Psychopathology, September 2020, “South Africa: Challenges and successes of the COVID-19 lockdown,” Annales Médico-Psychologiques, Revue Psychiatrique, 178(7), 695–698 https://doi.org/10.1016/j.amp.2020.05.006] /Triumph Debate
It is in this context that South Africa entered the fight against COVID-19 in March 2020, with the first declared positive case on March 5th in KwaZulu Natal. This person, considered as “patient” zero, came back to South Africa on 1 March from Milan, Italy. Faced by a rapid increase of cases in the following days, the South African Government swiftly reacted and imposed on 23 March a strict lockdown on the population for three weeks starting on 26 March. At that stage, the number of official positive cases had risen to 554, without any deaths. The lockdown, further extended to 30 April, was the most restrictive on the African continent, and one of the most restrictive in the world. Shops, restaurants and non-essential businesses were closed, the population was only authorised to leave home for essential grocery shopping and medical reasons; no social, outdoors activities, sports or dog-walking were authorised, and a total ban on alcohol and cigarettes was imposed. The lockdown was at the image of the country: diverse and contrasting. Among the middle class, the lockdown was particularly well respected [19]. People, in general, stayed at home, managed to work remotely with access to the Internet and families were often happy together. The situation was otherwise in poorest areas and informal settlements [12]. Promiscuity was a problem together with lack of proper sanitation [8], which made everybody fear for a human catastrophe if the virus was to spread in these communities. In actual facts, the main issue resided in the lack of food and financial resources, which lead to “hunger riots” [7], shop looting [6] and confrontation with police [1]. Distribution of food parcels [15] for the poorest communities was organised, but it seems that for many, it was not enough, even though several associations and individuals helped in providing food and helping with distribution [14]. Two trends in domestic violence were noted: sharp decline in domestic abuse due to alcohol, whereas domestic violence against women increased by the third week of lockdown [10]. Overall, violent crimes decreased [22], to even see gangs working together to feed communities [21]. Contrarily to what sometimes happened in Europe, it seems that South Africa did not suffer from ostracism of medical professionals because of the fear that those medical staff could carry the virus [2], [4]. The respect of South Africans for nurses and medical doctors together with the limited number of positive cases did not open the door to inappropriate behaviours [18]. However, medical staff did not go through these first two months of pandemic without casualties: more than 500 health workers were tested positive. As per 6 May, twenty-six medical doctors had been hospitalised and two health workers, a doctor and a nurse had died from the coronavirus [11]. As a result, nurses refused to continue working in some clinics close to Cape Town when some colleagues of them were tested positive [9]. Go to: 3. A quick assessment: how did people react to the lockdown? Overall, the response from South Africa to the dread of the pandemic seemed quite organised, and the response of the population was calm and composed. Considering this situation, we tried to collect some information running a small quick assessment to better understand the feeling of the selected individuals regarding the COVID-19 pandemic and the lockdown. Of course, such a quick assessment did not mean to replace a large-scale socio-economic and demographic survey, but at that stage, we aimed, at least, at reflecting on personal feelings. This quick assessment took place on 24 April, questions were sent via emails and text messages to more than forty people from different backgrounds and residing in different areas of the country. Respondents were from the top middle-class, middle class and poorer backgrounds. Living arrangements also covered different settings with some respondents being confined with families while others were alone, in formal or informal housing. Age-wise, we reached people from twenty to seventy-five years old. We were interested to know the conditions of the lockdown, and the state of mind of people confined, at that time, for little more than a month. Thirty-two people responded on the same day to the set of six questions: “According to your own experience: Was the lockdown well respected?; What were the biggest issues/challenges with the lockdown?; Was there a lot of “misconducts” reported to the police?; Was there any intimidation for nurses/assistant nurses/doctors/people working at hospital, for instance asking them to move house or to stay totally indoors, etc?; Was there an increase in domestic violence?; Please share anything that you consider important to note on a human/psychological point of view”. Overall, responses were very homogenous based on the situation of the respondents. Respondents from the middle class living in formal housing answered that the lockdown was strictly respected in their areas. Many of them had not gone out during the last four weeks, even not for grocery shopping that they’d rather ordered online to be delivered to their doors. Staying indoors was considered a real issue by all respondents from the middle class, who were all missing sport and outdoors activities. In informal settlements, respondents from poorer backgrounds stated that the lockdown was not always respected as people needed to find food. Those same respondents further stated that the biggest fear was not to be able to return to work, or find work, to earn a leaving to feed their families. Such a worry was shared by all respondents to a certain extent. Those with stable jobs were also concerned about the economic situation and the possibility to lose their jobs, but they also systematically stated fearing for the situation of the less privileged whom they knew and who were fighting for food. The biggest fear remained for all to fall sick or that a family member became infected. None of the people interviewed, even in informal settlements, stated problems with reporting cases of misconduct to police: the consistent answer was that the lockdown was generally well respected, so there was no need of reporting to police. Concerning domestic violence, respondents generally agreed that thanks to the ban of alcoholic beverages, domestic violence seemed to have decreased, and this especially in poorer areas. Finally, we observed that those who were confined with family members were systemically more optimistic than those confined alone. Those staying with families explained that their days were filled with family activities (once they had finished working/studying remotely), whereas those alone were getting bored and were more involved with anxiety inducing activities such as reading and watching the news throughout the day, and thinking about the situation. Go to: 4. Ending lockdown On 24 April, President Ramaphosa unveiled a deconfinement plan in phases or “alert levels”. This plan, organised in five stages, made provision for gradual reopening of the economy and social life as per 1 May. Stage four allowed reopening of a limited number of economic sectors with high economic or social value, authorised again trading of cigarettes and alcohol at certain times, but maintained confinement of the general population. Jogging and 56 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
short walks were allowed (on the morning of 1 May, cities’ boardwalks were packed with joggers and walkers), but a curfew was implemented between 20 h and 5am. Subsequent phases were to see restrictions lifted as the alert levels decrease. This clear system was organised in a way that the alert levels would move up or down depending on the level of the pandemic. Go to: 5. South Africa on the way to winning the fight against the COVID-19 pandemic? With challenges and many successes, South Africa has managed to flatten the curve of COVID-19 pandemic [5], as displayed below. At the end of the lockdown “phase 5”, on 30 April, the country bewailed 5647 confirmed positive cases and 103 officially declared deaths (Fig. 1 ). An external file that holds a picture, illustration, etc. Object name is gr1_lrg.jpg Open in a separate window Fig. 1 COVID-19 confirmed cases in South Africa. 5 March to 7 May 2020. Source: COVID-19 South Africa Dashboard. To continue containing the crisis, the Government chose to “deconfine” at a slow pace, respecting a five-phase plan. South Africa also received support from Cuban medical doctors that arrived in the country on 26 April [3]. South African authorities planned for transformation of stadiums into hospitals [13] in case of outbreak. Economically wise, the Government projected to inject 26 billion USD into the economy, especially to help small and medium businesses, which suffered from the halt in trading. The country seemed to have successfully controlled and planned the different phases of the pandemic. As per 7 May 2020, the next step was to enter winter season and its uncertainties and to deal with relaxed restrictions, hoping that the curve of the pandemic remained stable and soon decreased.
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Cases spiked in states that lifted lockdowns first Gamio 20 [Lazaro Gamio- journalist for the NY Times, July 9 2020, “How Coronavirus Cases Have Risen Since States Reopened,” The New York Times, NYTimes.com, https://www.nytimes.com/interactive/2020/07/09/us/coronavirus- cases-reopening-trends.html.] /Triumph Debate
The current surge in coronavirus cases in the United States is being driven by states that were among the first to reopen their economies, decisions that epidemiologists warned could lead to a wave of infections. Percent change in average daily cases since reopening Based on a 7-day rolling average in states with at least 2,000 total cases. Reopening 1 week 2 3 4 5 6 7 8 9 10 11 –100% +0% +200% +400% +600% +800% +1,000% Fla. +1,393% S.C. +999% Ariz. +858% Texas +680% Ga. +245% N.Y. –52% Fla. +1,393% Florida and South Carolina were among the first to open up and are now among the states leading the current surge. In contrast, the states that bore the brunt of cases in March and April but were slower to reopen have seen significant decreases in reported cases since. Average daily cases in New York are down 52 percent since it reopened in late May and down 83 percent in Massachusetts. The reopening dates shown here come from a New York Times database tracking when states lifted orders to stay at home or allowed major sectors such as retail, restaurants and personal care services to reopen either statewide or in most areas. (In the charts above and below, states with fewer than 2,000 total cases are excluded.) States that reopened before May 1 7-day rolling average of daily cases. Each state has its own scale. South Carolina +999% since April 20 143 1,570 Alabama +547% since April 30 177 1,143 Oklahoma +477% since April 24 94 540 Tennessee +279% since April 27 392 1,485 Georgia +245% since April 24 702 2,421 Mississippi +215% since April 27 226 713 South Dakota –26% since April 28 80 59 Colorado –41% since April 27 528 310 Note: South Dakota had not ordered closures but updated guidance for businesses and residents on April 28. South Carolina — the first state to reopen retail stores — continues to set records for reported cases. On Wednesday, the average daily case count was 1,570, up from 143 from when the state reopened. State health officials estimate that they have identified just 14 percent of cases, since most go undiagnosed. Cases in Georgia are up 245 percent since late April, prompting some cities to require the use of face masks. These local mandates go further than a statewide order signed by Gov. Brian Kemp that encourages, but doesn’t require, masks. States that reopened before May 15 7-day rolling average of daily cases. Each state has its own scale. Idaho +1,491% since May 1 24 375 Florida +1,393% since May 4 620 9,255 Arkansas +902% since May 6 58 578 Arizona +858% since May 8 366 3,508 Nevada +697% since May 9 94 747 Texas +680% since May 1 956 7,457 West Virginia +395% since May 4 21 104 Utah +287% since May 1 150 580 North Carolina +269% since May 8 422 1,560 Missouri +134% since May 4 229 535 Wisconsin +111% since May 13 286 603 Ohio +71% since May 12 613 1,045 Kansas +35% since May 4 283 381 Maine +5% since May 1 23 24 North Dakota –2% since May 1 51 50 Iowa –10% since May 1 489 443 Indiana –32% since May 4 674 456 Nebraska –58% since May 4 377 159 New Hampshire –74% since May 11 82 21 Rhode Island –79% since May 9 243 50 Florida has seen a more than tenfold increase in average daily cases since it began reopening in early May. Public health officials said the return to bars, restaurants and house parties was the cause for the spike. The state has since shut down on-site drinking at bars. Florida is not alone — more than a third of states are pausing or reversing plans to reopen. Arizona — on top of seeing a spike in cases — has the highest rate of positive tests in the country, with nearly 1 in 4 coming back positive. The nationwide rate is roughly 9 percent. States that reopened later 7-day rolling average of daily cases. Each state has its own scale. Oregon +299% since May 15 68 270 California +275% since May 25 2,153 8,077 Louisiana +193% since May 15 425 1,247 Washington +184% since May 26 221 629 Kentucky +69% since May 20 176 299 New Mexico +63% since May 16 153 249 Delaware +49% since June 1 91 136 Michigan +16% since June 1 416 483 Pennsylvania –26% since May 15 954 708 New Jersey –32% since June 9 464 315 Virginia –34% since May 15 904 596 Minnesota –37% since May 18 653 411 New York –52% since May 29 1,445 693 Illinois –54% since May 29 1,726 788 Maryland –55% since May 15 930 422 D.C. –57% since May 29 92 40 Massachusetts –83% since May 18 1,227 208 Connecticut –87% since May 20 595 77 Among the first states to be affected by the coronavirus, California is now seeing a spike in cases. The state was once seen as a model for how to contain the virus, but experts blame the current surge on an inconsistent adoption of prevention strategies and a haphazard reopening process that gave people a false sense that they were in the clear. New York, once the epicenter of the virus, has seen average daily case numbers plummet along with the rate of positive test results, which sits at 1 percent. The state is still reopening, but a full return to normal is a ways off, especially as hotspots emerge across the country. In an effort to prevent a resurgence of the virus in the region, New York, New Jersey and Connecticut issued a joint travel advisory requiring travelers from hotspots to quarantine for two weeks. Violators would be fined, but an enforcement mechanism isn’t currently in place. President Trump has blamed the rapid growth in cases on an increase in tests, but testing alone does not explain the surge. The United States is conducting nearly three times as many tests as earlier in the outbreak, but the growth in cases is outpacing the growth in testing in at least half of states. Shortages of test kits remain a widespread problem, with reports of some testing sites running out of supplies just minutes after opening. Percent change in average daily cases and testing since reopening Based on 7-day rolling averages. STATE REOPENED CHANGE IN DAILY TESTING CHANGE IN DAILY CASES TOTAL CASES Montana April 26 +567% +2,267% 1,371 Hawaii May 7 +64% +1,570% 1,076 Idaho May 1 +108% +1,491% 9,004 Florida May 4 +287% +1,393% 223,775 South Carolina April 20 +606% +999% 48,909 Arkansas May 6 +183% +902% 25,246 Alaska April 24 +571% +893% 1,472 Arizona May 8 +249% +858% 108,710 Nevada May 9 +237% +697% 24,378 Texas May 1 +208% +680% 229,116 Alabama April 30 +57% +547% 46,962 Oklahoma April 24 +287% +477% 17,893 West Virginia May 4 +102% +395% 3,707 Oregon May 15 +96% +299% 10,824 Utah May 1 +52% +287% 26,921 Tennessee April 27 +148% +279% 54,756 California May 25 +111% +275% 296,304 North Carolina May 8 +245% +269% 77,735 Georgia April 24 +310% +245% 96,538 Vermont May 15 +36% +229% 1,256 Mississippi April 27 +74% +215% 32,888 Louisiana May 15 +124% +193% 70,259 Washington May 26 +167% +184% 39,661 Wyoming May 1 +150% +143% 1,740 Missouri May 4 +159% +134% 26,343 Wisconsin May 13 +102% +111% 36,526 Ohio May 12 +116% +71% 60,181 Kentucky May 20 +73% +69% 18,204 New Mexico May 16 +32% +63% 14,017 Delaware June 1 +106% +49% 12,462 Kansas May 4 +121% +35% 17,807 Michigan June 1 +29% +16% 74,660 Maine May 1 +438% +5% 3,460 North Dakota May 1 –29% –2% 3,975 Iowa May 1 +168% –10% 32,716 South Dakota April 28 +39% –26% 7,242 Pennsylvania May 15 +82% –26% 96,817 New Jersey June 9 –21% –32% 175,986 Indiana May 4 +60% –32% 50,309 Virginia May 15 +65% –34% 67,375 Minnesota May 18 +60% –37% 39,627 Colorado April 27 +120% –41% 35,185 New York May 29 +25% –52% 403,619 Illinois May 29 +34% –54% 151,055 Maryland May 15 +97% –55% 71,455 D.C. May 29 +1,548% –57% 10,642 Nebraska May 4 +27% –58% 20,437 New Hampshire May 11 +17% –74% 5,952 Rhode Island May 9 –51% –79% 17,204 Massachusetts May 18 –23% –83% 110,602 Connecticut May 20 +25% –87% 47,108 Show all Additionally, this wave of cases across the country differs from the early outbreak — while older people were primarily affected before, younger people are 58 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
now making up a much greater share of new cases. Because younger people are driving the spike in new cases, death tallies are not rising as sharply. But experts warn that the United States may be on the verge of a wave of deaths. Earlier in the pandemic, when testing was more limited, deaths lagged cases by a week or two. With the more widespread testing being done now, that interval is now more like two to four weeks.
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Analysis across 18 nations finds that lifting lockdowns too early can lead to deadly spikes in cases Kottasová and Croker 20 [Ivana Kottasová- digital news producer at CNN International and Natalie Croker- senior news designer at CNN, July 3 2020, “The US, Brazil and Others Lifted Lockdowns Early. These Charts Show Just How Deadly That Decision Was,” CNN, https://www.cnn.com/2020/07/03/health/coronavirus-lockdown-lifting-deadly-charts- intl/index.html] /Triumph Debate
Patience in lifting coronavirus restrictions is paying off all over the world, but lifting lockdowns too early can have deadly consequences. A CNN analysis of policies across 18 nations has shown that most of the countries that have now been designated by the European Union as having the epidemic under control only started easing their regulations after seeing sustained drops in daily new cases of Covid-19. Why Covid-19 restrictions should be eased gradually Why Covid-19 restrictions should be eased gradually In contrast, three of the four countries with the world's highest death tolls and case counts -- the United States, Brazil and India -- have either never properly shut down or started reopening before their case counts begun to drop. The EU formally agreed a set of recommendations of 15 countries it considers safe enough to allow their residents to travel into its territory on Tuesday. To get on the list, countries have to check a number of boxes: their new cases per 100,000 citizens over the previous 14 days must be similar to or below that of the EU, and they must have a stable or decreasing trend of new cases over this period in comparison to the previous 14 days. The bloc will also consider what measures countries are taking, such as contact tracing, and how reliable each nation's data is. The list includes Algeria, Australia, Canada, Georgia, Japan, Montenegro, Morocco, New Zealand, Rwanda, Serbia, South Korea, Thailand, Tunisia, Uruguay. China, where the virus originated, is also on the list, but the EU will only offer China entry on the condition of reciprocal arrangements. An examination of the coronavirus response in the 14 countries shows they have one key thing in common. Despite economic pressure, the vast majority refused to ease social distancing measures while their case counts were still going up. And when they did lift their lockdowns, they did it in a careful, phased manner. Scientists say lockdowns have likely prevented hundreds of millions of infections around the world. A modeling study published in the scientific journal Nature last month estimated that by early April, shutdown policies saved 285 million people in China from getting infected, 49 million in Italy and 60 million in the US. "I don't think any human endeavor has ever saved so many lives in such a short period of time. There have been huge personal costs to staying home and canceling events, but the data show that each day made a profound difference," said the study's lead author, Solomon Hsiang, a professor and director of the Global Policy Laboratory at the University of California, Berkeley. Just how successful a lockdown has been depends on a number of reasons, including whether it was put in place early enough. No two lockdowns are alike, so while people in countries like Italy or Spain faced fines if they ventured outside their homes for anything other than essential reasons, in Japan, staying at home was a recommendation rather than an order. Australia, Canada, New Zealand were quick to restrict travel, while in other countries including Algeria, Georgia and Morocco, kids were the first to see the impact of the pandemic as schools shut. Critics say lockdowns will be more damaging than the virus. Experts say it's a false choice Critics say lockdowns will be more damaging than the virus. Experts say it's a false choice Other measures included stay-at-home orders, non-essential store closures, quarantining and isolation. Some countries, like Algeria, Rwanda, Montenegro and China have seen outbreaks after restrictions were lifted. That prompted officials to reintroduce some measures locally. In China, the capital city of Beijing was put under a partial lockdown last month following new cluster linked to a food market. Montenegro brought back bans on mass events last week after seeing a new outbreak of cases following a three weeks of being virus-free. And in Rwanda, health authorities placed a number of villages into renewed lockdown last week after new cases emerged there. But the restrictions launched to counteract the disease have also been hugely damaging for the economy and have exacerbated existing inequalities in education and the workplace, as well as between genders, races and socio-economic backgrounds. As shops and schools shut and nearly all travel ceased, hundreds of millions of people around the world have suddenly found themselves unemployed. The impact on the economy is one of the reasons why some leaders, including the US President Donald Trump, have been pushing for swift reopening, even as infectious diseases experts warned about lifting restrictions too early.
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Contact tracing, mandatory quarantines, travel restrictions, and increased surveillance resulted in the successful containment of SARS in Asia Ahmad et al 09 [Amena Ahmad- professor public health at the Hamburg University of Applied Sciences, Ralf Krumkamp, researcher at the Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany and Ralf Reintjes, professor of Epidemiology and Public at Hamburg University of Applied Sciences, Nov. 2009, “Controlling SARS: A Review on China’s Response Compared with Other SARS‐affected Countries,” Tropical Medicine & International Health, vol. 14, no. Suppl 1, pp. 36–45. PubMed Central, doi:10.1111/j.1365-3156.2008.02146.x] /Triumph Debate
Contact tracing All reviewed countries started epidemiologic investigation of probable and suspect cases as soon as possible (Table 2), by interviewing cases for exposure, travel and contact history, followed by active contact tracing of close contacts. Guangdong had developed a meticulous contact tracing system in early February, requiring a standard questionnaire to be completed within 24 h of reporting (Xu et al. 2004). Hong Kong had initiated contact tracing activities in late February for cases of atypical pneumonia (SARS 2003), followed by Singapore, Taiwan, Vietnam and Canada in March. Singapore for example made intensive efforts to locate contacts within 24 h of case notification, set up a contact tracing centre with up to 140 employees, involved the armed forces in contact tracing and set up a contact database accessible to all hospitals (Tan 2006). In Beijing, the district CDC staff started interviewing cases from 9 April about potential close contacts during the 2 weeks prior to symptom onset. This data was collected in a district close contact databases (Pang et al. 2003). Quarantine Mandatory quarantine of close contacts was instituted in all reviewed countries experiencing local SARS transmission, only the extent differed. Generally, a 10‐ to 14‐day home quarantine of close contacts of probable and suspect SARS cases was instituted. While Singapore placed contacts of SARS cases under home quarantine from the start (24 March) (James et al. 2006), Hong Kong initially placed contacts under medical surveillance asking them to visit a designated medical centre for 10 days (Tsang & Lam 2003). China quarantined close contacts from 21 April. Of the 30 000 contacts quarantined in Beijing, 60% were quarantined individually (Pang et al. 2003). In addition to home quarantine, people in Taiwan, Vietnam, Hong Kong (SAR) and China were also quarantined in groups, e.g. in hospitals, government housing, hotels, holiday camps, etc. Beijing among others within the provisions of the ‘Treatment and Prevention Law’ instituted collective quarantine for 12, 000 people by completely sealing off hospitals, construction sites, residential buildings and universities. In some rural areas in China, entire villages were cordoned off, e.g. in Hebei Province (Rothstein et al. 2003; Balasegaram & Schnur 2006). Travel‐related measures A large variety of travel‐related measures were introduced by the affected countries themselves and also in response to WHO recommendations to detect SARS cases among domestic and international travellers and hence prevent them from travelling within or leaving the country or isolate them immediately on entry. Fear of getting infected also led to a substantial reduction in travel volume. Health alert notices informing about the signs and symptoms of SARS, and where to seek help were provided to travellers by all reviewed countries (Bell and WHO Working Group on Prevention of International and Community Transmission of SARS 2004). From 27 March, WHO recommended countries experiencing local SARS transmission to screen departing passengers, which included asking them questions and checking their temperature. All reviewed countries required arriving and departing passengers to submit health declaration cards certifying that they were free of SARS symptoms and had no contact to SARS cases (Bell and WHO Working Group on Prevention of International and Community Transmission of SARS 2004). Millions of domestic and international travellers entering or leaving affected areas via different routes were subjected to thermal scanning using infrared scanners. Beijing for instance from late April onwards screened people travelling within the country by air, rail, bus, ferry, etc., and also set up checkpoints at all 71 roads connecting Beijing to other areas (Pang et al. 2003; Balasegaram & Schnur 2006). Travel was also restricted to and from quarantined villages in China (Rothstein et al. 2003). Hospital containment measures Hospitals acted as major sites for transmission and multiplication of SARS cases. In Singapore and Canada, more than two thirds of cases were hospital acquired (Svoboda et al. 2004; Tan 2006). All countries isolated probable and suspect SARS cases, either in a designated hospitals, as was the case in Singapore (Goh et al. 2006) and Vietnam (Brudon & Cheng 2006) or as in China, Taiwan and Hong Kong who initially designated hospital units and later entire hospitals for isolation of SARS cases. Canada initially required all hospitals to be prepared for isolating and treating SARS cases, yet in the later phase four hospitals in Toronto were designated for SARS cases. (Health Canada 2003b). Guangdong began isolating cases from the beginning of February 2003 (Xu et al. 2004). Beijing started isolating cases in late April and from 8 May admitted suspect and probable cases in separate hospitals (Pang et al. 2003). Countries with local transmission generally established separate triage facilities, for example, at hospitals to screen and separate symptomatic patients at the first point of presentation. Patients identified through triage were isolated or placed under observation. Taiwan (CDC Taiwan 2003) and Beijing had set up more than 100 fever clinics yet Beijing had to close many on account of SARS amplification at these facilities (Pang et al. 2003). All reviewed countries developed detailed infection control guidelines both for the hospital setup and for health care workers (HCWs) and conducted special infection control training courses for their HCWs. Singapore, Taiwan, Vietnam and Canada had hospital infection control teams, which monitored the infection control practice in hospitals and the proper use of personal protective equipment (PPE) by HCWs. Many countries faced acute shortage of masks and other protective equipment, even in Singapore PPE resources became stretched (Tan 2005). Toronto experienced a resurgence of the SARS outbreak in May after downgrading barrier precautions and relaxing visiting restrictions, which resulted in unrecognised nosocomial transmission. Reinstituting infection control, contact tracing and active surveillance in hospitals controlled the second outbreak (Loutfy et al. 2004; Svoboda et al. 2004). Additional measures to prevent the transmission 61 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
of SARS outside hospitals included the restriction of HCWs to work at one health care institution only and stay under work or home quarantine. Visiting SARS patients in hospitals was restricted in all studied countries. Singapore, Taiwan and Canada had hospital discharge guidelines requiring convalescent patients to observe home quarantine. In Hong Kong, elderly home residents had been infected with SARS (Tsang 2005); hence some countries issued special guidelines for this vulnerable group. HCWs were also asked to employ a high index of suspicion when dealing with immuno‐compromised or chronic patients because of their often atypical presentations. Community containment measures Community containment measures aimed at limiting social interaction and movement of people. China, Hong Kong and Singapore closed schools for a couple of weeks, even in Toronto‐Canada some schools were closed and students placed under home quarantine. Beijing from 26 April closed >3500 public places such as libraries, cinemas, bars, indoor sports complexes, etc. By late April, China made a unique move, to mobilise its rural and urban population in a ‘People’s War’ against SARS and developed a people’s surveillance system where family members, neighbours, etc., monitored each other to ensure that SARS cases were identified quickly (Balasegaram & Schnur 2006). Additional measures to enhance early detection of cases in the community and to reassure the public included public temperature screening, for example, before entering schools, public buildings, offices, hospitals, etc. In Taiwan, people were asked to wear masks in closed public places (Maloney et al. 2006). Affected countries held official press conferences and issued press releases to inform their public and different stakeholders about SARS, the status of the outbreak within and outside the country, about the risk factors and preventive measures and about government actions to counter the epidemic. Some countries did so as soon as information became available while others like China (Balasegaram & Schur 2006) or Taiwan (Maloney et al. 2006) initially tried to restrict the flow of information to the public. Various means of communication including electronic media, print media, the internet, telephone hotlines, advertisements, roving exhibitions, etc., were used. All reviewed countries broadcasted special educational programmes on television; Singapore dedicated a TV channel solely for informing about SARS. The ministries of health of most countries set up telephone hotlines for public enquiry. In addition, Hong Kong authorities held roving exhibitions at shopping malls, railway stations and health centres, arranged health talks at schools and conducted mass public health education campaigns using posters, pamphlets, exhibition boards, etc., to inform the public (SARS 2003). In China, with the listing of SARS as a notifiable disease on 8 April, openly communicating and informing the public was officially authorised (Rothstein et al. 2003). After mid‐April, once China officially declared a ‘People’s War’ against SARS, a huge propaganda machinery was activated to inform the public. Daily press conferences by the government, SARS educational programmes, folk songs, banners, advertisements on buses, etc., were some of the means used to inform and motivate the people to protect themselves and fight against SARS (Balasegaram & Schnur 2006). Table 2 summarises the date of SARS onset and the main control measures implemented by the reviewed countries. It shows that while the measures applied in mainland China were generally similar to those applied in the other countries yet they were initiated at a later stage. The table also shows that Guangdong province, which was the first affected region in the world in contrast to the rest of China, reacted earlier. Go to: Discussion The 21st century science and communication systems helped in rapidly identifying the SARS virus and providing continuously updated information, yet it was the 19 century public health tools of case detection and isolation, contact tracing, quarantine and infection control which resulted in the successful containment of SARS. The control measures implemented by the countries closely resembled each other and were generally in line with the WHO recommendations. However, differences among the countries were seen in the timeliness of implementation and in the mode and extent to which individual countries went to apply or enforce control measures.
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Increased health technology in Sierra Leone improved their Ebola response Houlihan et al 17 [Catherine Houlihan, Virology consultant at the London School of Hygiene & Tropical Medicine, London, Dan Youkee, King’s Sierra Leone Partnership in 2014 as Ebola Holding Units Coordinator, Colin. Brown, Infectious Diseases registrar and the infectious diseases lead for the King's Sierra Leone Partnership, May 2017, “Novel Surveillance Methods for the Control of Ebola Virus Disease” International Health, vol. 9, no. 3, pp. 139–41. Silverchair, doi:10.1093/inthealth/ihx010] /Triumph Debate
The Ebola virus disease (EVD) outbreak in West Africa was unprecedented in size, leading to the death of over 11 000 individuals, with a further 17 000 infected,1 and predictions of an additional avoidable 25 000 deaths per year from the loss of healthcare workers (HCWs) in the region.2 The scale of the outbreak was largely attributable to uncontrolled transmission from infected contacts of cases who were not monitored due to limited access to screening and diagnosis, poor pre-existing surveillance mechanisms, including human resourcing and information technology,3 overstretched isolation facilities to limit transmission, and lack of treatment to reduce mortality. Rapid and effective traditional surveillance systems, which include identification of possible cases by syndrome recognition with a mandatory reporting system, rapid laboratory confirmation of cases, community follow up, and regional/national standardised data aggregation and collection, have demonstrated their effectiveness in the eradication of smallpox and near eradication of polio.4 These approaches, used early in the EVD outbreak, were limited by lack of existing capacity and community mistrust and misconceptions, with subsequent lack of reporting of symptomatic individuals.5 Towards the end of the epidemic, novel public health approaches were also used, including large scale contact tracing with national coordination and ‘lockdown’ periods with door-to-door household reviews,6 rapid case identification and laboratory confirmation in both alive and dead, effective community engagement with messaging appropriate to specific communities, and appropriate infection prevention and control measures, which included safe burial. Implementation of this model of engagement in one Sierra Leone locality demonstrated a dramatic reduction in case numbers compared to elsewhere in the country.7 Innovative centralised command and control structures were implemented in Sierra Leone to allow for a coordinated approach to surveillance over the region, including monitoring of the geographic location of cases, real-time case-identification and reporting of suspect cases, detailed bed capacity within Ebola Holding Units (EHUs) and Ebola Treatment Centres (ETCs), and ambulance coordination for patient and body transfer.8 There is now a new, trained and experienced cadre of professionals, who came from a diverse background, including medical students and teachers, who can provide future resilience and preparedness, as well as a cohort of nursing staff who have significant experience in EVD recognition and management.9 Since surveillance capacity was limited in West Africa, alternatives to traditional methods were implemented, including community event-based surveillance (CEBS). In CEBS, selected community members were trained to identify suspicious events such as the presence of two or more deaths within a single household, or the death of a traveller, and were provided with a robust reporting system. CEBS was successfully implemented in June 2015 in Sierra Leone, and provided a useful adjuvant to countries that lack resources for dedicated disease surveillance at the end of an outbreak to allow for rapid detection of new cases.10 Using technology to improve surveillance, a novel open-source epidemiology platform (Epi Info Viral Hemorrhagic Fever [VHF] Application, v0.9.6.0., CDC, Atlanta, Georgia, USA) was deployed, originally in Guinea and subsequently in seven African countries, allowing for meaningful, comparable data to be collected across the region.11 Further use of technology was trialled in later stages of the outbreak and included the use of GPS coordinates and direct data entry onto smartphones and tablets,12 as well as the use of mobile phone text messages to report syndromic surveillance data.13 Given these successful trials, and the increasing proportion of mobile phone ownership and mobile network coverage in the countries affected by Ebola, we expect that smartphone technology will be used in the future for surveillance of infectious diseases in the region. Laboratory confirmation is vital to surveillance efforts. Initial testing capacity in affected countries was very limited, with only one laboratory (at Kenema Government Hospital, Sierra Leone) able to test for EVD. By November 2014, pressures on international laboratory capacity testing led to significant delays in result availability: in one central EHU, patients died without a known EVD diagnosis nearly 2 days before a positive result was available, limiting vital contact tracing efforts given their potential high infectivity.14 Limited diagnostics for other pathogens that mimic EVD, such as malaria, dengue and typhoid, hampered control efforts.15 Upscaling laboratory capacity early in any future response will be vital to aid surveillance efforts and outbreak control. Considerable effort has been afforded to determining a cluster of symptoms that allows for rapid and effective identification of patients with EVD, to curtail exposure to nosocomial infection for EVD-negative patients, and allow for effective use of limited beds for safe isolation of suspect cases. However, a universal set of symptoms, with adequate sensitivity and specificity for EVD, was not identified.16,17 Therefore, the field deployment of highly sensitive rapid diagnostic tests, ideally with no cold chain storage requirements, could allow for rapid discharge of suspect patients with a negative result from EHUs, allowing the freeing-up of vital bed space and enabling routine care to continue.18 Towards the end of the outbreak, viral sequencing was linked to patient location, disease onset date, sample collection date and patient outcome,19 and pinpointed the single introduction from animal to human,20 as well as demonstrating how infection was transmitted quickly across large distances and across borders.19 These important findings and capabilities will strengthen surveillance and response in the future. Commitment to improved, integrated disease surveillance is key to rapid identification 63 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
and containment of the re-emergence of EVD, and of other emerging infectious diseases in the region. Investment in robust laboratory infrastructure for all infectious disease aetiology is vital for future surveillance efforts beyond the three most affected countries in West Africa. For example, a review in northern Ghana highlighted that of ten patients flagged as EVD suspects during the outbreak, eight died with no cause of death identified, and significant gaps in HCW knowledge, health and surveillance infrastructure and outbreak preparedness were identified.21 We need to harness the lessons learned from West Africa: identification of novel diseases, timely dissemination of that information to potentially affected communities and health facilities alike, and the capacity to test for a variety of new and emerging pathogens, are the bedrock of disease surveillance. Novel mechanisms of disease control, including using new approaches to community engagement and information technology for surveillance, have the potential to augment these basic principles.
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*Western Exceptionalism The Global South is better at responding to COVID-19, faces the brunt of consequences of the Global North’s unwillingness to act, and is locked out of receiving vaccines due to patent laws Stevano et al 21 [Sara Stevano, Economics @ University of London, Tobias Franz, Economics @ University of London, Yannis Defermos, Economics @ University of London, Elisa Van Waeyenberge, Economics @ University of London, “COVID-19 and crises of capitalism: intensifying inequalities and global responses,” Canadian Journal of Development Studies, https://www.tandfonline.com/doi/full/10.1080/02255189.2021.1892606] /Triumph Debate
As the pandemic was declared by the World Health Organisation (WHO) on 11 March 2020, governments across the world successively crafted more or less apt responses, including declarations of nationwide lockdowns. In this context, COVID-19 has amplified pre-existing inequalities and created some odd juxtapositions. We list a few. First, many so-called “advanced economies”, despite having the strongest health security capabilities, as captured by the Global Health Security (GHS) index,3 were unable, or unwilling, to protect their citizens while various countries in the Global South seem to have been more successful at managing the pandemic. The United States as the richest country in the world, for instance, commanding one of the highest concentration of scientific skill and ranking first globally according to the GHS, registered more US Americans dying in the first three months of the US outbreak than during the entire Vietnam war (Horton 2020a, 47). At the same time, Vietnam, now a lower middle-income country with just short of 100 million people, recorded a total of 35 deaths as of December 2020, while deaths in the United States reach top 300,000. Across the world, more than 103 million people have been infected by COVID-19 and over 2.2 million have died at the time of writing.4 Despite only making up around a sixth of the world population, countries of the Global North have so-far accounted for nearly half of the deaths. On the other hand, some countries in the Global South, including Vietnam, Rwanda, Sri Lanka, Mali, Laos, Cambodia, and Cuba have been more effective at containing the spread of the virus. In a recent study of the impacts of the COVID-19 pandemic on global income inequality, Deaton (2021) finds that income inequality between countries has decreased because national per capita income has fallen more rapidly in high-income countries than in poor countries, unless income inequality is weighted by population.5 In addition, the presumed trade-off between protecting health and the economy is not supported by the data, which shows that countries with higher deaths per million are also those with lower predicted income per capita growth (ibid.). Second, pre-existing inequalities of class, race and gender within countries have been laid bare dramatically. When national lockdowns started to be enforced across most countries in the world, people were told not to step out of their homes except for a limited set of activities. Entire sectors came to a standstill and mobility − within and across countries − all but ceased. Initial studies demonstrate that lockdown policies had direct adverse effects on all economies across the globe (e.g. Jackson et al. 2020). Lower socio-economic groups have been more likely to bear the brunt of the negative economic fallouts, apart from often being disproportionately represented in the fatality rate. Alston (2020, paragraph 34) insists that: The public health community’s mantra for coping with COVID-19 encapsulates the systemic neglect of those living in poverty. The pithy advice to “stay home, socially distance, wash hands, and see a doctor in case of fever” highlights the plight of the vast numbers who can do none of these things. They have no home in which to shelter, no food stockpiles, live in crowded and unsanitary conditions, and have no access to clean water or affordable medical care. Far from being the “great leveler,” COVID-19 is a pandemic of poverty, exposing the perilous state of social safety nets for those on lower incomes or in poverty around the world. The class impacts of coronavirus are shaped by the unequal ability of different socio-economic groups to follow social distancing measures as well as their uneven underlying health and housing conditions (Reeves and Rothwell 2020). A key factor is employment. Depending on job type, the pandemic has differentiated effects on workers’ earnings, the likelihood of becoming unemployed, ability to work from home and exposure to the disease, with those in informal, precarious and front-line work most severely affected (Adams-Prassl et al. 2020; ILO 2020a). With labour markets in the Global South marked by a high degree of informality, job vulnerability during the COVID-19 crisis is particularly high. There are also significant intersections across class, race, gender and migrant status, with racial disparities underpinning the disproportionate effects of the pandemic on ethnic minorities in various countries including Brazil, the United Kingdom and the United States (Tai et al. 2020). Young workers, women, migrants, racialised minorities who are overrepresented in services and informal occupations are more likely to lose their jobs and not receive a replacement income. Those who had to continue working, including workers who have been deemed essential, face increased health risks (ILO 2020b). In addition to labour markets reproducing inequalities through the internal segmentation that exposes specific social groups to super-exploitation (see Elson 1999; Elson and Pearson 1981), the patterns of exclusion, marginalisation and expulsion from regular employment underpin processes of racialisation that are integral to the functioning of global capitalism (Bhattacharyya 2018). COVID-19 has illuminated how multiple inequalities are formed and re- constituted through divides of work/non-work, productive/reproductive work that fragment the global working classes and those 65 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
expelled from them. A gender lens reveals the complex ways in which inequalities filter the impacts of the pandemic, with women at a lower risk of mortality than men but, at the same time, disproportionately impacted through their concentration in jobs exposed to the disease, increased care needs, unemployment and domestic violence (Hawkes and Buse 2020 this issue; ILO 2020b; Wenham, Smith, and Morgan 2020). Third, aside from increasing intersecting inequalities within countries, the uneven power dynamics of capitalism manifest themselves in the perpetuation of the divide between Global South and North. The COVID-19 crisis reminds us of the stark topography of the unlevelled playing field of global capitalism, particularly through dynamics of production, reproduction and finance, in spite of the differential effectiveness of governments’ responses to the COVID-19 pandemic that escape South–North divides and new data analysis showing a decrease of global between- country income inequality (see Deaton 2021). The subordinate position of the Global South in the global economy exposes specific vulnerabilities, not just at the level of the nation but more structurally with regard to the organisation of the global economy as a whole. Relations of dependence, structured by re-iterations of colonial configurations of production, reproduction and exchange, continue to shape processes of development in the Global South. For instance, the growth underpinning the “Africa rise” phenomenon has been mostly jobless but was accompanied by a significant increase in the income payments made by African economies to the rest of the world in the form of primary income on foreign direct investment (Sylla 2014). Furthermore, the participation of Global South firms in global supply chains enables new forms of economic imperialism. In her study of imperialist practices, Suwandi (2019), for example, finds that Indonesian suppliers ̶ pressured by Multinational Corporations (MNCs) to adapt to flexible production regimes ̶ transfer unreasonable demands onto workers through various forms of control of the labour process (see also Mezzadri 2016). What are the structural conditions of the South–North divide that are relevant to understand the unequal impacts of the COVID-19 crisis on a global scale? The integration of countries of the Global South at the lower end of global value chains generates three distinct forms of vulnerabilities. First, the export-oriented growth model focussing on primary commodity extraction and labour-intensive manufacturing exposes countries directly to international price volatility and demand shocks (Blattman 2007; Nissanke and Thorbecke 2007). Whilst this is a recognised long-standing issue, the COVID-19 pandemic has had additional effects on export logistics, commodity prices, labour markets and demand composition (OECD 2020). The drastic drop in global demand, the dramatic fall in exports, and the sudden stop (and reversal) of capital inflows will have long-run ramifications for the sustainability of commodity exporting economic models (Asante-Poku and van Huellen 2021 this issue; Franz 2020 this issue; Hanieh 2020 this issue; UNCTAD 2020). Second, the unequal distribution of power in global supply chains has meant that Global North corporations have been able to transfer costs and risks down the chain, with severe implications for firms and especially workers at the bottom (Anner 2020). Again, the mechanism is not new, but the magnitude of the effects is. As a result of the informality of work arrangements, the lack of social protection and job security, the workforce in the Global South is in an overall position of structural vulnerability, both within and without global supply chains (ILO 2020c). This is another key dimension of how the pandemic is disproportionately affecting economies and workers in the Global South. Finally, the subordinate position of the Global South in the global financial architecture underpins the responses to the COVID-19 crisis that we have seen enacted so far (see section 3). However, before we reflect on whether (and if so how) policies implemented so far are likely to lead to any reconfiguration of global power dynamics, we want to point to a further dimension of inequality that is likely to play an important role in the COVID-19 recovery. As we write this article, the rollout of the COVID-19 vaccine is underway in many countries, with Israel, the United Arab Emirates, the United Kingdom and the United States spearheading the rollout. Whilst the timeframes of this unprecedented global immunisation campaign are not fully determined yet, it is clear that countries have widely different abilities to secure a vaccine for their citizens. The wrangling over the waiver request by South Africa and India to the World Trade Organisation to suspend intellectual property rights related to COVID-19 serves as a sobering reminder of the stark South–North divide (Aryeetey et al. 2021; Usher 2020). The ramifications of inequalities in vaccine distribution are likely to be multiple and long-lasting.
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Sub-Saharan Africa proves- responsive policy keeps case numbers low Moore 20 [Jina Moore, Contributor @ The New Yorker, “What African Nations Are Teaching the West About Fighting the Coronavirus,” The New Yorker, https://www.newyorker.com/news/news-desk/what-african-nations-are-teaching- the-west-about-fighting-the-coronavirus] /Triumph Debate
African governments, unlike their Western counterparts, aren’t relying on common sense. Judging from the numbers, and interpreting them with the scientific information that’s understood so far, Africa has made the better bet. Although cases on the continent are increasing, many African countries are not seeing the exponential daily growth in confirmed cases, nor in mortality, that has been happening in the United States and Western Europe. There are exceptions, especially above the Sahel: Egypt, Algeria, and Morocco alone account for a third of the continent’s seventy-two thousand cases, and fifty-one per cent of its 2,475 deaths. But in parts of sub-Saharan Africa—the forty-odd countries below the sand belt of the Sahara, the places about which the world is almost always wringing its hands—the picture is more optimistic. “Rwanda, in their first month, went from two cases to a hundred and thirty-four,” Joia Mukherjee, the chief medical officer for Partners in Health, a Boston-based nonprofit organization that works in ten countries, said. “Belgium, which is the same size—twelve million people—and is the former colonizer of Rwanda, grew from two cases to seventy- four hundred.” Uganda has only a hundred and thirty-nine known cases. Ethiopia has two hundred and sixty-three. South Sudan has two hundred and three. Burundi has twenty-seven. Botswana has twenty-four. Each of them saw their first cases later than Europe and the United States—but not that much later. If the virus had followed the same trajectory there that it has in the West, most African countries would have seen explosive transmission rates by now. Confronted with data patterns that don’t match our own, the impulse among Western observers has been to identify what makes these countries like each other but unlike us—to reach for the science (or its best guesses) that tells a soothing story about why Africa appears to have it so much better than, say, New York City. The most obvious question, to people from countries still lacking a true picture of their disease burdens, is whether Africa has enough tests. (The short answer is, often, yes.) From there, and in no particular order, Western analysts cite climate, demography, and magic. Africa is hot, which is to say sunny, and it is humid. Sunlight, some scientists have argued, degrades the virus, and humidity (maybe?) slows it down. Quite a bit of Africa isn’t actually humid, however, and its sun, like the sun the world over, is seasonal. In fact, in several East African capital cities that are home to the majority of their country’s coronavirus cases, it can get downright cold. Brazil, meanwhile, has nearly two hundred thousand cases of covid-19 and is quite humid. So is Singapore, where a second wave of infections has sent the country back into lockdown. Some experts point to the continent’s comparative youth: the median age in Africa is barely twenty, and studies (still) suggest that the disease is less severe in young people. Being young may help reduce mortality, but youth is a less satisfying explanation for the raw number of covid-19 cases, the majority of which have been occurring in people in their twenties and thirties. Finally, some experts speculate about the existence of a special African immunology, suggesting that diseases like malaria (or their treatments) act as biological talismans against the new disease. This coronavirus may be novel, but essentialist Western tropes about magical dark-skinned Africans date back centuries. Meanwhile, a rather obvious possibility stares us in the face: What if some African governments are doing a better job than our own of managing the coronavirus? “One reason why we may be seeing what we are seeing is that the continent of Africa reacted aggressively,” John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, told me. “Countries were shutting down and declaring states of emergency when no or single cases were reported. We have evidence to show that that helped a lot.” Rwandan officials responded to their first coronavirus cases by tracing, isolating, and testing “contacts,” people whom confirmed or suspected carriers might have encountered before realizing they were, in fact, covid-19 patients. Five days after the first cases were confirmed, commercial flights were halted, and two days later, the country was locked down, both to limit the spread of the disease and to ease the tedious work of contact tracing. By the end of April, health workers had tested more than twenty thousand people and conducted two random community surveys, a method for guarding against the bias of testing too narrowly, which might artificially deflate case figures. “We did not find any community transmission of covid-19 in Rwanda, which was quite good news for us,” Sabin Nsanzimana, an epidemiologist who heads the Rwanda Biomedical Center, which also houses the national reference laboratory that processes covid-19 tests, said. “So far, we are at the phase of containing the epidemic in Rwanda, which means that we know who has the disease.” Uganda and Ethiopia also responded to their first cases with aggressive contact tracing and isolation, and they’ve put considerable resources into checking their work. In early May, Uganda completed its first rapid- assessment survey, a randomized sampling of twenty thousand people; it uncovered only two new local cases. Ethiopia completed a door-to-door survey of its capital, Addis Ababa, in just three weeks, documenting symptoms and travel history for its five million residents, and testing anyone who was found to be at risk for the disease or symptomatic. South Africa, where health officials say early intervention staved off exponential transmission, sent thirty thousand community-health workers to survey roughly fifteen per cent of its population in less than a month; it uncovered only two positive cases for every thousand people. The remarkably low number of cases uncovered by community surveys, experts told me, suggest that contact tracing and isolation are working the way they’re supposed to. “Think of it as a web of transmission, not so much a chain,” Tom Frieden, who directed the U.S. Centers for Disease Control and Prevention during the 2014 Ebola outbreak and now spearheads Resolve to Save Lives, a health initiative focussed on global pandemic response, said. “With every filament in that web that you break, you reduce the burden of disease.”
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While the UK and US ignored advice, South Korea kept caseloads low through aggressive contact tracing Yoo et al 20 [Ji Youn Yoo, Nursing @ University of South Florida, Samia Valeria Ozorio Dutra, Nursing @ University of Tennessee, Dany Fanfan, Nursing @ University of Florida, Sarah Sniffen, Medicine @ University of South Florida, Hao Wang, Biomedical Engineering @ University of South Florida, Jamile Siddiqui, Health Studies @ Kingston University London, Hyo-Suk Song, Emergency Medicine @ Daejeon Health Institute of Technology, Sung Hwan Bang, Medicine @ Daejeon Health Institute of Technology, Dong Eun Kim, Disaster Safety @ Daejeon Health Institute of Technology, Shihoon Kim, Public Health @ Konyang University, & Maureen Groer, Nursing @ University of South Florida, “Comparative analysis of COVID-19 guidelines from six countries: a qualitative study on the US, China, South Korea, the UK, Brazil, and Haiti,” BMC Public Health, https://link.springer.com/article/10.1186/s12889-020-09924-7#Fun] /Triumph Debate
Although WHO provided a definition of symptoms observed in suspected cases that warranted further surveillance [11], it was a challenge to define the full clinical characteristics of COVID-19. Fever (> 38 °C), breathing problems, and chest radiographs showing bilateral lung infiltrates were the main clinical signs and symptoms reported during the outbreak [13, 29]. For this reason, most countries considered fever, respiratory symptoms, and pneumonia as clinical justification for initiating diagnostic testing. Although by March/April 2020, the UK and US countries were defined as ‘countries experiencing larger outbreaks’ (as referred to in Group 4 of the WHO guidelines), they did appear to be largely acting in accordance with WHO advice at that point in time, despite not acting on the previous advice regarding the screening of travelers [11]. Although there was ample evidence of human-to-human transmission, the US and UK did not include contact with confirmed or suspected cases as screening criteria very early in the pandemic. The absence of this criteria early in the pandemic may have led to increased risk of viral spread. In contrast, South Korea undertook an intense contact-tracing program: upon confirmation of a COVID-19 case through laboratory testing, the South Korean government conducted interviews with the infected person, traced their travel history, used GPS phone tracking, and checked their credit-card history. The anonymized data detailing the travel history before diagnosis was published on a public website by the South Korean government. This allowed government officials to quickly release information about potential COVID-19 exposed locations and help people who may have been near those locations make quick decisions on whether they needed to be tested. Though effective, there were and continue to be concerns regarding individual privacy.
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US guidelines created noncompliance, while South Korean contact tracing allowed for quick and effective responses Yoo et al 20 [Ji Youn Yoo, Nursing @ University of South Florida, Samia Valeria Ozorio Dutra, Nursing @ University of Tennessee, Dany Fanfan, Nursing @ University of Florida, Sarah Sniffen, Medicine @ University of South Florida, Hao Wang, Biomedical Engineering @ University of South Florida, Jamile Siddiqui, Health Studies @ Kingston University London, Hyo-Suk Song, Emergency Medicine @ Daejeon Health Institute of Technology, Sung Hwan Bang, Medicine @ Daejeon Health Institute of Technology, Dong Eun Kim, Disaster Safety @ Daejeon Health Institute of Technology, Shihoon Kim, Public Health @ Konyang University, & Maureen Groer, Nursing @ University of South Florida, “Comparative analysis of COVID-19 guidelines from six countries: a qualitative study on the US, China, South Korea, the UK, Brazil, and Haiti,” BMC Public Health, https://link.springer.com/article/10.1186/s12889-020-09924-7#Fun] /Triumph Debate
Despite physical distancing being vital to mitigating the spread of the novel coronavirus, political beliefs affected compliance with COVID-19 social distancing guidelines. This was especially evident in the US, where, in general, people who held contrasting political beliefs to the resident state governing body were less responsive to stay-at-home orders. For example, Republicans did not fully respect and react to stay-at-home orders when Democratic counties announced the order. In a similar fashion, Democrats were less likely to respond to stay-at-home orders when a Republican governor issued the decree [35]. On that point, it is worth noting that although the countries examined all referred to the government issued COVID-19 notices as ‘guidelines,’ these notices were not enforceable equally across countries. As an example, in the US, the CDC’s guidance acted as a framework that could be adapted for use by individual hospitals or by local/state governments for legislative purposes. However, in South Korea the guidelines essentially acted as enforceable legislation with serious financial repercussions. Another important political development to note occurred in Brazil, when the Ministry of Health included a video on their website focused on clarifying “fake news” about the coronavirus. The video requested users confirm whether information presented in various medias was true before sharing that information with others. It also suggested individuals consult with an official number via WhatsApp for information clarification and communication. An additional concern was raised regarding the use of health-tracking apps. Various countries used voluntary health-tracking apps to manage the COVID-19 pandemic either for informational, health vigilance, or contact tracing purposes. However, a unique aspect of the South Korean response was the mandate for all Koreans and long-term expatriates to install a health tracking app for contact tracing purposes. Privacy concerns were raised by several publications, some of whom referenced the possibility of preserving data protection [36], while others reflected on the legal implications and the need to refine the data into an aggregate, rather than individual-level data, to better deter the misuse of the data [37].
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Appeals to civil liberties have hamstrung the US response at every turn Fairchild et al 20 [Amy Fairchild, Public Health @ Ohio State University, Lawrence Gostin, Law @ Georgetown, Ronald Bayer, Public Health @ Columbia University, “Vexing, Veiled, and Inequitable: Social Distancing and the “Rights” Divide in the Age of COVID-19,” The American Journal of Bioethics, https://www.tandfonline.com/doi/full/10.1080/15265161.2020.1764142] /Triumph Debate
The “finger of blame” has greatly impeded the global response. Even the March 2020 G-7 summit, which planned to align big powers in their response to COVID-19, broke down with bitter recriminations. G7 countries were unable to even issue a consensus statement. Why? The United States insisted the statement refer to “the Wuhan virus” rather than WHO’s official designation of COVID-19. Europe refused to go along with President Trump (Lee 2020). Tellingly, to this day we call the Great Influenza Pandemic of 1918, the “Spanish flu,” but in reality, that pandemic began in the United States. We never called the H1N1 Influenza pandemic of 2009, the “US flu” even though it originated in the United States and Mexico. President Trump withheld funding from the World Health Organization, which amounted to $553 million last year (Trump halts World Health Organization funding 2020), claiming it “very much sided with China” in the COVID-19 response (Trump Lashes Out at WHO 2020). Of course, there are no “sides” in a pandemic. Yet this coronavirus pandemic has divided the global community. And it has deepened longstanding divides here in the United States. Much of the divide is political but also based on class, education, and geography. But perhaps most remarkable, because of the scope and scale of the COVID-19 pandemic and the knowns and unknowns about its spread, we are also seeing a transition in the ethical and legal discourse around liberty-limiting restrictions. SOCIAL DISTANCING AS RESTRICTION Although in large measure our current approach, in which the need for procedural transparency goes without question precisely because of historical examples that underscore the place of the law in protecting individuals or stigmatized groups from arbitrary government action, more striking than the continuities are the discontinuities with the past. At the outset of the COVID-19 pandemic, ethical and legal analysis of the use of quarantine was rooted in a Constitutional rights approach to containment. SARS seemed to provide a relevant model. Following the SARS outbreak in Ontario in 2003, targeted quarantines were effective. Health officials imposed “work” quarantines on health workers, so they could travel only between home and hospital. Along with other traditional public health prevention measures they were credited with containing a pandemic. Yet it was also impossible to deny, in retrospect, that large-scale quarantines had been too sweeping. We wrote a piece justifying reliance on precaution in the case of SARS, making the case that the risks in a context of uncertainty made it necessary to err on the side of containing the disease. At that time, we also made a strong case for procedural due process. In 2003, we wrote in the pages of JAMA, “Due process requires the right to be heard by an independent tribunal in a timely manner with representation by an attorney. The US Supreme Court has noted that civil confinement constitutes ‘a significant deprivation of liberty’ that ‘can engender adverse social consequences.’ Although some may argue that home quarantine need not trigger a full-blown hearing, we believe that anyone deprived of liberty under color of law, whatever the place of confinement, should have available a due process hearing. In a public health emergency, it may be necessary to confine individuals before a hearing is held, but a speedy hearing should, if requested, follow. We make these observations aware of the vast logistical complications of hearings in the event of mass quarantines” (Gostin et al. 2003, 3234). That remained our position at the outset of the COVID-19 pandemic. Even as it became clear that COVID-19 represented a threat that would justify even more rigorous interventions–indeed, at levels that US citizens had not experienced since 1918–the approach remained one in which it was vital to carefully balance public health with rights to privacy and liberty. In the balancing process, officials should ensure that interventions were evidence-based, proportionate, and no more restrictive than necessary. The standard was individualized assessments of the risk posed by the person whose liberty is being deprived (Gostin et al. n.d.). Precisely because COVID-19 was more threatening, protection of individual rights to due process were more pressing. As late as March 2020, mass quarantines were still viewed as too blunt an instrument that would bring too many people who do not pose a risk to the public into its ambit. Even under a declared public health emergency, it was hard to envision the courts upholding a mass quarantine (Gostin 2020). Yet it also became clear that presymptomatic or asymptomatic transmission might be surprisingly high. In addition to evidence that suggests that some individuals never experience any symptoms, evidence suggests that up to half of those who test positive are presymptomatic (Kimball 2020). By April 17, 2020, all but nine states had ordered the closure of non-essential businesses. All but eight had issued stay at home orders. And all but six had banned mass gatherings (https://www.stateside.com/ blog/2020-state- and-local-government-responsescovid-19). As of April 7, 2020, some 300 million Americans—95 percent of the population—were under some form of lockdown (https://www.businessinsider. com/us-map-stay-at-home-orders-lockdowns-2020-3). In this context in which the threat of both public health and economic catastrophe is of a scale without historical precedent, traditional constitutional safeguards for these large-scale interventions appear impractical. But also remarkable is that, sweeping though they are, because nearly nation-wide social distancing measures focus not on individuals or groups, but populations as a whole, they have a noteworthy equality. In response to COVID-19, cities and states around the country have closed all schools, restaurants, bars, and movie theaters. No one can go to church, out to a bar, or congregate at a sporting events. Because key federal officials and both democratic and republican governors across the nation have made persuasive scientific arguments, the majority of Americans have remained supportive. According to polling data released by the Pew Research Center on April 16, 2020, 65 percent of those interviewed expressed 70 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
concern that opening the economy too quickly would allow the virus to continue spreading. This position was also held by a majority of Republicans (Russonello 2020). As a result, large-scale stay at home orders applicable across large geographic areas remain untested in the courts, though that is likely to change. It is connected to political efforts in the streets. FreedomWorks, Tea Party Patriots, and other groups hostile to government intervention—some with potential ties to President Trump’s team—are organizing protests in the name of rights. Strikingly, and revealing of a deep divide, 65 percent of those who identified themselves as “very conservative” were concerned that efforts to reopen the economy were moving too slowly. The Facebook page of a conservative group that claimed two million “likes,” posted a statement that read, “heavy handed government orders that interfere with our most basic liberties are certain to do more harm than good” (Russonello 2020). Although relatively small, in some instances, and seemingly the outcome of “astroturfing” initiatives organized by Washington conservatives rather than organic, local social movements (Vogel 2020) such opposition was amplified by the White House. The New York Times, in a front page story headlined, “Trump Gives Right Wing Protestors a Megaphone,” focused on the President’s efforts to press for an end to what he viewed as both unacceptable and unnecessary limitations imposed in the name of public health. In a tweet on April 17th, even as his health officials urged the nation to lift restrictions in a slow, measured fashion, President Trump called upon states to “LIBERATE” their citizens from guidelines that entailed social restrictions on the economy. Thousands of Michigan protestors chanted “lock her up” in reference to Democratic Governor Gretchen Whitmer. Liberate Minnesota, a St. Paul-based group, demanded the end of what they called Democratic Governor Tim Walz’s “Lockdown!” by protesting at his home. Republican governors, too, felt the heat of small but vocal public protests. In Columbus, Ohio, protestors took to the state house. Tightly packed together, they pressed against the doors of the state capital to challenge Republican Governor Mike DeWine’s measured, systematic steps that culminated in closing all non-essential businesses and a stay at home order. Back in Colorado, hundreds of protestors, only some in masks, rallied at the state capital. “End the virus, not the economy” and “Fear is the real virus” was the theme in placards and chants. Underscoring the divide, healthcare workers wearing face masks and scrubs protested. In contrast to the evening cheers that healthcare workers receive in New York City, in Colorado protests honked horns and hurled insults at those on the front lines of the response (Protest in Washington, DC 2020). The President empathized with demonstrators across the nation and characterized social distancing measures as “too tough” (Shear and Mervosh 2020). The New York Times has reported lawyers with connections to socially conservative groups or causes have filed lawsuits aimed at governors. Some are narrowly focused and aim to lift bans on church services. Others target democratic governors. In Michigan, Governor Whitmer’s order banning vacation home travel and gatherings that extend beyond household members has been challenged in a lawsuit. Wisconsin Republicans have sued to block governor’s orders to extend social distancing orders. Attorney General William Barr has suggested the Justice Department may support such legal challenges (Vogel 2020).
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Attempts to profit off of health policy has justified imperialist intervention and catastrophizing Levich 15 [Jacob Levich, Public Health @ Stony Brook University, “The Gates Foundation, Ebola, and Global Health Imperialism,” American Journal of Economics and Sociology, https://www.researchgate.net/profile/Jacob- Levich/publication/281625639_The_Gates_Foundation_Ebola_and_Global_Health_Imperialism/links/5e46a2b64585150 72d9bb4e9/The-Gates-Foundation-Ebola-and-Global-Health-Imperialism.pdf] /Triumph Debate
Previously, world health was typically seen as a collaborative effort among sovereign nations under the guidance of the World Health Organization. Its stated goal was “health for all” in the spirit of the Declaration of Alma Ata Declaration (1978). Based implicitly on the “barefoot doctor” program that revolutionized public health in the People’s Republic of China, Alma Ata proposed a philosophy of primary care in which the people were held to have “a right and duty to participate individually and collectively in the planning and implementation of their health care” (Declaration of Alma-Ata 1978). In theory at least, wealthy states and philanthropists were expected to assist the developing world only on condition of respecting local concerns and national sovereignty. Alma Ata was effectively discarded during the subsequent triumph of neoliberalism, as structural adjustment programs required ruinous disinvestment in public health throughout the developing world (Colgan 2002). In its place arose “a collective of partially overlapping and nonhierarchical regimes” (Youde 2012)—that is, a profusion of foundation and state-sponsored NGOs, based primarily in the West and funded more or less directly by multi- billionaires. Providing support for national health-care operations was no longer on the agenda; to the contrary, health ministries were systematically bypassed or compromised via PPPs and similar schemes. As national health systems were hollowed out, health spending by donor countries and private foundations rose dramatically (Global Health Watch 2008: 210–211). The U.S.-based Council on Foreign Relations now envisions a withering away of state-sponsored health-care delivery, to be replaced by a supranational regime of “new legal frameworks, public-private partnerships, national programs, innovative financing mechanisms, and greater engagement by nongovernmental organizations, philanthropic foundations, and multinational corporations” (Fidler 2010). Western governments and foundations see an opportunity to effect a “shift to a post-Westphalian framework” (Ricci 2009: 1). Indeed, according to leading scholars in the field, the central argument of global health governance is that “the old formulas of Westphalian governance have failed and a new generation of innovation from many actors is emerging to take its place” (Kirton and Cooper 2009: 309). For obvious reasons, the attenuation of national sovereignty is only rarely discussed as a conscious aim of global health governance. Instead, GHG is proposed as a necessary defense against the Apocalypse. The world, advocates say, now stands at a critical, unprecedented juncture—one at which the acceleration of cross-border travel, urbanization, and trade has made “emerging infections” inevitable and potentially catastrophic. (This is asserted as self-evident, despite the fact that two of the three most deadly pandemics of the past century—the Spanish Flu of 1918 and the Asian flu of 1957–1958—took place decades before “global interconnectedness” became a fashionable concept.) The menace is invariably framed in terms reflecting colonialist assumptions and summoning racial fears: communicable diseases are discussed as phenomena emerging from poor countries and threatening to the Western world. The standard textbook on GHG sets forth its key case studies in revealing language: SARS arose from non- human sources and spread in uncontrolled fashion with great speed from South to North. Avian influenza ... likewise rose from non-human sources and has spread in uncontrolled fashion, although more slowly and still largely where it started among countries of the developing South. HIV/AIDS emerged from non-human sources in the South but was spread by humans to and in the North ... . (Kirton and Cooper 2009: 10) Infections inconvenient to this line of argument—the 2007–2008 global mumps resurgence originating in Halifax, Nova Scotia, or the ongoing cholera epidemic brought to Haiti by MINUSTAH peacekeepers (Engler 2011)—go unmentioned. GHG theory is “global” in a very specific sense: it is concerned with addressing perceived threats to the wealthy core posed by the impoverished periphery. It is an ideology that meshes neatly with the present phase of imperialism. Insofar as GHG articulated a demand that the West should set about defending itself against foreign threats, it was only natural that it should be folded into the larger discourse of “security” that arose in the wake of the 9/11 attacks. Worldwide alarm about bioterrorism provided an opportunity to “link together two previously separate fields: health and national/international security” (Rushton and Youde 2015: 18). This linkage was envisioned as reciprocal: not only would health-care workers “open up a medical front in the War on Terror” (Elbe 2010: 82), but military forces would now be mobilized as a response to health disasters. Global health security was a major pretext for Operation Unified Response, the U.S. military reaction to the 2010 earthquake in Haiti. Though purportedly motivated by humanitarian concern, the operation amounted to a full-scale invasion of a nation long dominated by U.S. imperialism: 17,000 U.S. troops entered Haiti along with 17 ships, 48 helicopters, and 12 fixed- wing aircraft (U.S. Fleet Forces Public Affairs 2010; CNN 2010). The following year, President Obama proclaimed the “Global Health Security Agenda,” outlining a U.S.-led “multi-sectoral response” to “every kind of biological danger—whether it’s a pandemic 72 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
like H1N1, or a terrorist threat, or a treatable disease” (U.S. Dept. of HHS 2014). Partners in the initiative included USAID and the U.S. Department of Defense. Imperialist interventions in the health field could now be justified in the same terms as recent “humanitarian” military interventions: “[N]ational interests now mandate that countries engage internationally as a responsibility to protect against imported health threats or to help stabilize conflicts abroad so that they do not disrupt global security or commerce” (Novotny et al. 2008: 41, emphasis added).
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NGOs like the Gates Foundation use deregulated global health governance to bypass safety measures and turn poorer countries into customers for big pharma Levich 15 [Jacob Levich, Public Health @ Stony Brook University, “The Gates Foundation, Ebola, and Global Health Imperialism,” American Journal of Economics and Sociology, https://www.researchgate.net/profile/Jacob- Levich/publication/281625639_The_Gates_Foundation_Ebola_and_Global_Health_Imperialism/links/5e46a2b64585150 72d9bb4e9/The-Gates-Foundation-Ebola-and-Global-Health-Imperialism.pdf] /Triumph Debate
The Gates Foundation intervenes directly in the agendas and activities of national governments, ranging from its financing of the development of municipal infrastructure in Uganda (BMGF 2012a), to its recently announced collaboration with the Indian Ministry of Science to “Reinvent the Toilet” (BMGF 2013b). At the same time BMGF supports NGOs that lobby governments to increase spending on the initiatives it sponsors (Global Health Watch 2008: 251). BMGF even feels free to “sit down with the Pakistan government” to demand security measures in support of its operations (Tweedie 2013). Influence with the governments of poor countries is critical to one of BMGF’s central missions: creating demand for the products of health related transnational corporations (TNCs), especially Big Pharma. Despite annual revenues approaching $1 trillion, the global pharmaceutical industry finds itself in a perpetual state of crisis, for which it lays most of the blame on costly regulatory requirements. Bringing a new drug to market requires staggering outlays in R&D, testing, and advertising; substantial assistance from government buyers is typically required to make even the most successful drugs profitable. BMGF functions as a crucial go- between, using its muscle to induce national health ministries to invest ever larger percentages of their meager social spending on medicines, especially vaccines and contraceptives (Levich 2014). Needless to say, the burden of these drug purchases falls on the taxpayers of the developing world—those least able to pay, while the profits flow from the periphery to the core. At the same time, BMGF exerts its power to “streamline” safety testing. Foundation publicity describes its support for R&D strategies tailored to the realities of the developing world, where “[t]o speed the translation of scientific discovery into implementable solutions, we seek better ways to evaluate and refine potential interventions—such as vaccine candidates—before they enter costly and time-consuming clinical trials” (BMGF 2015b). In plain language, BMGF promises to assist Big Pharma in its efforts to circumvent regulatory regimes by sponsoring cut-rate drug trials in the developing countries. Shortly after the 2014–2015 African Ebola epidemic stabilized, BMGF announced a lobbying effort to cut drug registration times by 50 percent in SubSaharan Africa within three years (Torjesen 2015). This would be done, the foundation claimed, “without sacrificing quality or safety” and justified the initiative as an emergency measure that would save many lives. In the past, however, BMGF’s efforts to outflank safety regulations have sometimes resulted in considerable human suffering and death, as when an illegal Gates-sponsored clinical trial of HPV vaccine in India killed seven adolescent girls and injured hundreds (Levich 2014). Presumably, BMGF executives submitted these deaths to a form of cost-benefit analysis, in keeping with their commitment to practices derived from the business world. Indeed, the Gates’s operation resembles nothing so much as a massive, vertically-integrated multinational corporation, controlling every step in a supply chain that reaches from its Seattle-based boardroom, through various stages of procurement, production, and distribution, to millions of nameless, impoverished “end-users” in the villages of Africa and South Asia. Emulating his own strategies for cornering the software market, Gates has created a virtual monopoly in the field of public health. The Gates Foundation’s global influence is now so great that former CEO Jeff Raikes was obliged to declare: “We are not replacing the UN. But some people would say we’re a new form of multilateral organization” (Pickard 2010). The Ebola outbreak of 2014–2015 was to supply ample confirmation of Raikes’s boast.
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Property rights ensure that the current system cannot solve- patent monopolies means that companies prioritize profits over ending the pandemic Hanna et al 20 [Thomas Hanna, Director of Research @ The Democracy Collaborative, Dana Brown, Director @ The Next System Project, Miriam Brett, Director of Research @ Common Wealth, “Democratizing knowledge: Transforming intellectual property and research and development,” The Next System Project, https://thenextsystem.org/democratizing-knowledge] /Triumph Debate
The COVID-19 pandemic has revealed shocking deficiencies in our countries’ commitments to the health and safety of all. For instance, as Mike Davies notes, “public employees and other groups of unionized workers with decent coverage will have to make difficult choices between income and protection. Meanwhile, millions of low-wage service workers, farm employees, the unemployed, and the homeless are being thrown to the wolves.”68 In general, the choice to prioritize corporate profits and IP rights over the development and distribution of effective, affordable medicines is both deadly and short-sighted. With little if any oversight, extraordinary amounts of public money are being pumped into a private monopoly-based system best placed to produce duplicative “me-too” drugs that generate excessive profits but have little to no impact on public health. To develop safe and effective medicines, especially vaccines during a global pandemic, cooperation and transparency are needed. But our IP regime prevents both. As Ady Barkan and Zain Rizvi recently wrote in The Nation, “patent monopolies have fueled the current drug pricing crisis, and they may block access to any future Covid-19 vaccine.” Regarding Moderna, a company which recently made headlines with its vaccine candidate, the authors warn that “the company has been granted over a hundred patent monopolies globally. If its vaccine proves safe and effective, Moderna’s monopolies will allow the corporation to set an exorbitant price…[and] block other manufacturers from supplying the vaccine.”69 In the end, it is likely that governments will be forced to spend considerable sums to purchase a successful vaccine from companies like Moderna and distribute it to the public; another classic case of “double taxation” when considering the public funding that went into the vaccine development in the first place. Critically, amid the current crisis of the COVID-19 pandemic, it is imperative that a global pool for all related technologies is created, which would allow for the compulsory sharing of intellectual property relating to medicines and vaccines during a health emergency. Access to medicines experts maintain that the real danger is in not pursuing a global IP pool and allowing corporate interests to artificially limit the supply of lifesaving technologies, essentially creating a “global vaccine apartheid.”70 With a limited supply of vaccines or treatments, rich countries could monopolize the global supply leaving much of the planet to continue battling the pandemic – potentially for many years – without the proper tools. These fears are not unfounded given that the US, UK and EU have all already signed contracts to secure a high number of available doses of vaccine candidates currently in development. However, despite having such contracts in place, an “every country for itself” strategy is very risky, even for rich countries. As the WHO put it in the announcement of the creation of its Access to COVID-19 Tools Accelerator (ACT- A), “we know that as long as anyone is at risk from this virus, the entire world is at risk – every single person on the planet needs to be protected from this disease.”71 Moreover, no one knows where a breakthrough will come from – for instance, currently, five of the top ten vaccine candidates are being developed in China – and unless a vaccine is accessible and affordable to everyone around the world, the health and economic impacts of the virus will continue to be profound.72 Only global cooperation with shared access to IP and R&D data can assure equitable, global access to vaccines and treatments, which in turn, is the most efficient way to end a global pandemic.
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Even within existing legal loopholes, companies do everything they can to avoid poorer countries accessing treatment Hanna et al 20 [Thomas Hanna, Director of Research @ The Democracy Collaborative, Dana Brown, Director @ The Next System Project, Miriam Brett, Director of Research @ Common Wealth, “Democratizing knowledge: Transforming intellectual property and research and development,” The Next System Project, https://thenextsystem.org/democratizing-knowledge] /Triumph Debate
The World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) provides a legal framework to establish minimum requirements for the protection of intellectual property for its members. In the context of pharmaceuticals, the patent holder can obtain exclusive rights for a 20-year period at a minimum, allowing them to charge a premium rate for the drug. While many countries (including India and Argentina) have used important safeguards within TRIPS (known as flexibilities) to limit IP protections, preventing or overcoming monopolies on medicines in the name of public health, resistance to their use has been intense. The US and many European governments, along with pharmaceutical companies, have exerted extreme pressure on countries pursuing the use of these flexibilities including threatening to impose trade sanctions and cut off countries’ medical supplies. For instance, Swiss-based pharmaceutical company Novartis threatened to sue Colombia in an international investment tribunal under the terms of a bi-lateral trade deal in 2016 for their attempt to access affordable medicine for leukaemia using TRIPS flexibilities.104/105 In the UK, mechanisms exist to control and regulate the price of drugs. This includes the National Institute for Health and Care Excellence (NICE), which assesses the cost effectiveness of medicines in England and advises whether the NHS should use them, and its sister organisation Scottish Medicines Consortium. Past this, the government oversees the Voluntary Scheme for Branded Medicines Pricing and Access – the successor to the Pharmaceutical Price Regulation Scheme – and sets a cap on the total NHS spend on branded medicines. While the system limits overall spending on patented medicines by the NHS, should NICE, or an equivalent body, reject drugs because of the excessive pricing demands of drug companies, patients can be left without access to the medicine. Yet, UK national and international law recognises the right to health, and thus allows for provisions to use such patents without the authorisation of the patent holder. This includes sections 55-59 of the UK Patents Act 1977 (as amended), which is supported at an international level byTrade-Related Aspects of Intellectual Property Rights (TRIPS).106 These mechanisms were used in the 1960s and 70s to supply generic medicines to the NHS, and were the subject of a landmark legal case confirming in the highest courts the NHS’ right to import generic versions of one of pharmaceutical giant Pfizer’s antibiotics for use in NHS hospitals.107 A safeguard in place to prevent the NHS being priced out of drugs is known as a Crown use licence, whereby the government has the power to give another company permission to make and sell an exact, high-quality, drug after paying a fair royalty to a company. The first and most immediate step the government should take is to enact this safeguard to strip pharmaceutical companies of their exclusive patents and secure access to vital drugs (based on a framework developed through a multi-stakeholder process with input from experts, patients, and public officials).108 Whilst rarely used in recent years, in June 2019, following pressure from patients and their families, as well as the campaign group Just Treatment, the UK Government did acknowledge its “moral obligation” to explore the use of this and other flexibilities to secure an affordable generic supply of the cystic fibrosis drug, Orkambi. This move followed a standoff with the manufacturer, Vertex, which was utilising its monopoly to hold patients’ lives to ransom in an effort to extract an unjustifiably high price for its medicine from the health service (despite the public sector having supported the drug’s development).109 Relatedly, going forward the UK and US governments should ensure (through passing new legislation or amending existing legislation) that new drugs and treatments created with significant public funding cannot be monopolized and enclosed by large corporations. For instance, In May 2020, £84 million of new government funding was provided to Oxford University and pharmaceutical company AstraZeneca for their work to develop a COVID-19 vaccine.110 Patient groups and campaigners joined together to call on AstraZeneca to fully disclose its plans and ensure that any vaccine created be patent-free. As Just Treatment’s Diarmaid McDonald explains, “they [AstraZeneca] haven’t created this vaccine, they aren’t taking a risk in producing it, why should they get the chance to make monopoly profits from it either now or in the future? NHS staff and patients, and people around the world, expect action to prevent any monopoly undermining access to this potentially world changing vaccine.”111 But, beyond this, broader problems are likely to persist in an industry geared towards maximising profits, requiring a shift in priorities to focus on broader societal and economic goals, safeguards, and rights. To that end, we recommend the creation of a system of publicly owned pharmaceutical development, manufacturing, and distribution entities to not only ensure accessible pricing of drugs in the UK and US, but safeguard affordable medicine elsewhere through technology transfers. Full details of this approach can be found in the report “Medicine For All: The Case for a Public Option in the Pharmaceutical Industry” by our colleague and co-author Dana Brown.112
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IP reinscribes existing health access problems and ensures that manufacturers can never meet the necessary global supply, dooming millions in the Global South Hanna et al 20 [Thomas Hanna, Director of Research @ The Democracy Collaborative, Dana Brown, Director @ The Next System Project, Miriam Brett, Director of Research @ Common Wealth, “Democratizing knowledge: Transforming intellectual property and research and development,” The Next System Project, https://thenextsystem.org/democratizing-knowledge] /Triumph Debate
We need to develop a flexible approach to IP and R&D to enable a meaningful wave of tech transfer. This includes exploring a workable approach to licensing, royalty rates, and the benefits of open access models, particularly in essential goods and services like medicines. More immediately, however, we need to move urgently to address COVID-19 and forestall the possibility that it drives further geographic and social inequality. Despite the World Health Assembly of the World Health Organization (WHO) reaffirming the role of WHO as the directing and coordinating authority on international health work and recognizing that all countries should have timely and affordable access to diagnostics, therapeutics, medicines, vaccines, and other essential health technologies and equipment to respond to COVID-19, it did not define concrete actions to address this in areas such as vaccine development. The development of a universal, free vaccine for all is key to addressing this devastating crisis. Building on the TRIPS framework, measures need to be taken as a matter of urgency to promote transparency around the costs and results of R&D as well as bolstering the “sharing of data, tools and technologies, and participate in capacity building through technology transfer.”115 Going further, campaign organisations such as Oxfam have called for an end to socialising the risk of this research (through government funding), only to privatise the reward by enabling private firms to reap the benefits. Instead they recommend ensuring that this reward is also shared by the public with a “new more public system [that] would help break free of the suffocating web of intellectual property and patents that has cost so many lives.”116 Moreover, by the pharmaceutical industry’s own estimates, no single company has anywhere near the production capacity needed to meet global demand for COVID-19 vaccines or treatments. Thus, if IP rights block manufacturers from ramping up production, it could be an issue of life and death for millions around the world, as it has been for decades with AIDS and other infectious diseases like tuberculosis. Already, the Trump administration has offered large sums of money to get exclusive access to a coronavirus vaccine being developed by a German company; and the US, UK, and EU are entering into contracts with multiple vaccine manufacturers that virtually assure these high-income countries will monopolize much of the world's COVID-19 vaccine supply in the first years after one becomes available on the market.117 Similarly, in June 2020 it was announced that the United States had bought up all of Gilead’s supplies of its IP- protected drug remdesivir (despite widespread concerns about its efficacy in treating COVID-19) sparking fears of shortages in countries around the world.118 Examples such as these portends a bleak future in which IP and R&D is increasingly used to fuel nationalist and imperialist imperatives as the world confronts the escalating health, ecological, and social challenges associated with run-away climate change. As of writing, there has already been at least one lawsuit over pharmaceutical IP rights that is holding up production of a promising COVID-19 vaccine candidate, INO-4800, developed by Inovio Pharmaceuticals.119 The vaccine candidate, which is backed by the Coalition for Epidemic Preparedness Initiative (CEPI) and the Gates Foundation, is one of a number of COVID-19 vaccine candidates that rely on new technologies protected by IP controlled by other companies. In this case, the biologics manufacturer VGXI, which Inovio had hired to produce early batches of its vaccine candidate, refused Inovio’s request to transfer key trade secrets to other manufacturers in order to scale up manufacturing. A recent US Patent and Trademark Office ruling is also expected to hold up progress on Moderna's COVID-19 vaccine candidate as it would enable a rival company to block the sale of Moderna's vaccine until the IP dispute is settled .120 These are likely the first of many such cases that will arise as in the global race for an effective COVID-19 vaccine. Fears of just this sort of scenario led the WHO to champion Costa Rica’s proposal for a global IP pool on all COVID-19 related technologies in May 2020.121 Though supported by dozens of member states, pharmaceutical giants such as AstraZeneca, GlaxoSmithKline, Pfizer and Johnson & Johnson have vehemently opposed the idea, with Pfizer chief executive Dr. Albert Bourla saying “I think it is nonsense,” and calling the move, “dangerous.”122 Moreover, while most countries around the world, including China, backed a resolution calling for the equitable distribution of any successful vaccines globally, the US failed to support the move which would allow for the compulsory sharing of intellectual property relating to medicines and vaccines during a health emergency.123
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*Structural Violence Poor and insured Americans saw a greater burden of H1N1, and those trends are continuing with COVID Khatana and Groeneveld 20 [Sameed Ahmed M. Khatana, MD at Division of Cardiovascular Medicine, Perelman School of Medicine, MPH, and Peter W. Groeneveld, MD at The Leonard Davis Institute of Health Economics, Aug. 2020, “Health Disparities and the Coronavirus Disease 2019 (COVID-19) Pandemic in the USA,” Journal of General Internal Medicine, vol. 35, no. 8, pp. 2431–32, PubMed Central, doi:10.1007/s11606-020-05916-w/ Triumph Debate
The coronavirus disease 2019 (COVID-19) pandemic has quickly demonstrated the many shortcomings of the US healthcare system. Based on evidence from the H1N1 influenza pandemic of 2009, it will likely exacerbate many of the disparities in healthcare access and outcomes that exist in the USA. Unlike every other developed country in the world, a large number of people in the USA still lack health insurance (27.5 million people as of 2018), a disproportionate number of whom are people of lower socioeconomic status and racial and ethnic minorities. Additionally, over half of non-elderly adults in the USA receive employer-sponsored health insurance, making them vulnerable to a loss of healthcare access in the event of losing their employment. Minority and lower socioeconomic status populations also experience a high burden of chronic cardiovascular and pulmonary disease that will place them at a higher risk of complications from infection. Urgent actions, such as expansion of health insurance coverage, need to be taken to lessen the burden of this pandemic and the accompanying economic consequences on vulnerable populations. The US experience with the H1N1 influenza pandemic demonstrated racial and ethnic minorities were at a higher risk of infection, partly because they were more likely to live in dense urban areas.1 Uninsured persons with H1N1 were also more likely to delay access to care and to use emergency departments, rather than seek care through an established primary care provider.2 For COVID-19, this raises the potential of uninsured patients increasing the risk of infection among already stretched emergency department staff. Delays in seeking care may also complicate efforts in tracking the spread of the infection and potentially increase exposure to others around them. During the H1N1 pandemic, patients from minority and lower socioeconomic status populations were also more likely to be hospitalized, in part related to their higher burden of underlying chronic diseases.3 Patients without health insurance were also less likely to receive antiviral therapy and have lower vaccination rates,4, 5 which may become critical to public health when these potentially become available for COVID-19. Although COVID-19 is a unique pandemic with different patterns of transmission and outcomes than previous viral respiratory pandemics, many of the unfortunate patterns seen previously are likely to repeat themselves. There is already some evidence that black Americans are disproportionately being impacted by the COVID-19 pandemic. In Illinois, 28.4% of confirmed cases and 42.9% of deaths are black, despite representing 14% of the state population.6 Similarly, in Louisiana, around 70% of COVID-19-related deaths have been among black residents despite comprising only 32% of the state population.7 Beyond the direct impact of infection, the current pandemic is likely to have major economic consequences. Unemployment statistics released by the Bureau of Labor Statistics indicate that in March 2020, the USA experienced its largest month-to-month increase in unemployment since January 1975. During the most recent economic downturn in the USA—the Great Recession of 2008-2009—black and Hispanic individuals experienced significantly higher unemployment rates than white individuals, suggesting that this likely is to happen again. This not only will result in direct health impacts from loss of household income but also will increase the number of uninsured people in the USA due to the loss of employer-sponsored health insurance.
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Socioeconomic Status disincentivizes people to seek medical treatment Singu et al 20 [Sravani Singu, MD candidate at University of Nebraska College of Medicine, Arpan Acharya, Post-Doc Research Associate at the University of Nebraska Medical Center, Kishore Challagundla, Assistant Professor, Biochemistry and Molecular Biology at the University of Nebraska and Siddappa N. Byrareddy, Associate Professor, Vice- Chair of Research at the University of Nebraska College of Medicine, 2020, “Impact of Social Determinants of Health on the Emerging COVID-19 Pandemic in the United States,” Frontiers in Public Health, vol. 8, Frontiers, doi:10.3389/fpubh.2020.00406] /Triumph Debate
Access to health care is described as the “timely use of personal health services to achieve the best possible health outcomes” by the National Academies of Sciences, Engineering, and Medicine (14). Many people face barriers to health care, which may hinder their ability to take responsible actions toward their well-being. Barriers include limited or no access to transportation for health appointments, lack of health insurance, limited education about health care, limited health care resources, provider hours limited to work hours, etc. Lack of health insurance is usually seen in populations with lower incomes and minorities. A study by Gallup and West Health found that 14% of adults in the U.S. revealed that they would not seek healthcare if they experienced a fever and dry cough (16, 17). Fever and dry cough are the most common symptoms of COVID-19. When adults were specifically asked whether they would seek healthcare if they had believed they had been infected with COVID-19, 9% still answered that they would not (16). The individuals that reported that they would not seek healthcare were non-white adults under the age of 30 who had a high school education or less earning less than a $40,000 income per year (16). Reluctance to seek healthcare is associated with socioeconomic status. Hispanics and African Americans were less likely to have health insurance compared to non- Hispanic whites (16). Without health insurance, primary care visits may not be feasible, or people may hesitate to use health care resources. This puts those without health insurance at risk of not being screened for chronic conditions, such as CVD, hypertension, asthma, and diabetes. Access to health care also relies on the availability of resources (14). Those who are minorities and/or have low incomes already face difficulty-accessing healthcare. Many of them primarily depend on student-run clinics for obtaining healthcare. The University of Nebraska Medical Center College of Medicine has a student-run clinic, called the Student Health Alliance Reaching Indigent Needy Groups (SHARING) clinic, which provides low-cost primary health care and services to the underprivileged populations in the Omaha community. This clinic has been closed due to the COVID-19 pandemic. Therefore, the underserved populations who already face barriers to healthcare now face a barrier to access primary care at these student-run clinics, which are their primary means of maintaining their well-being.
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Higher COVID mortality rates are found among impoverished groups Feldman and Bassett 20 [Justin M Feldman, social epidemiologist and a Health and Human Rights Fellow at the Harvard FXB Center for Health & Human Rights and Mary T Bassett, bachelor's degree in history and science from Harvard University, a doctor of medicine degree from the Columbia University College of Physicians and Surgeons, 6 Oct. 2020, “The Relationship between Neighborhood Poverty and COVID-19 Mortality within Racial/Ethnic Groups (Cook County, Illinois),” Epidemiology, DOI.org (Crossref), doi:10.1101/2020.10.04.20206318] /Triumph Debate
Two recent studies by Harvard University researchers have added striking new details to the story of racial disparities in deaths from the COVID-19 pandemic in the United States. In a pre-recorded presentation released Oct. 12 as part of the Council for the Advancement of Science Writing’s New Horizons in Science briefings at the virtual ScienceWriters2020 conference, Mary Bassett said the new research affirms that the higher death rates from COVID-19 among racial and ethnic minority groups are rooted in long-standing racism and the poverty that attends it. The data suggest that the death toll has also been higher among poor whites and among people of color not living in poverty. “We all need to think about how racism works. One of the ways it works is to distribute people of color into lower-income groups and higher-poverty neighborhoods,” said Bassett, François-Xavier Bagnoud professor of the practice of health and human rights at Harvard and former health commissioner for New York City from 2014 to 2018. People’s risk of exposure to the SARS-CoV-2 virus that causes COVID-19, she said, is tied to their living environments, their jobs, and their commutes. Bassett’s research shows that a young Black person in America is nine times more likely to die from COVID-19 than a young Non-Hispanic White person, and a young Latino person is nearly eight times more likely to die than a young white person. Other people of color in younger age brackets—such as Native Americans/Alaska Natives and Asian Americans—also show elevated mortality rates compared to whites. Overall, among younger adults, members of racial and ethnic minority groups are dying at much higher rates than their same-age white peers. With access to national COVID-19 fatality data tied to race, Bassett and her colleagues at Harvard’s FXB Center for Health and Human Rights have studied these racial disparities in detail. In a working paper released in June, they quantified the unequal mortality rates using a particularly sobering statistic: the potential years of life lost. Analyzing data from the National Center for Health Statistics, they calculated that more than 138,000 collective years of potential life were lost to COVID-19 between February and May 2020 in the United States. Although people of color account for just under 40 percent of the U.S. population, they account for about 75 percent, or 105,000, of those lost years. Such dramatic health inequities need to be brought to the forefront of the national conversation about COVID, Bassett said, a goal that requires more data. She specifically called for more research broken down not only by race, but also by gender, educational attainment, and employment. Looking at the relationships among these demographic factors can help paint a more nuanced picture, she added, and better inform policymakers. Poverty, racism, and a pandemic: a deadly combination In a study released as a preprint on the medRxiv archive Oct. 6, Bassett and her colleagues were able to do just that, she said, for data from Cook County, Illinois, home to the city of Chicago. They examined the effect of neighborhood poverty on COVID-19 mortality within racial and ethnic groups in Cook County. COVID-19 mortality rates by race in Cook County Across all racial groups, whites included, they found that those living in the highest-poverty neighborhoods were between 1.6 and 4.1 times more likely to die of COVID than those of their same race or ethnicity living in the most affluent neighborhoods. Adjusting for the differences in age and gender distribution among racial and ethnic groups, in the poorest neighborhoods, white and Black people under 65 years old had similarly high mortality rates of about 35 in 100,000 people. The data, Bassett explained, show that poverty itself is likely a major risk factor for getting and dying of COVID. “In all race groups, we see a gradient by area- based poverty. People who live in the wealthiest neighborhoods, regardless of their race or ethnicity, had the lowest COVID mortality rate among their race or ethnic group.” However, she added, racial disparities remain, even among the rich and elderly. Among the wealthy in Cook County, Black and Latino people under 65 were almost three times more likely to die from COVID than their white neighbors. Among the elderly, the wealthiest Blacks and Latinos had a higher chance of dying from COVID than the poorest whites. Bassett told her audience of science journalists and other communicators that “contextualizing” racial disparities in their reports is essential to the public understanding of COVID-19, and to the development of policies designed to end the health inequities in the COVID response. She pointed to the example of low-wage essential workers such as meatpackers, farm workers, and grocery store clerks, jobs that employ disproportionately high numbers of people belonging to racial and ethnic minority groups. With no option to telecommute and mostly denied paid sick leave, they are at elevated risk of exposure to the SARS-CoV-2 virus. Ideally, she said, researchers need access to individual-level data from counties, states, and the federal government. She said these data are collected, but are not generally available to researchers. The conversation should stay focused on the data, she said, and journalists have a big role to play. “This is a story that should not get old.”
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COVID-19 pandemic disproportionately impacts communities of color Myrick 20 [Neal Myrick, Neal Myrick is the Global Head of the Tableau Foundation, a philanthropic initiative led by the Tableau employees that encourages the use of facts and analytical reasoning to solve the world’s problems, 5-13-2020, "COVID-19 and communities of color: What the data tells us," Tableau, https://www.tableau.com/about/blog/2020/5/covid-19-disproportionately-affecting-communities-color-here-data- explains-why] /Triumph Debate
The novel coronavirus is anything but “a great equalizer.” As the outbreak has progressed through the United States, black and brown communities are facing particularly extreme impacts. New data from the Centers for Disease Control released on April 17 found that while black people make up 13% of the U.S. population, they’re currently accounting for 30% of reported COVID-19 cases. People from Latinx communities are also seeing higher rates of infection and hospitalization. We’re seeing right now that COVID-19 is disproportionately affecting communities of color—and to understand just how much, and how we can address these disparities, we need data. At Tableau, we are data people. And as the pandemic progresses, we’re seeing just how critical data is to understanding and taking action against it. We’re sharing stories of how data is informing decision- making at the macro level with state governments, and at the local level in small school districts. We’ve seen how data is illuminating the link between COVID-19 and the environment, and how data is enabling leaders to ensure that people’s basic needs, like food and shelter, are still being met. Our partners at Kaiser Family Foundation are showing just how critical data is and will be for assessing COVID-19’s impacts on communities of color. “With a pandemic, yes, the broad public is at risk,” says Samantha Artiga, Director of the Disparities Policy Project at. “But what we're really seeing with COVID-19 is the strong exposure of all the disparities that individuals and groups have been facing prior to the pandemic.” COVID-19 is not an equalizer—it’s a force multiplier for pre-existing inequalities. KFF has compiled data on those inequities to help explain some of the disparate impacts we’re seeing across communities, but there’s not enough of it, Artiga says. States and the federal government have only recently started collecting and sharing disaggregated data by race—and they need to do more as the virus progresses so we can truly understand its impacts. Having a clear picture of the data will enable policymakers to craft strategies to mitigate both the immediate and systemic effects of the virus. What the data is telling us As the COVID-19 outbreak has progressed, it’s only become clearer that people of color are bearing a disproportionate amount of the virus’ burden. The data on race and ethnicity and the novel coronavirus is still very incomplete, Artiga says, but even what we have now is showing a clear picture. Early data from states that are reporting disaggregated data reflects the fact that in many places, black people account for a greater percentage of COVID-19 cases than they do a portion of the population. According to KFF, “In the majority of states reporting data, Black people accounted for a higher share of confirmed cases (in 20 of 31 states) and deaths (in 19 of 24 states) compared to their share of the total population. These disparities were particularly large in Wisconsin, where Black people made up a four-times higher share of confirmed cases (25% vs. 6%) and an over six-times higher share of deaths (39% vs. 6%) compared to their share of the total population.” KFF also found disparities in a handful of states around the disproportionate burdens faced by Hispanic and Asian communities, and noted that more data is needed to assess the impacts on smaller vulnerable groups, including people who are American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander. Data from Pew shows a different view of inequities by race: According to the polling company, black and Latinx people are far more likely than white people in the U.S. to view the coronavirus as a threat to their health and communities. The reasons for this disparity in sentiment across race may have to do with the pre- existing inequities that KFF has documented. The uneven distribution of health risks Good health and healthcare are not evenly distributed across the U.S. population. Communities of color face higher risks of experiencing serious symptoms or dying due to COVID-19 because of a greater prevalence of underlying health conditions: diabetes, heart disease, asthma, and lung disease. KFF data shows that black Americans and American Indians and Alaska Natives are more likely than white Americans to report pre-existing health concerns that would heighten their risk amid the coronavirus pandemic. These disparities are not an accident, Keeanga-Yamahtta Taylor recently wrote in The New Yorker: They stem from decades of persistent racial and ethnic discrimination that has fenced communities of color off from good access to care, and the resources that form the foundation of good health. KFF’s analysis finds that people of color in the U.S. are much more likely to be uninsured than their white counterparts, which creates barriers in accessing care. Beyond the healthcare system, communities of color often face inequities when it comes to necessities like nutrition and access to green space. “Things like access to healthy food, what your transportation options are, what your housing situation is, what your neighborhood and built environment is—all these factors influence an individual's health, and that is applicable to health more broadly as well as the impact of COVID-19,” she says. Economic vulnerabilities are health vulnerabilities What underlies these health disparities across demographics is people’s overall economic well-being—which in the United States, is often correlated with race and ethnicity. Black, Latinx, and American Indian and Alaska Native people are much more likely to report income below the poverty line, according to KFF data. Artiga notes that as a result, “people of color are likely less able to be able to weather or deal with income decreases that may stem from job losses or reduction in work associated with the pandemic—and at the same time, they’re more likely to work in occupations that cannot be done remotely, like grocery store clerks or delivery drivers, which leaves them at higher
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risk for exposure to the virus.” That’s certainly holding true in Chicago, where Dr. Monica Peek, an associate professor at UChicago Medicine, says that “72% of our deaths here in Chicago residents have been in black Chicagoans. Though again, black Chicagoans just make up 30% of the city's population. The big picture is that racial or ethnic minorities in this city are more likely to be exposed to the virus because they are the ones that are working in jobs that allow the rest of the city to safely stay at home and shelter in place.” Economic insecurity also affects people’s housing circumstances, which according to The Brookings Institution are a key contributor to the spread of the coronavirus and its inequitable effects. Black majority neighborhoods have much higher concentrations of multigenerational households, and the increased number of people living in close proximity gives the virus more opportunities to spread. Across the U.S., communities of color—especially in urban environments—people are often forced to live in more cramped circumstances due to housing affordability and long-term economic inequities. KFF’s analysis finds that “roughly four in ten Blacks (41%), Hispanics (38%), and Asians (38%) indicate that the area surrounding their residence includes multi-unit residential buildings compared to 23% of Whites.” As Brookings notes: “The coronavirus does not discriminate, but our housing, economic, and health care policies do. Environmental racism, unaffordable housing, a lack of job opportunities, poverty, and inadequate health care are underlying social conditions, strongly influenced by policy, which place [people of color] and their neighborhoods at risk.”
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Structural inequities exacerbate public health emergencies Grant 20 [Alexis Grant, Alexis Grant is a PhD in Community Health Sciences student at the University of Illinois at Chicago (UIC) School of Public Health and a community engagement fellow with the School’s Collaboratory for Health Justice, 4-23-2020, "Commentary: COVID-19 Racial Disparities," No Publication, https://publichealth.uic.edu/news- stories/commentary-covid-19-racial-disparities/] /Triumph Debate
While we may all be in this pandemic together, public health professionals knew, communities of color would bare a disproportionate burden of the effects of COVID- 19. To track the effects of systemic racism, public health experts examine data on infection and hospitalizations by race/ethnicity. On Monday, April 6, we finally saw these figures for Chicago, and they were not surprising. While only 30 percent of Chicago’s population is Black, 72 percent of the city’s COVID-19 deaths were among Blacks Chicagoans. The spokesperson from the Chicago Mayor’s Office acknowledged this reality, saying “early community spread in Black communities and higher baseline rates of chronic underlying conditions are driving [these] issues.” Similar patterns can be seen in data released in Wisconsin, Louisiana, Philadelphia, Detroit and other cities and states. This is not a surprise to public health professionals. In fact, it is predictable. Health— and the opportunity to be healthy—is rooted in complex social and structural inequities that unfairly advantage some and disadvantage others (Jones, 2014). Long before this pandemic emerged, racism and classism created the conditions in which this inequity was able to take hold. The lack of access to health care and health insurance, to quality education, and to decent jobs and financial stability has led to rates of diabetes, heart disease, and lung disease that are higher in communities of color than in their white counterparts. These are the very conditions that make COVID-19 so dangerous, illustrating the many ways that injustice can kill. To address these systemic disparities, academic and public health professionals must engage in partnership with communities of color on research and action. Achieving health equity requires centering and elevating the voices and the leadership of those experiencing the inequities. This is not easy work. Authentic, reciprocal academic-community partnerships take effort. Historical abuses by researchers and unfair practices have led many African Americans to believe that research findings will be used to further stereotype them, expose them to unnecessary risk, and not benefit the community at all (Corbie-Smith et al., 2002, Brandon et al., 2005; Corbie-Smith et al., 2004; Katz et al., 2006). This means that fewer African Americans participate in research, so we know less about the fidelity of health promotion interventions. Negative encounters with doctors, unequal access to care, and experiences with discrimination compound to reinforce beliefs that scientists and physicians cannot be trusted (Katz et al., 2006; Brandon et al., 2005). It is up to us - the academic and public health community - to earn that trust, and the way we do so is through inclusivity, mutual respect, and community engagement. This work must be done before crises happen, so that communities can be part of the response, rather than watching from the sidelines. We applaud the City of Chicago’s partnership with West Side United to implement a strategy to reach out to residents and address “the realities of everyday life among those most impacted by COVID-19.” Across UIC, our academic and community partnerships are linking arms to maximize the impact of the city’s Racial Equity Response Team. As academic and public health professionals, we need to do more. We need to meaningfully invest in communities. We need to genuinely engage and build trusting partnerships. We need to transform our systems to create health justice.
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Vaccine hesitancy caused by institutional racism Golden 21 [Sherita Hill Golden, Vice President and Chief Diversity Officer, Johns Hopkins Medicine Professor of Medicine, M.D., M.H.S., 4-16-2021, "COVID-19 Vaccines and People of Color,", https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-vaccines-and-people-of-color] /Triumph Debate
The U.S. Food and Drug Administration has authorized two vaccines to protect against COVID-19, and vaccinations of the public have begun. People of color might have particular concerns about the vaccines’ safety and effectiveness. Although Black, Hispanic, Native American and other people of color are overrepresented in severe coronavirus disease, vaccine hesitancy among these groups and others can complicate the decision about whether to be vaccinated. Sherita Golden, M.D., M.H.S., vice president and chief diversity officer at Johns Hopkins Medicine, offers insights on the coronavirus vaccines and what people of color should know about the COVID-19 vaccines. Can we trust information about the COVID-19 vaccine? “People of color, along with immigrants and differently-abled men and women have endured centuries of having their trust violated. We need to give people the facts about the vaccine’s safety and efficacy, and renew their trust toward health care in general,” Golden says. “It’s incumbent on health care organizations and leaders to help repair and restore that relationship.” Golden says one way health care organizations can rebuild confidence is by working strategically with local elected officials, community leaders and religious leaders to convey accurate and essential health messages, including information about the COVID-19 vaccine. Here are her answers to some of the questions she is hearing from those considering COVID-19 vaccination. Were the COVID-19 vaccines developed too fast to be safe? “No,” Golden says. “Although people are understandably concerned about how quickly these vaccines were brought to market, and despite the name ‘Warp Speed,’ we know that there were large trials that were conducted correctly. They did not cut corners. “The Pfizer, Moderna and Johnson & Johnson COVID-19 vaccines have been tested and have shown their efficacy in preventing severe COVID-19 cases in particular,” Golden says. On Apr. 13, the CDC and FDA recommended a pause in using the J&J vaccine. Johns Hopkins Medicine will temporarily stop using the vaccine pending CDC and FDA reviews. Read full story. Does the COVID-19 vaccine change my DNA? “No,” Golden says. “The vaccines do not affect the nucleus of the cells, where the DNA resides. The technologies are not new. “Dr. Kizzmekia Corbett helped developed the vaccines,” Golden adds, referring to the African American viral immunologist at the National Institutes of Health. She adds that other leaders from communities of color volunteered to take part in the tests, noting, “Dr. Freeman Hrabowski III, president of the University of Maryland, Baltimore County, was a clinical trial participant.” Read more about the safety of the coronavirus vaccines. Demographics of the COVID-19 Vaccine Trials Sherita Golden, M.D., M.H.S., vice president and chief diversity officer for Johns Hopkins Medicine, discusses the demographic makeup of the Pfizer and Moderna COVID-19 vaccine trials. Was there enough participant diversity in testing the COVID-19 vaccine? “People of color were represented,” Golden says. “COVID-19 is affecting everyone, so clinical trials sought to ensure their participants reflected that. “When Pfizer tested their COVID-19 vaccine, 10% of their study participants were Black or African American people recruited from the United States — about 4,000,” she says. “Hispanic or Latinx people accounted for 26% of the study’s participants (about 11,000). Five percent of the participants were Asian. People age 56 and older made up 46% of the volunteers. “In the Moderna group of over 30,000 participants, we know that 10% of them were African Americans, 20% were Hispanic or Latinx, and 5% were Asian.” Moderna’s volunteers also comprised older adults, with one-quarter of the participants age 65 or older. Participants’ underlying health and profession were also tracked: 35% of Moderna’s study subjects were living with chronic health problems, including heart, lung or liver disease. About 22% were health care workers, and another 7% — about 2,000 women and men — were retail, restaurant or hospitality workers. The U.S. test participants for Johnson & Johnson’s one-shot COVID-19 vaccine were 15% Hispanic/Latinx; 13% Black/African American; 6% Asian and 1% Native American. Dr. Sherita Golden receiving her COVID-19 vaccination at the Johns Hopkins Hospital. Dr. Golden getting her COVID-19 vaccination at The Johns Hopkins Hospital. What is vaccine hesitancy? Although vaccines save lives, vaccine hesitancy — a tendency to avoid or put off getting a vaccine — affects all demographics, especially when a new vaccine enters the market. Institutional racism and historical inequities in health care may also play a role in vaccine hesitancy among African Americans and other people of color. Incidents of the medical establishment endangering the health or betraying the trust of Black patients and research participants have complicated the relationship between the medical establishment and these communities. A historic lack of diversity among health care practitioners and substandard services and care afforded to patients living with poverty can create enduring negative experiences with medical care. Vaccine hesitancy among some groups can result from fears that a family member’s immigration status will be under scrutiny, or that the costs of receiving a COVID-19 vaccine will be too expensive. (There is no charge for receiving the COVID-19 vaccines at this time.) syringe close up - covid19 coronavirus vaccine COVID-19 Vaccine Get information and updates from Johns Hopkins Medicine. Get COVID-19 vaccine updates Are there special reasons for people of color to get vaccinated to prevent COVID-19? Yes. The coronavirus pandemic has decimated communities of color, which are overrepresented in front-line, essential jobs, and vulnerable to risk factors that can make COVID-19 worse. Together with mask-wearing, physical distancing, hand hygiene and other coronavirus precautions, getting vaccinated can help keep you safe until the COVID-19 pandemic begins to ease. Golden is optimistic. “Communities will come around, but it will take patience as people deal with their reality and begin to see others taking part in COVID-19 vaccinations,” she says. But, at the same time, waiting is risky as COVID-19 and new coronavirus variants continue to spread. “I’m more concerned about long-term effects from COVID-19, which can be severe. Even though we don’t know everything about these new vaccines yet, I’d rather risk the unknown of the vaccines than what we know can happen with COVID-19. “Don’t delay,” she advises those considering COVID-19 vaccination. “We need herd immunity, and your protection cannot wait.”
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White communities get PPP loans easier Morel et. Al 21 [Laura C. Morel, Mohamed Al Elew, Emily Harris, Alejandra Reyes-Velarde, 5-1-2021, "Businesses in majority-white communities received PPP loans at higher rates, analysis shows," LA times, https://www.latimes.com/california/story/2021-05-01/ppp-loans-coronavirus-pandemic-businesses-trump] /Triumph Debate
In signing the Coronavirus Aid, Relief, and Economic Security, or CARES, Act, then-President Trump announced that PPP loans would provide “unprecedented support to small businesses” in order “to keep our small businesses strong.” The program has injected more than $770 billion into businesses, including Reveal from the Center for Investigative Reporting and the Los Angeles Times, since April 2020. But after submitting her application, Graham was notified that her request was rejected. In her corner of Inglewood, only 32% of businesses received PPP loans. “For me not to be able to get any help, it’s hurtful, that’s all I can say,” she said. Through the CARES Act, Congress ordered the Small Business Administration and the Treasury Department to issue guidance to lenders to ensure that the loan program “prioritizes small business concerns and entities in underserved and rural markets.” Yet a Reveal analysis of more than 5 million PPP loans found widespread racial disparities in how those loans were distributed. In the vast majority of metro areas with a population of 1 million or more, the rate of lending to majority-white neighborhoods was higher than the rates for any neighborhoods with Latino, Black or Asian majorities. Los Angeles had some of the worst disparities in the nation. Although communities of color were hit far harder by COVID-19, businesses in majority-white neighborhoods received loans at twice the rate that majority-Latino census tracts received, 1.5 times the rate of businesses in majority-Black areas and 1.2 times the rate in Asian areas. Shannon Giles, a spokesperson for the Small Business Administration, said the agency does not comment on third-party analyses of its data. The analysis, based on records released after Reveal and 10 other news organizations sued the Small Business Administration for access to PPP loan data, is the first look at how the federal program’s loans were distributed at the census tract level. Because the Treasury and SBA initially excluded a standard demographic questionnaire from the PPP application, banks did not routinely collect information on the race or gender of borrowers. So Reveal looked at loan totals and business data according to the racial makeup of each tract. A variety of factors contributed to the disparities, including failures by both banks and the government to adequately ensure fairness in the program, according to federal records and lending experts. PPP rules disfavored businesses without employees and required Social Security numbers and other records that some small entrepreneurs lack. Banks focused on existing and wealthier customers without conducting adequate outreach to communities of color, according to a congressional investigation. Jesse Van Tol, chief executive of the fair lending group National Community Reinvestment Coalition, said the disparities show that banks failed to live up to a 44-year- old federal law that requires them to equitably serve all communities where they do business. The racial disparities in the PPP rollout may not be patently illegal, Van Tol said, because the law has limited mechanisms for accountability. But of the disparities, he said: “Is it fair? No. Is it equitable? No. Does it violate the spirit of the Community Reinvestment Act? Absolutely.” In Playa del Rey in Los Angeles, where businesses have struggled during the health crisis, the Reveal analysis found that 61% of businesses in the predominantly white neighborhood have received PPP assistance. Cantalini’s Salerno Beach Restaurant — a local institution founded in 1962 — got a $95,000 PPP loan in April 2020 and an additional $133,000 in January. It wasn’t easy: When owner Lisa Schwab first contacted her own bank, Wells Fargo, she said, “They were just buried.” She submitted a successful application with WebBank, an online lender. “There’s no way we would’ve survived without that money,” Schwab said. “It was a lifeline.” Fifteen minutes east is the city of Inglewood, one of the area’s last Black enclaves, where business owners got PPP loans at roughly half the rate. Graham’s clothing shop, spanning several storefronts, marks the culmination of a decades-long dream for the former cosmetologist who moved to the city from Greenville, Ala., in the 1970s. She started piecemeal, hunting down merchandise at swap meets, thrift stores and garage sales, developing an eye for items with resale potential. Eventually, 15 years ago, she was able to rent a storefront on Manchester Boulevard. The pandemic threatened to upend her hard work. She first tried applying for a PPP loan at her bank, Wells Fargo, but found the online process complicated and couldn’t successfully submit an application. In May 2020, she heard that a company owned by former basketball star Magic Johnson had invested $100 million with MBE Capital Partners to fund PPP loans for minority- and women-owned businesses. So Graham applied with the New Jersey fintech company. MBE emailed her to say she needed to submit IRS payroll documents. But like 96% of Black business owners, Graham doesn’t have employees. MBE declined her application.
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White communities get more vaccinations Goodnough and Hoffman 21 [Abby Goodnough and Jan Hoffman, 3-4-2021, "The Wealthy Are Getting More Vaccinations, Even in Poorer Neighborhoods," New York Times, https://www.nytimes.com/2021/02/02/health/white- people-covid-vaccines-minorities.html] /Triumph Debate
WASHINGTON — As soon as this city began offering Covid vaccines to residents 65 and older, George Jones, whose nonprofit agency runs a medical clinic, noticed something striking. “Suddenly our clinic was full of white people,” said Mr. Jones, the head of Bread for the City, which provides services to the poor. “We’d never had that before. We serve people who are disproportionately African-American.” Similar scenarios are unfolding around the country as states expand eligibility for the shots. Although low-income communities of color have been hit hardest by Covid-19, health officials in many cities say that people from wealthier, largely white neighborhoods have been flooding vaccination appointment systems and taking an outsized share of the limited supply. People in underserved neighborhoods have been tripped up by a confluence of obstacles, including registration phone lines and websites that can take hours to navigate, and lack of transportation or time off from jobs to get to appointments. But also, skepticism about the shots continues to be pronounced in Black and Latino communities, depressing sign-up rates. Early vaccination data is incomplete, but it points to the divide. In the first weeks of the rollout, 12 percent of people inoculated in Philadelphia have been Black, in a city whose population is 44 percent Black. In Miami-Dade County, just about 7 percent of the vaccine recipients have been Black, even though Black residents comprise nearly 17 percent of the population and are dying from Covid-19 at a rate that is more than 60 percent higher than that of white people. In data released last weekend for New York City, white people had received nearly half of the doses, while Black and Latino residents were starkly underrepresented based on their share of the population. Dig deeper into the moment. Special offer: Subscribe for $1 a week. And in Washington, 40 percent of the nearly 7,000 appointments initially made available to people 65 and older were taken by residents of its wealthiest and whitest ward, which is in the city’s upper northwest section and has had only 5 percent of its Covid deaths. “We want people regardless of their race and geography to be vaccinated, but I think the priority should be getting it to the people who are contracting Covid at the highest rates and dying from it,” said Kenyan McDuffie, a member of the City Council whose district is two-thirds Black and Latino. Alarmed, many cities are trying to rectify inequities. Baltimore will offer the shot in housing complexes for the elderly, going door-to-door. “The key with the mobile approach is you can get a lot of hard-hit folks at the same time — if we just get enough supply to do that,” said the city’s health commissioner, Dr. Letitia Dzirasa. Officials in Wake County, N.C., which includes Raleigh, are first attempting to reach people 75 and over who live in nine ZIP codes that have had the highest rates of Covid. “We weren’t going to prioritize those who simply had the fastest internet service or best cell provider and got through fastest and first,” said Stacy Beard, a county spokeswoman. Fixing the problem is tricky, however. Officials fear that singling out neighborhoods for priority access could invite lawsuits alleging race preference. To a large extent, the ability of localities to address inequities depends on how much control they have over their own vaccine allocations and whether their political leadership aligns with that of supervising county or state authorities. The experiences of Dallas and the District of Columbia, for example, have resulted in very different outcomes. Dallas County, predominantly Democratic, has been thwarted by the state health department, under the aegis of a Republican governor, which quashed the county’s plan to give vaccines to certain minority neighborhoods first. But Washington was able to quickly course-correct.
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White communities get more testing sites Vann et. Al 2020 [Matthew Vann, Soo Rin Kim, and Laura Bronner, Grace Manthey, a data journalist for ABC Owned Television Stations in Los Angeles, ABC News’ Briana Stewart and FiveThirtyEight’s Rachael Dottle contributed reporting. Laura Bronner is FiveThirtyEight's quantitative editor. 7-22-2020, "White neighborhoods have more access to COVID-19 testing sites: ANALYSIS," ABC News, https://abcnews.go.com/Politics/white-neighborhoods-access-covid-19-testing- sites-analysis/story?id=71884719] /Triumph Debate
When the coronavirus outbreak threatened to rock Philadelphia’s predominantly Black neighborhoods, Dr. Ala Stanford knew that access to COVID-19 tests was going to be a problem. So she rented a van, loaded it up and headed to the areas of the city where residents needed tests the most. Every test conducted was free. Recent Stories from ABC News When Stanford began distributing tests in early April, she saw only a handful of testing centers in the city. Only a small share were in majority-Black neighborhoods and the bar for actually getting a test was high. “We’ve been to locations that are predominantly African American where everyone had insurance and they couldn’t get tested,” Stanford said referring to the often strict requirements providers had of those seeking tests as the outbreak began, such as doctor referrals, appointments and symptoms consistent with infection. Stanford, a pediatric surgeon, quickly assembled a group of doctors and volunteers called the Black Doctors COVID-19 Consortium to help meet the challenge of testing the city’s underderserved residents. Together, the group has issued Philadelphia’s residents more than 7,000 tests. But even with the intervention of medical professionals like Stanford stepping in to meet the rising demand, many communities of color across the country still face a dire situation in terms of getting a COVID-19 test. MORE: Black Americans 'epicenter' of coronavirus crisis made worse by lack of insurance PHOTO: Dr. Ala Stanford, wearing a white t-shirt at left, speaks with a COVID-19 test patient before administering a test in Philadelphia, in June 2020. Courtesy Marshall Mitchell Courtesy Marshall Mitchell Dr. Ala Stanford, wearing a white t-shirt at left, speaks with a COVID-19 test patient befo...Read More With nearly 4 million coronavirus cases across the United States and hospitalizations surging in different parts of the country, there continues to be a growing demand for COVID-19 tests. Currently, Americans routinely wait for hours to get an exam — if they can get one at all. Access is not available equally nationwide. ADVERTISING Simply put, where Americans live and how much income they earn can still determine the ease with which they get a COVID-19 test. According to a new, extensive review of testing sites by ABC News, FiveThirtyEight and ABC-owned television stations, sites in communities of color in many major cities face higher demand than sites in whiter or wealthier areas in those same cities. The result of this disparity is clear: People of color, especially Blacks and Latinos, are more likely to experience longer wait times and understaffed testing centers. This nationwide review is one of the first to look at testing site locations coast to coast, in all 50 states plus Washington, D.C., using data provided by the health care navigation company Castlight Health (the same data that Google Maps uses to surface COVID-19 testing sites). An assessment of city and state health department websites also revealed, over and over, fewer testing sites in areas primarily inhabited by racial minorities. Importantly, our analysis does not factor in the capacity of testing sites -- which can vary from just 50 tests at one site to 2,000 at another, meaning that one site might be equipped to serve a larger number of people than another site. Instead, it looks at the potential demand for each site based on the number of people and sites nearby. The data we used also is less likely to reflect tests done in private physicians’ offices than federally-funded community sites, local government-run mobile pop-up sites, urgent care clinics and hospitals. The analysis also doesn’t take into account other factors that could determine testing accessibility, such as staffing and wait times, as well as other restrictions on testing like appointment or insurance requirements. MORE: To defeat COVID-19, don't only treat the patient, treat the neighborhood: OPINION PHOTO: Demand at COVID-19 testing sites depends on the community you live in FiveThirtyEight FiveThirtyEight Demand at COVID-19 testing sites depends on the community you live in When the outbreak began, testing posed the most immediate challenge to states, as a shortage of supplies, testing kits and processing backlogs created capacity problems. Since then, states have vastly increased their bandwidth to perform tests, but even now, experts from the Harvard Global Health Institute say daily testing needs to be nearly doubled to mitigate the pandemic. And states and cities are still struggling to determine how to allocate testing resources and where to place testing centers. The Trump administration struggled early on in the pandemic to expand testing nationwide. Reliant on off-shore manufacturing that limited access to supplies like swabs and reagents, and armed with little data about who was getting sick and where, Trump’s political appointees quickly embraced that the federal government’s job would be mostly managing the logistics of testing such as supplies and distribution of state funds, as opposed to overseeing the coordination of state testing plans. But critics say that strategy left many states scrambling to meet the rising demand that health experts say will only grow more urgent in the fall, when students return and flu season starts. The Department of Health and Human Services recently released a comprehensive strategy to address the disparate access to COVID-19 testing, including expanding testing at federally qualified health centers as well as supporting public-private partnerships that establish testing at retail pharmacy companies to accelerate testing within vulnerable populations. CVS and Walgreens -- two of the retail pharmacies listed in the HHS plan -- both said in statements to ABC News that more than half of their store locations issuing COVID-19 tests are now located in areas most in need, based on the Centers for Disease Control and Prevention’s social vulnerability index. HHS also says it’s working to get more data on who is getting sick – a longtime challenge because most health care data resides in privately run hospitals and doctors. As of Aug. 1, labs will be required to report the race and ethnicity of COVID-19 test patients, months after an ABC News and FiveThirtyEight investigation found at least 19 states and U.S territories were missing data critical to understanding which communities were seeing the most fatalities from the novel coronavirus. The agency says they cannot assess the efficacy of their strategy to reduce the testing disparity until they get additional demographic information on COVID-19 test patients. MORE: 13 states now report coronavirus testing issues, in echo of early troubles “Requiring this level of detail in reporting of COVID-19 test data is a significant change for labs and especially for labs that may not operate with electronic reporting systems,” said an HHS spokesperson. “Once implemented, this guidance will rapidly advance the public health system reporting structure that has been lacking modernization for years.” What our analysis found The novel coronavirus itself does not distinguish between Black and white Americans. But virtually every other aspect of U.S. society does, including the nation’s response to COVID-19. Our analysis revealed that, in many cities, testing sites in and near predominantly Black and Hispanic 87 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
neighborhoods are likely to serve far more patients than those near predominantly white areas. A similar disparity exists between richer and poorer neighborhoods, our analysis showed: Testing resources were more scarce in poorer areas, with fewer sites per person and sites located farther away. And the disparity could be even higher in real life, considering wealthier people could also get tested by private practitioners who are less likely to be reflected in our analysis. Kevin Ahmaad Jenkins, a fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics who has been researching the impact of COVID-19 testing center availability on communities of color, told ABC News and FiveThirtyEight that his team found that testing sites serving minority communities in big cities are fewer in number, have longer lines and often run out of tests. The impact of such disparities, he said, is evident in the pandemic’s disproportionate effect on people of color. “It’s just as clear as George Floyd’s video. These numbers are right in front us: We are dying at disproportionate rates,” he said. To better understand the extent of this problem, we looked for cities whose broader “urbanized area” had at least 1 million residents. (“Urbanized area” is a census designation for cities and the densely populated areas immediately surrounding them.) We then calculated the potential level of demand at each testing site in that area, based on the number of people living nearby and additional sites in the area. MORE: COVID-19 exposes mistrust, health care inequality going back generations for African Americans We assumed that people would want to get tested at nearby sites, so we compared the number of patients a site would serve if the population of each census block group tried to visit sites that were close to them. This value, which we will refer to as potential patient demand, reflects how many people live near a given site and how many other options those people have. PHOTO: Testing sites in many nonwhite areas face greater demand FiveThirtyEight FiveThirtyEight Testing sites in many nonwhite areas face greater demand The disparities we found varied in severity across the country. In some major urbanized areas, they’re small or nonexistent. But in others -- from Dallas and Miami to San Diego and many places in between -- majority-Black and majority-Hispanic neighborhoods faced far more competition for COVID-19 testing than their white neighbors. Disparities were also seen in some predominantly Asian or Pacific Islander communities, such as those in Washington, D.C., Minneapolis and Riverside, Calif., but they weren’t as widespread as those among Black and Hispanic communities. Read more about our findings: MORE: COVID-19 test access disparities in some south Florida communities: ANALYSIS MORE: Some Southern California communities hit harder by COVID-19 testing restrictions: ANALYSIS MORE: COVID-19 testing disparities evident in San Antonio and Dallas areas: ANALYSIS MORE: Wealthy Philadelphians tested at higher rates than poorer residents: ANALYSIS And our calculation of potential demand for testing at some sites in those underserved neighborhoods is likely an underestimation: Based on our reporting, many of the testing sites in those neighborhoods are government-funded community sites set up to close the gaps in testing access in different communities, but they tend to be very popular among people from all across the county or urban area because they are often free and don’t require an appointment. We used data from the U.S. Census Bureau’s 2014-18 American Community Survey five-year estimates to figure out if, within urbanized areas, block groups that were majority Black or majority Hispanic were more likely to be close to sites with higher potential patient demand than majority- white block groups. To compare neighborhoods, we created a measure that we call potential community need, which is an average of the potential demand at nearby test sites. We also examined how block groups with a median income in the top 25 percent compared to those with median incomes in the bottom 25 percent. Castlight’s set of testing site locations is among the most comprehensive data available, but compiling every testing location in the nation is a massive undertaking, as sites are constantly opening, closing and moving. Given that, the data set is likely missing some testing sites. Additionally, our analysis is based on testing site data as of June 18, so many new sites have been added nationwide since then -- and others have likely closed or moved. We conducted separate analyses using a different source of testing site locations and examined other testing-related data to corroborate our findings. PHOTO: An aerial view of the line for the drive-thru COVID-19 testing center at the Ellis Davis Field House on July 2, 2020 in Dallas, Texas. Tom Pennington/Getty Images Tom Pennington/Getty Images An aerial view of the line for the drive-thru COVID-19 testing center at the Ellis Davis Fiel...Read More We’ve highlighted some of the cities with the most emblematic trends below. While we’re confident in the trends we’re presenting, we’d encourage you to think of them more as estimates (akin to a fire marshal’s approximation of the size of a crowd at a political rally) than exact measurements (such as a baseball player’s batting average). For more detail on our methodology, and some of the limitations in the data and thus this analysis, see here. MORE: Coronavirus is disproportionately killing the black community. Here's what experts say can be done about it However, this analysis still provides a vivid snapshot of the hurdles, complications and shortfalls in American efforts to slow the spread of COVID-19 this summer, a time when increased testing capacity in minority and low-income areas could have slowed the disease — a point widely acknowledged by public health experts. “Testing site distribution and capacity is a direct reflection of the inequalities in our existing health care system,” said John Brownstein, a professor of epidemiology at Harvard Medical School whose team of researchers at Boston Children’s Hospital’s Computational Epidemiology Lab also looked into the health care disparities underlying geographic access to testing. “The lack of access for those most vulnerable to infections will only serve to intensify the impact of this pandemic.” For Dr. Ala Stanford and her colleagues at the Black Doctors COVID-19 Consortium in Philadelphia, the choice early on was clear: adjust to a new normal of life indoors, or move swiftly to implement testing on the streets of Philadelphia to combat a virus that was proving deadly to Black communities. Stanford says she felt compelled to respond as she did because she knew that the same health care disparities she learned about in medical school, and as a practicing doctor, were still at play in Philadelphia during the coronavirus crisis -- the city in which she’s spent her entire life. “I stopped and said to myself: I’m a business owner in private practice, I have access, I can order these lab kits like anybody else, I know where the people are that are hurting,” she said. “And I am not afraid to go there.”
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Lack of health and transportation infrastructure creates vulnerability Johnson 21 [Akilah Johnson, Akilah Johnson joined The Washington Post in 2021 as a national reporter exploring the effect of racism and social inequality on health. She previously worked at ProPublica and the Boston Globe., 2-13-2021, "Lack of health services and transportation impede access to vaccine in communities of color," Washington Post, https://www.washingtonpost.com/health/2021/02/13/covid-racial-ethnic-disparities/] /Triumph Debate
For decades, Emery Wright filled his prescriptions at the community pharmacy around the corner from his Atlanta home. Now, the drugstore is gone, transformed into a private dialysis clinic that filled one need but created another, with the closest pharmacy a long car ride away. “It’s not like we needed less pharmacies in the neighborhood,” said Wright, 44, the co-director of Project South, a grass-roots social movement organization. “People should be able to access health care where they live.” As efforts accelerate nationally to provide the coronavirus vaccine to communities of color, skepticism about the inoculations is often highlighted as a major impediment. But a lack of pharmacies, hospitals, providers and transportation has emerged as an equally significant concern in those communities, where covid-19 has wrought its worst damage. What it's like to receive a surprise coronavirus vaccine Some non-priority District residents are receiving coronavirus vaccines just before they are set to expire. (Allie Caren/The Washington Post) Public health experts, physicians and civil rights advocates say attention must be paid to the practical barriers that fuel the disparities that have become a hallmark of the American health- care system. If not accounted for, they say, those same obstacles stand to stymie efforts to bridge a growing divide in coronavirus vaccinations. “Covid is exploiting not just human virus response, but our structured health-care response as well,” said Janice C. Probst, director emerita of the University of South Carolina’s Rural and Minority Health Research Center. “It finds the gaps.” Covid-19, the illness caused by the novel virus, has killed 1 out of every 645 Black Americans in the past year. But of the 13 million people who received the coronavirus vaccine during the first month shots were available, just 5 percent were Black, limited data from the Centers for Disease Control and Prevention shows. Those figures also show that Latinos, another community disproportionately affected by covid-19, are underrepresented in getting shots. Race and ethnicity data was missing for nearly half of all coronavirus recipients during that time. Researchers know that inadequate health-care infrastructure, including a lack of pharmacies, is one of the barriers. One out of eight pharmacies shut their doors between 2009 and 2015, according to a brief 2019 study published in the medical journal JAMA Internal Medicine. Independent, urban drugstores whose clients are mainly uninsured or publicly-insured patients — two groups who are disproportionately Black and Latino — were most at risk of shuttering, the report said. A separate study shows rural residents are contending with hospital closures and provider shortages that have left 4.4 million residents living in a county without a hospital. Probst has extensively studied the time and distance it takes to reach medical care, finding in a 2007 report that half of the trips made by African Americans for medical care took more than a half-hour compared with 25 percent of trips White people made. It’s a subject Probst and her colleagues are revisiting through a federally funded research grant to explore the degree to which historically disadvantaged racial and ethnic groups might be located farther from medical resources. “The magic word is infrastructure,” Probst said. “Covid has brought everything into perspective.” Catch up on the most important developments in the pandemic with our coronavirus newsletter. All stories in it are free to access. In Atlanta, Project South, along with the Hunger Coalition of Atlanta, has sought to plug holes in the health-care infrastructure of the city’s historically Black neighborhoods by offering free coronavirus testing or pop-up health education and first aid stations where people sometimes appear with major medical issues, such as uncontrolled diabetes, not just minor rashes. The Biden administration, which has stressed equity as a cornerstone of the pandemic response, is attempting to improve access to vaccines by shipping a limited number of doses directly to pharmacies and community health centers, with the intention to scale up as vaccine supplies increase. According to an analysis of state vaccine distribution plans by the Kaiser Family Foundation, about half of the publicly available plans — 25 of 47 — stated at least once that they were considering race, ethnicity or health equity in prioritizing targeted populations. Only 12 of the state plans, though, highlighted the number of providers needed to reach communities of color — a key factor in delivering vaccinations. “At the broader level is the extent to which a state outlines equity as a priority, but there is also this question of how is this priority, or focus on equity, then operationalized,” said Samantha Artiga, director of Kaiser Family Foundation’s racial equity and health policy program. “We’ve seen a lot of variation across states.” Advertisement D.C. recently started a door-knocking campaign in neighborhoods hit hardest by covid-19 to improve vaccination rates. In Massachusetts, advocates fought to get large-scale vaccination sites in communities of color. But they say newly created “companion appointments” undermine equity by allowing vaccinations for younger people who accompany older residents to appointments — even though younger people are not in current vaccination priority groups. Researchers at the University of Pittsburgh and West Health Policy Center applauded the decision by the Biden administration to use community pharmacies as vaccine access points — they tend to be open nights, weekends and holidays and have parking lots, capacity and are trusted. But they said not enough attention has been paid to gaps in the health-care system when addressing vaccine uptake in vulnerable populations. The complicated path to equitable vaccine distribution The Post’s Akilah Johnson explains the challenges the Biden administration faces to distribute the vaccine to low-income, vulnerable communities equitably. (Joy Yi/The Washington Post) “Pharmacies should be easy to access, but in some places there’s low capacity or low density, and the flood gates are opening,” said Lucas A. Berenbrok, an assistant professor at the Pitt School of Pharmacy who began analyzing travel distances to potential vaccination sites with colleagues. Transportation, including the logistical gymnastics required for people without a car or who rely on public transportation, has long led to differential access to health care. But it hasn’t been discussed as a potential reason for low vaccine uptake in communities of color “as much as hesitancy or skepticism,” said Inmaculada Hernandez, an assistant professor at the Pitt School of Pharmacy and one of Berenbrok’s collaborators. Historical discrimination faced by Black people from the medical system — and continuing inequities — must be acknowledged and remedied, said Sean Dickson, director of health policy at the West Health Policy Center. But practical hurdles must be addressed, too, because “we also fail to invest in those communities,” Dickson said. “Otherwise, that puts the onus on Black communities to overcome rather than recognizing there are real structural 89 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
barriers to accessing health care.” Alma Stewart, a retired nurse and founder of the Louisiana Center for Health Equity, said too often, not enough attention is paid to the political and business calculus that puts health services beyond the reach of communities of color. Advertisement “Those decisions didn’t happen by accident,” she said. The National Association of Chain Drug Stores said pharmacies are part of the solution, especially in medically underserved and rural areas where pharmacists can take vaccines directly to people with limited access through mobile pop-up sites at schools and in parking lots. “There is a pharmacy within five miles of 90 percent of Americans,” Steven C. Anderson, the association’s president and CEO, said during a news briefing this month. Traveling five miles might not seem like a substantial distance, but it can be depending upon ability and circumstance, especially for people without cars living in areas that don’t have sidewalks or accessible public transportation. In many densely populated metropolitan areas, going five miles anywhere means threading your way through traffic jams, congested walkways and crowded buses or trains. “We have to make sure that people don’t make it all about hesitancy,” Georges C. Benjamin, executive director of the American Public Health Association, said. “If you’ve got to take two buses and walk a few blocks, plus hesitancy, where is the incentive to go get that shot?” The lack of access comes on top of a constellation of other woes: technology issues — no computer or Internet — that make it hard to register for a shot or figure out where to get one; cellphones with limited talk and data plans; and shift work that conflicts with pharmacy schedules. Then, there are the shifting priorities of many states that have sparked confusion over when, where and how to get shots as people 65 and older were moved to near the front of the line. Different jurisdictions haven taken different approaches, with front-line workers, who often face the highest risk of exposure to the virus and are disproportionately people of color, being pushed back in the queue. “We have a fractured health-care system,” Benjamin said. Federal health-care regulators have told states they need to develop standards for the maximum distance Medicaid managed-care patients should have to travel to see doctors, dentists and pharmacists. In New Jersey, for example, the standards say 90 percent of enrollees in metro areas should not have to travel more than 30 minutes by public transportation or live no more than six miles from their primary-care provider. Allegra Brown, who doesn’t own a car and lives in Newark, said getting to the doctor or pharmacy is a headache that involves choosing between a $40 round-trip Uber ride or two buses. Public transportation, she said, is cheaper but takes much longer and isn’t reliable. “I’m not going to lie. There’s been times where I didn’t get prescriptions filled,” said the 23-year-old who prepares grocery orders for delivery at Amazon Fresh and has employer-based insurance. That’s what happened just before Thanksgiving, when she cut her leg, went to the emergency room and left with a prescription for antibiotics. (Amazon founder Jeff Bezos owns The Washington Post.) Brown went to the pharmacy she’s familiar with only to be told it wouldn’t accept her insurance and was sent someplace else that wasn’t open. Deterred by the time and cost, she said she didn’t try again. Her cut became so infected it required intravenous antibiotics. Experiences like this, she said, don’t engender confidence that pharmacies getting direct shipments of the coronavirus vaccine — which she said she needs “like yesterday” — will simplify her ability to get a shot. “It’s going to be some time before we get the vaccine, that’s what that means,” she said. Michigan health officials said they are determined to eliminate differences in drive times to ensure there are no racial and ethnicity disparities in vaccination rates. “We’ve set out an ambitious, but I think attainable, goal, that no Michigander should have to drive more than 20 minutes to reach a vaccination site,” said Joneigh S. Khaldun, chief medical executive for Michigan’s health and human services department. “Now, that may be 20 minutes to where there’s a mobile van on a corner. May be 20 minutes to the senior center. That includes our rural areas,” said Khaldun, who the White House announced Wednesday will be a member of the White House Covid-19 Health Equity Task Force. “This is just bread and butter public health. It’s going into the neighborhoods. It’s not asking people to come to you.” Michigan reduced disparities in covid-19 case and mortality rates between Black and White residents with public health interventions and more money, she said. Officials collaborated with trusted members of the community who used their platforms to educate people about masks and social distancing, placed testing sites in vulnerable communities and helped find housing for people whose homes weren’t conducive to isolating if they tested positive. “The progress,” Khaldun said, “is fragile.” According to the Covid Tracking Project, an independent group that collects data on cases, deaths and hospitalizations, Black people, who are 14 percent of Michigan’s population, accounted for 40 percent of the state’s deaths at the end of April. White people, who are 78 percent of the population, represented 45 percent of deaths. At this moment in the pandemic, Black people make up about 23 percent of deaths statewide, while White people make up 71 percent of deaths. A surge in cases among the state’s White population contributed to the disparity shrinking, figures show. Like Michigan, Louisiana plans to bring coronavirus vaccines to the people instead of expecting people in health-care deserts to travel, said Robert Maupin, an obstetrician and member of Louisiana’s covid- 19 health equity task force, convened by Gov. John Bel Edwards (D). “The only way to make it work is to make it mobile,” Maupin said. “Whether we’re talking about covid or we’re talking about other areas of health-care access, the patterns are similar.” Members of the Louisiana task force said the state is using the CDC’s social vulnerability index and is identifying those places that already suffer from a hospital or provider shortage to predict which areas will need additional services to administer the coronavirus vaccine. It is important to recognize that disparities in covid-19 death rates and in access to vaccines have roots that extend far beyond the disease’s emergence last year and require long-term strategies to solve, Maupin said. “We’re in covid now, but things cycle through,” said Maupin, who is associate dean of diversity and community engagement at the Louisiana State University School of Medicine in New Orleans. “If we don’t fix the system, when the next crisis comes, we’re going to see the same things. We have to use this moment of crisis as a call to action.”
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People of color are impacted by health inequity – discrimination, healthcare, housing, education, criminal justice, finance – CDC evidence CDC 21 [Centers for Disease Control and Prevention, 4-21-2021, "Community, Work, and School," https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html] /Triumph Debate
Health equity is when all members of society enjoy a fair and just opportunity to be as healthy as possible. Public health policies and programs centered around the specific needs of communities can promote health equity. The COVID-19 pandemic has brought social and racial injustice and inequity to the forefront of public health. It has highlighted that health equity is still not a reality as COVID-19 has unequally affected many racial and ethnic minority groups, putting them more at risk of getting sick and dying from COVID-19. [1], [2] The term “racial and ethnic minority groups” includes people of color with a wide variety of backgrounds and experiences. Negative experiences are common to many people within these groups, and some social determinants of health have historically prevented them from having fair opportunities for economic, physical, and emotional health. [3] Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes. Factors that contribute to increased risk Many factors, such as poverty and healthcare access, are intertwined and have a significant influence on the people’s health and quality-of-life. [3] Racial and ethnic minority populations are disproportionately represented among essential workers and industries, which might be contributing to COVID-19 racial and ethnic health disparities. “Essential workers” are those who conduct a range of operations and services in industries that are essential to ensure the continuity of critical functions in the United States, from keeping us safe, to ensuring food is available at markets , to taking care of the sick . A majority of these workers belong to and live within communities disproportionately affected by COVID-19. Essential workers are inherently at higher risk of being exposed to COVID-19 due to the nature of their work, and they are disproportionately representative of racial and ethnic minority groups. Doctor wearing protective work wear injecting COVID-19 vaccine to soldier Nurse wearing mask and talking with patient Farmworkers collecting fresh crops To achieve health equity, CDC is committed to understanding and appropriately addressing the needs of all populations, according to specific cultural, linguistic, and environmental factors. By ensuring health equity is integrated across all public health efforts, all communities will be stronger, safer, healthier, and more resilient. Factors affecting health equity: Some of the many inequities in the social determinants of health that put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19 include: Discrimination: Unfortunately, discrimination exists in systems meant to protect well-being or health. Examples of such systems include health care, housing, education, criminal justice, and finance. Discrimination, which includes racism, can lead to chronic and toxic stress, and shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for COVID-19. [5], [6] Healthcare access and use: People from some racial and ethnic minority groups face multiple barriers to accessing health care. Issues such as lack of insurance[10], transportation, child care, or ability to take time off of work can make it hard to go to the doctor. Cultural differences between patients and providers as well as language barriers affect patient-provider interactions and health care quality. [8] Inequities in treatment [9] and historical events, like the Tuskegee Study of Untreated Syphilis in the African American Male and sterilization without people’s permission, might also explain why some people from racial and ethnic minority groups do not trust healthcare systems and the government. [10], [11], [12], [13] Occupation: People in racial and ethnic minority groups often work in essential settings, such as healthcare facilities, farms, factories, grocery stores, and public transportation [14] Working in these settings can lead to more chances of exposure to COVID-19. Educational, income, and wealth gaps: Overall, people from some racial and ethnic minority groups have less access to high-quality education. Without a high-quality education, people face greater challenges in getting jobs that offer options for minimizing exposure to COVID-19[16]. People with limited job options likely have less flexibility to leave jobs that might put them at a higher risk of exposure to the virus that causes COVID-19. They often cannot afford to miss work, even if they’re sick, because they do not have enough money saved up for essential items like food and other important living needs. Housing: Living in crowded conditions can make it very difficult to separate when you are or may be sick. A higher percentage of people from racial and ethnic minority groups live in crowded housing as compared to non-Hispanic White people and therefore may be more likely to be exposed to COVID-19. These factors and others are associated with more COVID-19 cases, hospitalizations, and deaths in areas where racial and ethnic minority groups live, learn, work, play, and worship. [7], [17], [18] They have also contributed to higher rates of some medical conditions that increase one’s risk of severe illness from COVID-19. In addition, community strategies to slow the spread of COVID-19 might cause unintentional harm, such as lost wages, reduced access to services, and increased stress, for some racial and ethnic minority groups. [19] We all have a part in helping to prevent the spread of COVID-19 and promoting fair access to health. To do this, we have to work together to ensure that people have resources to maintain and manage their physical and mental health in ways that fit the communities where people live, learn, work, play, and worship.
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AT: Rights Prior Case law shows that more coercive methods such as quarantine and isolation are justified if they promote the general welfare and are proportional Nyamutata 20 [Conrad Nyamutata- Lecturer in Law, Faculty of Business and Law, De Montfort University, Leicester, UK, 2020, “Do Civil Liberties Really Matter During Pandemics?” International Human Rights Law Review, Vol 9. Pg 62-98. file:///Users/jospurgeon/Downloads/[22131035%20- %20International%20Human%20Rights%20Law%20Review]%20Do%20Civil%20Liberties%20Really%20Matter%20During %20Pandemics_.pdf]/ Triumph Debate
Case law has predominantly shown that coercive public health measures such as quarantine and isolation can be legitimately justified if the public health interests of society are carefully balanced against the freedom of the individual.163 Article 5 (e) of the echr allows for ‘the lawful detention of persons for the prevention of the spreading of infectious diseases.’ To pass the balancing test, the benefits to the public should outweigh the burdens or harms that a quarantine may place on individuals. In most cases, US courts have ruled in favour of quarantine in cases of disease outbreaks.164 The Hickox case165 illustrated the tension between individual rights and the claims of public health. On 22 October 2014, the Governor of New Jersey, Chris Christie, issued an executive Order No. 164 (2014), for the mandatory screening of individuals returning from West African countries affected by Ebola,166 Kaci Hickox, a nurse, had spent significant time in Sierra Leone with Doctors Without Borders treating patients infected the virus. After being ordered to strict home confinement upon her return,167 Hickox protested. A year later, she instigated a civil case against Christie and state public health officials, alleging that her 80-hour quarantine, upon returning to the United States, violated her rights under the Fourth and Fourteenth Amendments.168 The Court held that there was no violation of Hickox’s Fourth Amendment rights, or her right to procedural due process under the Fourteenth Amendment. These findings were premised upon the Court’s determination that the state is authorized to maintain and enforce regulations that are necessary to prevent the introduction, transmission or spread of communicable diseases from foreign countries into the United States. However, the court concluded that ‘parties cite no case striking down a quarantine order, however, that is even close to Hickox’s factual scenario, or that would have clearly indicated to any of these defendants that their actions violated established law.’169 The court concluded: I cannot find that the decision to quarantine Hickox for a limited additional period of observation violated clearly established law of which a reasonable officer would have been aware. The facts do not suggest arbitrariness or unreasonableness as recognized in the prior cases—i.e., application of the quarantine laws to a person (or, more commonly, vast numbers of persons) who had no exposure to the disease at all. Indeed, her quarantine fits well within the Supreme Court’s dicta in Jacobson, as well as the holdings in Reynolds and Shinnick.170 The US is a state party to the iccpr but no reference was made to the Convention, possibly because Ebola did not involve a ‘public emergency threatening the life of the nation,’ to invoke derogation. Instead, the court relied on precedent. In Jacobson, the Court had upheld a Massachusetts law requiring vaccination against smallpox, concluding: An American citizen arriving at an American port on a vessel in which, during the voyage, there had been cases of yellow fever or Asiatic cholera, he, although apparently free from disease himself, may yet, in some circumstances, be held in quarantine against his will on board of such vessel or in a quarantine station…171 In Reynolds v. McNichols,172 deferring in part to Jacobson, the court also upheld an ordinance ‘authorizing limited detention in jail without bond for the purpose of examination and treatment for a venereal disease of one reasonably suspected of having a venereal disease’ as a valid exercise of the police power.’173 In U.S. ex rel. Siegel v. Shinnick,174 the court permitted the quarantine of a woman who had arrived in the U.S. from Stockholm (deemed ‘a small pox infected area’) without presenting a certificate of vaccination. The court upheld an administrative order that she be quarantined for 14 days, the length of the smallpox incubation period.175 It acknowledged that public health officials ‘deal in a terrible context [where] the consequences of mistaken indulgence can be irretrievably tragic.’ A better-safe-than-sorry determination was therefore entitled to deference, absent a ‘reliable showing of error.’176 The federal authorities succeeded in pleading ‘qualified immunity’ which shields government officials from civil liability as long ‘as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known.’177 ‘[U]nless the plaintiffs allegations state a claim of violation of clearly established law, a defendant pleading qualified immunity is entitled to dismissal before the commencement of discovery.’178 In short, the judgment noted that Christie and state health officials’ decision to sequestrate Hickox for a limited period of observation did not violate clearly established law regarding quarantine and related public health measures. The Court, however, permitted Hickox’s torts for false imprisonment and invasion of privacy or false light arising from statements made by Christie implying she was ‘ill’179 The Hickox decision can be tested against, while rooted in the ECtHR jurisprudence, what have become common standards of legality and proportionality of actions acceptable in democratic society in 92 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
pursuit of an identified legitimate aim. In fact, the principles are inferred in the judgment. Hickox had tested negative of Ebola twice. The Centres for Disease Control and Prevention (cdc) had the authority to hold an individual for seventy-two hours before providing them information in writing as to why they are being detained. But the cdc can hold that person for at least 144 hours (six days) before they are allowed to request a medical review. And with no hard deadline on when this review must be conducted, a more accurate description of the regulations is that an individual can be held for an indeterminate amount of time before the regulations require a medical review. And yet, this is not the end of the process.180 Once that medical review is conducted, the written report is provided to the Director, who again has no specified deadline for reviewing the report or issuing a decision afterward, only needing to do so ‘as soon as practicable.’181 This approach would fall foul of the ‘harm principle,’ that is, establishing Hickox would actually spread disease (she had tested negative twice), and the ‘least restrictive means’ principle of public health. While the legitimate aim is recognised in the judgment, the actions of the authorities would also conflict with tenets of proportionality. Perhaps in recognition of the flaws, Hickox’ case ended with a non-financial settlement but a commitment by the state Health department that anyone who is quarantined in the future for Ebola must be informed of their rights.182 These include: the right to retain and communicate with a legal representative and litigate against the quarantine. They would be allowed to participate legal hearings – presenting evidence, making arguments and cross-examining witnesses – by telephone or electronic means.183 Further, a quarantined person would be allowed to send and receive communications to have visitors in a medically safe way. These changes would appear to comport with the ‘least restrictive means’ test and human rights precept of proportionality in a democratic society. Scholars in public health posit that quarantine and isolation should not be coerced whenever possible, and, when that fails, they should be implemented with the least intrusive means available.184 Human rights are considered to be inalienable (not be taken or given away) in the so-called ‘international bill of rights’: the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Economic Rights and the iccpr. However, pandemics, as demonstrated by state responses, show that human rights are not inalienable. Select rights are nonderogable, but the assumption is that all other rights cannot be taken away or transferred.185 Largely, however, the discussion has shown that authoritarian models are tolerated and illiberal approaches have been permissible in times of pandemics in democratic societies. covid-19 did not pose existential threat to the affected nations. On this conclusion, the interference with individual would, ordinarily, not be justified. However, the law on the management of pandemics and the jurisprudence pay little attention to human rights during disease outbreaks. They legitimize limitation of rights, and states can do so extensively. While China employed a more authoritarian approach, democratic states adopted expansive illiberal regimes to control covid-19. On the other hand, because of the fear generated by pandemics, citizens generally acquiesce to draconian rule. Jurisprudence evinces that challenges barely succeed.
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Violations of civil liberties such as surveillance and mandatory vaccination and treatment are necessary for global suppression of outbreaks Ghedamu & Meier 19 [Tsion Berhane Ghedamu, Program Manager @ The Aspen Institute, and Benjamin Mason Meier, Global Health Policy @ The University of Chapel Hill, “Assessing National Public Health Law to Prevent Infectious Disease Outbreaks: Immunization Law as a Basis for Global Health Security,” Journal of Law, Medicine, and Ethics, https://pubmed.ncbi.nlm.nih.gov/31560619/] /Triumph Debate
In developing these national laws as a foundation to meet the GHSA, there is a need for rigorous empirical analysis of the impacts of such immunization law reforms on disease prevention outcomes. Legal epidemiology has rapidly become a path to empirical analysis of public health law, and immunization law provides a straightforward approach to legal epidemiology across nations. Many nations collect public health data on immunization rates, alongside outcome data on outbreak incidence and prevalence for a range of infectious diseases. These data provide legal epidemiologists — in collaboration with public health practitioners, researchers, lawyers, and governments — with the ability to examine both national laws (as an independent variable) and public health outcomes (as a dependent variable) to analyze the public health impact of vaccination laws within each country.84 Policy surveillance on immunization laws, paired with public health data on disease outbreaks, can allow policymakers to understand the positive and negative effects of legal attributes on public health and reform laws based upon empirical comparisons with other countries. Where regional health governance has been effective in promoting national health law reform,85 the recent creation of the Africa CDC has established a regional governance framework to support countries in identifying best legal practices within Sub-Saharan Africa and providing an empirical basis to harmonize laws across countries. These reformed laws can assure that immunization policies provide the greatest benefit to public health while proving the least restrictive of individual rights. Although invaluable to the public’s health, immunization law poses a risk of infringing of personal rights and freedoms.86 Echoing rights infringements during the 2014 Ebola outbreak in Liberia, where entire communities were quarantined forcefully,87 the Democratic Republic of Congo recently acted through the police to bring an individual back to the hospital after he had left.88 These cases exemplify the tendency of infectious disease control policies to infringe on individual rights, with these rights infringements undercutting public health efforts. Especially where the law provides for mandatory vaccination, there is a potential for derogations from individual rights, and it will be necessary to assure that human rights are protected under immunization law. Where the state is obligated under international law to ensure a balance between the goals of public health and the rights of the individual,89 comparisons across national legal practices can provide understanding of the appropriate balance between public health and human rights, making vaccinations the norm and exemptions a rare occurrence. While there is no need to standardize immunization law globally — with each country having distinct disease control concerns that can be addressed within contextualized national policies — policymakers can look to models in other countries to share lessons and support reforms. This research has identified gaps in national immunization laws, and each country can look to other national approaches in filling these gaps, developing the public health law reforms necessary to strengthen public health systems. As a foundation for legal epidemiology research, policymakers can continuously work with public health practitioners, researchers, and lawyers to assure that any law adopted is continuously improving public health. Conclusion With the world at increasing risk of infectious disease, policymakers must create robust national health systems that can support efforts to prevent disease. Where a lack of immunization can create an opening for an infectious disease outbreak, which can quickly spread throughout a rapidly globalizing world, vaccines are an important tool for global health security and public health promotion. The GHSA has provided a model for key aspects of infectious disease control, but for the GHSA to function appropriately, national governments must develop legal frameworks to implement GHSA imperatives. Through policy surveillance of immunization laws across various countries, researchers can play a central role in assisting policymakers to understand the range of policy approaches to expand immunization. Supported by legal epidemiology, it is possible for researchers to combine policy surveillance with epidemiological data, clarifying the impact of these laws on public health and providing empirical justification for public health law reform. By assessing the role of law as a determinant of public health, such research can catalyze necessary law reforms, allowing national policymakers to create the legal structures needed for global health security.
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This is widely recognized as a necessary governmental tradeoff in order to ensure justice for the least advantaged Gostin & Powers 06 [Lawrence Gostin, Law @ Georgetown, and Madison Powers, Ethics @ Georgetown, “What Does Social Justice Require For The Public’s Health? Public Health Ethics And Policy Imperatives,” Georgetown University Law Center, https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1482&context=facpub] /Triumph Debate
The exercise of the state’s coercive power has been highly contentious throughout U.S. history. When public health officials act, they face troubling conflicts between the collective benefits of population health on the one hand, and personal and economic interests on the other. Public health powers encroach on fundamental civil liberties such as privacy, bodily integrity, and freedom of movement and association. Sanitary regulations similarly intrude on economic liberties such as freedom of contract, pursuit of professional status, and use of personal property. Justice demands that government take actions to safeguard the public’s health, but that it do so with respect for individuals and sensitivity to the needs of the underprivileged. In the realm of public health and civil liberties, then, both sides claim the mantle of justice. Finding an appropriate balance is not easy and is fraught with controversy. What is most important to justice is abiding by the rule of law, which requires modern public health statutes that designate clear authority to act and provide fair processes. Policymakers, therefore, should modernize antiquated public health laws to provide adequate power to reduce major risks to the population but ensure that government power is exercised proportionately and fairly.5 Fairness requires just distributions of burdens and benefits to all, but also procedural due process for people subjected to compulsory interventions. Certainly, the justice perspective cannot answer many of the most perplexing problems at the intersection of public health and civil liberties such as paternalistic interventions (for example, seat belt laws) or the exercise of powers in health emergencies (for example, avian flu or bioterrorism). These and many other problems pose major dilemmas for the field that neither considerations of justice nor traditional arguments based in beneficence can readily resolve. However, a more serious failure of public policy would be a failure to recognize and give great weight to the demands of social justice when faced with such challenges. National, state, and local public health functions. The arguments for and against the centralization of political power have remained largely the same over the course of U.S. history and are part of entrenched political ideologies. There is no simple resolution, and initially it might seem that the justice perspective can shed little light on this contentious area. Considerations of social justice do not side with either of the traditional combatants in the federalism debates, as they neither favor federal nor state action. What justice does do is insist that governmental action address the major causes of ill health, particularly among the disadvantaged; that commitment has major implications for political and social coordination. The justice perspective’s emphasis on the multicausal and interactive determinants of health suggests that strategic opportunities for prevention and amelioration of ill health arise at every level of governmental interaction. The challenge of combating the threat of systematic disadvantage can be met only with a systematic response among all levels of government. The level of government best situated for dealing with public health threats depends on the evidence identifying the nature and origin of the specific threat, the resources available to each unit for addressing the problem, and the probability of strategic success.
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General welfare trumps individual considerations when dealing with public policy Faden and Shebaya 19 [Ruth R. Faden- Berman Institute Founder; Core Faculty; Philip Franklin Wagley Professor of Biomedical Ethics at John Hopkins and Sirine Shebaya- Greenwall Fellow in Bioethics and Public Policy at the Johns Hopkins Berman Institute of Bioethics, Jan 2019, “Public Health Programs and Policies: Ethical Justifications,” Oxford Handbooks, DOI: 10.1093/oxfordhb/9780190245191.013.3] /Triumph Debate
Public health policies sometimes make demands on individuals who do not stand to benefit from the policies, and they sometimes interfere with liberty even when they do benefit the individuals in question. In such instances, a moral justification for a public health intervention is required. This chapter sets forth five justifications for public health interventions: (1) overall benefit, (2) collective action and efficiency, (3) fairness in the distribution of burdens, (4) prevention of harm (the harm principle), and (5) paternalism. The chapter discusses each justification in turn, posits that often more than one justification applies to a given policy, and argues against frameworks that place disproportionate attention on conflicts between liberty and health. Keywords: public health policies, liberty, collective action, efficiency, fairness, harm principle, paternalism (p. 21) Introduction Public health as a social institution draws its foundational moral legitimacy from the essential and direct role that health plays in human flourishing, whether that role is ultimately understood in terms of maximizing health or of promoting health in order to advance a broad conception of social justice. As powerful as this general justification is, however, it is often too broad to provide sufficient moral warrant for specific public health policies and programs. In this chapter, we put forward five justifications for public health interventions, each of which speaks to a different set of reasons why any particular policy or program might be ethically appropriate: (1) overall benefit, (2) collective action and efficiency, (3) fairness in the distribution of burdens, (4) prevention of harm (the harm principle), and (5) paternalism. Two observations are worth making at the outset. First, public health policies are rarely defended by only one justification. Usually a mixed set of justifications can plausibly be provided. For example, tax policies intended to decrease cigarette consumption can be defended both by appeal to paternalism and by appeal to reducing the harms of second-hand smoke to children in the home and in automobiles. Second, the impact of a public health policy is often not uniform across all the individuals affected by the policy, and thus different justifications are sometimes put forward specific to these different people. This complexity is unavoidable, since it results from the nature of public health. The focus of public health is population health, but populations are rarely internally uniform with regard to all features that are morally relevant to any particular (p. 22) policy. Some people may stand to benefit from the policy, while others may not. Moreover, in line with concerns about democratic legitimacy and state overreaching, some members of the population may support the policy, while others may object. Consider, for example, a New York City policy prohibiting restaurants from serving sugar-sweetened beverages in containers holding over sixteen ounces, which was eventually struck down by the courts. Public opinion polling suggests that while more New Yorkers opposed the policy than supported it, the level of opposition varied from one borough of the city to another (Grynbaum and Connelly, 2012). The first three justifications for public health policies—overall benefit, collective action and efficiency, and fairness—speak specifically to the context in which some members of the affected population do not directly benefit from a policy or object to it. The next two justifications appeal to the significance of harm, both to others and to oneself. They apply more specifically to traditional concerns about balancing respect for liberty with advancing health, and are more prevalent in the public health ethics literature than the previous three. In the fourth justification, the argument is from a relatively uncontroversial Millian harm principle (Mill and Gray, 1998), while the fifth justification is from somewhat more tendentious paternalistic principles. Depending on the specifics of a public health policy, any number of these justifications may be applicable, and they are generally used to best effect in combination. The chapter closes with a look at the limits of frameworks that focus disproportionately on liberty considerations and at the importance of considering the range of possible moral justifications in analyzing public health policies. Overall Benefit Ultimately, all people benefit from public health interventions, and from having trusted regulatory agencies such as the US Centers for Disease Control and Prevention (CDC) or the Food and Drug Administration (FDA) make decisions about such interventions and their reach. All things considered, having public health regulation is better than not having it. Public health decisions made on the basis of overall statistics and demographic trends are ultimately better for each one of us, even if particular interventions may not directly benefit some of us. Thus, the task of public health ethics is not necessarily to justify each particular intervention directly. Rather, public health interventions in general, as long as they stay within certain pre-established parameters, can be justified in the same way a market economy, the institution of private property, or other similarly broad and useful conventions that involve some coercive action but also enable individuals to access greater benefits can be justified: when properly regulated and managed, their existence is by and large better than their absence for everyone. So structured, the justification for particular public health interventions, requirements, or restrictions is derivative of or parasitic on a higher-level justification. This argumentative strategy has a lot of appeal, particularly as a way of justifying the existence of (p. 23) regulatory government agencies such as the FDA or CDC. However, it is ultimately insufficient on its own and needs to be supplemented by other kinds of ethical arguments, since it does not provide a basis for the parameters themselves, or for ethical oversight or scrutiny with regard to the particular decisions such agencies take. This is similar to the case of the free market, in which it is by and large preferable to have free markets than to not have them, but this does not render specific aspects of the operations of markets immune to criticism and reform from an ethical point of view. Collective Action and Efficiency A related justification views health as a public good, the pursuit of which is not possible without ground rules for coordinated action and near-universal participation. Thus, public health is viewed as having the structure of a coordination or collective efficiency problem. If one person (or at least, a sufficient number of such persons) decides to go when the traffic light is red and stop when the traffic light is green, it does not matter that everyone else is following the rules: this person will disrupt the smooth functioning of the system, with potentially dangerous results. Similarly, if one person (or a sufficient critical mass of such persons) decides not to abide by a public health regulation because the regulation does not directly benefit that person, or because the person otherwise objects, the ramifications will likely be felt by others in her or his environment and beyond. A classic example is when an outbreak of measles can be traced to the intentional undervaccination of children by their parents (Omer et al., 2009; Sugerman et al., 2010; Thompson et al., 2007). Everybody has to participate because, failing their 96 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
involvement, neither they nor anyone else can reap the benefit of a healthy society. In many public health contexts, the only feasible or acceptably efficient way to implement a policy affects the entire population, leaving no option, or only very burdensome options, open to individual noncooperation. Perhaps the most celebrated such example is water fluoridation, but all safety regulations affecting the food and drug supply and consumer products share this character, as do many environmental and occupational health standards. Here, collective efficiency considerations loom large. Although people want healthy environments and products, individuals are simply not positioned to make independent decisions about the impact on health and safety of their environment and of the hundreds of thousands of products available in the modern marketplace. Ceding this function to government institutions staffed with health experts is prudent and essential to the general welfare and social justice in the same respect as ceding protection of our interests in personal physical security to government institutions staffed with law enforcement and national defense experts is prudent and essential to the general welfare (Mill and Gray, 1998). Collective efficiency arguments rely on claims about the sheer number and technical complexity of the decisions that need to be made to protect health in the environment and in the marketplace, as well as the indivisible character of responses to some health (p. 24) threats. These arguments are buttressed by claims about the cognitive limitations and bounded rationality of individual human decision-makers, and by the disproportionate political power of corporate interests and the practices they use to manipulate and exploit our cognitive weaknesses against our health interests (Ubel, 1999). Fairness in the Distribution of Burdens Yet another appeal that can be used to defend certain public health interventions that impose unequal burdens on different members of a population relies on considerations of fairness. The basic premise of this line of argument would be that burdens should be roughly equivalent for everyone. This view justifies taxing different income brackets at different rates. The same could be said for certain public health “burdens,” understood as both the burdens of disease and disability and the burdens of public health interventions. Based on considerations such as a particular group’s likelihood to contract a certain disease or overall health status, other parts of the population can legitimately be asked to “contribute,” as it were, in order to make the distribution of disease burdens more equitable. For example, part of the rationale for requiring child immunization prior to enrollment in school is that this is a way to ensure that low-income children, who are generally less healthy than other children, have access to the needed vaccines (Feudtner and Marcuse, 2001; Orenstein and Hinman, 1999). Perhaps a more pertinent example is Japan’s seasonal influenza immunization policy between 1962 and 1994, where children were immunized against influenza explicitly in order to protect the elderly, for whom contracting seasonal flu is more likely to be fatal, and immunization more likely to be burdensome (Reichert et al., 2001; Sugaya, 2014). Yet another example of public health interventions that appear to be guided by this justification is rubella vaccination of children for the sake of pregnant women and their offspring (Marin et al., 2010; Miller et al., 1997). This reasoning can help explain why individuals are sometimes asked to bear public health burdens that do not directly benefit them. However, as with the tax example, the question of how far we can go in redistributing health-related burdens will likely continue to plague any proponent of this justificatory strategy. Moreover, questions about the plausibility of viewing health-related burdens as subject to distribution in this manner may also arise.
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Governments empirically under-restrict, not over-restrict, rights Orzechowski et al 21 [Marcin Orzechowski, Medical Ethics @ Ulm University, Maximilian Schochow, Medical Ethics @ Ulm University, and Florian Steger, Medical Ethics @ Ulm University, “Balancing public health and civil liberties in times of pandemic,” Journal of Public Health Policy, https://link.springer.com/article/10.1057/s41271-020-00261- y#ethics] /Triumph Debate
These two examples highlight an ongoing concern among political commentators and scientists around the world: how far can governments go in using pandemic for their political advantage? [29, 30] Containing a pandemic sometimes requires drastic measures that go against the very core of civil liberties [31]. Compulsory quarantine, isolation, and social distancing serve the goal of decreasing the number of new infections. Such extreme means need to follow rigorous safeguards such as parliamentary and judicial oversight. Governments should not impose or remove strong infection control measures based on the political interests of the regime in control of the government, without scientific assessment of risks and effectiveness. For more than 2 months starting in March 2020, Poland experienced some of the most severe restrictions among European countries on freedom of movement, association or travel. For example, the government prohibited essential travel with exception of travel to work or to home. It also closed parks, forests, and boulevards. It obliged individuals walking in public to keep a distance of at least two meters. It prohibited minors from leaving their homes unaccompanied by a legal guardian. Although the infection rate in Poland still did not decreased substantially by mid of June 2020, the Polish Ministry of Health canceled most of the restrictions in the few weeks before the election day on 28 June 2020 (and then 12 July 2020). This allowed the government to argue that the situation is ‘back to normal’ and that nothing should stand in the way of holding the election. The right to vote is fundamental for any democratic system. It should not, however, take precedence over the protection of voters’ health. Numerous experts in Poland and around the world are concerned that holding elections during a pandemic can be dangerous for public health, especially if there are no scientific data showing it is safe to do so [32]. Public gatherings for political meetings are associated with risks for individuals’ health and thus should preclude candidates from conducting electoral campaigns. Observing rules of social distancing in polling stations may delay the process and prevent many voters from taking part in an election. Yet, the Polish government was reluctant to introduce a state of emergency, that would constitutionally permit postponing the vote until a later (and safer) date.
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Limiting religious exemptions is necessary to protect the public Ghedamu & Meier 19 [Tsion Berhane Ghedamu, Program Manager @ The Aspen Institute, and Benjamin Mason Meier, Global Health Policy @ The University of Chapel Hill, “Assessing National Public Health Law to Prevent Infectious Disease Outbreaks: Immunization Law as a Basis for Global Health Security,” Journal of Law, Medicine, and Ethics, https://pubmed.ncbi.nlm.nih.gov/31560619/] /Triumph Debate
Over the past decade, researchers in many parts of the world have recognized an increase in individual objections to vaccination.57 These increasing objections to vaccines, threatening herd immunity to diseases, has amplified the debate around exemptions to vaccination requirements. Throughout the world, exemptions to vaccinations are often permitted under law based on health reasons, religious beliefs, or philosophical objections.58 Almost all countries explicitly allow exemptions necessary for health, usually given to individuals who have suppressed immune systems, are allergic to the vaccine, or might have medical contraindications with the vaccine.59 Beyond medical exemptions, further exemptions may allow large populations to remain unimmunized, with higher exemption rates threatening higher disease risk.60 Because of this, laws will often allow the government to limit vaccination exemptions (other than health exemptions) in cases of public health emergencies, with individuals who object to vaccination during emergencies either quarantined or isolated to stop any spread of the disease. Sub-Saharan countries that were assessed in this study do not have broad exemption laws, and any permissible objections to vaccinations were connected to health exemptions. Both Kenya61 and Ghana62 have laws that allow exemptions from vaccination mandates, but only based on a certificate given to them by a provider that states the adult or child is not fit to be vaccinated. While limiting individual freedom of choice, these limited exemptions to vaccination mandates serve to protect the public by supporting herd immunity against infectious disease.
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Negative Evidence
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*Classism Quarantines and travel advisories have historically misused due to a lack of good data and communication. This means that the burden of containment falls increasingly on a few, as opposed to allowing for a greater distribution of the burden Kapiriri & Ross 20 [Lydia Kapiriri, associate professor in McMaster’s Department of Health, Aging and Society, & Alison Ross, Professor in the Centre for Health Sciences at George Brown College, 2020, “The Politics of Disease Epidemics: a Comparative Analysis of the SARS, Zika, and Ebola Outbreaks”, Global Social Welfare, https://doi.org/10.1007/s40609-018-0123-y] /Triumph Debate
The use of quarantine as a control measure, although considered to be highly effective, is controversial. A telephone-based survey in the Greater Toronto Area aiming to ascertain public perceptions of the use of quarantine found that while quarantine was perceived to be a necessary and effective strategy, its ethical implementation should involve the collaboration of policy-makers, public health organizations, and the general population, and should be closely regulated to ensure appropriate use and protection of individual rights (Tracy et al. 2009). Despite these recommendations, Toronto quarantined significantly more people during the SARS outbreak compared to the other affected cities, including Hong Kong and Shanghai (Jacobs 2007). Given the reported psychological distress reported by those quarantined, Toronto might have considered other strategies, such as the use of face masks to better “distribute the burden of containment measures” (Jacob, 2007, p. 532). Critics note that the extensive quarantining in Toronto lacked proper policies and procedures to guide its implementation (Jacobs 2007). Others highlight a lack of public record detailing any consultation between public health officials and the Ontario Human Rights Commission (Jacobs 2007). There was little public scrutiny, which was suggested to be the result of effective conditioning of the public consciousness to believe that quarantining recommendations would be made fairly and legitimately by senior public health officials (Jacobs 2007). Ultimately, it was not quarantining that was problematic, but the lack of apparent or sufficient evidence to guide its implementation. Beyond extensive quarantining, The World Health Organization issued travel-advisories as an additional control measure to contain further national and international spread of SARS from Toronto (Paquin 2007). This travel-advisory cost Toronto $1.1 billion and restricted the international right for freedom of movement (Paquin 2007). Paquin (2009) criticizes these travel-advisories for various reasons. For example, the advisories were not made by the WHO in consultation with Toronto authorities and led to an uneven global distribution of the burden of SARS (Paquin 2007). Furthermore, the travel advisories were based on old data resulting from delayed communication between the federal government of Canada and the WHO, as information had to first travel from municipal to provincial to federal health authorities (Paquin 2007). Once again, the evidence used to inform the response was outdated and therefore considered unjustified. As such, there were problems with both the lack of quality evidence and the travel advisory as a response. Quarantining and travel advisories reflect the profound ethical and political implications inherent in responding to infectious disease outbreaks. The evidence on the efficacy of the two primary responses—quarantining and travel advisories—was inadequate to justify the extent of their implementation.
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Reactions by governments are tainted by class and cultural barriers, resulting in less action when the individuals impacted have lesser class privilege. Those actions which are taken ultimately disempower them further, as they target cultural practices Kapiriri & Ross 20 [Lydia Kapiriri, associate professor in McMaster’s Department of Health, Aging and Society, & Alison Ross, Professor in the Centre for Health Sciences at George Brown College, 2020, “The Politics of Disease Epidemics: a Comparative Analysis of the SARS, Zika, and Ebola Outbreaks”, Global Social Welfare, https://doi.org/10.1007/s40609-018-0123-y] /Triumph Debate
A case-specific review of the literature has demonstrated the influence of power and privilege on the experience of an epidemic. In the case of Zika in Brazil, the communities most vulnerable to the virus are those with insufficient resources and infrastructure (Plourde and Bloch 2016). Consequently, Zika has been socially distributed to exacerbate conditions of poverty. However, the voices of these most affected people are drowned out by more powerful and prestigious groups. This is seen in the comparison that Lotufo (2016) makes between the politics of HIV/AIDS and the politics of Zika (Lotufo 2016). HIV/AIDS research in Brazil procured greater funding because those affected tended to be very notable Brazilians with more dominant social and politics voices (Lotufo 2016). The same pattern was reported in relationship to the Ebola outbreak in Liberia, where weak public health infrastructure aggravated Liberian experiences of Ebola (Burkle and Burkle 2015; McNamara 2016; Maras and Miranda 2016; Scott et al. 2016), while interventions targeted cultural practices, ultimately disempowering the economically disadvantaged (Garbuglia 2016). This review found that infectious disease outbreaks disproportionately affect the poor, specifically communities with poor physical infrastructure and limited access to quality public health services. The link between income and politics of epidemics has been discussed in the social science literature, where poverty is perceived to be the greatest risk factor. For example, Farmer (1996) argued that disease outbreaks, e.g., Ebola systematically affecting poor people and are tied to regional trade networks (Alsan et al. 2011). Building on this literature, Marcella (2011) uses the term structural violence to highlight the institutional biases, inequalities, and economic policies that emanate from global centers of power and privilege, which tend to marginalize poor people during outbreaks (Leach et al. 2010). These linkages highlight social and economic inequalities (within communities, societies and countries), which are complex and often ignored by the medical (and political) communities (Alsan et al. 2011; Leach et al. 2010). Indeed, some of the narratives criticized the (epidemiological) evidence, which tends to overlook the role of poverty in the facilitation of disease spread. For instance, focusing on pregnancy in the case of Zika in Brazil was criticized for overlooking the conditions of poverty that might also/instead be responsible for the spike in cases of microcephaly (Diniz 2016). Furthermore, responding to Ebola in Liberia with developmental aid that is not designed for contexts with insufficient infrastructure was criticized again for overlooking the role of poverty (Nunes 2016). This limited focus on the role of poverty in the peer-reviewed medical literature calls into question the politics of the research process itself. For example, what institutions are funding the research and what are the interests of the stakeholders in the research process? Who gets funding to conduct the research? What are the advantages of overlooking poverty for those producing the evidence? By disregarding the role of poverty and income inequality, epidemic responses will remain insufficient, and may, instead worsen the situation of poor populations (Mykhalovskiy and Weir 2005). Perhaps poverty remains unaddressed in epidemic responses as its origins in a neoliberalist society feel too deep to uproot.
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Technological Innovation in disease research will widen health inequality Arcaya, and Figueroa 17 [Mariana C. Arcaya, assistant professor of urban planning and public health in the Department of Urban Studies and Planning, Massachusetts Institute of Technology, and José F. Figueroa, instructor of medicine at Harvard Medical School and an associate physician in the Department of Medicine, Brigham and Women’s Hospital, June 2017, “Emerging Trends Could Exacerbate Health Inequities In The United States,” Health Affairs, vol. 36, no. 6, pp. 992–98, healthaffairs.org (Atypon), doi:10.1377/hlthaff.2017.0011] /Triumph Debate
Technological progress against diseases—for example, in the form of new drugs, diagnostics, or devices—can widen disparities in the likelihood of survival between patients with high versus low socioeconomic status. 9,10 Personalized medicine (also known as precision or genomic medicine) uses information about a person’s genome to diagnose and treat disease, and it will likely deliver breakthroughs in clinical care 11 that disproportionately benefit privileged groups. This is the case for several reasons: First, racial and ethnic minority populations are underrepresented in the foundational studies that undergird translational research efforts in personalized medicine, 12,13 which means that technological advances may be less effective in meeting the needs of these populations. Second, the cost of precision medicine 14 is likely to limit access for poorer patients. Finally, enthusiasm for personalized medicine itself may be a threat to health equity, with investment in genomic research crowding out funding to address the social determinants of health disparities. 15 Similarly, health technologies such as telehealth or wearable devices that monitor physical activity, diet, sleep, and vital signs threaten to unevenly benefit patients with high socioeconomic status. Hospitals that disproportionately serve minority populations—which already provide lower-quality care, compared to hospitals serving fewer minorities 16 —face greater challenges in adopting health information technology (IT) than do high- performing, well-resourced academic medical centers. 17 At the patient level, expensive wearable devices have become common among wealthier and healthier patients, 18 although evidence on the benefits of wearable devices remains mixed. 19,20 Seniors, adults with low education, and the poor are less likely to have access to IT and the Internet (a phenomenon known as the digital divide 21 ), which suggests that these groups may be the first to fall behind as wearables and other health technologies become more sophisticated and actually lead to better health.
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Low-income individuals are more likely to experience job loss during an outbreak Parker et al 20 [KIM PARKER, director of social trends research at Pew Research Center, RACHEL MINKIN, research associate focusing on social and demographic trends research at Pew Research Center, AND JESSE BENNETT, research assistant focusing on social and demographic trends research at Pew Research Center, Sept. 2020, “Economic Fallout From COVID-19 Continues To Hit Lower-Income Americans the Hardest,” Pew Research Center’s Social & Demographic Trends Project, 24, https://www.pewresearch.org/social-trends/2020/09/24/economic-fallout-from-covid-19-continues- to-hit-lower-income-americans-the-hardest/] /Triumph Debate
It’s been roughly six months since the coronavirus outbreak sent shockwaves through the U.S. economy. While the labor market has recovered somewhat and early stock market losses have been reversed, many Americans continue to face deep financial hardship. Financial pain points during coronavirus outbreak differ widely by race, ethnicity and income A new Pew Research Center survey finds that, overall, one-in-four adults have had trouble paying their bills since the coronavirus outbreak started, a third have dipped into savings or retirement accounts to make ends meet, and about one-in-six have borrowed money from friends or family or gotten food from a food bank. As was the case earlier this year, these types of experiences continue to be more common among adults with lower incomes, those without a college degree and Black and Hispanic Americans. Among lower-income adults, 46% say they have had trouble paying their bills since the pandemic started and roughly one third (32%) say it’s been hard for them to make rent or mortgage payments. About one-in-five or fewer middle-income adults have faced these challenges, and the shares are substantially smaller for those in the upper-income tier.1 To be sure, some of these financial pain points may have existed even before the pandemic – particularly for lower-income adults. Job loss has also been more acute among certain demographic groups. Overall, 25% of U.S. adults say they or someone in their household was laid off or lost their job because of the coronavirus outbreak, with 15% saying this happened to them personally. Young adults (ages 18 to 29) and lower-income adults are among the most likely to say this has occurred in their household. Of those who say they personally lost a job, half say they are still unemployed, a third have returned to their old job and 15% are in a different job than before. Lower-income adults who were laid off due to the coronavirus are less likely to be working now than middle- and upper-income adults who lost their jobs (43% vs. 58%). Adults ages 18 to 29 are less likely than those 30 to 64 to have returned to their previous job. Financial hardship much more pronounced among those who’ve lost a job or wages Even if they didn’t lose a job, many workers have had to reduce their hours or take a pay cut due to the economic fallout from the pandemic. About a third of all adults (32%) say this has happened to them or someone in their household, with 21% saying this happened to them personally. Most workers who’ve experienced this (60%) are earning less now than they were before the coronavirus outbreak, while 34% say they are earning the same now as they were before the outbreak and only 6% say they are earning more. Job disruption, which has been much more pronounced among certain demographic groups, is strongly linked to financial struggles. Americans who have experienced job or wage loss – either personally or in their household – are more than twice as likely as those who have not to say they’ve had trouble paying their bills, struggled to pay their rent or mortgage, used money from savings or retirement to pay bills or borrowed money from friends or family. In the meantime, many Americans say their ability to save money has been curtailed by the recent economic upheaval. Among those who indicate they are usually able to put money into savings, 36% say they’ve been saving less since the coronavirus outbreak started. Some 44% say they’ve been saving the same amount as they did before, and 19% say they’ve been saving more. Again, lower-income adults have been hardest hit – 51% among those who can typically save say they have been able to save less in recent months. By comparison, 35% of middle-income adults and 21% of those in the upper-income tier say they’ve been saving less. These are among the findings of a Pew Research Center survey of 13,200 U.S. adults conducted from Aug. 3-16, 2020, using the Center’s American Trends Panel.2 One-third of adults who said they were laid off because of the coronavirus outbreak are back in their old jobs Roughly four-in-ten adults say they or someone in their household lost a job or wages because of COVID-19 A quarter of U.S. adults say they or someone in their household has been laid off or lost a job because of the coronavirus outbreak, and 32% say they or someone else in their household has taken a pay cut due to reduced hours or demand for their work. Overall, 42% say their household has experienced one or both of these. These figures are largely unchanged from when Pew Research Center last asked these questions in early May. Lower-income adults continue to be the most affected by coronavirus-related job loss or pay cuts. Some 47% of those with lower incomes say they or someone in their household has had these experiences, compared with 42% of those with middle incomes and 32% of upper-income adults. These experiences also vary by age, with adults younger than 30 more likely than those who are older to say they or someone else in their household has been laid off or taken a pay cut because of the outbreak: 54% of adults ages 18 to 29 say their household has had one or both of these experiences, compared with 48% of those ages 30 to 49, 40% of those 50 to 64 and 21% of adults ages 65 and older. Among Hispanic Americans, 53% say they or someone else in their household have either been laid off or taken a pay cut because of the coronavirus outbreak, larger than the shares of White (38%) and Black (43%) adults who say the same; 47% of Asian Americans say they or someone else in their household has been laid off or taken a pay cut because of the outbreak. Half of adults who say they were laid off because of the coronavirus outbreak remain unemployed Younger adults laid off because of the outbreak are more likely to be in a new job than their older counterparts Fully 15% of adults report that they personally were laid off or lost their jobs because of the coronavirus outbreak. Of 105 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
those, one-third say they have returned to the job they had before the outbreak, while 15% are working at a different job. Half say they are currently not employed. Lower-income adults who lost their job because of the coronavirus outbreak are more likely than those with middle or upper incomes to remain unemployed. Some 56% of workers with lower incomes who lost their job because of the coronavirus outbreak say they are currently unemployed, compared with 42% of middle- and upper-income adults. 3 Among lower-income adults who were laid off because of the outbreak, 24% say they are now back at their old job and 18% are working in a different job. In turn, those with middle and upper incomes who lost their job are far more likely to be back in the same job (42%) than to be in a different job (13%).
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Low-income workers are 6 times less likely to be able to telework, resulting social distancing and lockdowns increasing economic harm on poorer communities Ross and Kinder 20 [Molly Kinder, David M. Rubenstein Fellow at the Brookings Metropolitan Policy Program and Martha Ross, Senior Fellow at the Brookings Metropolitan Policy Program, 23 June 2020, “Reopening America: Low- Wage Workers Have Suffered Badly from COVID-19 so Policymakers Should Focus on Equity,” Brookings, https://www.brookings.edu/research/reopening-america-low-wage-workers-have-suffered-badly-from-covid-19-so- policymakers-should-focus-on-equity/] Triumph Debate
Faced with the staggering economic fallout of the COVID-19 pandemic, state and local leaders are exploring how and when to lift stay-at-home orders and reopen local economies. Unemployment rates have skyrocketed and job losses rival those of the Great Depression. Leaders are also confronting the health risks that reopening poses for workers, their families, and the community— risks exacerbated by inadequate testing, shortages of personal protective equipment (PPE), weak enforcement of workplace safety standards, and no readily available treatment or vaccine. The rising death toll of essential workers such as nurses, bus drivers, and grocery workers is a grave reminder of what is at stake in these decisions. As leaders across the country seek opportunities to put laid-off workers back to work, their decisions will have an outsized impact on lowwage workers and people of color, who shoulder some of the most severe financial and health burdens associated with the coronavirus and will be some of the first workers called back to the job site. Leaders must create the conditions for a more equitable next phase of the pandemic so that low-income and minority workers are not forced to make an impossible choice between surviving financially or surviving the virus. Molly Kinder Molly Kinder David M. Rubenstein Fellow - Metropolitan Policy Program MollyKinder Martha Ross Martha Ross Senior Fellow - Metropolitan Policy Program marthahross COVID-19 JOB LOSSES HIT LOW-WAGE WORKERS AND PEOPLE OF COLOR THE HARDEST Low-wage workers in America have suffered the worst economic pain of the pandemic. Social distancing measures taken in response to COVID-19 resulted in massive job loss concentrated among lower-wage workers. Retail and leisure/hospitality, which typically offer lower wages than other industries, took the hardest hits. In April, retail posted a 17.1 percent unemployment rate, totaling 3.2 million people. In leisure/hospitality, the unemployment rate was a staggering 39.3 percent, totaling 4.8 million people. Workers with the least education have suffered the most. In April, unemployment rose to 21.2 percent for those with less than a high school degree— more than twice as high as the 8.4 percent unemployment rate for those with a bachelor’s degree or higher. Financial shocks and unemployment are widespread, but Black and Latino or Hispanic workers are disproportionately affected. One of the reasons low-wage workers have suffered disproportionate job losses is their limited ability to telework. Low-wage workers are six times less likely to be able to work from home than high-income workers. Fewer than 10 percent 31 of leisure and hospitality workers can telework, while a majority of workers in higher-paid fields such as the finance, business, professional, and information sectors can. The vast majority of workers who held jobs just a few weeks ago in restaurants, bars, gyms, salons, movie theaters, and malls could not perform those jobs from home once the pandemic started and were laid off as social distancing requirements caused many of those establishments to close. Low-wage workers in America have suffered the worst economic pain of the pandemic. Social distancing measures taken in response to COVID-19 resulted in massive job loss concentrated among lower-wage workers. As cities and regions across the country start to reopen businesses, millions of laid-off, low-wage workers face a dual dilemma. To earn a paycheck, the vast majority will have to show up physically to work, risking exposure to the coronavirus. But their pay could be less than the already low wages they earned before, and even less than what they were collecting through enhanced unemployment insurance at the beginning of the pandemic. Servers may return to half-empty restaurants and far smaller tips, for instance, and hours for low-paid retail and leisure workers may be cut. As their eligibility for unemployment benefits expires, many may find themselves in the difficult position of choosing between their health and their (potentially even smaller) paychecks.
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Income is related to the ease and extent to which people social distance Papageorge et al 21 [Nicholas W Papageorge, Broadus Mitchell Associate Professor of Economics at Johns Hopkins University, Matthew V Zahn, Ph.D. candidate in the Economics Department at Johns Hopkins University, Michèle Belot, Professor of Economics at Department of Economics, Cornell University and IZA, Eline van den Broek-Altenburg, Assistant Professor of Radiology and Vice-Chair for Population Health Science at the University of Vermont Medical Center, Syngjoo Choi, Professor, Department of Economics, Seoul National University, Julian C. Jamison, Professor of Economics at the University of Exeter & Egon Tripodi, Assistant Professor of Economics at the University of Essex, Apr. 2021, “Socio-Demographic Factors Associated with Self-Protecting Behavior during the Covid-19 Pandemic,” Journal of Population Economics, vol. 34, no. 2, pp. 691–738. Springer Link, doi:10.1007/s00148-020-00818-x] /Triumph Debate
Table 5 Difference in means by characteristic for increased social distancing Full size table For our main analysis, we examine three outcomes: any behavior change, social distancing, and mask wearing or hand washing. As mentioned earlier, while we examine three different outcomes, we are testing one main hypothesis: whether socio-demographic factors predict the adoption of self-protective behaviors. We view using three measures of behavior as important. First, each of these behaviors impose a different cost for individuals. Different types of people may be more responsive to low- cost behaviors such as changing behaviors or hand washing-mask wearing as opposed to more costly behaviors such as social distancing. Second, as these behaviors are correlated with one another, common findings across each of these behaviors serves as a form of robustness for the demographic patterns we identify. For each outcome, we estimate linear probability models as a function of income and different sets of explanatory variables. We use heteroskedastic robust standard errors. Our main findings are summarized in Table 6. We discuss these results and other findings in greater detail in the following subsections. In general, we find that income, work arrangements such as tele-working, lost income and beliefs about the effectiveness of social distancing are significantly associated with the self-protective measures we examine. Detailed results are presented in Tables 7, 8 and 9 in the Appendix. In each table, all columns include income quintiles as explanatory variables. Column (1) includes only income, column (2) adds in socio- demographic characteristics, column (3) adds in pre-existing health conditions, column (4) brings in housing characteristics, column (5) introduces work arrangements and economic loss characteristics, and column (6) adds in beliefs about social distancing and local infection rates and perceived benefits from the pandemic. Finally, in column (7) we include all of these sets of controls in a single specification. We will discuss each of these columns in the following subsections.Footnote20 Table 6 Summary of factors associated with self-protective behaviors Full size table Income Across all three of our dependent variables we find strong, statistically significant associations with income. Higher income individuals are more likely to engage in the behaviors we examine. To fix ideas, relative to the first income quintile, a member of the fifth income quintile is 10–15 percentage points more likely to change their behaviors, 11–24 percentage points more likely to increase social distancing behaviors, and 17–25 percentage points more likely to increase hand washing or mask wearing. Put another way, when all controls are included, a member of the fifth income quintile is 13% more likely to change their behaviors, 32% more likely to increase social distancing and 30% more likely to increase hand washing or mask wearing. We find that these income effects are fairly robust to the inclusion of controls. From the baseline to the case where we include all of our controls, the size of the coefficient estimates remain fairly stable as we add additional variables, which means that these other factors do not fully explain the income gradient. The slight exception is for the increased social distancing outcome. When all of our controls are added, we only see a significant difference between the fifth and the first income quintiles, suggesting that our explanatory variables help to explain the relationship between income and what appears to be the a costly self-protective measure. In general, the income gradients presented here strongly suggest that the adoption of self-protective behaviors is a costly prospect, one that is easier for people with more income. While providing cash transfer could help, the income gradients alone do not provide very much policy guidance. Thus, we now consider whether additional factors associated with self-protective behavior adoption. Gender, age, race and location The next set of control variables we examine are gender, age, race and state. We do not find many significant associations between these factors and the change behaviors outcome. In the baseline case we see negative associations between males, people 56 years or older, and some regional effects. Some of these relationships lose significance when other variables are added to the analysis, though we find more robust patterns when examining increases in social distancing behavior. We find strong negative associations between males, and respondents from Florida and Texas, which maintain significance once other controls are added. To fix ideas, we find that males are 23% less likely than females to increase social distancing. This could be evidence that the pandemic is driving women into “traditional” care taker roles—staying at home to maintain the household—while males continue to work in person and are unable to adopt social distancing behaviors. Similarly, we find that relative to respondents from California, people in Texas and Florida tended to be 21% and 22% less likely to increase social distancing, respectively. These results may presage the surges in Covid-19 cases that happened in these two states that began towards the end of June 2020. This finding complements recent work that has found a significant relationship between political affiliation and beliefs about the Covid-19 pandemic and the adoption of social distancing behaviors. These are states led by governors who were less responsive to the outbreak of the pandemic, which may have had an influence on behavior. Finally, we find positive significant associations between race and people 56 years or older for the hand washing-mask wearing outcome. Specifically, we find that Black respondents are 19% more likely than white respondents to increase hand washing or mask wearing.Footnote21 We find a similarly sized relationship for those 56 years or older. It is interesting that find these effects for increased hand washing or mask wearing. This may reflect the fact that of the three activities we examine, this one is a relatively low-cost way to self- protect for people who face risks, but are unable to engage in higher cost, less practical activities, such as social distancing. Health We also examine various pre- existing health conditions, including diabetes, high blood pressure, heart disease, asthma, allergies, and other conditions. Overall, and surprisingly, these variables are not strongly correlated to behavior change. Oddly, we find a strong negative association between heart disease and increased social distancing, which may reflect that people with heart disease are generally unhealthy and thus less likely to engage in self-protective behaviors. Yet, it is surprising that health conditions more 108 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
strongly associated with serious illness (e.g., diabetes, asthma, or high blood pressure) are not associated with behavior change. An exception is that we find a robust significant association between allergies and increases in hand washing and mask wearing. Allergies would presumably be less likely to be associated with unobserved factors capturing an unwillingness or inability to engage in self-protective behaviors. Another possibility that people with allergies could feel they are becoming ill even if they are not and thus be more willing to take precautions. More generally, the lack of a health gradient could be a byproduct of our non-representative sample. As mentioned previously, pre-existing conditions were not targeted for representativeness either in the data collection process. As our understanding of Covid-19 grows, future data collection efforts may want to target specific health conditions to determine if an association with self-protective behaviors exists. Housing Next we examine housing characteristics. We find a negative significant relationship between respondents in the countryside and changing behaviors but this association becomes indistinguishable from zero as other controls are added. We find a robust negative association for having no access to open air space at home and increased social distancing behavior. In our full control case, we find that respondents that live in homes without open air access are 20% less likely to increase social distancing behaviors. We find this to be an intuitive result. People who are more comfortable sheltering-in-place are more likely to do it. Policies aiming to slow the pandemic should take these factors into account as they suggest cramped and uncomfortable housing can potentially undermine efforts to “flatten the curve.” This result could also guide the design of future housing policy as government prepare for future pandemics. For example, communities could increase the size and availability of public parks to accommodate social distancing. Governments could also prioritize the opening of parks or other open public spaces during a pandemic, though of course the risks in terms of increased exposure would need to be weighed against the benefits in terms of higher rates of social distancing among low- income people. Another, longer run possibility would be to incorporate some open air spaces such as balconies or community gardens into the designs for public housing, which would help facilitate social distancing behavior. Finally, we find similar patterns for the two other outcome variables, though estimates are less precise in the final specification. Work arrangements and losses We also consider work arrangements and economic losses. In general we find fairly consistent results across all three of our outcome variables. People who transitioned into tele-working are more likely to change behaviors, increase social distancing, and increase hand washing-mask wearing. This association ranges from roughly 9–15 percentage points relative to somebody who continued to work. When all controls are included, a person that transitions to tele-work is 20 to 28% more likely to increase these self-protective behaviors. This effect is robust to the inclusion of other controls. We find a similarly sized effect for those that stopped working or never worked but significance was retained with less consistency. This result is intuitive. People who can work from home are more likely to abide by stay at home orders. Factors related to work arrangements, which vary across socio-demographic groups, can determine the sustainability and effectiveness of policies aiming to prevent the spread of illness.
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The benefits of social distancing are significantly lower in poor countries given the economic burden Barnett-Howell and Mobarak 20 [Zachary Barnett-Howell, lecturer at Yale; Ph.D.: University of Wisconsin, Madison Ahmed Mushfiq Mobarak, PhD and an MA from the University of Maryland at College Park and a BA from Macalester College, April 2, 2020, “Should Low-Income Countries Impose the Same Social Distancing Guidelines as Europe and North America to Halt the Spread of COVID-19?” Yale School of Management, https://som.yale.edu/sites/default/files/mushifiq-howell-v2.pdf] /Triumph Debate
Social distancing has become the primary policy prescription for combating the COVID-19 pandemic, and has been widely adopted in Europe and North America. We combine country-specifi c economic estimates of the benefi ts of disease avoidance with an epidemiological model that projects the spread of COVID-19 to analyze whether the benefi ts of social distancing and suppression varies across rich and poor countries. This modeling exercise yields the following key insights: 1. Populations in rich countries tend to skew older, and COVID-19 mortality effects are therefore predicted to be much larger there than in poor countries, even after accounting for differences in health system capacity. 2. Social distancing measures are predicted to save a large number of lives in high-income countries, to the extent that practically any economic cost of distancing is worth bearing. The economic value generated by equally effective social distancing policies is estimated to be 240 times larger for the United States, or 70 times larger for Germany, compared to the value created in Pakistan or Nigeria. The value of benefi ts estimated for each country translates to a savings of 59% of US GDP, 85% of German GDP, but only 14% of Bangladesh’s GDP or 19% of India’s. 3. The much lower estimated benefi ts of social distancing and social suppression in low-income countries are driven by three critical factors: (a) Developing countries have smaller proportions of elderly people to save via social distancing compared to low-fertility rich nations. (b) Social distancing saves lives in rich countries by fl attening the curve of infections, to reduce pressure on health systems. Delaying infections is not as useful in countries where the limited number of hospital beds and ventilators are already overwhelmed and not accessible to most. (c) Social distancing lowers disease risk by limiting people’s economic opportunities. Poorer people are naturally less willing to make those economic sacrifi ces. They place relatively greater value on their livelihood concerns compared to concerns about contracting coronavirus. Not only are the epidemiological and economic benefi ts of social distancing much smaller in poorer countries, such policies may also exact a heavy toll on the poorest and most vulnerable. Workers in the informal sector lack the resources and social protections to isolate themselves from others and sacrifi ce economic opportunities until the virus passes. By limiting their ability to earn a living, social distancing can lead to an increase in hunger, deprivation, and related mortality and morbidity in poor countries. Flattening the epidemiological curve of COVID-19 to buy time until a vaccine can be developed may not be very useful for poor countries if the timeline for vaccine development is too long for social distancing to be maintained. Poorer countries also have limited capacity to enforce distancing guidelines, and lock-downs may have counterproductive effects if it forces informal sector workers and migrants to reverse-migrate from densely-populated urban areas and spread the disease to remote rural areas of poor countries. It is imperative that the source code for infl uential epidemiological models (on which the widely-adopted social distancing guidelines are based) are made publicly accessible, so that social scientists can explore the sensitivity of benefi t estimates to changes in assumptions about compliance with distancing guidelines or the baseline prevalence of co-morbidities, chronic illnesses or malnutrition that make COVID-19 infections more deadly. Not accounting for co-morbidities, or the greater pollution in poorer countries is an important limitation of these projections. Publicizing code would also allow the research community to quantitatively explore the costs and benefi ts of alternative harm-reduction measures that better allow poor people to sustain themselves economically while reducing COVID-19 related mortality to the greatest possible extent: 1. Masks and home-made face coverings are comparatively cheap. A universal mask wearing requirement when workers leave their homes is likely feasible for almost all countries to implement. 2. Targeted social isolation of the elderly and other at-risk groups, while permitting productive individuals with lower risk profi les to continue working. Given the prevalence of multi-generational households, this would likely require us to rely on families to make decisions to protect vulnerable members within each household. 3. Improving access to clean water, hand-washing and sanitation, and other policies to decrease the viral load. 4. Widespread social infl uence and information campaigns to encourage behaviors that slow the spread of disease, but do not undermine economic livelihoods. This could include restrictions on the size of religious and social congregations, or programs to encourage community and religious leaders to endorse safer behaviors and communicate them clearly
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Blanket lockdowns fail in developing countries due to a lack of financial capabilities and the issues within their labor market. Targeted support for vulnerable populations is preferable Alon et al 20 [Titan Alon, Assistant Professor of Economics at the University of California San Diego, Minki Kim, fourth- year PhD candidate in Economics at University of California, San Diego, David Lagakos, associate professor of economics at Boston University, Mitchell VanVuren, PhD candidate in economics at University of California San Diego, 26 June 2020, “Lockdowns in Developing Countries Should Focus on Shielding the Elderly,” VoxEU.Org, https://voxeu.org/article/lockdowns-developing-countries-should-focus-shielding-elderly/] /Triumph Debate
We simulate a variety of different lockdown scenarios in advanced and developing countries and analyse the effect on both lives and livelihoods by calculating the impact on welfare, GDP, and deaths per 100,000 people. We simulate lockdowns that apply to the entire population, which we refer to as blanket lockdowns, as well lockdowns that allow the young population to work while requiring only the older population remain at home. We refer to these latter regimes as age-targeted policies, following Acemoglu et al. (2020) and Bairoliya and İmrohoroğlu (2020), who explore age-targeted policies in the United States. The first takeaway from our analysis is that blanket lockdowns are less effective in developing countries both at preventing the outbreak of disease (i.e. ‘flattening the curve’) and at saving lives. Due to low fiscal capacity, developing countries can only provide small transfers to help replace income lost during lockdown. As a result, many workers turn to the informal sector to make up the income difference and so continue to spread the disease. Consequently, a 28-week blanket lockdown in a developing country saves about 70 lives per 100,000 people, while the same lockdown in an advanced country saves about 320. Blanket lockdowns are also less efficient in developing countries as measured by lives saved per unit of lost GDP. For instance, a 28-week blanket lockdown saves 320 lives per 100,000 people in advanced economies and reduces GDP by 16%, resulting in about 20 lives saved per 100,000 people for each unit of GDP. The same policy in developing economies saves only about 10 lives per 100,000 people for each unit of GDP lost. In other words, saving a given number of lives costs more output in developing countries under blanket lockdowns. The second takeaway is that age-targeted policies are more potent in developing countries. Table 1 displays the potency of blanket and age-targeted policies for both the advanced and developing economies according to our simulations. For each unit of lost GDP, an age-targeted policy saves 95 lives per 100,000 people in the developing economy. This is roughly 10 times more than a blanket lockdown. Additionally, unlike blanket lockdowns, the age-targeted policy saves more lives per unit of GDP in the developing economy than in the advanced economy. Table 1 Lives saved per 100,000 people per unit of GDP lost Why are age- targeted policies so much more effective in developing economies? The answer stems from their dramatically younger populations, and how age-targeted policies leverage this demographic difference to mitigate the deleterious effects of weaker fiscal capacity and widespread labour market informality. Weak fiscal capacity normally constrains the ability of developing countries to provide sufficiently large transfers to keep workers out of the informal sector, where they continue to spread the disease. However, the vulnerable old population is sufficiently small that large enough transfers can be sustained to keep them from turning to the informal sector. Since the risks of COVID-19 increase dramatically with age, encouraging compliance among the most vulnerable elderly population proves especially effective at reducing mortality during the pandemic. Conclusions Developing countries face a unique set of challenges that limit the effectiveness of the blanket lockdowns adopted by the west. Our analysis suggests that the weaker fiscal capacity and widespread labour market informality in developing countries pose especially salient challenges in implementing blanket lockdowns successfully. Age-targeted lockdown policies – which focus on shielding elderly populations – appear to be a much more effective option for developing economies, as they leverage their younger and less-susceptible populations to focus limited resources on the most vulnerable parts of their populations.
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Lack of digital technology in developing countries limits the effectiveness of digital contact tracing Gasser et al 20 [Gasser, Urs, Executive Director of the Berkman Klein Center for Internet & Society at Harvard University and a Professor of Practice at Harvard Law School, Marcello Lenca, Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland, James Scheibner, Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland, Joanna Sleigh, Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland, and Effy Vay, Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich 8092, Switzerland, June 29 2020, “Digital tools against COVID-19: taxonomy, ethical challenges, and navigation aid,” The Lancet, https://www.thelancet.com/journals/landig/article/PIIS2589- 7500(20)30137-0/fulltext/] /Triumph Debate
Digital technology, particularly mobile phone technology, is increasingly widespread globally but unevenly distributed. In 2019, two-thirds of the world's population did not own smart phone technology, and one-third did not own any mobile phone. Smart phone ownership disparities are particularly noticeable in emerging economies. For instance, in India, the world's second most populous country accounting for more than 17% of the global population, only 24% of adults report owning a smart phone.42 Even in advanced economies with high smart phone ownership rates, not all age cohorts are catching up with digital tools. In 2018, most citizens of Japan, Italy, and Canada older than 50 years did not own a smart phone.42 In addition, not all smart phones have the technology built in that is necessary to support certain functions, such as proximal location sensing.43 Any digital public health technology solution that relies on mobile phones excludes those without access to these technologies for geographical, economic, or demographic reasons, as well as a broad range of already marginalised groups. If not complemented with non-digital strategies, the risk of exclusion of marginalised groups might exacerbate health inequalities. When addressing these challenges, researchers and policy makers might face conflicts between different ethical values. In public health ethics, there is a continuing tension between public benefit and individual rights and civil liberties.44 This tension mirrors an underlying conflict between personal autonomy (ie, protecting personal freedom) and beneficence (ie, maximising public benefit) and has already emerged in the ongoing COVID-19 pandemic as public-benefit-motivated lockdown measures have caused a temporary restriction to individual freedoms in the name of the public good. These include freedom of movement, freedom of assembly, and entrepreneurial freedom.45 Digital public health technologies generate a similar tension with rights and freedoms, especially the rights to privacy and informational self-determination. Since these technologies require high uptake and massive and ubiquitous data availability to be effective, their successful deployment for the public good might conflict with the protection of private information of users (eg, their serological status, health records, geolocation, proximity, voice records, pedometrics and other activity data, data upload, and download transmission, etc). Risks for individual rights are also raised by a temporal factor—namely the urgent need to mitigate the pandemic. Software, application programming interfaces, and other digital tools require time to be developed in a privacy-preserving manner, and to be adequately validated via rigorous beta testing and pen testing. Given the immense time pressures under which global actors are operating, it is reasonable to expect that some of them will roll out tools without the necessary validation, and hence they won't be able to prevent misconfigurations, software bugs, and other errors that can jeopardise individual and collective privacy. To offset this risk of infringing individual rights, there must be a framework for deciding what public benefit is appropriate. In this regard, Laurie46 suggests the test of reasonable benefit in the context of data sharing for pandemic response. Assessing what is reasonable for a digital public health technology depends on two main variables: scientific evidence and risk assessment. Prospective scientific evidence is necessary to predict and quantify the expected benefit of a new digital public health technology, and should be corroborated with the continuous monitoring of efficiency during the rollout phase. Risk impact assessments, including privacy impact assessment, are necessary to predict and quantify the potential risks, including risks for individual rights. Deployers of digital health technology have a moral responsibility to conform to the highest standards of scientific evidence and risk assessment, and show that the magnitude and probability of public benefit outweigh the magnitude and probability of risk at the individual level. In the absence of clear public health benefit, even minor restrictions of individual rights might result in being disproportional, and hence are unjustified. Whether one principle should be prioritised over another as a design choice is a matter that must be decided on a case by case basis and using established methods to resolve ethical conflicts or dilemmas such as risk–benefit assessment and reflective equilibrium. For example, among populations susceptible to COVID-19 (such as people older than 70), there might be lower computer literacy. Therefore, the beneficence principle might take priority over autonomy in justifying developing simplified digital public health technologies.
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Democracy Open communication and collaboration make democracies more effective at responding to pandemics Berengaut 20 [Ariana A. Berengaut, director of programs, partnerships, and strategic planning at the Penn Biden Center for Diplomacy and Global Engagement and a senior adviser to National Security Action, 24 Feb. 2020, “Democracies Are Better at Fighting Outbreaks,” The Atlantic, https://www.theatlantic.com/ideas/archive/2020/02/why-democracies-are-better-fighting-outbreaks/606976/] /Triumph Debate
Are authoritarian governments better equipped than democracies to meet the challenge of an epidemic? Read: How the coronavirus revealed authoritarianism’s fatal flaw A decade into a global backlash against liberal democracy, that question is urgent. Aspiring autocrats, from Hungary’s Viktor Orbán to Uganda’s Yoweri Museveni, cherry-pick from a menu of repressive tactics and technologies—from building surveillance systems to banning independent media outlets—to exert control and retain power. The “China model” is alluring to democracy’s critics, for whom China’s firm handling of the COVID-19 outbreak looks like another proof point for authoritarianism. Yet good public-health practice doesn’t just require control. It also requires transparency, public trust, and collaboration—habits of mind that allow free societies to better respond to pandemics. Democracies’ ability to cope with COVID-19 will soon be tested; after a proliferation of cases in South Korea, Japan, and Italy in recent days, officials are weighing how to respond. But citizens of democratic nations can reasonably expect a higher level of candor and accountability from their governments. American citizens, for example, can count on the objectivity and accuracy of the U.S. Centers for Disease Control and Prevention, whose weekly morbidity and mortality report has been a fixture of critical communication between the government and the public in one form or another since the late 1800s. Reliable reporting enables epidemiologists to predict a disease’s trajectory, researchers to develop treatments and vaccines, responders to trace transmission, and the public to protect itself. In contrast, China actively hid the 2003 SARS outbreak from the international community, and, especially in the initial stages of COVID-19, it appears to have done so again. Local authorities deliberately suppressed early reports of the unknown virus, missing an early window responders had to stop the infectious disease before it spread. Although researchers released the virus’s genetic sequence in record time, local officials underreported cases, downplayed the risk of human-to-human transmission, and detained doctors who discussed the disease. When one of those doctors, Li Wenliang, tried to warn friends on the social-media service WeChat, he was summoned before authorities and required to disavow his concerns. He later died of complications from COVID-19. When asked during a BBC interview about Li’s treatment, the Chinese diplomat Liu Ziaoming shrugged it off as the handiwork of overzealous local officials. But that is precisely the point. China’s cover-up of the virus was not the result of a system malfunction. In an authoritarian state, cover-ups happen by design. The language of authoritarianism—the language of fear and force—is one that every low-ranked apparatchik from Pripyat to Wuhan understands when acting on his or her own initiative to bury bad news. Two months into the crisis, international researchers continue to warn of missing information from China. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, diplomatically referred to this gap recently as the difference between “numbers that are given to you in a press conference as opposed to numbers [where] you can actually look at the data.” Full transparency is impossible without public trust, something authoritarian regimes have a steady deficit of. China’s Communist Party now says it wants to hear the truth. But public trust—the freedom citizens enjoy to think critically, the safety they feel to speak out, the confidence they require to overcome fearful or difficult circumstances—is not a resource a government can turn on and off like tap water. It is a habit forged over time. Today, rampant fear and mistrust are perhaps the greatest barriers health-care workers face in the Democratic Republic of the Congo, for example, where an Ebola outbreak is continuing into its 18th month. During the 2014 Ebola response, community trust, not intimidation, was the key component in persuading people to adopt proven solutions—such as surrendering the infected bodies of deceased loved ones—that run counter to human instinct. In China, the lack of trust was precisely what forced discussion of a previously unknown coronavirus deep into the bowels of supposedly private-messenger programs. Nahid Bhadelia: The best defense against disturbing new diseases China’s reliance on coercion will only intensify as officials become more desperate to restart the country’s economic engine and reestablish normal ties with the world. There is no doubt that China can efficiently compel certain behavior changes in the short term. But the longer the crisis lasts, the less effective these tactics will be. Democracies do not get everything right. In 2014, a returning Ebola nurse named Kaci Hickox was forced into quarantine at the Newark airport without clear medical cause and initially prohibited from seeing a lawyer or receiving visitors. But unlike in authoritarian systems, citizens in democracies have established channels through
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which they can reassert their rights and seek accountability for abuse. Although American courts typically defer to a state’s authority to enact necessary quarantine orders, Hickox’s suit against New Jersey state officials led to important changes to the law, including guaranteeing those in quarantine the right to legal counsel and privacy. Instead of undermining public trust, the incident helped replenish it. The ease with which an infectious disease spreads around the world demands international collaboration to contain it, and democracies cooperate more than non-democracies. (The popular board game Pandemic, in which players must work together in order to win, isn’t far from the truth.) Historically, from the United Nations charter to the Paris climate accords, the nations that have had the wherewithal to identify shared problems and build partnerships behind common solutions have been democracies. In 2014, the United States led 62 countries to stop a major Ebola outbreak. Although nations like China and Cuba contributed to the response, it was the United States that also led the effort to prevent the next disaster. (At the time, I was working on the Ebola crisis response at the U.S. Agency for International Development.) At the height of the Ebola crisis, President Barack Obama convened 44 nations in Washington to advance the Global Health Security Agenda, a community that now includes 67 nations. Unsurprisingly, China’s political system is incompatible with this approach. Recently, after weeks of negotiating, China finally agreed to allow in a senior WHO team, which includes two Americans. But Beijing continues to ignore the CDC’s offers to send its own expert team. Even in a public-health crisis, the Communist Party comes first. As cases of the virus first popped up around the world and nations started suspending flights, Taiwan—which Beijing views as a breakaway province—was excluded from fast-moving discussions. Barred from international organizations at Beijing’s behest, Taiwan struggled to gain access to timely information and technical meetings of the WHO and the International Civil Aviation Organization. Members of the global community cannot stop new outbreaks, but they can work together to build systems that quickly detect and effectively respond to them, especially by protecting the most vulnerable. Democratic societies tend to have better health and human development indicators, and not just because democratic societies are wealthier. A study published in The Lancet in April 2019 found that a government responsive to voters is more likely to invest in durable health-care systems and asserted that policy makers concerned with health outcomes, particularly chronic conditions, “should also be concerned with democratic experience.” Read: The coronavirus outbreak could bring out the worst in Trump Yet the very advantages that a democracy has in a public-health emergency are also those under greatest threat today from Trump and like-minded populists and nationalists around the world. In the United States, Trump has eviscerated traditional sources of public trust and trampled on almost every form of international cooperation. He drove away science-policy advisers, dismantled the White House office tasked with preventing pandemics, and ousted its well-respected chief. Even as the number of COVID-19 cases multiplied, Trump proposed slashing more than $3 billion in overall funding for global health. If and when the coronavirus is finally brought to heel, China will rightly celebrate its success but wrongly view it as validation of its system. The world may never know how many lives could have been saved if nations embraced democratic norms of transparency and collaboration. But as China expands its quarantine restrictions ever further, it offers a glimpse of the future should the world continue to lean away.
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Even though authoritarian countries imposed more stringent democracies were more successful in enforcing them given that they foster a higher degree of citizen cooperation Frey et al 20 [Carl Benedikt Frey, Oxford Martin Citi Fellow at the University of Oxford, Chinchih Chen, Oxford Martin Fellow of the Oxford Martin Programme on the Future of Work and a post-doctoral researcher of the Oxford Martin Programme on Technological and Economic Change, and Giorgio Presidente, Postdoctoral Research Officer on the Oxford Martin Programme on the Future of Work, May 12 2020, “Democracy, culture, and contagion: Political regimes and countries' responsiveness to Covid-19,” CEPR Press, 18, https://cepr.org/sites/default/files/news/CovidEconomics18.pdf#Paper8/] /Triumph Debate
Democracies can get trapped in institutional arrangements that make problem-solving harder (Fukuyama, 2011; 2015). Political divisions, checks and balances, and special interest groups can cause gridlock (March and Olsen 1984; Olson, 1982), and limit democratic governments ability to effectively respond to a crisis, like Covid- 19. Yet so far, as noted by the New York Times, “it is hard to draw up a conclusive balance sheet on the relative disease-fighting abilities of autocracies and democracies” (Schmemann, 2020). This paper constitutes a first partial assessment. Exploring governments policy responses across 111 countries over the whole lockdown period up until the latest Google Mobility Reports data release, we find that even though autocracies have introduced more stringent lockdowns and use more contact tracing, democracies have seemingly been more effective in meeting the policy objective of reducing geographic mobility in their countries. We also show that state capacity to enforce the lockdown is associated with sharper declines in movement and travel. That said, the negative correlation between autocracy and declining mobility remains statistically significant, also when accounting for state capacity. This is in line with studies showing that political repression reduces social capital and perceptions that support cooperation (Xue and Koyama, 2019), while democracies provide more public goods and experience less social unrest (Acemoglu et al., 2019), making people more likely to follow and support government interventions in democratic societies. However, what drives this relationship is a line of enquiry that deserves further attention. Finally, building on a growing literature showing that individualistic societies—where conformity, obedience, in-group loyalty are perceived to be less important—tend to be more dynamic and innovative, we provide evidence that for a given level of policy stringency, more conformist countries saw steeper declines in travel relative to their more individualistic counterparts. In other words, the flipside of the individualism that drives dynamism and inventiveness is that it makes collective action harder, such as a collective coordinated response to a pandemic. Indeed, countries with more individualistic cultural traits have more negative attitudes towards government interventions (Pitlik and Rode, 2017). Our results lead us to conclude that collectivist and democratic countries have mounted relatively effective responses to Covid-19 in terms of reducing geographic mobility. However, cultural traits and the form of government in place are likely to be interrelated. For instance, Gorodnichenko and Roland (2015) have shown that collectivist countries are more likely to experience a transition towards autocracy while individualist countries are more likely to experience a transition towards democracy. Therefore, in light of our results, an interesting direction for future research is studying how compliance with mobility restrictions varies across the individualism-collectivism spectrum in countries with similar institutional arrangements.
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4 major failings of authoritarian government limit their response to pandemics Carothers and Wong 20 [THOMAS CAROTHERS, senior vice president for studies and the Harvey V. Fineberg Chair for Democracy Studies at the Carnegie Endowment for International Peace AND DAVID WONG, a 2019–2020 James C. Gaither Junior Fellow at the Carnegie Endowment for International Peace and is currently working on a digital start-up, August 2020, “Authoritarian Weaknesses and the Pandemic,” Carnegie Endowment for International Peace, https://carnegieendowment.org/files/Carothers_Authoritarianism_Pandemic.pdf/] /Triumph Debate
As the coronavirus has spread, many political observers have warned that it is bolstering authoritarianism globally. The pandemic has provided a trigger or opportunity for numerous nondemocratic or illiberal governments to impose new restrictions on civil liberties, persecute opponents, limit protests, delay elections, and introduce new mass surveillance techniques. A devastating biological virus has translated into a damaging political virus that has markedly eroded the overall state of freedom in the world in just six months. Yet this discouraging near-term political picture becomes less ominous, or at least less clear-cut, if one looks down the road. Many authoritarian and authoritarian-leaning governments have not responded well to the pandemic. The governments of Algeria, Azerbaijan, Belarus, Burundi, Eritrea, Equatorial Guinea, Iran, Nicaragua, Russia, Tajikistan, Tanzania, Turkey, Turkmenistan, and Zimbabwe, for example, have displayed serious shortcomings in confronting the coronavirus, shortcomings that often reflect core features of their authoritarian governance. These problems range from refusals to recognize the severity of the problem to the suppression of valuable domestic voices or sources of information, disorganized policy responses, and unwillingness to maintain the lockdown measures that would safeguard their populations. These failings are likely to have negative long-term consequences for these regimes. Angry, aggrieved citizens are not a solid foundation for regime durability. Of course, some authoritarian or authoritarianleaning governments have mounted relatively effective responses to the virus: in this respect, countries like Bahrain, Singapore, the United Arab Emirates, and Vietnam come to mind. Those that have done well may gain enhanced domestic popularity and credibility for their competence, thus reinforcing their hold on power. But they are a minority in the authoritarian camp, and regimes with relatively successful pandemic responses are not guaranteed to reap political benefits from their actions. In Singapore’s elections in early July, the main opposition party won more seats than any opposition force has in decades, at least partly due to citizens’ discontent over the government’s pandemic response. After initial success in containing the virus, Singapore was struck by subsequent outbreaks among its population of migrant workers. Moreover, most authoritarians—whatever the quality of their pandemic policies—face enormous new economic pressures as a result of the virus. Slowed or negative growth, straitened budgets, devastated middle classes, and swelling ranks of poverty-stricken citizens will create political pressure on governments around the world—authoritarian and democratic alike. KEY WEAKNESSES PLAGUING AUTHORITARIANS To probe the potential political consequences of the pandemic for authoritarian regimes, it is useful to look more closely at why many have fallen short in their responses to the coronavirus. Four key weaknesses are manifest. First and foremost is a penchant for feeble rather than decisive leadership. Authoritarian leaders revel in projecting an image of strength. Some have, in fact, exhibited valuable decisiveness and clarity when confronted with the coronavirus. Vietnam’s leaders, for example, responded to the country’s first confirmed infections as early as January, imposing travel restrictions and quarantines with a speed that made it a textbook case of an effective response to the public health emergency. Yet many other authoritarian or authoritarian-leaning leaders have shown startling weakness in facing the pandemic, falling back on deeply ingrained habits of lying to deny inconvenient facts, spin conspiracy theories, and create alternative realities. In late March, as case rates and fatalities soared across Europe, President Alexander Lukashenko of Belarus dismissed a reporter’s concerns about the spread of the virus in his own country: “There are no viruses here. Do you see any of them flying around? I don’t see them either.” In Tanzania, which has not published nationwide figures relating to the coronavirus since May 8, President John Magufuli insisted that the country had defeated the virus through prayer. The president of Burundi assured his citizens that divine protection would suffice against the virus, while Venezuela’s president trafficked in farfetched conspiracy theories and promoted on social media the use of herbal concoctions to treat the virus. The leaders of Tajikistan and Turkmenistan both responded to the arrival of the virus by outright denying its presence in their countries. In lieu of claiming that the coronavirus was invisible and therefore not present, quite a few authoritarian leaders have made themselves invisible instead. Cameroon’s President Paul Biya vanished in March for over two months, while in Nicaragua, President Daniel Ortega has ducked from public view for extended periods twice, including once for more than a month. In Eritrea, President Isaias Afwerki did not speak to the country from mid-February through mid-April. Even Russian President Vladimir Putin, the prototypical authoritarian strongman, displayed striking avoidance behavior—or perhaps apathy—by moving to his countryside residence outside Moscow after the virus arrived in Russia, leaving his subordinates to convey negative news to the public. A second weakness of many authoritarian regimes in confronting the coronavirus is their suspicion or outright hostility toward independent voices and civil society. In recent months, countries such as Algeria, Azerbaijan, Cambodia, Russia, Thailand, and Uzbekistan have passed so-called fake news laws related to the pandemic that criminalize criticisms of 116 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
their governments’ responses to the public health emergency or even reporting of pandemic conditions that does not match the governments’ preferred narratives. These crackdowns impede effective public health responses, given that civil society can be a crucial partner to governments—especially for authoritarians with weak state capacity, such as those in many countries in Africa, former Soviet states, and the Middle East—in terms of collecting and distributing accurate and timely healthrelated information and delivering resources and care. In late December 2019, for instance, Chinese authorities silenced and reprimanded Li Wenliang, a Wuhan Central Hospital doctor who warned of the initial CARNEGIE ENDOWMENT FOR INTERNATIONAL PEACE 3 outbreak. By censuring Li instead of acting on his alerts, local authorities may have facilitated the coronavirus’s unchecked spread; consequently, Li’s death from the virus in early February sparked an outpouring of anger and grief on Chinese social media. Although Chinese citizens mobilized to respond to the pandemic by using social media to procure scarce protective gear or find open hospital beds, the Chinese Communist Party’s long-standing distrust of civil society has hindered potential collaboration between government officials and volunteers. In Egypt and Russia, doctors who criticize or challenge the government’s response to the pandemic risk detention or physical retaliation. A third debility of the pandemic responses of many authoritarian regimes has been the lack of coherence and flexibility in the hierarchy of governance. Effective national public health responses to the pandemic require not just clear, consistent mandates from the top, but integrated approaches in which regional and local authorities can take initiative, adapt responses to local conditions, and report critical information up the line. Yet many authoritarians instead misuse subnational governance as a “flak jacket”—a shield for deflecting responsibility and criticism more than for solving governance challenges. In Russia, for example, Putin devolved pandemic decisionmaking to regional officials more accustomed to executing his orders than responding to local citizens’ concerns. With a lack of guidance from the top, disorder among the governors ensued, as some officials adopted measures the Kremlin criticized as excessive and others took measures that were deemed insufficient. Infighting among elites also has emerged: when the mayor of Moscow took initiative in response to the virus and ordered people to stay home, users on Telegram—an app that permits citizens to share information and anonymously criticize each other—lambasted him. In Turkey, where mayors in Istanbul and Ankara affiliated with the opposition party have won praise among their constituents for their responses to the pandemic, President Recep Tayyip Erdoğan has actively tried to undermine them whenever possible—announcing weekend curfews on short notice to leave the opposition mayors flat-footed, canceling charity fundraisers that the mayors organized, and shutting down oppositionrun food kitchens—even at the cost of weakening the country’s broader response to the pandemic. Finally, issues with political legitimacy have also hurt some authoritarians’ pandemic policies. The devastating economic effects of lockdown measures have pressured all governments to find a workable balance between public health concerns and citizens’ economic needs. But this challenge is especially difficult for governments that do not enjoy the legitimacy that comes from winning free and fair elections and that instead rely heavily on economic performance as their primary source of popular legitimacy. Some in this boat have reacted by prematurely lifting initially tough lockdown measures. In Turkey, last month’s lifting of many restrictions saw a spike in cases, but Erdoğan refrained from reimposing another lockdown, fearful of the economic damage it would cause. Alternatively, some regimes also must grapple with the demands of influential societal sectors, even at the expense of delaying the government’s response to the pandemic. In Iran, in late February as the coronavirus began spreading through the country, Shia clerics vociferously resisted government demands that major shrines be closed—an encapsulation of the power of the country’s religious establishment. Of course, some democracies have struggled with some or all of these challenges in their pandemic responses. Some democratic leaders have displayed weakness and avoidance, tried to suppress contrary voices, failed to work effectively with local authorities, and refrained from implementing much-needed public health measures out of concern about their economic impact. But on the whole, these tendencies have been much less marked among democracies compared to autocracies. Moreover, among democracies, those with leaders who have strong illiberal tendencies, like U.S. President Donald Trump and Brazilian President Jair Bolsonaro, have done the worst in responding to the pandemic.
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Authoritarian responses aren’t more effective than democracies. East Asian democracies had some of the best pandemic responses even when compared to countries like China Beauchamp 20 [Zack Beauchamp, World correspondent for VOX, 26 Mar. 2020, “The Myth of Authoritarian Coronavirus Supremacy,” Vox, https://www.vox.com/2020/3/26/21184238/coronavirus-china-authoritarian-system- democracy] /Triumph Debate
A lot of people seem to think that there’s a simple cure for the coronavirus: authoritarianism. Article after article in the Western press has touted the superiority of China’s response to the West’s, using its draconian lockdown after the Wuhan outbreak to suggest that liberal democracies simply aren’t up to the harsh tasks of preventing disease spread. It’s a message that Chinese government propaganda has been only too happy to echo. But the unanimous verdict of political scientists and public health scholars I spoke with is that the theory of authoritarian superiority in this crisis is wrong: There is no evidence that one type of political system has performed systematically better against Covid-19 than the other. China’s response, while eventually good, was criminally slow early on — as was Iran’s, another notably authoritarian regime. Meanwhile, democracies like South Korea and Taiwan had some of the best responses anywhere on the planet. “Among all the factors, [regime type is] going to be at the bottom of the list,” says Joshua Michaud, an associate director for global health policy at the Kaiser Family Foundation. “You can have very poor public health practices in an authoritarian system or a democratic system.” The myth of authoritarian superiority is not only wrong but actively harmful in two key respects. First, it lets China off the hook for a botched early response to the coronavirus — one that likely led to the disease becoming a global pandemic in the first place. It turns what should be a damning indictment of certain aspects of the Chinese system into an ideological victory for Beijing. Second, it gives cover to leaders of allegedly democratic states to claim dangerous emergency powers during the crisis. This is happening right now in both Hungary and Israel, where authoritarian-inclined leaders are using the outbreak as a pretense to seize powers undreamed of in normal times. The myth of authoritarian superiority could well grant unnecessary legitimacy to these dangerous moves — and thus needs to be challenged. “The challenge here is seeing so many people saying authoritarianism works in these cases, when it’s so clearly not authoritarianism that makes a difference. And that’s actually a dangerous argument to make,” says Sofia Fenner, a political scientist at Bryn Mawr who has studied authoritarian-versus-democratic responses to the crisis. Some of the best performers in coronavirus are democracies — and some of the worst are authoritarian states When we want to examine a country’s success at containing coronavirus, we don’t merely want to look at the raw number of cases in that country but at how swiftly and effectively the government has taken measures endorsed by public health experts — mandatory social distancing measures, widespread testing, ramped-up production of masks — and whether those measures appear to have slowed the disease’s spread. On these metrics, the gold standard for a good national response comes from a cluster of three East Asian countries — South Korea, Taiwan, and Singapore (Hong Kong is also often mentioned, but it’s not exactly an independent country). The New York Times LIMITED TIME OFFER: SUBSCRIBE FOR $1 A WEEK. Enjoy expert reporting on the subjects that matter to you at this specia... AdThe New York TimesView Site Two of those are large democracies, the other an authoritarian city- state. Yet all three acted almost immediately after the crisis began and started testing individuals, isolating those who tested positive or had contact with those who did, and working swiftly to support their stressed health care systems. This pattern undermines the notion that you need to have a single authoritarian leader in charge to act decisively. South Korea and Taiwan are both raucous democracies, yet their elected leadership still managed to mobilize swiftly. What Taiwan and South Korea share with Singapore is something political scientists call “state capacity”: the political and economic resources available to a government to implement its policies. Countries with high state capacity are marked by (among other things) effective bureaucracies, high-quality public infrastructure, and a system that centralizes political power at the national level. All three of the clear East Asian success stories have high state capacity in general. But they also have particularly powerful states when it comes to infections disease response, owing to relatively recent experience with illnesses like SARS, MERS, and H1N1 (swine flu). Their governments were prepared to organize to contain outbreaks with action plans and lessons learned allowing for a swift response.“The best outcomes so far come from higher-capacity states, regardless of regime type,” Fenner writes in a post on the international relations blog Duck of Minerva. “Many of the high-capacity East Asian cases also benefited from recent experience dealing with SARS and H1N1; they have had opportunities to develop state capacities specifically suited to this kind of crisis.”
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Increased governmental powers both become permanent and immediate, allowing for countries to silent dissidents and set up the future of surveillance of their people Rutzen & Dutta 20 [Doug Rutzen, President and CEO of the International Center for Not-for-Profit Law and professor at Georgetown Law, Nikhil Dutta, Legal Advisor on Global Programs at the International Center for Not-for-Profit Law (INCL), 3/12/20, “Pandemics and Human Rights”, Just Security, https://www.justsecurity.org/69141/pandemics-and- human-rights/] /Triumph Debate
Pandemics are fertile breeding grounds for governmental overreach. After the outbreak of COVID-19 (“coronavirus”), China required citizens to install software on their smartphones which predicts people’s health status, tracks their location, and determines whether they can enter a public place. According to a New York Times analysis, the software “appears to share information with the police, setting a template for new forms of automated social control that could persist long after the epidemic subsides.” Meanwhile in Bishkek, Kyrgyzstan, coronavirus may have been used as a justification to stifle political and social activism. Protesters recently held demonstrations seeking the release of an opposition politician in advance of upcoming parliamentary elections. At the same time, women’s organizations were planning a rally on International Women’s Day to draw attention to the problem of domestic abuse in the country. Against this backdrop, a court in Bishkek granted the mayor’s application to ban all protests in the city center until July 1. The Bishkek court cited the coronavirus as one of the reasons for the ban, even though there were no confirmed cases of coronavirus in the country. Although the mayor’s office subsequently revoked the ban, participants in the International Women’s Day march were nonetheless arrested, while a large group of men were permitted to participate in a traditional ceremony to ward off coronavirus. In Iraq, the government has faced widespread protests over corruption, unemployment, and inefficient public services. The government responded with force, killing an estimated 600 protesters since October. On Feb. 26, citing the coronavirus, the Iraqi Health Minister announced that “all gatherings in public places, for any reason, are banned” through March 7. Questions have arisen about the motivations behind the ban, especially since there was only one confirmed case of coronavirus when the ban was imposed (with the number rising to 71 earlier this week). In the words of one Iraqi activist: The government uses coronavirus as an excuse to end the protests. They tried everything — snipers, live bullets, tear gas, abduction and so on and on — but they failed. They are now finding another way to stop us…. In addition to banning large-scale protests, the government also targeted small gatherings, requiring all cafes and restaurants to close and sending security forces to break up funerals in private homes. “This is Not a Drill” The coronavirus is indeed a significant threat to public health. As of writing, there are over 120,000 confirmed cases of coronavirus, and the number will exponentially grow, sparking the World Health Organization to officially label the crisis a pandemic on Wednesday. Swift and effective government action is necessary. However, as we have seen during other emergency situations, some governments use a crisis as a pretext to infringe rights. Others retain over-broad emergency powers after the crisis subsides.
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Public health emergencies incentivize democratic nations to abuse power and overreach Nyamutata 20 [Conrad Nyamutata. Lecturer in Law, Faculty of Business and Law, De Montfort University. 2020, “Do Civil Liberties Really Matter During Pandemics? Approaches to Coronavirus Disease (covid-19)”, International Human Rights Law Review, doi:10.1163/22131035-00901002] /Triumph Debate
Across Europe and beyond, states ushered in similarly heavy-handed measures, if not worse. The Italian government adopted Decree no. 6103 on 23 Feb- ruary 2020. The decree granted power for issuance of further and more de- tailed decrees aimed at the containment of covid-19. The initial decrees issued by the government imposed a containment zone for only the most affected areas. Later, the edicts issued increasingly draconian steps to the entire country. Violation of any of the provisions would constitute a criminal offence. The crime would attract detention of up to three months or a fine up to 206€.104 Furthermore, individuals who defied mandatory quarantine after testing posi- tive of covid-19 would be prosecuted105 with punishments of up to life impris- onment. Rule by decree is anathema in democratic societies. France also introduced a tough set of rules limiting movement, gatherings and imposing fines on for proscribed movement. Similarly, the Spanish government resorted to fining citizens for unauthorized movement. Under Spain’s emergency measures citizens would generally not be allowed to leave their homes other than to buy food, pharmaceuticals or other necessary products unless they have a compelling reason such as caring for the ill or travelling to work.106 In Australia, different states resorted to different laws. In New South Wales, for instance, under the Public Health Act,107 anyone who entered Aus- tralia would be subject to a 14-day quarantine, with fines of up to $11, 000 or six months imprisonment for failure to comply. The proscription of mass gather- ings of more than 500 people was invoked under the Public Health Act, with fines of up to $55,000 for corporations who violated the ban, and $27,500 for each additional day the event continues.108 Section 361 of the US Public Health Service Act,109 grants the Secretary of Health and Human Services (hhs) au- thority to ‘make and enforce such regulations as in [their] judgment are neces- sary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the States or possessions, or from one State or possession into any other State or possession.’110 While discretionary power can be positively instrumental, it is opens up the potential for abuse of power. During the covid-19 outbreak, Trump issued an executive order under the archaic Defense Production Act Authorities.111 Specifically, the dpa allows the federal government to have ‘requests’ to private industries proritised. While couched in benign language, in essence, the President would force companies to produce particular goods. In Spain, the government also announced sweeping measures allowing it to take over private healthcare providers and requisition materials such as face masks and Covid-19 tests.112 Liberalism is associated with non-authoritarianism, the rule of law, constitutional government with limited powers, and the guarantee of civil and political liberties. 113 Illiberal action would therefore be antithetical to the latter. I describe the responses of ‘democratic’ states as illiberal for their minimal allowances of liberties114 during covid-19, compared to China’s highly restrictive model. Human rights advocates argue that the mitigation of disease spread must be done in accordance with current beliefs about individual rights and civil liberties.115 Pandemics are fertile breeding grounds for governmental overreach. Lessons from past epidemics caution that without ethical safeguards, public health interventions can inadvertently encroach on human rights.116 As this article illustrates, in times of pandemics, states employ excessive measures. It is also evident that in response to covid-19, not only individuals be- come susceptible to authoritarian and illiberal public health interventions but also private companies. The orthodoxy of scrupulous law-making makes way for fast-tracked legislation pushed through with little or no scrutiny. Rule by decree was also a feature of the covid- 19 interventions.
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COVID-19 shows governments in over 80 countries are using the pandemic to erode democracy – accelerating rights violations, causing damage that will last beyond the pandemic Freedom House 20 [Freedom House. 10/2/2020, “https://freedomhouse.org/article/new-report-democracy- unNEW%20REPORT:%20Democracy%20under%20Lockdown%20-%20The%20Impact%20of%20COVID- 19%20on%20Global%20Freedomder-lockdown-impact-covid-19-global-freedom”, https://freedomhouse.org/article/new-report-democracy-under-lockdown-impact-covid-19-global-freedom] /Triumph Debate
The COVID-19 pandemic has deepened a crisis for democracy around the world, providing cover for governments to disrupt elections, silence critics and the press, and undermine the accountability needed to protect human rights as well as public health, according to Democracy under Lockdown, a new Freedom House report produced in partnership with the survey firm GQR. Since the coronavirus outbreak began, the condition of democracy and human rights has worsened in 80 countries, with particularly sharp deterioration in struggling democracies and highly repressive states, according to the experts surveyed by the project. More than 60 percent of the respondents predicted that the pandemic’s impact on political rights and civil liberties in their countries of focus would be mostly negative for the next three to five years. “What began as a worldwide health crisis has become part of the global crisis for democracy,” said Michael J. Abramowitz, president of Freedom House. “Governments in every part of the world have abused their powers in the name of public health, seizing the opportunity to undermine democracy and human rights.” “The new COVID-era laws and practices will be hard to reverse,” said Sarah Repucci, vice president for research and analysis at Freedom House and a coauthor of the report. “The harm to fundamental human rights will last long beyond the pandemic.” The country experts surveyed as part of the project identified four problems as the most acute during the COVID-19 pandemic: lack of government transparency and information on the coronavirus, corruption, lack of protection for vulnerable populations, and government abuses of power. The pandemic is accelerating a global decline in freedom of expression. Restrictions on the news media as part of the response to COVID-19 occurred in at least 91 countries. Governments enacted new legislation against spreading “fake news” about the virus. They also limited independent questioning at press conferences, suspended the printing of newspapers, and blocked websites. This report is the most in-depth effort to date to examine the condition of democracy during the pandemic. Freedom House conducted its research from January to September 2020. The work included an online survey by GQR, conducted from July 29 to August 15, 2020, in which 398 experts reported on the state of democracy in 105 countries and territories. In addition, Freedom House consulted its global network of analysts, bringing the total number of countries examined to 192. “Our survey found that governments’ responses to the pandemic are eroding the pillars of democracy around the world,” said Repucci. “The blatant obfuscation of facts by governments is always harmful, but it is especially egregious at a time when so many people’s lives are at stake.” Authoritarian and democratically elected leaders alike have failed to be candid about the impact of the coronavirus. In the survey, 62 percent of the respondents said they distrust what they are hearing about the pandemic from the national government in their country of focus. Among the experts on countries that the annual Freedom House report Freedom in the World classifies as Not Free, 77 percent distrust such information, indicating that lack of transparency is most common in countries with weak protections against abuses of power. Governments are also using the outbreak as a justification to grant themselves special powers beyond what is reasonably necessary to protect public health. They have exploited new emergency authority to interfere in the justice system, impose unprecedented restrictions on political opponents, and sideline crucial legislative functions. As one respondent said of Turkey, “Coronavirus was used as an excuse for the already oppressive government to do things that it has long planned to do but had not been able to.” Some governments have applied lockdown measures in an openly discriminatory manner or used marginalized populations as scapegoats. Muslims in India and Sri Lanka were accused of being “superspreaders,” while in Serbia, one respondent said, “migrants were portrayed as possible carriers of the virus.” In Kuwait, authorities imposed tighter restrictions on noncitizen neighborhoods. At the same time, parliaments have been hamstrung by health restrictions and emergency laws, and at times they have been manipulated for political purposes. One respondent on Singapore noted that the most disturbing development has been the “passage of laws that curb freedom but claim to curb the virus.” Government abuses are also affecting elections. Authorities delayed or otherwise disrupted national elections in nine countries, as well as a larger number of regional and local votes in other settings, between January and August 2020. Some of these election changes failed to meet democratic standards, either because new elections were not scheduled promptly or because officials set new dates without making adequate preparations for safe and secure voting. The issue extends to the United States. Local election authorities across the country appear to be ill-prepared for nationwide balloting in November, given increased demand for voting by mail, likely staffing shortfalls, and last-minute changes to electoral rules—all related to the pandemic. The Trump administration has created a fog of misinformation around the pandemic, regularly making false or misleading statements that put lives at risk and undercut the 121 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
broader government response. “The US administration unfortunately is not alone in its failure to be candid about the impact of the coronavirus,” said Sarah Repucci, vice president of research at Freedom House. “Leaders around the world who fear public condemnation for their handling of the crisis have diverted attention by scapegoating marginalized groups, attacking their critics, or downplaying the severity of the health situation.” In Hong Kong, the government cited the pandemic as a reason to delay legislative elections by an entire year, but the move was widely seen as part of a broader effort by Beijing to cement its elimination of Hong Kong’s remaining freedom and autonomy. The endurance of protest movements is a possible bright spot. Though 158 countries have placed new restrictions on demonstrations, significant protests have taken place in at least 90 countries since the outbreak began, the research shows. “The persistence of public protests, under every type of regime, shows that citizens remain willing to challenge authorities, even as governments use the crisis to try to increase their own powers,” said Amy Slipowitz, research manager at Freedom House and a coauthor of the report. “The erosion of political rights and civil liberties began long before the pandemic, but people in every region of the world are clearly committed to reclaiming their freedom.”
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Empirically states use expansion of emergency powers beyond what is necessary, increasing undo rights violations and accelerating autocratization by 75% Luhrmann and Rooney 20 [Anna Luhrmann and Bryan Rooney. Anna Lührmann works for the V-Dem Institute/University of Gothenburg and Bryan Rooney works at the RAND Cooperation. April 2020, “Autocratization by Decree: States of Emergency and Democratic Decline”, V-Dem Institute, https://www.v- dem.net/media/filer_public/31/1d/311d5d45-8747-45a4-b46f-37aa7ad8a7e8/wp_85.pdf] /Triumph Debate
We begin with some descriptive results. Over the last forty years, most (63 percent) democracies were in a state of emergency at least once. From 1974 to 2016, 8.3 percent of states of emergencies coincide with a period of substantial autocratization, while such episodes occur in just 5.2 percent of years without a state of emergency. This comprises 21.7 percent of the years with democratic decline in our sample. In most cases, such autocratization periods are lethal for democracies. We find that 90 percent of democracies collapsed during an autocratization episode with a state of emergency and only 10 percent survived. Conversely, 46 percent of democracies survived autocratization episodes without a state of emergency (Table 1.2 in the online appendix). Thus, autocratization episodes with a state of emergency tend to be more severe for democracy than those without. Table 1.3 in the online appendix details which components of the Electoral Democracy Index deteriorate during an autocratization episode. Overall, the indices capturing freedom of expression, freedom of association, and free and fair elections experience the largest number of decreases. Very few states see changes in the elected officials index - which would signify abandonment of electoral processes - and none see changes in the suffrage indicator. However, the pattern for autocratization episodes looks different depending on whether or not a state of emergency was declared. During autocratization episodes with a state of emergency, more aspects of democracy deteriorate. For instance, while freedom of association deteriorates substantially in only in 29 percent of episodes without a state of emergency, it does so in 57 percent of the cases with a state of emergency. Further, in six cases with a state of emergency, even the elected officials index sees a substantial decline, which happens only once during a period of autocratization without a state of emergency. In Figure 1, we provide a graphical depiction of electoral democracy in Sri Lanka, Venezuela, Moldova, and Nicaragua from 1990 to 2010, as an illustration of the relationship between states of emergencies and autocratization. These countries share a number of important differences, including each country’s level of democracy when the time frame begins. In each country, however, spells of autocratization coincide with a state of emergency. In each case, the states of emergency occur at the beginning of a dramatic trend, and additional states of emergency appear to coincide with further autocratization over time. This is true despite wide variation in the series of events inciting the state of emergency. In Sri Lanka in 2003, the emergency decree resulted from political turmoil during negotiations with the Liberation Tigers of Tamil Eelam. The Venezuelan government called a state of emergency as the result of a constitutional crisis. In Moldova, states of emergency were used to jail suspected terrorists in light of the conflict over Transnistria. In Nicaragua in 2005,the government declared a state of emergency in response to an economic and energy crisis. This substantial variety in inciting events suggests that there is something fundamental to the mechanism of the state of emergency that spurs democratic decline. We now turn to our regression analysis in Table 1. To reiterate, we expect the occurrence of a state of emergency to be positively correlated with the occurrence of autocratization episodes. Model 1 fits the bivariate relationship and shows - as expected - a positive and statistically significant relationship. Model 2 adds the confounders discussed above. The focal relationship remains strong and statistically significant. The predicted probability of an autocratization episode is .04 without a declared state of emergency and .07 with one in place. Thus, with a state of emergency, countries are 75 percent more likely to decline than without a state of emergency. Most confounders show the expected relationships. Autocratization episodes are less likely to occur the more democratic a country is, as well as the more it grows and prospers economically. Income inequality is associated with a lower risk of autocratization, which supports the idea that right-leaning elites may lead autocratization efforts in more egalitarian societies. We find no significant effects for political corruption, globalization, or oil rents. As expected, autocratization is more likely in later years of the sample. Robustness Analysis For robustness purposes, we estimate Model 2 with year- fixed effects (see Table 2 in the appendix). Findings hold even when looking solely at variance within years.66 We also estimate a model using a different dependent variable: the change in the V-Dem Electoral Democracy Index (EDI) in the year of a declaration of the state of emergency compared to the year prior in Table 3 (appendix). Findings again hold; a declaration of a state of emergency is associated with a statistically significant decline in the EDI. We also test the role of specific emergency provisions in driving autocratization. In Table 4 (appendix), rather than states of emergency, we examine the strength of the emergency powers given to the leader during a state of emergency. We take this variable from Rooney and the measure captures such variation as the breadth of declaration, the existence, scope, and depth of policy powers, as well as limitations on powers via institutional oversight and the expiration of the policies and powers taken during the crisis.67 We find that the existence of stronger emergency powers increases the likelihood of autocratization. In Table 5 (appendix), we include both the declaration of a state of emergency and emergency power strength in the model.68 This allows us to test for the danger of the institutional mechanism of a state of emergency as such, in addition to the attractiveness of the specific powers granted therein. We find that the effects of the declaration persist even when controlling the effect of the emergency powers. This suggests that the declaration itself matters, even independent of the specific content of the emergency provisions. While we focus on aspects of the state that might make a state of emergency particularly dangerous, it is also important to consider when a state of emergency is likely to be seen as legitimate. We do this in Table 6 (appendix). We argue that states of emergency are most likely to be considered legitimate when called in response to a natural disaster, an interstate military dispute, or a civil conflict. We control for each of these factors, and find that our results nonetheless hold. To ensure the robustness of the results, we also narrow our sample in two ways. First, in Table 7 (appendix), we examine only cases of national political emergencies as coded by Hafner-Burton, Helfer, and Fariss.69 National political emergencies entail, on average, the greatest deviation from political norms and thus we would expect to see the mechanism most clearly at work here. We find the results are in fact stronger in such instances. Second, in Table 8 (appendix), we examine only those countries in which the ability to declare a state of emergency is an institutional feature of the democracy, again using data from Rooney, since such emergencies involve no deviation from the institutional rules of the game.70 We find that the results hold with similar magnitude and maintain significance. We argue that states of emergency should increase the likelihood of autocratization beyond the effect of the emergency’s inciting event. To consider this more deeply, we examine only those states of emergencieswe believe could most be considered exogenousto the political process – those driven by natural disasters. While we concede that natural disasters may not be entirely exogenous to autocratization, the literature suggests their relationship is very much in question. For instance, while some in the literature might suggest a positive relation- ship with autocratization, as deaths resulting from a lack of disaster preparedness could lead to public protest, leader removal, and perhaps democratic decline, recent evidence suggests natural disasters can inspire future democratization. 71 Further, these events are unanticipated, and thus not manipulable by the government itself, as noted by Bjørnskov and 123 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
Voigt, and as such we argue they provide the best possible source of exogenous variation given the constraints inherent in our question.72 We model this relationship in two ways. First, we consider states of emergency driven by the presence of a natural disaster as coded by Hafner-Burton, Helfer & Fariss in Table 9.73 We find that states of emergency driven by natural disasters still strongly predict autocratization. In Table 10, we instead use the existence of any natural disaster as a predictor of a state of emergency in an instrumental variable analysis. We find that natural disasters do predict the occurrence of a state of emergency, and again find strong support for the relationship between states of emergency and autocratization. This suggests that even if leaders themselves could not anticipate the emergency arising, they take advantage of the opportunities presented to them to expand their power. The relationship between states of emergency and autocratization persists regardless of the analysis chosen.
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Rights Public health emergencies have been used to expand governmental power in ways which cannot be reversed post emergency Farr 20 [Christina Farr, technology and health reporter for CNBC, 4/18/20, “The Covid-19 response must balance civil liberties and public health – experts explain how”, CNBC, https://www.cnbc.com/2020/04/18/covid-19-response-vs- civil-liberties-striking-the-right-balance.html] /Triumph Debate
The Covid-19 pandemic is barely four months old, but civil liberties groups are already alarmed by how some governments are responding. At the start of the crisis, Chinese authorities used software to sort citizens into color-coded categories -- red, yellow, green -- corresponding to their level of risk for having the virus. Those in the green group had the most freedom of movement. Yellow and red meant that citizens could find themselves barred from entry to eateries and shopping malls. This is the kind of “big data” that experts like Gostin have not encountered before in prior pandemics, and it presents new challenges as well as opportunities. Ronald Bayer, a professor at the Center for the History and Ethics of Public Health at Columbia University, sees potential in using new technology for public health surveillance to get ahead of an infectious disease outbreak. But he also warns that there may be examples of countries using the threat of a disease as a “pretense” to justify authoritarian impulses to amass power, and that technology can be used as a tool in that process. He also notes that measures introduced during emergencies can’t easily be dismantled. Consider the September 11th terror attacks, which fundamentally changed airline travel for good. Many will recall how it became a lot more challenging to get through security. Heightened fears also led to the Patriot Act, which gave the federal government vast new investigative powers that it claimed were necessary in the fight against terrorism. A terror attack and a pandemic are vastly different, but both present opportunities for governments and the private sector to take on new powers in the name of keeping citizens safe.
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*China has utilized the quarantine and other pandemic fighting techniques to harm the Uighur populations in their country Rogin 20 [Josh Rogin, columnist covering foreign policy and national security, 2/26/20, “The coronavirus brings new and awful repression for Uighurs in China”, The Washington Post, https://www.washingtonpost.com/opinions/2020/02/26/coronavirus-brings-new-awful-repression-uighurs-china/] /Triumph Debate
The Chinese government has subjected tens millions of its citizens to draconian restrictions to try to contain the coronavirus. But for millions of Uighur and other ethnic minorities who were already living under severe repression, Beijing’s cruel and thuggish response to the pandemic is now compounding their anguish and pain. In Xinjiang, in China’s northwest, millions of people already have plenty of experience with the police state mentality. Over 1 million Uighurs and other ethnic minorities are currently imprisoned in “re-education camps,” where they are deprived of basic freedoms, religious practice, contact with their families or any legal recourse whatsoever. Those camps are especially vulnerable to contagious disease due to the cramped cells, lack of medical resources and generally dire conditions. Now Uighur activists are presenting evidence that the Chinese authorities’ reaction to the epidemic is causing hunger and panic even outside the camps. There are also separate reports that the Chinese authorities are forcing Uighurs to return to work at factories that had been shut down because of the epidemic — despite the ongoing risks. The Uyghur Human Rights Project released a briefing Wednesday that included Uighur-language videos and social media posts about the dire conditions in Xinjiang. The videos, which could not be independently verified, show Uighurs confronting a desperate shortage of food. The group says its claims are corroborated by news reports and messages members of the Uighur diaspora have received from family and friends in recent weeks. “The reports of desperation and agony among Uighurs are genuine,” said Omer Kanat, the group’s executive director, at a Wednesday press conference. “Early this year, as soon as we started hearing about the coronavirus outbreak, Uighurs in the diaspora immediately began to warn that we now face a whole new threat, a threat that could easily wipe out even more of our people.” In late January, he said, Chinese authorities forced millions of Xinjiang residents into staying quarantined in their homes, with no advance warning and without providing access to food. In one of the videos shared widely among Uighurs, a man is yelling at authorities, “I’m starving. My wife and children are starving.” He bangs his head into a pole and shouts, “Do you want to kill me? Just kill me.” In several of the posts, Chinese-language seals have been affixed to doors to confirm that residents have not left their homes. Another shows an elderly man who is told that he can’t go outside. He responds in the Uighur language: “What’s a person supposed to eat when they get hungry? What should I do, bite a building?”
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Restricting civil liberties for public health is counterproductive by reacting with punishment, and undercutting public confidence in health officials Annas et. Al 08 [George J. Annas, Wendy K. Mariner and Wendy E. Parmet. George J. Annas, Edward R. Utley Professor and Chair of the Department of Health Law, Bioethics & Human Rights, Boston University School of Public Health; Professor of Law, Boston University School of Law; and Professor of Socio-Medical Sciences, Boston University School of Medicine. Wendy K. Mariner, Professor of Health Law, Bioethics and Human Rights, Boston University School of Public Health; Professor of Law, Boston University School of Law; and Professor of Socio-Medical Sciences, Boston University School of Medicine. Wendy E. Parmet, George J. and Kathleen Waters Matthews Distinguished University Professor of Law, Northeastern University School of Law. January 2008, “Pandemic Preparedness: The Need for a Public Health – Not a Law Enforcement/National Security – Approach”, ACLU, https://www.aclu.org/sites/default/files/pdfs/privacy/pemic_report.pdf] /Triumph Debate
Lessons Forgotten Unfortunately, past lessons appear to have been forgotten. In the post-9/11 climate, public health policy has increasingly been viewed through the prism of, and indeed as a part of, law enforcement and national security. Rather than focusing on how government can work with individuals and their communities to be healthy, public health policymakers now often emphasize the need to take tough, coercive actions against the very people they are charged to help. This approach not only targets people as the enemy instead of the disease, but also encourages health officials to believe that government cannot do much to help people in an epidemic. Little thought is therefore given to what society can and should do to help people prevent and mitigate epidemics. In effect, individuals are viewed as personally responsible for the spread of illness as well as for their own care. This law enforcement/national security strategy shifts the focus of preparedness from preventing and mitigating an emergency to punishing people who fail to follow orders and stay healthy. While there have been and probably always will be a few people with contagious diseases who, unwittingly or deliberately, behave in ways that expose others to infection, existing state laws provide health officials with the tools they need to respond to such situations, for example, by confining such persons to hospitals. Such cases, however, are the exceptions to the rule. Americans generally do not want to spread disease to others and are generally capable of controlling their behavior to avoid infecting others. However, the law enforcement/national security approach converts the exception into the rule by treating everyone in the general population as a potential threat who warrants coercive treatment. Examples of the Push to Expand Law Enforcement Powers Examples of the law enforcement/national security approach are easy to find. For example, after 9/11, the Bush Administration’s Centers for Disease Control and Prevention (CDC) supported a Model State Emergency Health Powers Act (sometimes termed a “miniPatriot Act”) which purported to clarify and update the already broad coercive powers available to state governments in the event of a “public health emergency.” The Act used fear to justify methods better suited to quelling public riots than protecting public health. The premise of the Act was that every outbreak of disease could be the beginning of some horrific epidemic, requiring the suspension of civil liberties For example, Section 502 of the model as originally proposed authorized mandatory medical examinations and testing: Any person refusing to submit to the medical examination and/or testing [required by a public health official] is liable for a misdemeanor…the public health authority [may subject the refusing person] to isolation or quarantine… Any …[health care provider] refusing to perform a medical examination or test as authorized herein shall be liable for a misdemeanor….an order of the public health authority…shall be immediately enforceable by any peace officer. Section 504 provides for compulsory treatment, something that has been soundly repudiated in the decades since at least 60,000 Americans were forcibly sterilized in the early 20th Century9 : Individuals refusing to be vaccinated or treated shall be liable for a misdemeanor. [The refusing person] may be subject to isolation or quarantine… An order of the public health authority given to effectuate the purposes of this Section shall be immediately enforceable by any peace officer. The Bush CDC’s recommended law would have returned us to the late 19th and early 20th centuries when state “police powers” in health were sometimes enforced by police officers, and people who were sick were frequently treated as if they had committed a crime. But the CDC’s plan would have set us back even further. It applied its penalties to people who did not have any contagious disease and to people who would never expose anyone else to disease. Moreover, it included provisions to make all public health personnel, and those acting under their orders, immune from liability for any injury—even if forced vaccination or other mandated treatments killed the “patient.” At the same time, the Act ignored effective steps that states could take to mitigate an epidemic, such as reinvigorating their public health infrastructure and increasing access to health care. Although state public health departments saw some budget increases following 9/11, most of that money was for bioterrorism preparedness activities, leaving public health agencies even more resource-starved. As a result, although some states now have new laws that more precisely specify their power to isolate or quarantine people during an emergency, they are less capable than ever of actually helping people or controlling an epidemic. These proposals were modified and the criminal sanctions removed in response to public protest. But at least one state, Florida, enacted the “model” law nonetheless, and went even further, authorizing forced treatment of an individual if the state had no quarantine facility available for confinement. Despite criticism by public health lawyers, the Bush CDC nonetheless continues to recommend that all states “update” their laws to provide for mandatory surveillance, examination, isolation, and quarantine. In the real world, of course, laws that equate medicine and public health with law enforcement severely undercut public confidence in public health and are likely to lead people to avoid public health officials rather than to seek out and follow their guidance.
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Civil liberty restrictions on the basis of health become endless – there will always be new diseases Annas et. Al 08 [George J. Annas, Wendy K. Mariner and Wendy E. Parmet. George J. Annas, Edward R. Utley Professor and Chair of the Department of Health Law, Bioethics & Human Rights, Boston University School of Public Health; Professor of Law, Boston University School of Law; and Professor of Socio-Medical Sciences, Boston University School of Medicine. Wendy K. Mariner, Professor of Health Law, Bioethics and Human Rights, Boston University School of Public Health; Professor of Law, Boston University School of Law; and Professor of Socio-Medical Sciences, Boston University School of Medicine. Wendy E. Parmet, George J. and Kathleen Waters Matthews Distinguished University Professor of Law, Northeastern University School of Law. January 2008, “Pandemic Preparedness: The Need for a Public Health – Not a Law Enforcement/National Security – Approach”, ACLU, https://www.aclu.org/sites/default/files/pdfs/privacy/pemic_report.pdf] /Triumph Debate
The Daniels and Speaker cases are cautionary tales that illustrate the counterproductive nature of a punitive, law enforcement approach to preventing the spread of disease. Instead of recognizing these dangers, however, both Congressional leaders and the media presented these cases as demonstrating a need for even tougher new laws that permit aggressive and punitive action against individuals. In so doing, they did not note the futility of stopping a disease as widely prevalent as tuberculosis by detaining one single traveler, nor did they recognize the need to develop more rapid and accurate diagnostic tests and more effective TB treatments. Nor did they mention that existing treatments are not currently available to everyone with the disease. Rather, the spotlight remained on the alleged need to enact new laws to provide officials with more power to “get tough” with individual patients. This is unfortunate because: • It’s ineffective. The law enforcement approach has not and cannot prepare us for serious epidemics. Effective public health efforts, whether aimed at pandemic influenza or more common diseases such as TB and HIV/AIDS, are neither cheap nor glamorous. They are costly and difficult. These efforts require working with rather than against communities, providing communities with as healthy an environment as possible, health care if they need it, and the means to help themselves and their neighbors. Most importantly, to protect public health, public health policies must aim to help, rather than to suppress, the public. • It’s dangerous for civil liberties. The law enforcement approach to public health offers a rationale for the endless suspension of civil liberties. The “Global War on Terror” may go on for a generation, but the war on disease will continue until the end of the human race. There will always be a new disease, always the threat of a new pandemic. If that fear justifies the suspension of liberties and the institution of an emergency state, then freedom and the rule of law will be permanently suspended. • It’s usually unjustly applied. The law enforcement/national security approach is unlikely to affect everyone uniformly. While blatantly racist public health policies, such as those instituted by San Francisco in 1900, are unlikely today, we should not assume that the new law enforcement approach to public health will be applied in a fair and equal manner, especially at our borders. Already anti-immigrant advocates mix fears of terrorism and disease as reasons for cracking down on immigrants. Should a new disease outbreak arise, a public health policy that emphasizes coercion and the dangerousness of the sick will most assuredly fall disproportionately on those who already face discrimination and/or are least able to protect themselves.
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*Vaccine passports pose fundamental dangers to mass amounts of human rights – particularly harming the most vulnerable Arroyo 21 [Verónica Arroyo, Raman Jit Singh Chima, and Carolyn Tackett. Arroyo, Chuma, and Tackett are all authors at the non-profit publisher, Access Now. April 2021, “Protocol for exclusion: Why COVID-19 vaccine "passports" threaten human rights”, Access Now, https://www.accessnow.org/cms/assets/uploads/2021/04/Covid-Vaccine-Passports- Threaten-Human-Rights.pdf] /Triumph Debate
COVID-19 has imposed the highest toll on individuals and communities who have long been marginalized and underserved, affecting their exposure to the disease, access to adequate healthcare, physical and mental wellbeing during lockdowns, economic stability, access to education, and more. 11 Many digital vaccine certificate proposals currently being developed or under consideration would perpetuate rather than mitigate these harms. It is imperative that policymakers prioritize protecting the rights and needs of people who are most vulnerable in any plans for vaccine distribution and certification, in particular when a demand to certify vaccination would impact people’s access to fundamental rights and freedoms. A. UNEQUAL ACCESS TO VACCINATIONS Many people around the world are still waiting for access to a COVID-19 vaccine. While some countries have secured vaccines for their entire population, others have only a partial supply or have not yet even begun vaccination programs. 12 Even in the countries that are rolling out a vaccination program, governments are facing significant distribution challenges, including limited capacity for population mapping, access to cold chains and transportation, and trained human resources. Distribution is especially challenging in communities that already lack the necessary infrastructure and access to essential services. 13 This means that marginalized and vulnerable populations — the poor, the stateless, migrants, and refugees, among others — will likely be among the last to receive vaccinations, if they are able to get them at all. Moreover, even individuals in communities with easy access to the vaccine may not be able to get it due to medical conditions or other restrictions public health authorities put in place. Several countries identify the primary use for digital vaccine certificates, apart from tracking vaccinations, is to grant or deny people access to travel, workplaces, and social services. These systems are therefore likely to push people who already face exclusion and discrimination further to the margins. Whatever their circumstances, someone who is unable to get a vaccine should not be penalized by restrictions on access to spaces and services based on their vaccination status. B. RESTRICTIONS TO FREEDOM OF MOVEMENT AND CROSS-BORDER TRAVEL Many stakeholders interested in facilitating a return to pre-pandemic levels of travel — from hotels and airline companies to governments whose economies rely heavily on tourism — are pushing proposals for digital vaccine certificates that could form the basis of access to or denial from international travel. 14 Coalitions of companies, governments, and technologists are coordinating to standardize such certificates through jointly developed tools and protocols. 15 The World Health Organization itself initially considered developing “e-vaccination certificates” for travel as part of its coordination with Estonia to establish a “digital yellow card” focused on portability and smooth cross-border exchange of vaccination data. 16 However, after further research, the WHO released an interim position paper on February 5, 2021, stating that “national authorities and conveyance operators should not introduce requirements of proof of COVID-19 for international travel as a condition for departure or entry, given that there are still critical unknowns regarding the efficacy of vaccination in reducing transmission.” 17 The WHO has also noted that the limited availability of vaccines will negatively affect individuals who cannot get access to a vaccine if they are therefore barred from travel. 18 While there is precedent for requiring vaccine certificates for travel to specific countries — for example, the yellow fever vaccination required when traveling between countries with differing levels of exposure — the current proposals for COVID-19 digital vaccine certificates operate on a bigger scale and impact many more people. COVID-19 is a pandemic, not a disease like yellow fever that is endemic to certain countries. 19 While many proponents of vaccine “passports” are focused on restoring tourism, making these certificates mandatory for travel would have severe consequences for individuals crossing borders out of necessity, such as refugees, migrants, and people who travel to get specialized medical care. They would also systematically disadvantage everyone around the world living in countries with limited access to COVID-19 vaccines. C. REDUCED ACCESS TO SERVICES AND PUBLIC SPACES In addition to contemplating use of vaccine “passports” for travel across national borders, countries such as Israel and Denmark, as well as local governments like New York State in the U.S. (where vaccination is optional), are pushing the use of digital vaccine certificates to deny or grant access to services and spaces domestically. These proposals pose the greatest threat of interfering with fundamental rights. These restrictions may impact people’s ability to access essential services, pursue their livelihood, and participate in civic life. People who have a health condition or cannot be vaccinated due to other restrictions imposed by health authorities will likely face exclusion, along with those who are unable to access the internet or an internet-connected device. Unless there are clear safeguards to prevent it, use of digital vaccine certificates may interfere with the freedom of peaceful assembly and association, and could block essential movement for social, racial, economic, and environmental justice. Although public health constitutes a legitimate purpose to limit the exercise of some rights, those in power must not impose digital vaccine certificate schemes that can be leveraged to silence dissent, suppress social movements, or impose additional burdens on at-risk individuals 129 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
who are already targeted and underserved. Even if a government does not formally mandate use of digital vaccine certificates for access to services, private actors may start requiring them on their own initiative. In India, for example, pharmacy owners appropriated the Aarogya Setu COVID-19 exposure notification app for unofficial use, restricting people from entering their stores unless they showed they had installed the app on their phone. 47 This kind of response to digital vaccine certificates could result in many more instances of discrimination, both purposeful and unintended.D. ADMINISTRATIVE BURDEN A global vaccination drive in the middle of a pandemic is a challenge, to say the least. The logistics, the politics, and the resources required make this an unenviable task for the agencies responsible. If we add to this the integration of a parallel infrastructure for digital vaccine certificates, the task becomes more complicated, and potentially more expensive. Consider a hypothetical vaccination drive in a village in Jharkhand in India. There are a huge number of people waiting their turn to get the vaccine, after more than a year of lockdowns, lost jobs, loss of family members, friends, or colleagues to COVID-19, and other kinds of distressing situations. The internet is down, or has been deliberately cut off due to unrelated security concerns. 58 The administrator of the vaccine is required not only to vaccinate people, but to authenticate their identity, create their unique identity on the Co-WIN platform, and log their vaccination status. 59 With no internet, the drive is halted until connectivity is restored. The lack of functioning technological infrastructure means that even though both people and vaccines are present, people are leaving unvaccinated. This kind of scenario already plays out in India when people who do not have a digital ID or cannot be authenticated do not get access to food rations and other government benefits. 60 Governments and international organizations must make sure that unnecessary administrative barriers do not hinder vaccine distribution. Digital vaccine certificates should not become a barrier to public health objectives or lead to discriminatory outcomes for people who are not connected or are deliberately disconnected from the internet.
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Vaccine passports will become defacto mandatory, violating the right to privacy for basic yet essential services Arroyo 21 [Verónica Arroyo, Raman Jit Singh Chima, and Carolyn Tackett. Arroyo, Chuma, and Tackett are all authors at the non-profit publisher, Access Now. April 2021, “Protocol for exclusion: Why COVID-19 vaccine "passports" threaten human rights”, Access Now, https://www.accessnow.org/cms/assets/uploads/2021/04/Covid-Vaccine-Passports- Threaten-Human-Rights.pdf] /Triumph Debate
IV. PRIVACY AND SECURITY CONCERNS Most digital vaccine certificates currently under consideration would significantly expand the amount of data collected about a person’s vaccination status, as well as generating ongoing new data about, for example, when and where the person has used the certificate. This opens the door to both mistakes and abuses that impact people’s privacy, and creates a valuable target for cyber attacks. Information from these certificates could also be copied to create fraudulent documents if security standards are not robust enough. These concerns are heightened even further if a digital vaccine certificate is integrated into a centralized digital identity system, or when it would serve as the basis for a new health identity infrastructure. A. RISKS OF MASS COLLECTION AND PROCESSING OF HEALTH DATA Any COVID-19 digital vaccine certificate would likely require the collection of sensitive personal information, putting individuals’ privacy at risk. Health information is private and sensitive by nature and reveals intimate details about a person’s life. The use, collection, access, and any other processing of this information should be protected, ideally through a comprehensive data protection law. 61 But many countries considering proposals for digital vaccine certificates have either a weak or outdated data protection framework, or none at all. Further, it is important to note that approaches using centralized storage of information — especially without adequate checks and balances for sharing of data within and between governments — can create mammoth yet fragile systems that put both individuals’ privacy and data security at risk. Governments must approach digital vaccines certificates with caution, acknowledging the unique risks of collecting health-related and other sensitive personal data, especially when it may be collected, accessed, or processed by people who are not medical professionals. 62 Further, governments must refrain from using COVID-19 as an excuse to expand mass or targeted surveillance practices. No one should have to compromise their fundamental right to privacy in order to maintain access to essential services or freedom of movement. The collection and use of health data must be grounded in the principles of necessity and proportionality, which may be evaluated through a three-part test. 63 The data collection and use must be: 1. in accordance with or prescribed by law (i.e. the legality principle), 2. necessary to achieve a certain aim (i.e. the necessity principle), and 3. proportionate to the aim pursued (i.e. the proportionality principle). B. ENTRENCHMENT AND PROLIFERATION OF CENTRALIZED DIGITAL IDENTITY SYSTEMS Many civil society organizations, experts, and coalitions, including the #WhyID community, have been questioning the need for centralized digital identity systems and highlighting their human rights harms for years. 74 Such programs carry risks of surveillance, profiling, exclusion, privacy violations, and cybersecurity threats, among others, yet they are being rapidly deployed around the world, especially in developing countries. 75 The COVID-19 vaccination drive should not be used to entrench or further advance these dangerous centralized digital identity systems, nor to create new health identity systems. One of the most worrying parts of the current paradigm of digital identity systems is the interlinking of various aspects of a person's life under one identity umbrella. Some proponents and governments have sought to have a person’s tax records, mobile numbers, ration cards, health data, financial records, driving license, and many other registrations linked under one digital identity system. There is a danger that digital vaccine certificates would grow the tentacles of this “octopus” of identity, adding vaccination status and other sensitive health records. In developing countries where centralized identity systems are most prevalent, there are many realities which increase their risk. These countries often lack effective data protection regulations and institutions, surveillance standards are generally lax, minimal investment in security infrastructure makes centralized data an easy target for hacks and susceptible to leaks, and weak governance standards do not provide a pathway to remedy for people whose privacy has been violated. This is especially concerning considering that many of these systems use biometrics as their authentication mechanism. Further, we have seen in many cases that data initially collected for one purpose is often exploited for surveillance or other misuses down the line. 76 Centralized digital identity systems are highly susceptible to mission creep, growing far beyond uses and limitations first envisaged. It is essential that data regarding a person’s vaccination status, or any additional data generated by a digital vaccine certificate (such as the locations a person has shown proof of vaccination), are not weaponized against them. Beyond the privacy risks, these centralized mechanisms are highly prone to error, which can leave many — and especially the most vulnerable — without access to essential services. In countries like India, digital identity system failures have led to starvation deaths when people were unable to access food rations. 77 Using such imperfect systems to determine whether — based on vaccination status — a person can travel, work, go to school, or carry out other basic functions of daily life is likely to have both immediate and long-term impacts that are detrimental to human rights. 78 Advocates for such identity systems often argue that their human rights shortcomings can be mitigated by making participation in the system voluntary and by ensuring informed consent for enrollment. However, a person’s agency to give consent is severely compromised if a COVID-19 digital vaccine certificate — either on its own or integrated into a centralized digital identity system — is the easiest way to get a vaccine or to be allowed to fully participate in 131 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
daily life. These conditions would make participation de facto mandatory. Especially in the case of centralized digital identity systems, the pressure to get a vaccine and a digital vaccine certificate would mean a person is not empowered to fully understand and evaluate the harms of such identity systems before getting onboard, and thus the identity system becomes entrenched in their lives. Though it is not sufficient on its own, ensuring everyone has meaningful options outside of the digital vaccine certificate or digital identity system is an essential component for the design of any rights-respecting system.
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A human rights approach to public health has fostered increased medical attention to marginalized communities and bolstered government accountability for pandemic response Meier et al 18 [Benjamin Mason Meier, Associate Professor of Global Health Policy at the University of North Carolina at Chapel Hill and the Past Chair of the APHA Human Rights Forum, Dabney P. Evans, Associate Professor of Global Health at the Hubert Department of Health in the Rollins School of Public Health at Emory University and the Chair of the APHA Forum, Matthew M. Kavanagh, Visiting Professor at Georgetown University Law Center and Director of the Global Health Policy & Governance Initiative at the O’Neill Institute for National & Global Health Law, Jessica M. Keralis, Doctoral student in the Department of Epidemiology at the University of Maryland and the Policy/Advocacy Chair of the APHA Human Rights Forum, and Gabriel Armas-Cardona, Post-Graduate Research Assistant at the Law Faculty of the University of Leipzig and the Programing Chair of the APHA Human Rights Forum, Dec. 2018, “Human Rights in Public Health,” Health and Human Rights, vol. 20, no. 2, pp. 85–91, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293343/] /Triumph Debate
Human rights offer a universal framework to advance justice in public health, elaborating the freedoms and entitlements necessary to realize dignity for all. With international law evolving to address threats to health, a rights-based approach transforms the power dynamic that underlies public health. Rather than passive recipients of governmental benevolence, individuals are recognized as rights-holders, with human rights imposing corresponding obligations on governmental duty-bearers.1 Human rights law is now understood to be central to public health policies, programs, and practices. International human rights standards have been shown repeatedly to play a key role in public health over the past 70 years, framing health concerns within a legal context, integrating core principles into policy debates, and facilitating accountability for realizing the highest attainable standard of health.2 In developing human rights law for public health promotion through the United Nations (UN), the WHO Constitution conceptualized for the first time that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being,” defining health positively to include “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”3 With human rights framing a healthier world out of the ashes of the Second World War, nations adopted the UDHR on December 10, 1948, embracing within it a set of interrelated economic and social rights by which: [e]veryone has the right to a standard of living adequate for the health and well- being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widow-hood, old age or other lack of livelihood in circumstances beyond his control.4 Seventy years ago, the UN proclaimed the UDHR as “a common standard of achievement for all peoples and all nations,” holding that the human right to health includes both the fulfillment of necessary medical care and the realization of underlying determinants of health—including food, clothing, housing, and social services.5 However, the rapidly escalating Cold War would limit international opportunities to advance human rights for health in the UN system, with the 1966 International Covenant on Economic, Social and Cultural Rights providing only for “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”6 From the human rights system to global health governance, WHO would work with advocates in the 1970s to revitalize health-related rights in its “Health for All” campaign, which culminated in a rights-based approach to “primary health care” in the 1978 Declaration of Alma-Ata.7 Extending these human rights advancements in the years after the Cold War, the UN Committee on Economic, Social and Cultural Rights formally clarified state obligations regarding the right to health in 2000, finding that the right to health depends on a wide variety of interdependent and interrelated human rights through public health systems—including both preventive and curative health care and encompassing underlying social, political, and economic determinants of health.8 Given the dramatic development of these health-related human rights, the human rights system has now shifted from the development of human rights under international law to the implementation of those rights through national governance. Policy makers have been pressed to implement rights through national policies, assuring that determinants of health are available, accessible, acceptable, and of sufficient quality.9 Each country has codified a unique set of constitutional obligations, laws, and regulations that implement international law through national policy, with contextually specific social movements rallying to assure that “health is a human right.” Even in the United States, which has long resisted international human rights obligations—especially for economic, social, and cultural rights—there are expanding areas where health policies reflect human rights norms and increasing calls to realize the right to health.10 Go to: Operationalizing human rights in public health The operationalization of these human rights standards has provided normative clarity in public health policy and legal accountability for public health outcomes. Reversing a political neglect for human rights during the Cold War and a policy focus on medical care within WHO, the global response to AIDS in the 1980s clarified the inextricable linkages between human rights and public health, as scholars and advocates looked explicitly to human rights in framing HIV prevention, care, and support.11 Where governments responded to an emerging AIDS crisis through traditional public health policies—including compulsory testing, named reporting, travel restrictions, and isolation or quarantine—human rights activism both 133 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
questioned intrusive infringements on individual liberties and revealed the inadequacy of government responses .12 Focusing on the individual and structural factors underlying HIV transmission, activists demanded a public health response that recognized the inherent dignity of people living with HIV, recognizing the importance of human rights protection to public health promotion and giving birth to a “health and human rights” movement.13 With the advent of antiretroviral treatment in the 1990s, human rights thereafter framed demands for access to medicines—in the streets and in the courts—establishing the normative, and in many settings judicially enforceable, socioeconomic right to health.14 A global movement mobilized human rights to challenge the patent system and secure access to generic medicines in the Global South, driving down the cost of HIV treatments by up to 99%.15 This human rights framework—which demanded agency, dignity, and access—has since been expanded far beyond the HIV/AIDS response. Into the 21st Century, this movement has brought human rights to bear in the context of disease prevention and health promotion efforts throughout the world. Litigation to enforce health-related rights has extended across tuberculosis in prisons in South Africa, maternal mortality in Uganda, the health insurance system in Colombia, and the regulation of medicines in India. 16 In the United States, activists have utilized the right to health to frame health policy reforms in Vermont.17 While some have questioned whether a rights-based framework is too individualistic to address public health, the right to health has been seen to bring about lasting societal improvements, with empirical evidence beginning to show how countries that implement human rights see a benefit to population health.18 This national implementation of human rights in public health provides a basis to facilitate accountability for the progressive realization of health-related human rights. As governments have implemented human rights in health policy, scholars, practitioners, and advocates have sought to create accountability mechanisms to assess the progressive realization of rights, with these mechanisms committing governments to health-related rights, maximizing available resources through health policy, and improving programmatic results in health outcomes through:
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Valuing a human-rights based approach to public health policy increases the likelihood of compliance Barugahare et al 20 [John Barugahare, lecturer at Department of Philosophy at Makerere University in Uganda, Fredrick Nelson Nakwagala, Endocrinologist at Department of Internal medicine, Mulago National Referral Hospital, Erisa Mwaka Sabakaki, Senior Lecturer and Chair of Biomedical Sciences Higher Degrees and Research Ethics Committee, Makerere, Uganda, Joseph Ochieng, associate professor at Department of Anatomy, School of Biomedical Sciences, College of Health Sciences, Makerere University, & Nelson K Sewankambo, Principal of the Makerere University College of Health Sciences and Dean Emeritus of the School of Medicine in Uganda, Sept. 2020, “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,” BMC Medical Ethics, vol. 21, no. 1, p. 91. BioMed Central, doi:10.1186/s12910-020- 00523-0/] /Triumph Debate
The ethical principles such as reciprocity, transparency, non-discrimination, accountability, non-maleficence, equity, and others have been recommended to guide any implementation of restrictive and burdensome public health measures [19, 20]. It has also been observed that these ethical principles bear intrinsic value and are important in ensuring the effectiveness of the adopted measures [16, 20]. However, in designing and implementing public health measures including during PHEs such as the COVID-19 pandemic, there is a likelihood of regarding ethics and human rights considerations as of secondary importance. This is more probable in severely resource- limited settings like Uganda and other similar contexts in LMICs. The reasons are evident: since there is usually no sufficient time and resources to facilitate careful ethical deliberations in these circumstances [16], focus should exclusively be on implementing measures with prima facie potential effectiveness. This is what some claims in the media in Uganda have revealed in response to some of the potentially morally controversial measures adopted by the Government to contain the spread of COVID-19 [21]. However, the measures’ inherent potential to achieve a public health goal, and the extent to which such measures satisfy basic ethics and human rights criteria, play complementary roles in ensuring uptake and actual effectiveness of the adopted measures [22,23,24,25,26, 20]. Therefore, to contain pandemics such as COVID-19, ethical assessment of contemplated measures and their mode of implementation are as critical as their prima facie potential for effectiveness [27, 16, 20]. The assumption of the assertion of complementarity is that many public health measures adopted to reduce, and eventually stop the spread of human-to-human infections, largely depend on voluntary compliance by the public, and the simplicity of their enforcement. These two factors depend on the ethical legitimacy of such measures, which in turn depends on the extent to which those measures satisfy certain ethics and human rights criteria. A careful look at such criteria intuitively reveals that ‘ethically legitimate public health measures are easier to voluntarily comply with and/or enforce’. Consequently, it has been advised that when alternative potentially effective measures are identified, the principles of ethics and human rights should be applied to hone them and make them just, fair, non-discriminatory and acceptable [28] (emphasis added). We take as axiomatic a contention that it is this inherent acceptability of measures which is crucial for inducing voluntary compliance and facilitating their enforcement. However, the concept of acceptability itself presupposes a number of other specific ethical criteria, which lead to the public’s perception of the measures’ legitimacy. Some of such criteria can be seen in a recommendation in reference to the COVID-19 pandemic, that containment, mitigation, and suppression plans must be as inclusive and equitable as possible, or else they risk undermining response efforts [27]. The case for explicitly integrating ethical considerations in public health policy and program evaluation has been articulated as a complement to traditional ‘evidence’. The motivating concern for this view is that the traditional concept of ‘evidence’ exclusively focuses on the potential effectiveness of alternative policy measures without reflecting on how the ensuing actions will impact ethical-related goals of public health. Hence, this position is based on the need to capture some of the common but mostly implicit ethical goals of public health – ‘doing good’, ‘avoidance of harm’, ‘preventing or reducing avoidable health disparities (health equity), among others. This suggests a need for going beyond the traditional and mechanistic approach to health policy evaluation that relies on ‘evidence’ per se, to a more holistic one that captures the ethical-related goals of public health [20]. It is important to appreciate that in uncertain situations where there are overwhelming burdens on health systems such as those presented by the COVID-19 pandemic, it is extremely difficult to implement public health measures that are free of ethical controversy [18]. This is even more difficult in severely resource-limited countries like Uganda. This is so because, as it has been cautioned in reference to responses to the H1N1 influenza pandemic, in similar circumstances, minimalist measures are likely to be ineffective, while maximalist, disproportionate ones pose potential long-lasting negative effects on community trust, public services, social order, and the economy [29]. Generally, ethical controversies about public health measures can result from perceived deception in the form of deliberate under-reporting of statistics of the pandemic [30] or exaggeration of the same statistics; compulsory institutional quarantines at one’s own cost [7,8,9], or judicial detention of potentially infectious patients who are uncooperative [31]. It should be noted that some ethically controversial measures usually come with seemingly robust pragmatic justifications. However, their failure to satisfy ethics and human rights criteria will jeopardize their effectiveness. For example, deception in the form of deliberate under-reporting of the magnitude of the pandemic may be justified by the goal of staving off the devastating psychological impact of truthful reporting on the economy. On the other hand, such deception will lead to false low-risk perceptions among the public, which directly compromise public’s voluntary compliance with highly restrictive safety measures or complicate their enforcement. Such measures will be wrongly perceived as disproportionate, unnecessary and unreasonable in the circumstances; therefore, they will increase the spread of the infection. The reverse is true for deception in the form of exaggeration of the statistics – unnecessary speculations may devastate the economy and lead to the adoption of highly restrictive 135 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
measures, thus unnecessarily limiting and derogating human rights. Furthermore, it is natural that perceptions of discrimination in the form of privilege-like exemptions for some people from compliance with highly burdensome measures such as institutional quarantine – inequitable imposition of burdens – will generally weaken a sense of obligation for voluntary compliance among the public and even make enforcement largely unsuccessful, or unnecessarily violate people’s rights. The emerging insight is that the importance of explicitly integrating ethics and human rights considerations into the choice of effective policies and measures cannot be overstated. Our contention is that public health policies and measures chosen following a more holistic approach that combines ‘evidence’ and ‘ethics and human rights considerations’ as its criteria has better chances of success than a mechanistic one which relies on ‘evidence’ alone. Hence, if ‘evidence’ is the only input for such decisions, then there is a strong case for revisiting the traditional concept of ‘evidence’ as it applies to public health, to include the potential ethical and human rights impact of alternative policies, programs and measures.
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Harm Reduction That Protects Rights Voluntary app measures are able to operate without violating civil liberties, ensuring they aren’t left at home Farr 20 [Christina Farr, technology and health reporter for CNBC, 4/18/20, “The Covid-19 response must balance civil liberties and public health – experts explain how”, CNBC, https://www.cnbc.com/2020/04/18/covid-19-response-vs- civil-liberties-striking-the-right-balance.html] /Triumph Debate
Modern approaches to contact tracing can be designed to protect privacy. For instance, Google and Apple are working to develop a system to do that uses a Bluetooth-based approach, which aims to prevent governments or the companies providing the technology from identifying any one person who might be sick. Users must opt-in to participate. Here’s how the Electronic Frontier Foundation, a privacy-focused organization, describes it: When two users of the app come near each other, both apps estimate the distance between each other using Bluetooth signal strength. If the apps estimate that they are less than approximately six feet (or two meters) apart for a sufficient period of time, the apps exchange identifiers. Each app logs an encounter with the other’s identifier. The users’ location is not necessary, as the application need only know if the users are sufficiently close together to create a risk of infection. This kind of approach differs vastly from methods that use GPS to track the movements of citizens without their consent. On a technical level, GPS doesn’t work well in buildings, and it has a hard time understanding whether two people are within 20 feet from each other. But more important, if consumers don’t trust a smartphone- based tracking system, they can simply leave their phone at home. That would render the technology useless. “Having consent and good processes to grant and withdraw consent is critical,” said Bennett Cyphers, a staff technologist at EFF by phone.
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Media campaigns remain an effective measure for large scale social health changes without limiting civil liberties Riley et al., 17 [Kristen E. Riley, postdoctoral research fellow at Memorial Sloan Kettering Cancer Center in NYC, Michael R. Ulrich, assistant professor in the Center for Health Law, ethics & Human Rights and the Department of Health, Law, and Policy management at Boston University School of Public Health, Heidi A. Hamann, associate professor in the Departments of Psychology and Family and community Medicine at the University of Arizona in Tucson, Jamie S. Ostroff, chief of the behavioral sciences service in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer center and professor of psychology in the Dept. of Healthcare Policy and Research at Weill Cornell Medical College, May 2017, “Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care”, AMA Journal of Ethics, doi: 10.1001/journalofethics.2017.19.5.msoc1-1705] /Triumph Debate
Hard-hitting media anti-smoking campaigns often focus on both raising awareness about the health consequences of smoking and denormalizing smoking behavior, thereby motivating prevention among the general public and motivating smokers specifically toward cessation [7-9]. The term “hard-hitting” has been used to describe ad campaigns that are uncompromisingly direct, often with strong fear-arousing messages and personal stories about negative health consequences of smoking. These types of ads are supported by well-established theories of health behavior change (e.g., the Health Belief Model [10], the theory of planned behavior [11, 12]) that focus broadly on cognitive, emotional, and social processes (e.g., perceived susceptibility to disease, health beliefs regarding the consequences of behavior change, self-efficacy, and social norms) that predict behavior change. Hard-hitting ads have been shown to be more effective than humorous or neutral educational communication messages at reducing smoking [13]. Most recently, the Tips From Former Smokers™ campaign [14], featuring real people suffering from serious medical conditions as a result of smoking and exposure to secondhand smoke, has been credited with an estimated 1.64 million American smokers making a quit attempt; 100,000 of these smokers are expected to maintain smoking abstinence [8]. Public health leaders assert that the hard-hitting ads are justified by the benefits observed in reducing smoking and related health consequences [5, 15-17]. Although some hard-hitting anti- tobacco campaigns (e.g., graphic warnings on cigarette packs) have been challenged by the tobacco industry [18, 19], the Family Smoking Prevention and Tobacco Control Act of 2009 gives the FDA authority to regulate the tobacco industry [20]. Regardless of these legal challenges, hard-hitting anti- tobacco public health campaigns remain best practice for mass-reach public health communications.
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Combining community engagement with low-cost products can work, allowing for communities to change where more coercive actions fail Vital Strategies 21 [Vital Strategies is a public health organization that aims to strengthen and provide research for governments and CSO’s worldwide, March 2021, “Promoting mask-wearing during the Covid-19 pandemic: A Policymaker’s Guide”, Vital Strategies and John Hopkins Center for Health Security, https://preventepidemics.org/wp- content/uploads/2020/08/Promoting-Mask-Wearing-During-COVID-19.pdf] /Triumph Debate
Communities have been affected by the COVID-19 pandemic in different ways. Community engagement strategies seek to involve community leaders and members in the public health response and deliver context-specific and culturally appropriate support to overcoming barriers and promoting positive information and behaviors. Such strategies are important during any public health intervention, and critically important during a pandemic. Engage and empower community leaders During the 2014 Ebola epidemic in West Africa, distrust of the government and public health authorities in many countries led some communities to forgo protective behaviors such as modified burial practices. Engaging and empowering religious leaders was considered one of the critical strategies to bring the outbreak under control. During the COVID-19 pandemic, governments should engage leaders from ethnic and religious minorities, with an emphasis on any communities that are at higher risk. For instance, in the United States, Black and Latinx people are more than twice as likely to die of COVID-19. Engaging community leaders can provide powerful insights into what types of community engagement will best improve mask use, and community leaders can be important and trusted messengers for promoting mask- wearing. This could include measures such as asking leaders to reach out through community- based media such as WhatsApp or Facebook groups. Use community-level activities to increase access to masks There is evidence of the effectiveness of health promotion campaigns that combine strategic communication with low- or no-cost products (e.g., condoms). Dispensing masks in low-resource, low-adherence communities, along with health promotion messages, may help increase mask use. This may include teaching community members how to make masks from materials ready at hand.
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Contact Tracing by Bluetooth instead of GPS could preserve location data of individuals Abeler et al. 20 [Johannes Abeler, research fellow at the University of Oxford, Ph.D. in Economics from the University of Bonn in 2008, Matthias Bäcker, professor at Johannes Gutenberg University Mainz Law and Economics, Ulf Buermeyer, chairman and legal director of the Gesellschaft für Freiheitsrechte eV (GFF), and Hannah Zillessen, professor in the Department of Economics at Oxford, Apr. 2020, “COVID-19 Contact Tracing and Data Protection Can Go Together,” JMIR MHealth and UHealth, vol. 8, no. 4, PubMed Central, doi:10.2196/19359] /Triumph Debate
Another example for this kind of “privacy by design” COVID-19 tracing approach is the TraceTogether app [5] from the Singaporean government. Unlike the contact point system, it only requires users to enable Bluetooth on their phone. Pan-European Privacy-Preserving Proximity Tracing (PEPP-PT) by the European consortium [3], as well as Google and Apple’s recently announced joint initiative [4], are following a very similar concept. We present a slightly modified version below. In order to detect whether two people have come into close enough physical proximity to risk an infection, one can use Bluetooth low energy technology. The general drawback of Bluetooth—that it can only reach across a few meters—becomes an advantage here. The tracking itself would work as follows: as many people as possible voluntarily install the app on their phone. The app cryptographically generates a new temporary ID every half hour. As soon as another phone with the same app is in close proximity, both phones receive the temporary ID of the respective other app and record it. This list of logged IDs is encrypted and stored locally on the users’ phones (Figure 1). An external file that holds a picture, illustration, etc. Object name is mhealth_v8i4e19359_fig1.jpg Figure 1 A COVID-19 tracing approach via Bluetooth. Every mobile phone stores a list of mobile phones that were within 2 m for at least 15 minutes. IDs are temporary but can be decrypted by the server. As soon as an app user is diagnosed with COVID-19, the doctor making the diagnosis asks the user to share their locally stored data with the central server (Figure 2). If the user complies, the central server receives information on all the temporary IDs the “infected” phone has been in contact with. The server is not able to decrypt this information in a way that allows for the identification of individuals. However, it is able to notify all affected phones . This is because the server does not need any personal data to send a message to someone’s phone. The server only needs a so-called PushToken, a kind of digital address of an app installation on a particular phone. This PushToken is generated when the app is installed on the user’s phone. At the same time, the app will send a copy of the PushToken, as well as the temporary IDs it sends out over time, to a central server. The server could be hosted, for example, by the Robert Koch Institute for Germany or by the National Health Service for the United Kingdom. This way, it would be possible to contact phones solely based on temporary IDs and PushTokens whilst completely preserving the privacy of the person using the phone. An external file that holds a picture, illustration, etc. Object name is mhealth_v8i4e19359_fig2.jpg Figure 2 A user can share their data with the server after receiving a COVID-19 diagnosis. The server then alerts all phones that have been in close proximity to the infected phone. The alerted people would still need to contact their local health authorities, as their identity is not linked to the app. If a phone has been in close proximity to an “infected” phone, the user of that phone receives a notification together with the request to immediately go into quarantine at home. The user will then need to contact the local health authorities to get tested for the virus as soon as possible so that, depending on the outcome, the user is either able to stop quarantining or all their contacts can be informed (Figure 2). During the entire process, no one learns the identity of the app user (eg, other users who got in close contact with them, the local health authorities, the central server) since the app is not linked to an identity. Location data is neither recorded nor stored at any point of the process. As mentioned above, we did not come up with this concept. Singapore introduced a very similar app, and several European countries [3] are working on comparable apps as well. We do not agree with all aspects of the Singaporean app and their practice of contact tracing. For example, every app installation in Singapore is linked with the user’s telephone number, making the user identifiable—something that is not strictly necessary and thus, for data protection reasons, should be rejected. Nevertheless, we like the general concept. The recently published PEPP-PT [3] looks promising and might prove to be a legitimate implementation of the privacy-friendly tracing approach outlined above. Such an app could implement contact tracing much more effectively than a system that relies on radio cell or location data, since neither of these two data sources permit determining a person’s position with the necessary precision of 2 m maximum. At the same time, such a concept would comply with existing data protection regulations. Finally, it would work even without users paying constant attention to potentially risky interactions as would be necessary in a contact-point system. Thus, this concept is potentially more robust to fatigue or inattentiveness.
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Privacy by Design Apps being used in several countries can reduce privacy concerns OECD 20 [OECD, April 23 2020, “Tracking and Tracing COVID: Protecting Privacy and Data While Using Apps and Biometrics,” OECD, https://www.oecd.org/coronavirus/policy-responses/tracking-and-tracing-covid-protecting-privacy- and-data-while-using-apps-and-biometrics-8f394636/] Triumph Debate
The use of geolocation data-collecting apps can allow data-sharing with explicit, built-in privacy and data protections, and enable users to give their explicit, informed consent to the collection and sharing of their personal data (assuming use of the app is not mandatory). For instance, Singapore’s TraceTogether app has a number of privacy safeguards, including that it does not collect or use geolocation data and data logs are stored in an encrypted form. To protect the privacy of its users, the Pan-European app encrypts data and anonymises personal information. In addition, as two phones never exchange data directly and the users’ aliases are changed frequently, it is virtually impossible to reveal the identity of users. However, the range of personal data these apps collect, process and share can be very broad and difficult for users to understand. In many cases, apps continue to run in the background even when the device is not in use. Some apps can also exchange information with other apps through application programming interfaces (APIs), generating more detailed information. While the World Health Organization (WHO) praised Korea’s extensive tracing measures, some uses by designated local authorities of the data collected through the Epidemiological Investigation Support System on the movements of persons with confirmed cases have raised privacy concerns. In response, the Korean government recently published guidance related to the disclosure of the movements of persons with confirmed cases based on the Infectious Disease Control and Prevention Act passed in 2015 which does not allow any information specific to the data subject to be disclosed. Leveraging biometric data adds both benefits and challenges Facial recognition has been one of the most frequently used biometrics in a number of countries to monitor the spread of COVID-19. Facial recognition enables authorities to reduce the use of identification technologies that require physical contact (such as iris scans and fingerprints). It can also be paired with other technologies, including thermal imaging enhanced by artificial intelligence, to better track citizens who may test positive for COVID-19. In Poland, the government has launched a biometrics smartphone app to confirm that people who are infected with COVID-19 remain under quarantine. In the People’s Republic of China (hereafter “China”), facial recognition has been used to prevent citizens who may be infected with COVID-19 from travelling. In addition, companies in China have developed a technology that could allow the government to successfully identify people even when they are wearing masks. In the Russian Federation, facial recognition systems are being used to track individuals who fail to respect mandatory quarantine. However, the use of biometrics (including facial recognition) in response to COVID-19 raises a number of privacy and security concerns, particularly when these technologies are being used in the absence of specific guidance or fully informed and explicit consent. Individuals may also have problems exercising a wide range of fundamental rights, including the right of access to their personal data, the right to erasure, and the right to be informed as to the purposes of processing and who that data is shared with. Facial recognition systems can also have inherent technological bias, e.g. when based on race or ethnic origin. Privacy-by-design can help address the risks Privacy-by-design seeks to deliver the maximum degree of privacy by ensuring that personal data protections are built into the system, by default. Privacy-by- design may, for example, involve the use of aggregated, anonymised, or pseudonymous data to provide added privacy protection, or the deletion of data once its purpose is served. For instance, the COVID-19 app developed by the Norwegian Institute of Public Health is designed to store location data only for 30 days. The use of additional privacy enhancing solutions (such as homomorphic encryption)1 may provide added security, as can the use of data sandboxes, through which access to highly sensitive (personal) data is only granted within a restricted digital and/or physical environment to trusted users. An example of the latter is Flowminder, which collaborated with telecommunication companies during the 2014-16 Ebola outbreak to provide epidemiologists with secured access to de-identified low-resolution geolocation data. Flowminder is using a similar strategy in contributing to the response to the COVID-19 crisis.
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The slow uptake of contact tracing apps is explained by low public trust Chan and Saqib 21 [Eugene Y. Chana, Division of Consumer Science, Purdue University and Najam U. Saqibb, Department of Marketing and Management, Laurentian University, Canada, June 2021, “Privacy Concerns Can Explain Unwillingness to Download and Use Contact Tracing Apps When COVID-19 Concerns Are High,” Computers in Human Behavior, vol. 119, p. 106718. PubMed Central, doi:10.1016/j.chb.2021.106718] /Triumph Debate
As of December 2020, there were over 81 million infections of COVID-19 and over 1.8 million deaths around the world. Luckily, over 57 million have also recovered from the deadly disease. The pandemic resulted in a seismic shift in how people live, work, and play, with the worldwide economy being shattered, families unable to see loved ones, and air travel coming to a halt (Garfin, Silver, & Holman, 2020). Given the severity of the COVID-19 disease, doctors, policy makers, and government officials have introduced measures to help “flatten the curve” such as by introducing guidelines—sometimes mandates—concerning staying-at-home, wearing face masks, and social distancing when outside (Anderson, Heesterbeek, Klinkenberg, & Hollingsworth, 2020; Chan, 2020a, 2020b; Feng et al., 2020; Glass, Glass, Beyeler, & Min, 2006; Horwell & McDonald, 2020; Jia et al., 2020; Lewnard & Lo, 2020; Wu et al., 2020). One particular effective method to help “flatten the curve” is to conduct contact tracing. Contact tracing has long been recognized to help keep pandemics at bay (Ahmed et al., 2020; Eames & Keeling, 2003; Klinkenberg, Fraser, & Heesterbeek, 2006; Kretzchmar et al., 2020). When a person is known to have been infected with a disease, such as COVID-19, public health officials usually “race against time” to find all known contacts of the person in their recent days, contacting those persons and asking them to quarantine in order to avoid subsequent spread of the disease. In efforts to conduct contact tracing during the COVID-19 pandemic, some Asian countries such as the People's Republic of China and Republic of Korea have accessed people's banking and mobile records to determine where an infected person has been (COVID-19 National Emergency Response Center, 2020; Sternlicht, 2020). Another tool that countries have used to facilitate contact tracing is via the introduction and promotion of “contact tracing” apps for people to download on smartphones (Ahmed et al., 2020; Kretzchmar et al., 2020). Relying on Bluetooth technology, these apps “detect” if the smartphone user is near someone else with the same app for a specified amount of time (usually 15 min). This digital interaction is then recorded, allowing public health officials to quickly contact the other individual via a notification on their app if they are deemed at-risk from possible exposure to an infected individual. Many countries including South Korea along with others such as Singapore and Australia have already introduced such apps, while other countries such as the United Kingdom and France have either discussed it or planning on introducing contact tracing apps. For a list of countries as of December 2020, please see Appendix 1. Contact tracing apps have been promoted, moreover, not just with the goal to conduct contact tracing. In Australia, Prime Minister Scott Morrison encouraged Australians to download the CovidSafe app on phones in exchange for reducing lockdown measures back in May 2020. But, uptake of tracing apps is slow. The app in Australia was introduced in May 2020. As of December 2020, only 7.1 million downloads have been recorded (Barbaschow, 2020), far short of the 40% of the 26 million population in the nation that Prime Minister Scott Morrison said was required for the app to be effective (Dick, 2020). Low uptake levels in Singapore promoted the Prime Minister Lee Hsien Loong in the South-East Asian city-state to legally enforce its download back in October 2020 (Nakano, 2020). There are also low levels of uptake in other countries where the apps have been introduced, such as India, Norway, and Singapore, thereby hampering efforts in tracing contacts and flattening the curve (Findlay, Palma, & Milne, 2020). The question is interesting then. One would intuitively envisage that concerns about one's own and the public's health would be greater when a viral disease is rampant. Why is there low uptake of contact tracing apps when the goal of these apps is to promote both personal and public health, especially in the face of a deadly viral pandemic? Go to: 1. Hypothetical development One of the key reasons for the resistance against the use, download, and adoption of any contact tracing app is due to the potential invasion of personal privacy (Findlay et al., 2020; Meade, 2020; Rudgard, 2020), which consumers must weigh against the potential benefits for public and also their personal health as with many other technological advances such as electronic health records (Jozani, Ayaburi, Ko, & Choo, 2020; Park & Shin, 2020). Indeed, contact tracing apps often require giving away one's movements and possibly (depending on the app or country) medical information, increasing reluctance among the public to download and use these apps. For example, in India, which introduced the “Aarogya Setu” app in April 2020 (with only 127.6 million downloads by July), had few privacy safeguards, with data collected being stored in centralized servers but without any data protection laws in place (Arun, 2020). In Australia, concerns about its CovidSafe app largely surrounded the fact that there are now legal restrictions about secondary use of any data collected with the app beyond its primary purpose of protecting public health (Remeikis, 2020). Could privacy concerns trump even concerns about health, during a time when health intuitively should be weighted more on people's minds?
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Voluntary Contact Tracing Apps have higher support across Europe and the US Altmann et al 20 [Samuel Altmann, Phil Economics candidate at the Department of Economics and Wadham College, Luke Milsom, DPhil (PhD) candidate in the department of economics at Oxford University, Hannah Zillessen, MPhil at the University of Maryland, Raffaele Blasone, MPhil in Economics at University of Oxford | Bocconi graduate | Dartmouth, Frederic Gerdon, Professor for Statistics and Methodology at the University of Mannheim, Ruben Bach, postdoctoral researcher at the University of Manheim, Frauke Kreuter, Co-director of the Social Data Science Center at the University of Maryland, Daniele Nosenzo, Professor, Department of Economics and Business Economics, Aarhus University, Séverine Toussaert, Associate Professor Of Economics chez University of Oxford, Johannes Abeler, Professor of Economics at the University of Oxford, and a Supernumerary Fellow of St Anne's College, Aug. 2020, “Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study,” JMIR MHealth and UHealth, vol. 8, no. 8, p. e19857, DOI.org (Crossref), doi:10.2196/19857] /Triumph Debate
We find broad support for app-based contact tracing. Support is high in all countries, across all subgroups of the population, and under both installation regimes (opt- in and opt-out). Panel A of Figure 1 shows that, under the voluntary (opt-in) installation regime, 4484 out of 5995 respondents (74.8%) across all countries say they would probably or definitely download the contact-tracing app, if it was available. Panel B shows that 4059 out of 5995 respondents (67.7%) say they would probably or definitely keep the app installed on their phone under the automatic (opt-out) installation regime. In both regimes, the share of respondents who say they would not have the app installed on their phone is very small (red portion of the bars in Figure 1). Figure 1. Likelihood of having the app installed, under opt- in and opt-out regimes and by country. Light/dark red bars correspond to probably/definitely won’t install in Panel A and probably/definitely uninstall in Panel B. View this figure Support is high in all five countries where we implemented the survey: in each country, at least 68% of respondents say that they would install or keep the app. Moreover, Figures 9–11 in Multimedia Appendix 1 show that support for the app is generally high across various subgroups of the population (eg, across men and women, across different age groups, etc), suggesting widespread acceptability of the app-based contact tracing solution to the COVID-19 pandemic. Despite the broad and widespread acceptability of the app, we find that support varies systematically across countries and individuals. For instance, Figure 1 shows that Germany and the United States are relatively less supportive of the app compared to the other countries. This is the case both under the opt-in and opt-out regimes. Among individual characteristics, we find that those who have less trust in their national government are more hesitant to have the app installed on their phones (Figure 11 in Multimedia Appendix 1). We further explore this heterogeneity using multivariate regression analysis, where we examine the relationship between support for the app and a variety of individual- and country-level covariates. Figure 2 shows the impact that these covariates have on the probability of definitely or probably installing the app under the opt-in regime, using a linear probability model (see Section C.1 in Multimedia Appendix 1 for a similar analysis of the opt-out regime). Figure 2. Determinants of stating definitely install or probably install. Note: the dependent variable is an indicator variable taking the value 1 if a respondent chose definitely install or probably install when asked whether they would install the app or not, and 0 otherwise. We use a Linear Probability Model. Lines represent 95% CIs calculated with heteroskedasticity-robust standard errors. All coefficients are the result of a single regression and thus display marginal effects. A coefficient of 0.1 implies a respondent who chose this option is 10 percentage points more likely to state they would definitely or probably install the app relative to the base category. View this figure The analysis confirms that Germany and the United States are significantly less supportive of the app, especially compared to France and Italy. Taking the two most extreme cases, respondents in Italy are 15.1 percentage points (95% CI 12.1-18.1) more likely to support the app than respondents in the United States. Surprisingly, Figure 2 shows very little correlation between regional-level COVID-19 mortality rates and support for the app. Among individual-level characteristics, we find that people who carry their phone with them more often are more likely to install the app. Those who always carry their phone with them are 33.6 percentage points (95% CI 26.4-40.8) more likely to support the app than those who carry their phone only rarely. App support is also 3.7 percentage points (95% CI 1.3-6.2) larger among respondents with one or more comorbidities. Moreover, the probability of installing the app increases with trust in the government. People who completely trust the government are 25.9 percentage points (95% CI 21.6-30.3) more likely to install the app than those who do not have any trust in the government. We found similar results using an ordered logit model, a linear probability model dichotomizing on just definitely install, and when using a probit model ( Multimedia Appendix 1). Finally, results are also qualitatively similar when considering installation intentions under opt-out rather than opt-in (Figure 8 in Multimedia Appendix 1). Interestingly, under the opt-out regime, trust in government displays an even stronger correlation with the intention to keep the app installed on one’s phone. We can use the data on respondents’ reasons for or against installing the app to better understand the nature of the observed variation in app support across countries and individuals. A first set of reasons against the app revolved around concerns about government surveillance at the end of the epidemic (mentioned by 2518 out of 5995 respondents, 42%) and cybersecurity (fears that the app could make the phone vulnerable to hackers; 2098/5995, 35%). Respondents also reported that usage of the app may increase feelings of anxiety (1559/5995, 26%), possibly reflecting aversion to feedback about a possible infection. The most frequent reasons in favor of the app were willingness to protect family and friends (4077/5995, 68%), a sense of responsibility toward the community (3177/5995, 53%), and a hope that the app may stop the epidemic (3297/5995, 55%). Figures 16 and 17 in Multimedia Appendix 1 show the relationship between the probability of selecting a particular reason and country- and individual-level characteristics.
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Voluntary lockdowns coupled with government support are more effective and don’t violate civil liberties Human Rights Watch 20 [Human Rights Watch, 19 Mar. 2020, “Human Rights Dimensions of COVID-19 Response,” Human Rights Watch, https://www.hrw.org/news/2020/03/19/human-rights-dimensions-covid-19-response/] /Triumph Debate
International human rights law, notably the International Covenant on Civil and Political Rights (ICCPR), requires that restrictions on rights for reasons of public health or national emergency be lawful, necessary, and proportionate. Restrictions such as mandatory quarantine or isolation of symptomatic people must, at a minimum, be carried out in accordance with the law. They must be strictly necessary to achieve a legitimate objective, based on scientific evidence, proportionate to achieve that objective, neither arbitrary nor discriminatory in application, of limited duration, respectful of human dignity, and subject to review. Broad quarantines and lockdowns of indeterminate length rarely meet these criteria and are often imposed precipitously, without ensuring the protection of those under quarantine – especially at-risk populations. Because such quarantines and lockdowns are difficult to impose and enforce uniformly, they are often arbitrary or discriminatory in application. Freedom of movement under international human rights law protects, in principle, the right of everyone to leave any country, to enter their own country of nationality, and the right of everyone lawfully in a country to move freely in the whole territory of the country. Restrictions on these rights can only be imposed when lawful, for a legitimate purpose, and when the restrictions are proportionate, including in considering their impact. Travel bans and restrictions on freedom of movement may not be discriminatory nor have the effect of denying people the right to seek asylum or of violating the absolute ban on being returned to where they face persecution or torture. Governments have broad authority under international law to ban visitors and migrants from other countries. However, domestic and international travel bans historically have often had limited effectiveness in preventing transmission, and may in fact accelerate disease spread if people flee from quarantine zones prior to their imposition. In China, the government imposed an overly broad quarantine with little respect for rights: In mid-January, authorities in China quarantined close to 60 million people in two days in an effort to limit transmission from the city of Wuhan in Hubei province, where the virus was first reported, even though by the time the quarantine started, 5 million of Wuhan’s 11 million residents had left the city. Many residents in cities under quarantine expressed difficulties obtaining medical care and other life necessities, and chilling stories have emerged of deaths and illnesses: A boy with cerebral palsy died because no one took care of him after his father was taken to be quarantined. A woman with leukemia died after being turned away by several hospitals because of concerns about cross-infection. A mother desperately pleaded to the police to let her daughter with leukemia through a checkpoint at a bridge to get chemotherapy. A man with kidney disease jumped to his death from his apartment balcony after he couldn’t get access to health facilities for dialysis. Authorities have also reportedly used various intrusive containment measures: barricading shut the doors of suspected infected families with metal poles, arresting people for refusing to wear masks, and flying drones with loudspeakers to scold people who went outside without masks. The authorities did little to combat discrimination against people from Wuhan or Hubei province who traveled elsewhere in China. In Italy the government has imposed a lockdown but with greater protections for individual rights. The Italian government adopted progressively restrictive measures since the first major outbreak of COVID-19 cases in the country in late February. Authorities initially placed ten towns in Lombardy and one in Veneto under strict quarantine, prohibiting residents from leaving the areas. At the same time, they closed schools in affected regions. Citing a surge in cases and an increasingly unsustainable burden on the public healthcare system, the government on March 8 imposed a slew of new measures on much of the country’s north that put in place much more severe restrictions on movement and basic freedoms. The next day, the measures were applied across the country. Further measures imposed included restrictions on travel except for essential work or health reasons (upon self-certification), closure of all cultural centers (cinemas, museums), and cancellation of sports events and public gatherings. On March 11 the government closed all bars, restaurants, and stores except food markets and pharmacies (and a few other exceptions) across the country. People who disobey the travel restrictions without a valid reason can be fined up to 206 euros and face a three-month prison term. All schools and universities were closed throughout the country. People have been allowed out to shop for essential items, exercise, work (if unable to perform work from home), and for health reasons (including care for a sick relative). Other governments, such as those in South Korea, Hong Kong, Taiwan, and Singapore have responded to the outbreak without enacting sweeping restrictions on personal liberty, but have reduced the number of travelers from other countries with significant outbreaks. In South Korea, the government adopted proactive and ramped-up testing for COVID-19. It focused on 144 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
identifying infection hotspots, conducting a large number of tests on at-risk people without charge, disinfecting streets in areas with high numbers of infections, setting up drive-through testing centers, and promoting social distancing. In Hong Kong, there have been concerted efforts to promote social distancing, handwashing, and mask-wearing. Taiwan proactively identified patients who sought health care for symptoms of respiratory illness and had some tested for COVID-19. It also set up a system that alerts the authorities based on travel history and symptoms during clinical visits to aid in case identification and monitoring. Singapore adopted a contact-tracing program for those confirmed to have the virus, among other measures. However, the government’s decision to deport four foreign workers for violating a mandatory 14-day leave of absence from work and ban them from working in the country raises concern of disproportionate penalties. Recommendations: Governments should avoid sweeping and overly broad restrictions on movement and personal liberty, and only move towards mandatory restrictions when scientifically warranted and necessary and when mechanisms for support of those affected can be ensured. A letter from more than 800 public health and legal experts in the US stated, “Voluntary self-isolation measures [combined with education, widespread screening, and universal access to treatment] are more likely to induce cooperation and protect public trust than coercive measures and are more likely to prevent attempts to avoid contact with the healthcare system.” When quarantines or lockdowns are imposed, governments are obligated to ensure access to food, water, health care, and care-giving support. Many older people and people with disabilities rely on uninterrupted home and community services and support. Ensuring continuity of these services and operations means that public agencies, community organizations, health care providers, and other essential service providers are able to continue performing essential functions to meet the needs of older people and people with disabilities. Government strategies should minimize disruption in services and develop contingent sources of comparable services. Disruption of community-based services can result in the institutionalization of persons with disabilities and older people, which can lead to negative health outcomes, including death, as discussed below.
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Monetary Incentives worked for the influenza vaccine in the 2005-2006 flu season Mayoryk and Levy 06 [Stephanie Mayoryk, infection preventionist who has served most recently as the Corporate Director of Infection Prevention for the LifeBridge Health System, and Susan Levy, VPMA at Levindale Hebrew Geriatric Center and Hospital, June 2006, “Incentive Program Increases Employee Influenza Vaccine Compliance at a Chronic Hospital/Long-Term Care Facility,” American Journal of Infection Control, vol. 34, no. 5, p. E49. DOI.org (Crossref), doi:10.1016/j.ajic.2006.05.104] /Triumph Debate
Influenza vaccination rates for employees at Levindale Hebrew Geriatric Center and Hospital employees have historically been approximately 40% annually. We set out to increase organizational employee vaccination compliance by utilizing the facility’s existing monetary rewards program. PROJECT: Quarterly at Levindale, all employees are eligible for a monetary bonus based on results of selected indicators, such as customer satisfaction survey results. Due to an Influenza outbreak on two LTC units within the facility during the 2004-2005 Influenza season, the 2005-2006 flu planning committee received support from administration to allow Influenza Vaccination administration among employees to be the selected indicator for the winter quarter (October-December 2005). Employees who received vaccine were given a cash bonus (part-time and prn employees received half of all bonus amounts). If 80% of employees became vaccinated during the quarter, another cash bonus of the same amount would follow (part-time and prn employees received half). The only exclusions to the program included employees on disciplinary action and those who worked less than 18 shifts for the quarter. Employees who refused vaccination signed a declination form. RESULTS: Influenza vaccine was received on October 3rd, 2005 and was administered through December 31, 2005. 528 total vaccines were administered to 627 total employees. Levindale improved its employee Influenza Vaccine compliance from 32% during the 2004-2005 season to 84.2% during the 2005-2006. LESSONS LEARNED: A monetary incentive program improved Levindale’s Influenza vaccination rates among employees. Development of a successful Employee Influenza Incentive Campaign required substantial buy-in and financial support from administration. The incentive program made the Levindale flu vaccine program a success during for 2005-2006 Influenza season.
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Both SARS and subsequent WHO efforts have shown the importance of transparency in early disease detection and compliance with restrictions O’Malley, et al 09 [Patrick O’Malley- Professor at Centre for the Study of Democracy, Queen’s University, Jon Rainford- IHR Coordinate, Country Surveillance and Response Strengthening, World Health Organization & Alison Thompson- Professor at the Joint Centre for Bioethics, University of Toronto, August 2009, “Transparency during Public Health Emergencies: From Rhetoric to Reality,” Bulletin of the World Health Organization, vol. 87, no. 8, pp. 614–18. DOI.org (Crossref), doi:10.2471/BLT.08.056689.] /Triumph Debate
Ongoing work to address the challenge of public health emergencies has increasingly recognized the role that public communication plays in their effective management. Pro-active communication, as one example, allows the public to adopt protective behaviours, facilitates heightened disease surveillance, reduces confusion and allows for a better use of resources, all of which are necessary for an effective response. The severe acute respiratory syndrome (SARS) crisis of 2003 stands as a recent example of the risks and benefits arising from open information associated with a public health threat. Reluctance by authorities to acknowledge and communicate a potential problem in the first stages of the outbreak aided in the quick global spread of the disease.1 In contrast, the eventual break in transmission and international control was rooted in public awareness, community surveillance and behaviour modification – all of which was directly supported by a massive international public health information effort. Food safety crises, chemical events and bioterrorism threats of recent years have similarly underscored the crucial role that proactive communication of risk plays in public health emergency management. The final report of the WHO Global Conference on Severe Acute Respiratory Syndrome held in 2003 in Kuala Lumpur was clear in its conclusions: “Information should be communicated in a transparent, accurate and timely manner. SARS had demonstrated the need for better risk communication as a component of outbreak control and a strategy for reducing the health, economic and psychosocial impact of major infectious disease events.”2 This emphasis on proactive dissemination of risk-related information has been echoed time and again when senior public health representatives meet to discuss public health emergency management. But beyond a rhetorical commitment to transparency, does this translate into substantive action by public health authorities and governments? Unlike many other public health indicators, transparency by public health authorities can be difficult to track. Definitions of transparency may vary, measurement norms are ill-defined and, ultimately, assessments may be subjective. The strong sense among those closely involved, however, is that transparent public communication during crisis situations remains an elusive goal. Indeed, interviews conducted with WHO communication staff who were involved in various high profile public health emergencies between 2004 and 2008 reflect several persistent challenges that tend to undermine transparency: reluctance to announce a potential health threat and inform an at-risk population of appropriate precautionary measures until all information is scientifically confirmed and formally endorsed; a tendency to withhold information that is potentially damaging to an economic sector – often against the recommendations of public health experts; an emphasis on strict information control within organizations, making constructive engagement of potential partners in coordinated public communication difficult. With the coming into force of the International Health Regulations (2005), the global community is working to confront barriers to improved health security. With risk communication now identified as one of the eight core capacities of IHR implementation under surveillance and response, an opportunity exists to consider and promote practical steps to ensure that the rhetorical commitment to transparency translates into practice. Why transparency? The first and most pressing rationale for transparency during a health emergency is the role that information plays in promoting core public health objectives. When the public is at risk of a real or potential health threat, treatment options may be limited, direct interventions may take time to organize and resources may be few. Communicating advice and guidance, therefore, often stands as the most important available tool in managing a risk. In addition to serving core public health objectives, transparent public communication also addresses key strategic imperatives – political, economic and psychosocial – which are associated with public health emergencies. Some of the most well-known research into these strategic dimensions comes out of the experience of the private sector. The literature includes case studies of corporations struggling with an oil spill, product contamination or other incident that threatens the organization’s “brand” and share price, and also introduces the issue of legal liability.3 Proactive announcements and ongoing transparency in this context is seen not just as an organizational responsibility but as also the most effective way of seizing control of media reports, public discourse and customer relations associated with the event. Communication control is seen as a strategic tool to ensure perceptions of risk align with actual risk so as to limit negative information associated with the company and, ultimately, help to ensure that the reputation of the organization rebounds to its pre-crisis level. Although this model may not directly transfer to the public sector, public health authorities can not dismiss these purported benefits. Indeed, given the tendency for public health emergencies to be managed by multiple organizations with different perspectives, integrating such strategic arguments into the case for transparency could have particular appeal for actors outside public health. Beyond the immediate public health and broader strategic advantages of transparency there exists an additional, longer-term rationale, central not only to the management of a particular incident, but also to the capacity of the public health authority to fulfil its ongoing responsibilities – that of preserving and building trust. Recent scholarship in the field of public health ethics and pandemic influenza planning has emphasized the importance of transparency in managing infectious disease outbreaks.4 In this context, transparency not only provides individuals and communities with information needed to survive an emergency, it is also an element of procedural fairness in decision-making and priority setting.5,6 It is also a necessary, if not sufficient, condition for accountable decision-making and for the promotion of public trust. The reality is that most measures for managing public health emergencies rely on public compliance for effectiveness. Measures ranging from hand washing to quarantine require public acceptance of their efficacy, as well as acceptance of the ethical rational for cooperating with instructions that may limit individual liberty so as to protect the broader public from harm. This requires that the public trust not only 147 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
the information they are receiving, but also the authorities who are the source of this information, and their decision- making processes. WHO’s Outbreak communication planning guide 20087 highlights the crucial importance of information transparency in maintaining trust during an emergency but also in building risk communication capacity to support all phases of emergency management. As previously acknowledged, convincing public health authorities and governments to be transparent in their communication in the face of scientific uncertainty can be difficult. Transparency, however, about what is not known is just as important to the promotion of public trust as transparency about what is known. Trust requires honest, open and two-way communication. For countries where public trust in government and public health is low, efforts to build and maintain trust are best made in collaboration with stakeholders before a public health emergency occurs. The “bunker mentality” during a crisis results in a less inclusive decision-making process because fewer stakeholders are involved. This in turn results in less transparency and accountability.4 As research on SARS in Toronto has shown, in times of uncertainty and crisis, the notion of accountability is more important, not less so.8 Without it, public trust is diminished and it is difficult to restore. When this happens, the effectiveness of risk communication diminishes and public health emergency management efforts may be significantly less effective.
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Preparation Across 188 during the 2009 H1N1 pandemic countries that higher levels of pandemic preparedness did better in terms of response Oppenheim, et al 19 [Ben Oppenheim, VP of Product, Policy, and Partnerships at Metabiota, Mark Gallivan, Senior Clinical Data Scientist at Verana Health, Nita K Madhav, Chief Executive Officer at Metabiota, Naor Brown, epidemiologist and risk modeler who is currently CEO of Metabiota, Volodymyr Serhiyenko, Senior Data Scientist & Statistician at Metabiota, Nathan D Wolfe, Professor in Epidemiology at UCLA, Patrick Ayscue, senior biosecurity fellow at Metabiota, Jan. 2019, “Assessing Global Preparedness for the next Pandemic: Development and Application of an Epidemic Preparedness Index,” BMJ Global Health, vol. 4, no. 1, p. e001157. gh.bmj.com, doi:10.1136/bmjgh-2018- 001157/] /Triumph Debate
Validating the Index against detection and response outcomes during historical outbreaks and epidemics To assess if a country’s EPI score was correlated with evidence of epidemic preparedness and response, we evaluated the association of EPI cluster with empirical measures reflecting disease outbreak detection and response capacity for selected historical outbreaks and epidemics. Metrics for preparedness are challenging to empirically validate, especially against epidemic impacts (eg, numbers of cases or deaths), as variation in surveillance can lead to systematic bias in observed outcomes. Epidemic severity is a function of a number of factors, including pathogen characteristics (eg, infectiousness, transmission mechanism), population size and density, and travel and social contact patterns. All else equal, countries with effective surveillance systems may experience fewer cases due to timely recognition of cases which may lead to generally more effective outbreak mitigation and response. However, countries with weak health surveillance systems may also report fewer cases due to their limited capacity to identify cases and deaths, and therefore could (incorrectly) appear to have better outcomes than countries with more developed surveillance capacity. To mitigate against these factors, we validated the EPI against measures of system outputs and epidemic impacts for high-profile and high-impact epidemics and pandemics, which are less likely to be affected by surveillance biases, due to intensive and well-resourced efforts to estimate relevant epidemiologic measures. To measure outbreak detection and reporting, we assessed the timeliness of outbreak reporting for 854 events from WHO Disease Outbreak News (DON) reports over the period 1996–2016. Timeliness was estimated for each event by computing the gap in time between the initial event date and the date of report by the WHO DON reports. Reporting timeliness has been used as a proxy measure for surveillance and reporting capacity in prior analyses, and provides a useful summary metric of the capability of these systems.13 16 26 For outbreak response, we assessed the correlation between EPI cluster and country-level vaccination rates during the 2009 H1N1 influenza pandemic. The 2009 pandemic is a useful case to examine because the global nature of the 2009 influenza pandemic allows for the evaluation of many countries, and influenza vaccination is a critical component of influenza pandemic response, which requires a country both to possess the resources to obtain vaccines as well as the ability to distribute and administer them. In addition, countries are not penalised in this case because all countries were alerted to the pandemic at the same time and vaccines were globally available at the same time. Results EPI rankings and comparison to other metrics Mean country scores for the EPI clusters spanned 25.1–88.9 (table 1), a wide range demonstrating significant global disparities in epidemic preparedness. The largest within-cluster SD was found in the least prepared EPI cluster. EPI scores are also geographically clustered (figure 2), with the highest average scores identified in the wealthiest regions of the planet: Western Europe, North America, and Australia and New Zealand. Conversely, countries with weak preparedness were found to be clustered in Western and Central Africa, Western Asia and within Southeast Asia. VIEW INLINE VIEW POPUP Table 1 Epidemic Preparedness Index score by k-means clusters Figure 2 Download figure Open in new tab Download powerpoint Figure 2 Global distribution of Epidemic Preparedness Index (EPI) scores, with countries binned by k-means clustering (1=most prepared, 5=least prepared). We additionally compared countries’ EPI scores against two key existing metrics for infectious disease preparedness: the IHR and JEE core capacity scores (details on IHR and JEE score estimation are provided in the online supplementary information). These metrics are important points of reference, as they also measure national capacity to manage infectious disease outbreaks. However, as noted above, both metrics focus primarily on attributes of the health and emergency response systems, and do not capture other institutional, financial and infrastructural factors. While the IHR core capacity scores have been critiqued due to their reliance on country self-reporting, the JEE’s external evaluation component is designed to mitigate reporting bias.5 8 We find that the EPI correlates well with the JEE scores (0·85), while the correlation between the IHR and JEE core capacity metrics, while positive, is weaker (0.62) (see figure 3 and online supplementary table 4). Empirical evaluation of the EPI Detection and reporting Countries with EPI scores indicating higher preparedness were found to report outbreaks more rapidly to international health authorities. Our analysis of WHO DON reports covering outbreak events during 1996–2016 found an association between a country’s EPI cluster and reporting timeliness (table 2). Figure 4 illustrates that more prepared EPI clusters have faster outbreak reporting, compared with less prepared EPI clusters. A multivariable Cox proportional hazards regression model, adjusting for year of report, shows that on average, when compared with the most prepared EPI cluster, reporting timeliness decreases for worse prepared EPI clusters, from a 14% decrease (HR 0.86, 95% CI 0.67 to 1.1) for EPI cluster 2 to a 47% decrease (HR 0.53, 95% CI 0.42 to 0.67) for EPI cluster 5 (table 2). Public health response Data on influenza vaccine dissemination and uptake during the 2009 H1N1 pandemic were identified for 86 countries.27–29 We found that countries in the most prepared EPI cluster had a mean per cent of population vaccinated of nearly 20%, while countries in the least prepared EPI cluster had a mean vaccination percentage of 149 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
approximately 5% (table 3). Additionally, a linear regression model predicting the per cent of population receiving vaccination by EPI cluster as a categorical variable showed a significant difference for each pairwise comparison with the best prepared EPI cluster. The best prepared EPI cluster had the highest percentage of population that was vaccinated during the 2009 H1N1 pandemic; for each 1 unit increase of EPI cluster value (in the direction of the worst epidemic preparedness), percentage of population vaccinated decreased significantly by the following number of percentage points: 10.18 (p=0.007) in EPI cluster 2; 10.34 (p=0.008) in EPI cluster 3; 12.59 (p=0.0005) in EPI cluster 4; and 14.98 (p=0.001) in EPI cluster 5. Discussion We developed a conceptual framework for comparatively evaluating national-level epidemic preparedness, and we operationalised that framework through the development of a global EPI. The EPI scores were binned for further analysis using a k-means clustering algorithm, and the results show significant variation in proxy measures of outbreak outcomes and response across EPI clusters. Low-scoring EPI countries (ie, having lower preparedness levels) are geographically concentrated in West and Central Africa, Southwest Asia and areas within Southeast Asia. These geographies are also widely considered to be at heightened risk for disease emergence, particularly from zoonotic reservoirs. This suggests a potentially dangerous mismatch between infectious disease emergence and outbreak risk, and local capacity for its detection and mitigation.30 These countries likely face elevated morbidity and mortality risk arising from infectious disease outbreaks, and weak preparedness may also increase the risk of regional or global disease spread. A comparison of preparedness metrics found good concordance between the EPI and JEE metrics, and weaker concordance between both metrics and the IHR. The EPI correlates well with the rigorous, yet slower moving and resource-intensive peer-reviewed assessments generated by the JEE. Because the EPI can be generated based on open- source data, it may shed light on preparedness in contexts where JEE estimates are sparse or not yet available. Additionally, the EPI can be updated quickly as conditions change in a country or region of interest, for example, during episodes of political instability or the onset of armed conflict that could adversely affect public health capacity. As such, it may serve as a leading indicator for the JEE during periods of instability and change, until the more resource-intensive JEE can be conducted and updated. We are not aware of any prior efforts to assess metrics for epidemic preparedness against empirical outcomes. This gap is notable, as empirical validation is needed to assess the reliability and validity of any such framework. The EPI was tested against multiple historical outbreaks of differing aetiology, geographic location and scale. The empirical analysis assessed the association between EPI clusters and key observable implications of the quality of national preparedness, including the timeliness of outbreak detection and reporting, and the effectiveness of outbreak response. We found that higher scoring countries had significantly faster outbreak reporting, and higher levels of vaccine deployment during the 2009 H1N1 influenza pandemic. The work described here is subject to limitations. Due to gaps in global data, we are unable to include a metric capturing whether countries have developed an outbreak response plan for epidemic or pandemic events, and whether this plan has been practised via simulations or drills, and updated. This is an important capacity which is measured through the JEE, but there are insufficient cross-national data to include in the model that we present here. Similarly, we are unable to include data on public trust in government, which is a critical factor influencing whether risk communication campaigns are accepted and adopted by the population, as well as whether the public accepts non-pharmaceutical interventions such as measures to increase social distancing. Unfortunately, data on institutional trust are fragmented, and up-to-date, globally comparable data are unavailable. As such measures become available with appropriate temporal and spatial coverage, they should be incorporated into measures of public health preparedness. Additionally, while the empirical analysis demonstrates that the EPI is an effective metric for country-level preparedness for epidemics, it does not consider disease-specific factors which may impact response, detection or communication efforts. We have also limited the scope of the work here to national-level preparedness and have not considered the effects of community resilience or recovery. The EPI is intended to measure national preparedness for outbreaks and by design does not consider the differential intrinsic risk (eg, likelihood of disease emergence) of infectious disease impacts carried by different countries. Policy reviews conducted in the aftermath of recent epidemics and pandemics have consistently emphasised the importance of strengthening national-level preparedness for public health emergencies.7 31 32 The capacity of these systems is a critical determinant of whether outbreaks are quickly identified and contained before they grow and spread locally, regionally or globally. However, assessments of global infectious disease risk—and debates over resource prioritisation—have been limited by the absence of robust and reliable data on national preparedness.
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Because of early investment in pandemic infrastructure Uganda went from being the site of the largest Ebola outbreak to being able to cope with disease National Research Council 16 [National Research Council, 2016, “The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises,” Washington, DC: The National Academies Press. https://doi.org/10.17226/21891/] /Triumph Debate
ROBUST PUBLIC HEALTH CAPACITIES ARE ACHIEVABLE IN THE CONTEXT OF BUILDING AND SUSTAINING STRONG HEALTH SYSTEMS Before the current West African Ebola outbreak, Uganda was the site of the largest Ebola outbreak in history, with 425 reported cases in 2000 (CDC, 2001). Yet the out- come of this outbreak was distinctly more positive, be- cause Uganda had in place an operational national health policy and strategic plan, an essential health services package that included disease surveillance and control, and a decentralized health delivery system (Mbonye et al., 2014). After 2000, Uganda’s leadership realized that, despite the successful containment of the outbreak, a fo- cus on strengthening surveillance and response capaci- ties at each level of the national system would greatly improve the country’s ability to respond to future threats (Aceng, 2015). Uganda has since suffered four additional Ebola outbreaks (CDC, 2014b), as well as one outbreak of Marburg hemorrhagic fever. However, due to its new approach, Uganda was able to markedly improve its de- tection and response to these public health emergencies (see Table 3-2). The success of the Ugandan experience is founded in a deep political commitment to strengthen core capacities despite limited resources. The key elements of the strat- egy implemented in Uganda are described in Annex 3-2. To build strong public health capacities that will allow detection, reporting, and response to infectious disease threats, countries should focus on revising pub- lic health law frameworks, strengthening public health infrastructure; building partnerships; using research evi- dence to inform program and policy decisions; engaging and improving communication with communities; and establishing a public health emergency operations center (PHEOC) (see Box 3-1). An alternative, but essentially equivalent, blueprint for reinforcing public health capacities is embodied in the 11 “action packages” set forth in the Global Health Security Agenda (GHSA).1 This multi-national initia- tive was launched in 2014, linking several member states, international organizations, and civil society together to 1 For more information, see https://ghsagenda.org (accessed April 1, 2016). prioritize health security activities and help countries to achieve core capacities of the IHR. The GHSA seeks to achieve coordinated action and undertake specific, mea- surable steps to prevent, detect, and respond quickly to emerging infectious diseases. To facilitate this goal, the 11 action packages provide guidance in areas ranging from prevention to detection to response (see Table 3-3). These packages include baseline assessments, planning activities, and monitoring and evaluation activities that break down the broad issues of global health security into more discrete and attainable goals. As of April 2015, 44 countries had signed on to at least 1 of the 11 action packages with a 5-year target goal, either com- mitting themselves to meet core capacity criteria or as- sisting another country in need (IOM, 2015). For each action package, there are designated lead and contribut- ing countries that will work together (Katz et al., 2015).
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Rwanda’s model of disease emphasized early pandemic investment and increasing healthcare equity National Research Council 16 [National Research Council, 2016, “The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises,” Washington, DC: The National Academies Press. https://doi.org/10.17226/21891/] /Triumph Debate
Where needed, governments should work with devel- opment partners to strengthen health systems capacity with an approach that focuses on country ownership and accountability. Rethinking the current approach to aid implementation and management in building health systems can bring about significant improvement in the breadth and quality of care provided, as well as in coun- tries’ social and economic development. This is dem- onstrated best through the study of Rwanda and how the country has transformed its circumstance begin- ning from the ruins of the 1994 genocide to being “the only country in the region on track to meet each of the health-related millennium development goals by 2015” (Farmer et al., 2013). The Vision 2020 policy, Rwanda’s comprehensive na- tional plan, provides a clear, long-term development path and objectives for moving forward post-genocide. These comprehensive and transparent development plans allow for coordination among the government, donors, and implementing partners. Critical to the progress achieved is the strict adherence to country ownership and ac- countability, maintained in an effort to further national capacity building by “reducing the country’s dependence on external aid” (MoFEP, 2000). The Rwanda Aid Pol- icy, published by the Ministry of Finance and Economic Planning in 2006, explicitly states, “The Government will decline any or all offers of assistance where it considers transaction costs to be unacceptably high, alignment to government priorities to be insufficient, or conditionali- ties to be excessive” (MoFEP, 2006). This ensures invest- ment in national systems and institutions— investment that is beneficial to countries with weak institutional ca- pacity (UN Office of the Special Envoy for Haiti, 2012). This does not mean, however, that vertical funding from programs such as the Global Fund or the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) should be turned away. Instead, funds can be harnessed to build and strengthen platforms for integrated service delivery (Walton, 2004). In Rwanda, funds from PEPFAR, the Global Fund, and the U.S. Agency for International Development (USAID) were used to launch the Human Resources for Health program to combat shortages in health personnel with investments in health facilities and training (Binagwaho et al., 2013). Leveraging shared infrastructure, such as supply chain and procurement systems, laboratory capacity, health personnel, and information management also enabled greater efficiency in the system through improved access to care at lower cost (Farmer et al., 2013; Porter et al., 2009). Finding opportunities for funders to work in alignment with the government’s agenda have proven successful, with dramatic changes observed in poverty, life expectancy, spread of infectious disease, and child mortality (Binagwaho et al., 2014). The Vision 2020 policy emphasizes reduction of inequality through improved access to high-quality health care and education, especially for previously neglected rural communities (MoFEP, 2000). Often, despite millions of dollars in aid, individuals who rely on the help of national institutions see little improvement in their situations. In the case of Sierra Leone, a country hugely impacted by the ongoing Ebola outbreak despite more than $712 million in aid, only 5 percent was funneled into national systems, therefore bypassing communities who would stand to benefit most (Office of the Secretary-General’s Special Adviser on Community Based Medicine and Lessons from Haiti, 2015). Rwanda has addressed this issue by implementing and managing its own effective system to track donor disbursements, based on recommendations from the Paris Declaration of Aid Effectiveness (UN Office of the Special Envoy for Haiti, 2012). Utilizing donors’ external aid-tracking systems instead of letting governments take ownership in tracking disbursement “undermines the government’s appropriation of the process and the validity of the figures” (UNDP, 2010). Including aid management and documented delivery in policy recommendations, such as in Rwanda’s Donor Performance Assessment Framework, allows for effective, timely, and high-quality data on aid programs and management (MoFEP, 2010). This holds the performance of donors accountable against “a set of established indicators on the quality and volume of development assistance,” ensuring the establishment of transparent dialogue, and “allow[s] for comparison, individual reflection on performance, accountability and peer pressure” among all involved partners (MoFEP, 2010). These data are essential for enabling the government to make evidence-based decisions to strengthen the public sector and effectively deliver public services (UN Office of the Special Envoy for Haiti, 2012). Rwanda observed 58 percent of its aid channeled into country systems in 2010, allowing for vast progress to be made in building and strengthening the country’s health system (UN Office of the Special Envoy for Haiti, 2012). From this experience, we can also learn that bridging gaps in access to care for marginalized communities can be accomplished with community-based interventions quickly and at low cost. As of 2012, approximately 91 percent of the country was enrolled in the national community-based insurance scheme with subsidized premiums and co-payments on an income-based tiered payment structure that allowed for the poorest enrollees to obtain access to health care (Farmer et al., 2013). Strengthening community-based interventions by scaling up numbers of community health workers was accomplished rapidly and at low cost. These personnel are considered essential for bridging the health care worker gap through providing treatment, monitoring, surveillance, referral, and reporting services, and allowing for strong community linkages to be formed with the national health care system (Binagwaho et al., 2014). Rwanda’s inclusion of clear 152 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
guidelines for financing, management, and delivery in its national policy has indeed helped overcome disparities in access to high- quality health care. It is important to keep in mind for the future that, as in the Ebola response, we have witnessed that where high-quality care was provided, Ebola patients survived. This is strong testimony to a national policy that builds a resilient, country-owned health system, thereby preventing future spread of disease and saving countless lives.
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Economic bills passed do not address long term issues. Investments in the social safety net are crucial moving forward Enda and Gale 20 [Grace Enda, Senior Research Assistant, Tax Policy Center, William G. Gale, The Arjay and Frances Fearing Miller Chair in Federal Economic Policy Senior Fellow, “Economic Relief and Stimulus: Good Progress but More Work to Do.” Brookings, 16 Dec. 2020, https://www.brookings.edu/research/economic-relief-and-stimulus-good- progress-but-more-work-to-do/] /Triumph Debate
Congress responded rapidly to the emerging COVID pandemic. In March and April 2020, Congress enacted a series of bills to support businesses, individuals, and public health efforts. These include the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the Paycheck Protection Program and Health Care Enhancement Act. Combined, the various pieces of legislation cost $2.4 trillion. These bills appropriately largely provided relief, rather than stimulus. The distinction between relief and stimulus is important. Relief provides support for people while they are observing public health guidelines that require them to stay home and lose employment. The goal of relief is to reduce economic activity and encourage people to act in ways that lessen the spread of the virus. As many commentators have noted, the goal was to put the economy in a temporary coma so that public health efforts could have a better chance of containing the virus. In contrast, stimulus provides incentives for people increase spending or work effort and businesses to increase hiring and investment. The goal of stimulus is to raise economic activity. The key insight is that until the virus is sufficiently contained, relief will be needed, and stimulus will be ineffective. The COVID response measures established the paycheck protection program (PPP); provided a direct payment to most households; expanded eligibility for—and the level and duration of—unemployment insurance; increased SNAP benefits; provided funds for health care providers, vaccine development, and health institutions; funded loans and direct support for state, local, and tribal governments; and established pandemic-related health care rights for workers. Although the policies were implemented imperfectly—social services agencies and the Internal Revenue Service struggled to meet heightened demands placed on them and agencies had to quickly issue rules related to the new policies—the policies did support household income and preserve jobs as people observed social distancing guidelines. Summer and fall 2020 impasse Though these policies were a good start, they were inadequate in addressing the pandemic, for a variety of reasons. First, automatic stabilizers in the federal budget—changes in taxes and spending programs that are triggered by changes in economic conditions—are weak, relative to those in other countries. Second, several of the policies were not meant to provide relief for a year-long pandemic. Some measures, like the Paycheck Protection Program and Pandemic Unemployment Compensation, expired. The Economic Impact Payment (or “stimulus check”) reached most households over the summer but was a one-time benefit. Third, the benefits of additional policies would be substantial. Funds targeted to state and local governments help mitigate the recession and retain vital human services. States face balanced budget rules and thus would otherwise have to cut spending as their revenues decline, deepening the downturn. Funds provided to firms would help preserve jobs and potentially stimulate new employment. Expanded unemployment insurance help the millions of people currently out of work through no fault of their own. Increasing resources for the rest of the safety net—including the Earned Income Tax Credit, the Child Tax Credit, SNAP, WIC, housing assistance, the Low- Income Home Energy Assistance Program, TANF, Supplemental Security Income, and Medicaid—would also provide needed support. Investments in the social safety net not only help people in the short-term, but often provide long-term benefits back to the economy that exceed the initial costs.[1] Federal investments in infrastructure and research and development, which can generate high returns, have fallen short for decades now and should be raised. Aid to businesses protect jobs, helping to speed up the recovery when people can safely return to work. And, of course, increasing resources devoted to fighting the virus—including testing, tracing, research, vaccine distribution, and so on—is necessary and economically productive. Sheiner and Edelberg (2020) estimated – before the package Congress enacted in December – that implementing five policies (rebates to households, additional unemployment insurance, aid to state and local governments, support for businesses, and other aid to public health and highly impacted industries) at a total cost of $2 trillion would let GDP regain its pre-pandemic path by mid-2021, much sooner than it would under current law projection, according to CBO.
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Failure to invest in healthcare infrastructure after SARS hurt our COVID response. The short-term fixes put in by the CARES act do nothing to stop the long-term failure to invest in healthcare King et al 21 [Jonathan King, professor in the Department of Biology, Massachusetts Institute of Technology, David Goldenberg, professor in the school of Biological Sciences at the University of Utah, Gary Goldstein, professor of physics and astronomy at Tufts, William Hartung, director of the Arms and Security Program at CIP and a senior adviser to the center's Security Assistance Monitor, Catherine Royer, professor of biochemistry at RIT, Eric Sundberg, Professor and Chair in the Department of Biochemistry at Emory University School of Medicine, Cornelia van der Ziel, MD is a Obstetrics & Gynecology Specialist in Cambridge, Michael Van Elzakker, neuroscientist affiliated at Massachusetts General Hospital, Harvard Medical School, and Tufts University, and Richard Roberts, Cold Spring Harbor Laboratory where his group discovered RNA splicing for which he was awarded the Nobel Prize in 1993, Feb. 2021, “Congressional Budget Responses to the Pandemic: Fund Health Care, Not Warfare,” American Journal of Public Health, vol. 111, no. 2, pp. 200–01. PubMed Central, doi:10.2105/AJPH.2020.306048] /Triumph Debate
The coronavirus outbreak is not the first crisis to affect a large swath of the nation’s population: the Great Depression, World War II, and the HIV epidemic did so previously. Of the national responses to each of these examples, perhaps the most relevant would be the Manhattan Project model, as proposed by Senator Edward J. Markey (D, MA) and Peter L. Slavin, MD, of Mass General Hospital.1 In 1943 the government diverted tens of billions of dollars from civilian programs to the project to build the atomic bomb. What the COVID-19 pandemic requires is the reverse: the diversion of a substantial chunk of the more than $700 billion appropriated for the Pentagon’s military budget to the biomedical, public health programs desperately needed to limit the current coronavirus outbreak and prevent future pandemics. Congress needs to recognize the actual challenges to our national security and thereby sustain our people’s health and promote a prosperous and just economy. We are not in danger of being invaded by Russians, Chinese, Venezuelans, or Iranians; we are in danger of having the fabric of our society undermined by our failure to invest in and protect our national health and welfare. In the scientific and medical communities, we know that the path to solving problems is investing in a focused effort. We can make quite a long list of successes that followed from concentrated federal investment: the Manhattan Project, radar development during World War II, the national interstate highway system, landing on the moon, sequencing the human genome, and developing HIV therapies, to name a few. By contrast to the these successes, failure to invest prevents solving national problems. For example, once it became clear that the SARS-CoV-1 epidemic was under control in 2003, the nation failed to invest the sums needed to develop a SARS vaccine.2 Had that been done, we would have been better prepared to counter the SARS-CoV-2 virus strain, a cousin of SARS-CoV-1. The lack of investment reflects the overall imbalance between congressional funding for military and civilian programs, which has been exacerbated under President Trump. Figure A (available as a supplement to the online version of this article at https://www.ajph.org) shows the congressional discretionary budget for 2017, with more than half the total allocated to Pentagon accounts. Subsequent years follow this same pattern. The CARES Act directed about $1 billion to the National Institutes of Health (NIH), $4.5 billion to the Centers for Disease Control and Prevention, and $3.5 billion to the Biomedical Advanced Research and Development Authority for vaccine development.3,4 President Trump’s Project Warp Speed is an attempt to respond to these needs but is more a giant Band- Aid than a change in national priorities and investment in the basic public health and biomedical research infrastructure needed for the current and future threats. These investments are equal to merely a few cents on the dollar of the fiscal costs of the COVID-19 pandemic.
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Investments in pandemic preparedness are the most important tool against pandemics, yet they often get ignored for short term solutions National Research Council 16 [National Research Council, 2016, “The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises,” Washington, DC: The National Academies Press. https://doi.org/10.17226/21891/] /Triumph Debate
ROBUST PUBLIC HEALTH CAPACITIES ARE ACHIEVABLE IN THE CONTEXT OF BUILDING
We have not done nearly enough to prevent or prepare for such potential pandemics. While there are certainly gaps in our scientific defenses, the bigger problem is that leaders at all levels have not been giving these threats anything close to the priority they demand. Ebola and other outbreaks revealed gaping holes in preparedness, serious weaknesses in response, and a range of failures of global and local leadership. This is the neglected dimension of global security. Part of the problem is the way this threat is perceived. Framed as a health problem, building better defenses against the threat of potential pandemics often gets crowded out by more visible and immediate priorities. As a result, many countries have underinvested in their public health infrastructure and capabilities. And global agencies, such as the World Health Organization (WHO) and the rest of the United Nations system, have lacked the focus and capacity to provide the required international support and coordination. Yet, framed as an issue of human security, the current level of investment in countering this threat to human lives looks even more inadequate. There are very few threats that can compare with infectious diseases in terms of their potential to result in catastrophic loss of life. Yet nations devote only a fraction of the resources spent on national security to prevent and to prepare for pandemics. Framed as a threat to economic growth and stability, the contrast is equally stark. Both the dynamics of infectious disease and the actions taken to counteract it can cause immense damage to societies and economies. And in a globalized, media-connected world, national borders are no barriers to real or perceived threats. Fears, whether rational or unwarranted, spread even more quickly than infections. And such fears drive changes in behavior and public policy, often leading governments to implement non-scientifically-based actions that exacerbate economic impact, such as travel bans, quarantines, and blockades on the importation of food, mail, and other items. Yet both at the level of individual countries and at the global level, there has been remarkably little analysis and preparation for potential pandemics as a source of economic risk. Moreover, while economic or financial problems in fragile or failed states pose very little direct risk to the rest of the world, infectious disease outbreaks in such states represent a direct threat. The lack of health care and public health capacity in these countries is both a disaster for their own populations and an acute vulnerability for the world as a whole. The recent Ebola outbreak showed how fragile post-civil-war nations can serve as incubators for infections of global pandemic potential. Guinea, Liberia, and Sierra Leone are far from being major engines of the African economy, let alone the global economy, but the sparks that came out of their remote jungles ignited an enormously expensive global reaction. Moreover, it could have been much worse. If Ebola had spread to much bigger, more globally integrated cities, such as Lagos, Nairobi, or Kinshasa-Brazzaville, it would have been a very different story. Indeed, we saw the impact of an infectious disease spreading rapidly through urban centers around the world in 2003 when SARS emerged from China. It was against the backdrop of the Ebola outbreak that the Commission on a Global Health Risk Framework for the Future was conceived. While Ebola was the catalyst, the aim of this exercise was to look to the future, taking a broad view of the potential threats from infectious diseases, without putting particular emphasis on a single outbreak or agent. Indeed, our objective was to set out a framework of institutions, policy, and finance that would be resilient to a wide range of such potential threats, whether known—such as influenzas, coronaviruses, and haemorrhagic fevers—or as yet unknown. The Commission was established in response to an urgent need. Eight philanthropic and government sponsors recognized the crisis of Ebola, the underlying neglect of health systems around the globe, and the associated peril for economies and security. Because of its extensive history of managing complex advisory studies, these sponsors asked the U.S. National Academy of Medicine (NAM, formerly the Institute of Medicine) to provide staff to support the Commission in carrying out its task in a comprehensive, rigorous, and objective manner. While the NAM provided staff expertise, the Commission’s report should be regarded as independent of the NAM and all other organizations. The Commission’s task was to provide peer-reviewed consensus recommendations based on evidence and expert opinion. The 17 members of the Commission include citizens of a dozen countries, and its peer reviewers are similarly balanced. Rather than following the well-established procedures of the NAM, the process and policies of the Commission were informed by them and customized to reflect the international nature of this effort and the constrained timeframe. An Independent Oversight Group, composed of 12 eminent and diverse leaders from Africa, the Americas, Asia, and Europe, provided oversight. To ensure that the Commission drew on insights and expertise across the globe, it was informed through a total of 11 days of public meetings held in Accra, Ghana; Hong Kong; London; and Washington, DC. More than 250 invited presenters offered their perspectives at these events. The Commission’s recommendations encompass three broad areas: first, reinforcing national public health capabilities and infrastructure as the foundation of a country’s health system and the first line of defense against potential pandemics; second, reinforcing international leadership and coordination for preparedness and response; and third, accelerating research and development in the infectious disease arena. Together, these recommendations amount to a comprehensive, costed, and coherent framework to make the world much safer against the threat of infectious disease. Inevitably, there will be discussion as to which of the Commission’s recommendations are most important and which are the hardest to implement. Four observations are perhaps worth making in this context. First, a policy framework is most effective when the various elements combine to complement each other. Partial implementation makes even those elements that are put in place less efficacious. Second, we should heed the oft-learned lesson that, in this arena as in others, investment in prevention and preparation is worth much more than spending on response, and that the best response is a well-prepared response. Third, ultimately the fight against infectious disease outbreaks will be fought on the ground within specific communities, and the battle will only be won if these communities are engaged with and part of the response. Finally, science is our most powerful weapon in combating infectious diseases, but the development of tools such as vaccines and diagnostics must be begun before the crisis occurs. Otherwise, the time it takes to deploy scientific tools effectively could be immensely costly in terms of lives and livelihoods. So, while we 156 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
should reinforce international mechanisms to lead, coordinate, and resource the response to infectious disease crises, including strengthening WHO’s capabilities and creating contingency financing mechanisms through WHO and the World Bank, we should avoid the temptation to see such initiatives as being in any respect a complete answer. These may be the most visible actions, and perhaps the least difficult to achieve, but that does not mean they are the most important. To make a truly significant impact in reducing the risks to humanity and to human prosperity, we must catalyze the building of stronger public health capabilities and infrastructure at a national level, even in failed and fragile states, and do so in a way that establishes effective community engagement. We do not underestimate the difficulties in achieving this, because it requires leadership at multiple levels and sustained financing. Yet this must be the top priority. Neither do we underestimate the challenges of mobilizing additional funds for research and development in the infectious disease arena, or of achieving greater harmonization and efficiency in development and approval processes. Yet ultimately, we depend on science to enable us to counter potential pandemics. So we need to find the money and make our processes less complex and cumbersome. Infectious disease pandemics represent one of the potent threats to humankind, both in terms of potential lives lost and in terms of potential economic disruption. The Commission’s recommendations represent a framework for making the world much safer. Now the challenge is to make them happen.
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Pandemic Preparedness in South Korea allowed them to avoid strict lockdown seen in Europe Stutzman et al 20 [Hayley Stutzman, data analyst on the resource tracking team at the University of Washington's Institute for Health Metrics and Evaluation, Angela E. Micah, assistant professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Joseph L. Dieleman, associate professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, April 23 2020, “Funding Pandemic Preparedness: A Global Public Good | Think Global Health,” Council on Foreign Relations, https://www.thinkglobalhealth.org/article/funding-pandemic-preparedness-global-public-good/] /Triumph Debate
The relentless march of COVID-19 across the world demonstrates how pandemics can have disastrous consequences for health and the global economy. That's why funding pandemic preparedness is an important and necessary long-term investment we should make, now more than ever. Investing in pandemic preparedness is essential for health security and requires international cooperation. Furthermore, research and development aiming at discovery, development, and delivery of key tools that will slow and prevent pandemics is critical. ‘…having national response plans, resources, and the capacity to support operations in the event of a pandemic...’ WHO definition of pandemic preparedness The World Health Organization (WHO) defines pandemic preparedness as “having national response plans, resources, and the capacity to support operations in the event of a pandemic.” Pandemic preparedness includes programs that aim specifically at preventing issues that arise from pandemics such as a shortage of personal protective equipment, hospital capacity, and vaccine testing. The International Health Regulations, an agreement across 195 countries that includes rules related to identifying and sharing critical information about epidemics, defines steps that its member countries should take to be prepared for global health events. A prime example of a country with national efforts at pandemic preparedness is South Korea. Having learned from its experience with an outbreak of Middle East Respiratory Syndrome (MERS) in 2015, the country was better prepared than most when COVID-19 arrived. South Korea has an infectious disease surveillance system in place that provides investigation and management guidelines for a number of different types of infectious diseases. Widespread testing, tracing, and isolation of cases, along with government advisories on physical distancing, were key for getting the disease under control. Thanks to its pandemic preparedness, the South Korean government contained the virus, and also managed to avoid applying the stringent lockdowns seen in other countries such as Franc, Italy, and the UK. The image shows the tiny figure of a person walking along a huge corridor all by himself. A person wearing a mask to prevent contracting the coronavirus disease (COVID-19) walks along an empty street in Seoul on March 25, 2020. South Korea is a prime example of national efforts at pandemic REUTERS/Kim Hong-ji Who Funds Pandemic Preparedness and Should This Be More of a Global Effort? While all nations have a role to play in funding pandemic preparedness, health security, and global public goods, not every country is able to invest the same amount. Globally, 83 percent of government spending on health occurred in high-income countries, while some countries such as Somalia and the Democratic Republic of Congo have total government spending (across all sectors) of less than $100 per person, according to new research from the Institute for Health Metrics (IMHE) and Evaluation and its collaborators. Expecting countries to contribute equally to these critical health investments (which have global consequences) is not realistic. This is where development assistance for health can and should play a key role. Development assistance for health includes the financial and non-financial contributions that aim to improve or maintain health in low- and middle-income countries. Development Assistance for Health, 2019 Pandemic preparedness makes up only a small portion of development assistance for health. In 2019, the total amount of development assistance for health applied toward pandemic preparedness came to a total of $374 million, which is less than 1 percent of all development assistance, according to the IHME. 1 Percent Less than 1 percent of all development assistance for health goes toward pandemic preparedness Some $5.2 billion was spent on strengthening health systems, some of which should have improved countries’ ability to deal with global epidemics. An additional $2.4 billion was spent on infectious diseases (excluding funds for HIV/AIDS, tuberculosis, and malaria, which collectively received $13.5 billion in 2019). This is shown in the figure above. Those funds may also indirectly impact pandemic preparedness. In total, about 20 percent of development assistance is going to programs that are potentially impacting the ability to contain pandemics and other health emergencies, even though only a small fraction is specifically focused on building capacity to respond to and prevent pandemics. In the past, the dramatic increases in pandemic preparedness funding have occurred following some major epidemics. This can be seen in the figure below, where there is an increase in development assistance for pandemic preparedness in 2010, after the 2009 H1N1 pandemic, and again in 2014 and 2015, after the Ebola outbreak in West Africa. The majority of development assistance for pandemic preparedness funding comes from high-income countries and is disbursed by WHO. The current pandemic highlights the need to build a better-prepared global community by raising the importance of pandemic preparedness and health systems strengthening on the global agenda. These efforts will require commensurate funding. Communicable diseases cannot be contained by national borders, and an increasingly globalized world requires a global response to such diseases.
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Comparisons between the 4 Asian polities, Japan, and the US show the importance of pre-pandemic infrastructure in responding to crises An and Tang 20 [Brain Y An- Master of Science in Foreign Service from the Georgetown University and Bachelor of Arts in Political Science and International Studies from the Yonsei University in South Korea and Shui-Yang Tang- professor at the University of Southern California Sol Price School of Public Policy, August 2020, “Lessons From COVID-19 Responses in East Asia: Institutional Infrastructure and Enduring Policy Instruments.” The American Review of Public Administration, vol. 50, no. 6–7, , pp. 790–800. DOI.org (Crossref), doi:10.1177/0275074020943707.] /Triumph Debate
The four East Asian polities—Hong Kong, Korea, Taiwan, and Singapore—were able to take stringent actions early on because they had established an early warning system and put in place institutional infrastructure before the current virus outbreak. What prompted them to make such an investment? Table 2 shows that Hong Kong, Taiwan, and Singapore were among the hardest-hit polities by SARS in 2003. Although Korea suffered minimal damage from the same disease, the country became second to Saudi Arabia in terms of total MERS cases in 2015. Since then, all four polities overhauled their public health systems with a focus on preparing for the next round of epidemic. Specifically, they all created their Centers for Disease Control and Prevention (CDC)-equivalent emergency institutions. These centers were empowered with substantial staff, budget, specialties, and autonomy over the issuance of emergency guidelines to the public and policy advice to the top leadership. The four polities also invested in developing critical health infrastructures such as specialized medical centers and doctors, negative pressure rooms, intensive care units (ICUs), and public–private partnerships to augment existing medical capacity. Emergency manuals and guidelines were also overhauled; legislations were modified to streamline the approval process for test-kit development and clinical trials. Notably, Japan and some western countries also had prior experience. Many nations, for example, experienced the swine flu (H1N1) pandemic in 2009. The country estimates of swine flu cases and deaths differ across studies (United States Center for Disease Control and Prevention, 2012). Still, in general, the death tolls were much higher among the advanced western economies listed in Table 2, compared with the SARS and MERS cases among the four East Asian polities. For instance, at least 8,800 were killed due to the swine flu in the United States, and the corresponding lower bound estimates for the United Kingdom and Japan are 1,237 and 198, respectively (Dawood et al., 2012). Yet, few had developed institutional infrastructure comparable to that in the four East Asian polities. For instance, the United States had the Global Health Security and Biodefense Unit, which was established in 2015 during the Obama presidency. The unit was responsible for pandemic preparedness, but the Trump administration abolished it in 2018 (Reuters Fact Check, 2020). Japan exposed its vulnerability to the swine flu pandemic, with nearly 200 people killed (Japan Ministry of Health, Labor and Welfare, 2010). Scholars have consistently expressed an urgency for creating an independent CDCequivalent unit or empowering the current National Institute of Infectious Diseases so that the country can be more proactive in disease control and prevention. The government, however, focused on building the infrastructure for natural disasters that historically have posed more significant threats. In the Japanese context, these include earthquakes, tsunamis, typhoons, volcanic eruptions, and large-scale transportation accidents. The country has more than 700 disaster-based hospitals with medical assistant teams (DMATs) that specialize in these emergency responses, but they have not received proper training relevant to respiratory diseases (Egawa, 2020). Such a lack of preparedness was revealed when DMATs were dispatched to the Diamond Cruise ship and mishandled the inspection and quarantine of COVID-19 infected passengers (Schumaker, 2020). Furthermore, the National Institute of Infectious Diseases has experienced budget and staff cuts over the past few years (Osaki, 2020). In the absence of a CDC-equivalent capability, a government’s public health actions are more likely to be shaped by political and international considerations (Egawa, 2020). These problems worsened as the Abe administration had persistently tried to host the Tokyo Olympic on schedule, resulting in sluggish responses to COVID- 19 at the early phase of the crisis.
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*Drug Epidemics Current actions to confront the public health crisis surrounding drug use is increasingly punitive against Black and Latinx drug users, while simultaneously rehabilitating White individuals Netherland & Hansen 16 [Julie Netherland, Managing Director of the Department of Research and Academic Engagement for the Drug Policy Alliance and holds a PhD in sociology from the City University of New York Graduate Center, & Helena Hansen, Associate Professor at NYU and research scientist at Nathan Kline Institute for Psychiatric Research, 2016, “The War on Drugs that wasn’t: Waste Whiteness, “Dirty Doctors,” and Race in Media Coverage of Prescription Opioid Misues”, Cult Med Psychiatry, DOI: 10.1007/s11013-016-9496-5] /Triumph Debate
Constructions of white drug scares, just like those centered on people of color, are about policing boundaries and shoring up cultural expectations based on race and class. Poor, rural methamphetamine users violate white expectations of productive, rational citizens fitting with the neoliberal requirements of whiteness. As Linnemann and Wall argue, the construction of methamphetamine “polices moral boundaries and fabricates social order through the specter of a ‘white trash’ Other who threatens the supposed purity of hegemonic whiteness and white social position (2103: 318).” Methamphetamine users are “outside community, outside law, outside reason, outside bourgeois conventionality (Linnemann and Wall: 323).” As such, methamphetamine and the anxieties about “White trash” threaten to dilute and undermine hegemonic whiteness. In these contexts, the association between whiteness and drug use have been used to extend the punitive logic generally applied to people of color who use or sell drugs. As discussed more fully below, in the case of White opioids, we see a different, but related, strategy for reinforcing hegemonic whiteness. Two crucial factors distinguishing prescription opioid painkillers from methamphetamine as “white” drugs are 1) the social class of the imagined users, with prescription opioids initially marketed to a suburban, privately insured clientele with regular access to primary doctors, and 2) the fact that prescription opioids enter the space of drug trade as legal drugs dispensed by healthcare practitioners, while methamphetamine had to be processed in illegal plants for non-medical use and from its inception was there for more criminalized. As a result, rather than simple casting out or disparaging of white opioid users, we see instead attempts to reclaim and restore (through medicalization of their drug use) these white bodies. As opioid use grows among middle class suburban whites, we argue that opioids are constructing another kind of White drug user – an innocent victim worthy of empathy and deserving of less punitive policy responses These representational tropes reinforce racially disparate policy responses. Although black Americans are no more likely than whites to use illicit drugs, they are 6-10 times more likely to be incarcerated for drug offenses (Bigg 2007; Goode 2013). Drug offenses accounted for two-thirds of the rise in the federal inmate population and more than half of the rise in state prisoners between 1985 and 2000, with more than half of young black men in large cities in the U.S. currently under the control of the criminal justice system (Alexander 2010), and middle aged black men more likely to have been in prison than in college or the military (Rich et al. 2011). Alexander (2010), Wacquant (2009) and others make the case that the criminal justice system is, in effect, a new state-sponsored racial caste system. Indeed, not only are black and brown people who use drugs more likely to be incarcerated than white drug users, they are also less likely to be seen by healthcare providers and offered addiction treatment, counseling or tools for prevention of overdose and injection related infections (Acevedo et al. 2015). If they do receive medical treatment for opioid dependence, they are more likely than their white counterparts to receive methadone, under DEA surveillance in stigmatized methadone clinics, than to receive buprenorphine, which is pharmacologically similar to methadone but can be prescribed in the privacy of a doctor's office and taken at home (Hansen and Roberts 2012; Hansen et al. 2013). The history of race and moral drug panics demonstrates similar legal inequities. During the crack cocaine epidemic of the 1980s-90s, for instance, policy responses rested on demonizing black and Latino crack users, while leaving relatively untouched white powder cocaine users. The resulting policy was harsh minimum sentencing for crack possession: the amount of crack cocaine and powder cocaine needed to trigger certain U.S. federal criminal penalties was set at a disparity of 100:1, even though crack and powder cocaine have essentially the same chemical make up (Felner 2009). The primary policy response to crack was to lock up hundreds of thousands of black and Latino people for possession and sales. To date, we have seen no move to similarly criminalize white suburbanites for their illegal use of prescription opioids and heroin, even though the scope of this epidemic far exceeds that of crack in the 1980s and 1990s. Indeed, Americans are far less likely to face arrest for illicit use of prescription medication than they are for possession of illicit drugs. For example, in 2009, the arrest rate per 100,000 was 15.6 for the illegal possession of manufactured drugs, compared to 72.8 for the possession of heroin or cocaine (U.S. Census Bureau 2009). These differences are especially striking given the high prevalence of illicit prescription drug use (but low arrest rates) and low prevalence of heroin use (but high arrest 160 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
rates). In 2013, the specific illicit drug category with the largest number of recent users (excluding marijuana) was nonmedical use prescription drugs (6.5%); 1.7 % of those using prescription drugs illegally were misusing pain relievers. In comparison, 1.5% of Americans used cocaine and 0.3% used heroin (Substance Abuse and Mental Health Services Administration 2014). The “non-medical use” of pain relievers is almost twice as high among whites as Blacks (SAMHSA 2010), while rates of heroin use among Blacks, Latinos, and whites are almost identical (SAMHSA 2014). Given these numbers, if our enforcement policies were applied proportionally, we would expect to see a greater jail and prison population of whites illegally using prescription drugs than we do.
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The opioid epidemic has been officially recognized as a public health emergency Wetter et al. 19 [Sarah A. Wetter, Research Scholar, Center for Public Health Law and Policy and Staff Attonrye for Network for Public Health Law at ASU, James G. Hodge, Professor of Public Health Law and Ethics and Director for Public Health Law and Policy at ASU, Danielle Chronister, J.D. Candidate and Senior Legal Researcher at Center for Public Health Law and Policy at ASU, Alexandra Hess, J.D. Candidate and Senior Legal Researcher at Center for Public Health Law and Policy at ASU, June 2019, “The Opioid Epidemic and the Future of Public Health Emergencies”, Center for Public Health Law and Policy at Arizona State University, https://www.nga.org/wp-content/uploads/2019/06/The-Opiod-Epidemic- and-the-Future-of-Public-Health-Emergencies.pdf] /Triumph Debate
On October 26, 2017, after weeks of internal deliberations, President Donald Trump directed Acting Secretary of Health and Human Services (HHS) Eric Hargan to declare[d] a national state of public health emergency (PHE) in response to the escalating opioid epidemic. In so doing, the President classified the opioid epidemic as the deadliest PHE to ever be so designated since the nomenclature originated in 2001. Over the last two decades, overuse and abuse of prescription and illicit opioids have contributed to rampant morbidity and mortality across the country. Since 1999 over 600,000 deaths among all ages, sexes, races, and classes are 23 attributable to opioid abuse. Solutions to this “Medusa of epidemics” are not easy, quick, or cheap. Absent enhanced and innovative public health interventions funded by a sizable infusion of resources, hundreds of thousands more may die by 2020. 4 Like opioid-related declarations issued already by a half-dozen states and multiple tribal governments and localities, 5 the federal PHE declaration is a purposeful step. Alongside other interventions, it legally authorizes federal, state, tribal, and local authorities to allocate existing personnel and resources toward opioid prevention efforts, waives some key legal inhibitions, ramps up critical public health surveillance, and facilitates greater coordination across federal agencies. 6
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Decriminalization in countries such as Portugal has helped to reduce the use of drugs in other countries while also improving public health more broadly. Non-coercive means operate as a bridge towards these health improvements Clay 18 [Rebecca, Clay, freelance writer for APA and the APA Practice Organization, writer for Ford Foundation and the University of Chicago, October 2018, “How Portugal is solving its opioid problem”, American Psychological Association, https://www.apa.org/monitor/2018/10/portugal-opioid ] /Triumph Debate
Like the United States today, Portugal in the 1990s was in the grip of an opioid epidemic so intense that Lisbon was known as the "heroin capital" of Europe. But thanks to an innovative law that went into effect in 2001, Portugal has turned its crisis around. With the backing of psychologists and other health-care professionals, the law decriminalized the use and possession of up to 10 days' worth of narcotics or other drugs for individuals' own use. (Dealers still go to jail.) Instead of facing prison time and criminal records, users who are caught by police go before a local three-person commission for the dissuasion of drug addiction, a panel typically composed of a lawyer plus some combination of a physician, psychologist, social worker or other health-care professional with expertise in drug addiction. The commission assesses whether the individual is addicted and suggests treatment as needed. Nonaddicted individuals may receive a warning or a fine. However, the commission can decide to suspend enforcement of these penalties for six months if the individual agrees to get help—an information session, motivational interview or brief intervention—targeted to his or her pattern of drug use. If that happens and the person doesn't appear before the commission again during the six-month period, the case is closed. Shifting from a criminal approach to a public health one—the so-called Portugal model—has had dramatic results. According to a New York Times analysis, the number of heroin users in Portugal has dropped from about 100,000 before the law to just 25,000 today. Portugal now has the lowest drug- related death rate in Western Europe, with a mortality rate a tenth of Britain's and a fiftieth of the United States'. The number of HIV diagnoses caused by injection drug use has plummeted by more than 90 percent. Delegates from the United States and other nations—including APA's Amanda Clinton, PhD, senior director for international affairs—arrive regularly to see the model firsthand. "You cannot work with people when they're afraid of being caught and going to prison," says psychologist Francisco Miranda Rodrigues, president of the Ordem dos Psicólogos Portugueses. "It's not possible to have an effective health program if people are hiding the problem." Emphasizing harm reduction The Portuguese model is based in humanism—seeing people with drug problems as people with an illness, says psychologist Domingos Duran, head of the treatment division of the government's Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências. "By doing that, you can put the person in the framework of health interventions, not judicial interventions," he says. When a dissuasion commission refers someone to treatment, that person typically seeks care in the country's national health service, which offers integrated outpatient treatment that addresses the individual's physical, psychological and social needs. Led by a physician or psychologist, the treatment team provides all services at one site to increase access to care. "We don't have methadone clinics, for example," says Duran. "We have methadone in all the public centers in this framework of an integrated model." For those who aren't ready or who are unwilling to seek treatment, the emphasis is on harm reduction. That means psychologists often leave their offices and go into the streets to bring care to the drug users who need it. For example, Rita Lopes, a psychologist with a nongovernmental organization called Crescer, spends her days in one of two vans cruising set routes in Lisbon. In addition to a psychologist, these mobile outreach teams consist of a nurse, doctor and social worker who provide psychological support, exchange used syringes for clean ones, hand out condoms and urge drug users and other vulnerable populations to take advantage of shelters, hospitals and treatment centers. The 1,200 patients the teams serve each year are encouraged to move at their own pace. "It's OK for us if they don't want to stop using drugs," says Lopes. "If they want to, we help them." The mobile units are a bridge to treatment, she explains. The main goal is to build a relationship with drug users. "Without a relationship, you can't do anything," she says. "First we create a relationship, then we help people." Other psychologists coordinate harm-reduction programs. Hugo Amaral Faria, for example, manages a mobile methadone program run by a nongovernmental organization called the Ares do Pinhal Association for Social Inclusion in Lisbon. Staffed by a doctor who consults with patients and administers medication, a nurse, and two psychosocial technicians—professionals without university degrees who provide education on such topics as safer drug consumption and safe sex—the mobile units visit five spots across Lisbon each day. There the staff screen for infectious diseases, exchange needles, offer condoms and distribute methadone, along with medication for mental disorders, HIV and hepatitis. The program describes itself as "low-threshold," meaning that individuals aren't required to abstain from drugs to use its services. Faria and the other psychologists and social workers join the mobile units at least once a week to check on participants who can't or won't come into the Ares do Pinhal office. Each of the psychologists and social workers is responsible for around 100 patients, who might need help finding a place to live or a referral to a substance abuse treatment program. "It's not therapy but psychological support," says Faria. The goal is to empower individuals and help them attain autonomy, whether that means helping someone get an identification card to help reintegrate them into society or getting them to the hospital for treatment of HIV. 163 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
The organization also offers participants access to regular medical and psychosocial assessment, greater awareness of their health status and access to community health and social services. This harm-reduction approach is paying off, says Faria. When the program first started three decades ago, for example, 55 percent of its clients were HIV-positive. Today, just 13 percent are. And the mobile units don't just improve participants' health, adds Faria. Because staff watch infectious disease patients take their medication and thus ensure treatment adherence, they also help safeguard public health.
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Decriminalization and/or legalization is necessary in order to decrease the dangers of addiction while also being a part of a cultural shift which does not demonize those who use drugs, increasing the ability to provide rehabilitation Doyle 18 [Kevin Doyle, associate professor and chair of the education and counseling department at Longwood University, November 17th, 2020, “Decriminalization could help ease the nation’s drug epidemic, but the devil is in the details”, STAT, https://www.statnews.com/2020/11/17/drug-decriminalization-could-help-ease-the-nations-drug- epidemic-but-the-devil-is-in-the-details/ ] /Triumph Debate
Among the 120 statewide ballot measures before voters in the 2020 election, drug decriminalization measures passed in six states. In Arizona, Montana, New Jersey, and South Dakota, voters approved legalizing marijuana use for adults, while Mississippi voters approved the use of medical marijuana. But Oregon became the first state to decriminalize the possession of small amounts of drugs such as cocaine, heroin, and methamphetamine. The passage of these ballot measures seems to reflect the idea that voters are beginning to reject the so-called war on drugs and its emphasis on addressing the nation’s drug epidemic through a criminal justice approach and move toward the public health approach that is so clearly needed. With the opioid epidemic continuing unabated — and made worse by the Covid-19 pandemic — and with spiraling rates of cocaine-induced deaths, a dramatic readjustment in how the nation approaches its problem with substance use is essential. By itself, decriminalization is just a small piece of a broader, comprehensive effort that is needed to help with this public health crisis. As with all new ideas, it is important to think through the possibility of unintended consequences. For example, the fact that a substance is illegal may prevent, or at least delay, some individuals from beginning to use it. Once a substance becomes legal, as marijuana has in many states, it becomes socially acceptable in ways that will likely lead to increased rates of use. This has been true in nearly every area that has recently decriminalized or legalized marijuana. While most people can use marijuana relatively safely, some people develop cannabis use disorder, an established and accepted mental health diagnosis that often requires treatment by addiction treatment professionals. That begs important questions, such as whether funding is in place for additional treatment programs, whether a sufficient workforce is in place to address additional treatment needs, and whether third-party payers (private insurance, federal programs such as Medicare, and state-administered programs such as Medicaid) will provide coverage for treatment. With legalization or decriminalization, the devil truly is in the details. As with regulating alcohol and tobacco, few individuals seem to support unfettered legal access regardless of the age. One of the risks, then, becomes whether those who currently sell illegal substances will simply shift their sales and marketing activities to those younger than a state’s age of access. Drug dealers and the drug trade in general have been referred to as one of the purest forms of supply and demand capitalism that exists. If new laws reshape the market, those who sell drugs might target younger customers, something no one wants. Of course, compelling arguments exist in support of the effort to decriminalize simple drug use and drug possession. Overdose risks for substances such as marijuana are virtually nonexistent and largely only when what is sold as marijuana contains or is laced with other substances. The quality-control measures that typically come with the sale of a legal product serve to reduce risk and increase safety, noble goals that should be supported and pursued. Criminalizing drug use also strains the criminal justice system. In 2018, there were 663,000 marijuana-related arrests in the U.S., 608,000 of those were for marijuana possession, showing that police are arresting recreational marijuana users, not dealers. This means more state revenue, about $30,000 to $35,000 a year, goes into incarcerating these individuals. The initiative that passed in Oregon will decriminalize the possession of small amounts of cocaine, heroin, methamphetamine, LSD, and other drugs. Those caught with amounts for personal use only will be able to pay a fine or enter treatment in addiction recovery centers funded with tax revenue generated by marijuana sales. Time will tell, of course, whether such a dramatic step will prove effective in facilitating the move from a drug war to a health improvement approach. Close monitoring of rates of use, treatment access and admissions, and treatment effectiveness will all be necessary parts of the evaluation of this landmark legislation. Any comprehensive policy solution must pay attention to access to appropriate, professional care. If individuals who become addicted to substances, or whose use results in significant disruption to their lives, do not have access to adequate treatment, the new approach will have failed. If we continue to look at people with substance use disorders as weak-willed, of poor moral character, or underserving of assistance for having brought a problem on themselves, then little would have been gained. Decriminalization by itself does not accomplish these things. What is required is an entire shift in cultural attitude, coupled with an infusion of resources consistent with public health strategy rather than a criminal justice one. On the positive side of the decriminalization discussion, tax revenues will substantially increase, providing the opportunity to fund the kinds of treatment that will be needed. For example in Colorado, the tax revenue helps create jobs, prevents youth consumption, protects public health and safety, and invests in public school construction. As encouraging as this is to public health officials and addiction experts, the decriminalization
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measures may appear to be, a deeper, more comprehensive response needed in the drug epidemic our country faces. Moving away from the criminalization of drug use is promising; even more promising would be such a comprehensive effort.
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We must rethink our approach to drug use - criminalization has led to mass incarceration, long lasting impacts on the lives of individuals, but has produced no change in drug usage Borden et al. 16 [Tess Borden, Aryeh Neier Fellow with the US Program at Human Rights Watch and the Human Rights Program at the ACLU, Brian Root, quantitative analyst at Human Rights Watch, Maya Goldman, US Program associate, Maya and W. Paul Smith, US Program Coordinator, October 12, 2016, “Every 25 Seconds: The Human Toll of Criminalizing Drug Use in the United States”, HRW, https://www.hrw.org/report/2016/10/12/every-25-seconds/human- toll-criminalizing-drug-use-united-states# ] /Triumph Debate
Every 25 seconds in the United States, someone is arrested for the simple act of possessing drugs for their personal use, just as Neal and Nicole were. Around the country, police make more arrests for drug possession than for any other crime. More than one of every nine arrests by state law enforcement is for drug possession, amounting to more than 1.25 million arrests each year. And despite officials’ claims that drug laws are meant to curb drug sales, four times as many people are arrested for possessing drugs as are arrested for selling them. As a result of these arrests, on any given day at least 137,000 men and women are behind bars in the United States for drug possession, some 48,000 of them in state prisons and 89,000 in jails, most of the latter in pretrial detention. Each day, tens of thousands more are convicted, cycle through jails and prisons, and spend extended periods on probation and parole, often burdened with crippling debt from court-imposed fines and fees. Their criminal records lock them out of jobs, housing, education, welfare assistance, voting, and much more, and subject them to discrimination and stigma. The cost to them and to their families and communities, as well as to the taxpayer, is devastating. Those impacted are disproportionately communities of color and the poor. This report lays bare the human costs of criminalizing personal drug use and possession in the US, focusing on four states: Texas, Louisiana, Florida, and New York. Drawing from over 365 interviews with people arrested and prosecuted for their drug use, attorneys, officials, activists, and family members, and extensive new analysis of national and state data, the report shows how criminalizing drug possession has caused dramatic and unnecessary harms in these states and around the country, both for individuals and for communities that are subject to discriminatory enforcement. There are injustices and corresponding harms at every stage of the criminal process, harms that are all the more apparent when, as often happens, police, prosecutors, or judges respond to drug use as aggressively as the law allows. This report covers each stage of that process, beginning with searches, seizures, and the ways that drug possession arrests shape interactions with and perceptions of the police—including for the family members and friends of individuals who are arrested. We examine the aggressive tactics of many prosecutors, including charging people with felonies for tiny, sometimes even “trace” amounts of drugs, and detail how pretrial detention and long sentences combine to coerce the overwhelming majority of drug possession defendants to plead guilty, including, in some cases, individuals who later prove to be innocent. The report also shows how probation and criminal justice debt often hang over people’s heads long after their conviction, sometimes making it impossible for them to move on or make ends meet. Finally, through many stories, we recount how harmful the long-term consequences of incarceration and a criminal record that follow a conviction for drug possession can be—separating parents from young children and excluding individuals and sometimes families from welfare assistance, public housing, voting, employment opportunities, and much more. Families, friends, and neighbors understandably want government to take actions to prevent the potential harms of drug use and drug dependence. Yet the current model of criminalization does little to help people whose drug use has become problematic. Treatment for those who need and want it is often unavailable, and criminalization tends to drive people who use drugs underground, making it less likely that they will access care and more likely that they will engage in unsafe practices that make them vulnerable to disease and overdose. While governments have a legitimate interest in preventing problematic drug use, the criminal law is not the solution. Criminalizing drug use simply has not worked as a matter of practice. Rates of drug use fluctuate, but they have not declined significantly since the “war on drugs” was declared more than four decades ago. The criminalization of drug use and possession is also inherently problematic because it represents a restriction on individual rights that is neither necessary nor proportionate to the goals it seeks to accomplish. It punishes an activity that does not directly harm others. Instead, governments should expand public education programs that accurately describe the risks and potential harms of drug use, including the potential to cause drug dependence, and should increase access to voluntary, affordable, and evidence-based treatment for drug dependence and other medical and social services outside the court and prison system. After decades of “tough on crime” policies, there is growing recognition in the US that governments need to undertake meaningful criminal justice reform and that the “war on drugs” has failed. This report shows that although taking on parts of the problem—such as police abuse, long sentences, and marijuana reclassification—is critical, it is not enough: Criminalization is simply the wrong response to drug use and needs to be rethought altogether.
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White use illicit drugs at equally or greater rates than Black individuals, and yet Black adults are eleven times more likely to be arrested for drug possession, reflecting the bias within the criminal justice system. Borden et al. 16 [Tess Borden, Aryeh Neier Fellow with the US Program at Human Rights Watch and the Human Rights Program at the ACLU, Brian Root, quantitative analyst at Human Rights Watch, Maya Goldman, US Program associate, Maya and W. Paul Smith, US Program Coordinator, October 12, 2016, “Every 25 Seconds: The Human Toll of Criminalizing Drug Use in the United States”, HRW, https://www.hrw.org/report/2016/10/12/every-25-seconds/human- toll-criminalizing-drug-use-united-states# ] /Triumph Debate
Over the course of their lives, white people are more likely than Black people to use illicit drugs in general, as well as marijuana, cocaine, heroin, methamphetamines, and prescription drugs (for non-medical purposes) specifically. Data on more recent drug use (for example, in the past year) shows that Black and white adults use illicit drugs other than marijuana at the same rates and that they use marijuana at similar rates. Yet around the country, Black adults are more than two-and-a-half times as likely as white adults to be arrested for drug possession. In 2014, Black adults accounted for just 14 percent of those who used drugs in the previous year but close to a third of those arrested for drug possession. In the 39 states for which we have sufficient police data, Black adults were more than four times as likely to be arrested for marijuana possession than white adults.[2] In every state for which we have sufficient data, Black adults were arrested for drug possession at higher rates than white adults, and in many states the disparities were substantially higher than the national rate—over 6 to 1 in Montana, Iowa, and Vermont. In Manhattan, Black people are nearly 11 times more likely than white people to be arrested for drug possession.
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The War on Drugs has is routinely used to justify violations of privacy, body autonomous, impose financial burdens, as well as jail time – disproportionately impacting low income and racial minorities Garcia 13 [Gilbert G. Garcia, board certified criminal lawyer in Texas, member of the State Bar of Texas Criminal Justice Section and Individual Rights & Responsibility Section, May 17, 2013, “How the war on drugs infringed on U.S. civil liberties”, James A. Baker III Institute for Public Policy, https://blog.chron.com/bakerblog/2013/05/how-the-war-on- drugs-has-infringed-on-u-s-civil-liberties/] /Triumph Debate
America has lost its constitutional footing because of the war on drugs. More arrests equal more prosecutions, more convictions, more jails, and more police and prosecutors. The system benefits prosecutors, police and the prison industry. Set out below are stark examples of our severe loss of civil liberties as a result of the War on Drugs. Search and Seizure Peace officers now have the right to strip search individuals in jail for even a minor offense such as a traffic violation. In April 2012, the U.S. Supreme Court declared that any person who is arrested and processed at a jail, regardless of the offense (i.e., they can be guilty of nothing more than a minor traffic violation), can be subjected to a strip search by police or jail officials, without reasonable suspicion. The U.S. Supreme Court’s 5-4 ruling disregards this significant overreach of state power and legitimizes an unreasonable intrusion upon a citizen accused of a crime. If a peace officer alleges to “smell marijuana” then s/he has a right to perform a full body cavity search. A perfect example occurred when Angel and Ashley Dobbs were driving in Texas on July 13, 2012, and were stopped for allegedly littering by State Trooper David Farrell. After stopping the vehicle, Farrell claimed to have “smelled marijuana.” He interrogated the two women about the marijuana and searched their car. Trooper Farrell did not find any marijuana in the vehicle. However, the Dobbs police video clearly shows that they were subjected to a very public roadside body cavity search. The incidence of police planting drugs on defendants seems to be on the rise. Barnes v. Camden is an example of an innocent man that was jailed for more than a year after police officers planted drugs on him. The officers were later implicated in a large-scale evidence planting conspiracy affecting nearly 200 Camden, N.J., residents. Conditions of Bond In Texas, when a citizen is arrested, allegedly innocent until proven guilty, conditions of bond are routinely imposed. This means that a defendant, although not convicted, must adhere to conditions of bond to remain free, even after posting bond. Conditions of bond can and often include: home curfew, electronic monitoring, drug testing on a weekly basis, reporting to a probation officer, paying probation fees, very restrictive limits on travel and limits on locations where the defendant may frequent. A Texas magistrate has the power to require some defendants to provide a DNA sample purely for the purpose of creating a DNA record. Further, a Texas Court may revoke a bond and order the defendant arrested if the defendant violates any condition of bond, refuses any testing, fails to pay for testing, fails to pay for probation fees or tests “dilute” on any drug test (which can be caused by drinking water). Assigned Counsel for Indigent Cases Poverty also weakens a defendant’s access to justice and impedes one’s civil liberties. Many more drug cases are brought against the poor and racial minorities. African-Americans represent an alarming 62 percent of all drug offenders sent to U.S. state prisons, yet they only represent 12 percent of the U. S. population. Black men are sent to state prisons on drug charges at a rate that is 13 times that of white men. More than 25.4 million Americans have been arrested on drug charges since 1980; about one-third of them were black. Many low income defendants utilize a court appointed attorney/assigned counsel for indigent defense to represent him/her when charged with a drug crime. However, unreasonably low rates of compensation are paid to court appointed attorneys who represent these indigent defendants in state courts, which can often lead to ineffective representation. The lack of even minimal funding limits the pool of attorneys willing to represent indigent defendants. Younger, less experienced attorneys are usually the ones that participate in the various assigned counsel systems for indigent defense across the United States. Assigned counsel representing indigent defendants are paid hourly rates far below the market value. These low hourly rates often lead these attorneys to accept more clients than they can effectively represent in order to make a living. Attorneys are forced to limit the amount of work they perform on a case for an indigent client as a result of perversely low compensation and large volume of cases. The result is often an inadequate, inexperienced, overworked and inherently conflicted lawyer working for a poor, uneducated client. Inadequate Testing The drug case defendant is also subjected to lengthy delays in the criminal justice system as a result of a lack of adequate testing facilities for the alleged illegal drugs. Crime labs in Texas and nationally face an ever-increasing backlog. For instance, the crime lab in Oakland, Calif., had a backlog of 3,500 cases, according to recent published reports. No national agency tracks backlogs or has standards for how quickly cases should move through a lab. It takes months to get even a small possession of marijuana case analyzed in many counties throughout Texas. The War on Drugs has not only been a colossal failure, it has harmed the spirit and tenets of the framework of our freedom and liberty: 170 TRIUMPH DEBATE LINCOLN DOUGLAS BRIEF – NSDA NATIONALS TOPIC 2021
the U.S. Constitution. Search and seizure, conditions of bond, assigned counsel, and inadequate testing are only a few areas that have been instrumental in corroding our system of justice as a result of the drug war. Further damage to our culture, our independence and system of justice must stop. We must end this ill-conceived policy before it causes more harm to our country and civil liberties, and to Americans.
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An ethical approach to drug epidemics must be based in a methodology other than criminalization. Even best practices cannot operate within a system that stigmatizes and prevents individuals from accessing the broader medical and social communities they need Tyndall & Dodd 2020 [Mark Tyndall, infectious diseases physician, public health specialist, and professor at the University of British Columbia School of Population and Public Health, Zoë Dodd, co-organizer with the Toronto Overdose Prevention Society, August, 2020, “How Structural Violence Prohibition, and Stigma Have Paralyzed North American Responses to Opioid Overdose”, AMA Journal of Ethics, https://journalofethics.ama-assn.org/article/how- structural-violence-prohibition-and-stigma-have-paralyzed-north-american-responses-opioid/2020-08 ] /Triumph Debate
At the core of the response to the current opioid overdose crisis is the unspoken discrimination against and willful neglect of many of society’s most vulnerable people. The opioid overdose crisis has exposed the tragic reality of how little we can do when the dominant response to illicit drug use is based on prohibition and criminal enforcement rather than on a broader sociomedical approach. We don’t often think of personal drug use as a human rights issue, but, arguably, it is one. In 2016, Human Rights Watch and the American Civil Liberties Union released a report on the criminalization of drug use in the United States, the summary of which concluded that “enforcement of drug possession laws causes extensive and unjustifiable harm to individuals and communities across the country.”27 The people impacted by the criminalization of drug use are poorly organized and often hidden, as drug use is illegal and highly stigmatized. People using drugs face numerous barriers with regard to employment, housing, food security, and health care, while spending much of their time in the criminal justice system.28 Despite these barriers, drug user groups can be a critical force for change, and there are good examples of how people using drugs have changed drug policy. The Supreme Court of Canada’s decision to keep open InSite, North America’s first legally sanctioned supervised injection site, was largely due to the advocacy of drug users in Vancouver.29 If personal drug use is a human right, then addressing drug use and addiction will require a much broader approach. The best interventions proposed and practiced in the medical community will always be limited within the confines of a system in which drugs are illegal and the people using them must turn to sources that are entirely unregulated and often toxic. An ethical response to the opioid overdose crisis must include providing a strong social support system, breaking down stigma and discrimination, improving access to addiction treatment, and promoting harm- reduction interventions. Physicians and physician groups can play a major role in all of these areas by including social support in their treatment plans, actively breaking down stigma by treating patients with respect, offering evidence-based addiction treatment, and promoting harm reduction. These interventions could greatly improve health care outcomes and reduce opioid overdose deaths. In addition, physicians should be at the forefront of challenging drug laws and a criminal justice system that inflicts so much harm on patients and their families. If we do not recognize and address the drivers of drug use, challenge destructive drug policies, and tear down the pillars of structural violence, we will not see real change.
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AT: Environment Pollution taxes are historically successful - precedent Komanoff 09 [Charles Komanoff, Charles Komanoff is widely known for his work as an energy-policy analyst, transport economist and environmental activist in New York City. He “re-founded” NYC’s bike-advocacy group Transportation Alternatives in the 1980s, co-founded the pedestrian-rights group Right Of Way in the 1990s, and wrote or edited the landmark reports Subsidies for Traffic, The Bicycle Blueprint, and Killed By Automobile. Earlier, Komanoff gained prominence for deconstructing the disastrous economics of nuclear power in the United States as author-researcher and expert witness for states and municipalities across the U.S. He was a prime mover in the successful campaign to pass a congestion pricing plan for New York City, both as creator of the spreadsheet model used by state government and transit advocates to evaluate different toll plans, and as tireless advocate for the idea of balancing transit investment with traffic-pricing. Komanoff also directs the Carbon Tax Center, a clearinghouse for information, research and advocacy on behalf of robust and transparent carbon-emissions pricing to address the climate crisis. A math-and- economics graduate of Harvard and father of two grown sons, Komanoff lives with his wife in lower Manhattan., 4-29- 2009, "Pollution taxes work," Grist, https://grist.org/article/pollution-taxes-work/] /Triumph Debate
The Environmental Defense Fund’s Fred Krupp threw down the gauntlet to carbon taxers in the Wall Street Journal last month: Environmental taxes have worked well to raise revenue, but without a cap they inevitably become a license to pollute in unlimited amounts. No air pollution problem has ever been solved except by imposing a legal limit on emissions. (emphasis added) This is a little like the Pope complaining that sex isn’t enough fun: how would he know? Pollution taxes have seldom been tried. But in the few cases where they’ve been tried, they’ve worked rather well. One example is from the dawn of my own career, in early 1973, when I was a junior economist with the New York City EPA, and the City was almost entirely dependent on fuel oil to generate electricity and heat offices and apartments. A local law requiring a switch to low-sulfur oil had just gone into effect. Swearing that supplies of the cleaner fuel were drying up, the oil companies began jawboning city officials for variances to keep selling the dirtier (and cheaper) fuel. The city was about to cave, until an EPA lawyer channeled Adam Smith and suggested granting the variances with a condition: that each barrel of dirty oil be “surcharged” at a rate slightly greater than the price premium for the clean fuel. After researching market conditions, the City settled on a surcharge of 75 cents to $2.00 a barrel of higher- sulfur oil, depending on the sulfur content. Guess what? The Invisible Hand carried the day. With the surcharge canceling the profit from polluting, the oil companies discovered ways to get more clean fuel from their refineries and otherwise re- allocate supplies. For the rest of that year’s heating season, the dirty stuff amounted to a tiny fraction of the total granted in the variances. A simple, market-correcting tax probably saved hundreds from succumbing to emphysema and other pulmonary diseases while keeping the lights on. Another pollution-tax success story is the global phase-out of chlorofluorocarbons and other ozone- destroying chemicals. While this landmark achievement is often ascribed to the cap-and-trade system built into the 1987 Montreal Protocol, the fact is that emissions barely dropped until a U.S. tax on CFC’s took effect on Jan. 1, 1990. Graph. The rate of reduction in emissions in 1990, the first year with the tax, was at least five times greater than in the preceding period with the cap alone. While a more aggressive cap might have worked by itself, the fact is that, contrary to Krupp, a pollution tax did the job quite well. Krupp’s hostility to pollution taxes represents a retreat from good sense on the part of EDF, which used to be a conspicuous – and prescient – advocate of price incentives. For example, it was EDF that hired economist William Vickrey to testify for social-cost-based pricing in regulatory proceedings on electricity and rail transit in the mid-1970s – 20 years before Bill’s work on peak-load pricing won him the Nobel Prize. Back then, EDF understood the simple idea that when something becomes more expensive to do, people do less of it. Even granting the group’s allegiance to cap-and-trade, is it really necessary for them to turn up the rhetorical heat against pollution taxes? True, price internalization isn’t the sole answer to everything, including slashing carbon emissions. Institutional barriers like split incentives and unequal access to capital need to be addressed by complementary policies. Regulatory standards, technology-forcing measures and pollution limits all have a part to play. But without fuel prices that clearly convey the real price of pollution to the purchaser, the transition from fossil fuels won’t happen until most of the carbon still underground has moved into the atmosphere. On the other hand, if human nature is anything like what it was in Adam Smith’s day, then a phased-in, upward-adjustable and largely revenue-neutral carbon tax, such as proposed last month by Rep. John Larson (D-Conn.), is the best tool for the job. The market insiders lined up at the cap-and-trade trough will gnash their teeth. But in some celestial think-tank, Mr. Smith will be smiling.
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US air pollution policies work – satellite data Pullano 19 [Nina Pullano, Nina writes about science and the environment at Inverse. , 11-7-2019, "Satellite data shows US air pollution policies actually work," Inverse, https://www.inverse.com/article/60758-satellite-data-greenhouse-gas- pollution] /Triumph Debate
To know how best to address air pollution, scientists need to gather as much information as possible about the greenhouse gases and pollutants in our atmosphere. Low-orbit satellites enable them to measure toxic gases from above. Nitrogen nitrogen dioxide, or NO2, is one such pollutant. To get a sense of NO2 levels in the air above the United States, researchers measured NO2 levels in 30 cities across the country. The data, published Thursday in the journal Science, shows that overall NO2 across the US is decreasing. That suggests US pollution regulations are working, the researchers say. The researchers used a satellite-mounted tool called an Ozone Monitoring Instrument to measure NO2 over time and the pollutant’s life expectancy in the atmosphere. Knowing this information is important for mitigating pollution, says study lead author and University of California, Berkeley professor Ron Cohen. “The amount of NO2 in the atmosphere is an important control over air pollution, and it’s one of the key ingredients in the chemistry of the atmosphere,” Cohen tells Inverse. NO2 is typically produced as a result of combustion, often coming from cars, trucks, and power plants. Some US cities emit more of the gas than others, according to the study; New York City is a particularly potent hotspot. That wasn’t a surprise to Cohen, who grew up in New York. “When there’s a lot of people, and they drive, there’s a lot of NO2,” he says. But concentration patterns of NO2 can look unusual. The compound’s lifetime, or how long it takes it to disappear from the atmosphere, isn’t linear. Cohen explains what that means. “There’s not a simple one-to-one relationship between lifetime and concentration,” he says. With a linear lifetime, the relationship is simple: Double the amount of a gas and it takes twice as long to disappear from the atmosphere. But NO2 is different; sometimes doubling the gas does double the lifetime, but in other instances it cuts it in half. It depends on the concentration, location, and atmospheric chemistry. Understanding that tricky relationship is important for cutting down levels of NO2 overall. POLLUTION POLICY POINTS “We’d like to be the scientists who can give good policy advice,” Cohen says. When talking about emissions reductions, it’s important to understand the role of NO2, “because the lifetime complicates your story.” When it comes to policy, the US has, to an extent, successfully mitigated air pollution, Cohen says. His research, as well as past findings from NASA, shows the Clean Air Act, made law in 1970 and amended in 1990, has been hugely successful at this. Some call it the most cost-effective regulation in the country, Cohen says. That’s because dirty air causes major health problems for people, including asthma, fertility issues, and even heart attacks and strokes. Those all have economic impact, and preventing them saves money. Polluted air can also cause visibility issues, slowing global transit and technology. Going forward, it could be that the best way to regulate emissions is through strategies that tackle multiple pollutants at once, Cohen says. Electric cars, for example, reduce CO2, a greenhouse gas, because they’re more efficient than regular cars. At the same time, they temper NO2 levels. It’s easier to reduce emissions from major sources like factories or oil and gas plants sources because the problem is centralized and the buildings can use emissions-cutting technology. FUTURE TECHNOLOGIES More work is needed to understand how NO2 and other gas levels change in the long-term. In the next few years, scientists plan to launch even more advanced satellites to get a more precise picture of the pollutants in our atmosphere. satellite above earth The Sentinel-5P satellite, shown here above Earth, will host the soon-to-be-launched Tropospheric Monitoring Instrument. ESA The Ozone Measuring Instrument used in the latest research is a satellite that orbits Earth measuring NO2 levels and reporting back once a day. But a new tool to be launched soon, dubbed the Tropospheric Monitoring Instrument, will take similar measurements once an hour. “The fact that we’ll have measurements every hour, Cohen says, “will allow us to ask a set of questions that we’ve never been able to ask before.” Abstract: NOx lifetime relates nonlinearly to its own concentration; therefore, by observing how NOx lifetime changes with changes in its concentration, inferences can be made about the dominant chemistry occurring in an urban plume. We used satellite observations of NO2 from a new high-resolution product to show that NOx lifetime in approximately 30 North American cities has changed between 2005 and 2014 in a manner consistent with our understanding of NOx chemistry.
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Governments must implement clean air policies Laake 2018 [Lynne Laake, Media contact Camfil USA air filters, 10-26-2018, "What Policies Can Governments Implement to Lower Pollution Levels?," Air Filters for Clean Air, https://cleanair.camfil.us/2018/10/26/government- policies-to-reduce-pollution/] /Triumph Debate
Despite the tremendous efforts to make the air cleaner and safer to breathe since the 1970s, air pollution continues to be a major problem in the United States, impacting both the environment and public health. The latter is also the reason why high efficiency air filters are a much-needed addition in many homes and buildings. Air pollution, after all, can still affect indoor air quality. How Policies and High Efficiency Air Filters Partner to Solve Air Pollution Under the Clean Air Act, the United States Environmental Protection Agency (EPA) continues to work with state, local and tribal governments, as well as other federal agencies and stakeholders, to lower air pollution levels and mitigate their damage. “Although technically passed in 1963, the Clean Air Act of 1970 (1970 CAA) was the first law to authorize the federal government and states to create regulations to limit emissions from both stationary sources and mobile sources of air pollution,” notes Camfil USA’s Charlie Seyffer, Manager of Marketing & Technical Materials for commercial air filters and 37-year ASHRAE member and active committee participant. “For more than 40 years, the Clean Air Act has proven time and again that protecting public health, building the economy, and keeping the air clean and safe can go hand in hand.” Four major regulatory programs for stationary sources of air pollution arose from the law: The National Ambient Air Quality Standards (NAAQS) New Source Performance Standards (NSPS) State Implementation Plans (SIPs) National Emission Standards for Hazardous Air Pollutants (NESHAPs) A Future Where Commercial High Efficiency Filters Are No Longer Needed to Fight Outdoor Air Pollution The Clean Air Act has done much to reduce air pollution across the United States as the economy continues to grow, so much so that a time may come in the future when commercial high efficiency filters are no longer needed. For starters: The Clean Air Act of 1970 has proven that protecting public health and growing the economy doesn’t have to be at odds with each other. Clean Air Act programs have succeeded in lowering levels of six common types of air pollutants: Particulate Matter (PM) Ozone Lead Carbon Monoxide Nitrogen Dioxide Sulfur Dioxide Between 1970 and 2015, aggregate national emissions of these six pollutants dropped by an average of 70 percent. Meanwhile, the country’s gross domestic product grew by 246 percent—a reflection of the efforts of state, local and tribal governments, the EPA, the private sector, and environmental groups among others. Reductions in emissions have naturally led to dramatic improvements in air quality. From 1990 to 2015, the national concentrations of lead have improved by 85 percent, 84 percent for carbon monoxide, 60 percent for nitrogen dioxide, and 67 percent for sulfur dioxide. “Not surprisingly, these air quality improvements have allowed many cities, counties, and states in the country to meet national air quality standards and protect the public health and the environment,” said Seyffer. How Heavily Polluted Cities are Coping Using Commercial High Efficiency Air Filters Of the many U.S. cities dealing with poor air quality, Los Angeles perhaps offers the best example of what government intervention can do to solve the problem of air pollution. Yes, most homes and buildings in the Los Angeles-Long Beach area still require commercial high efficiency air filters to maintain safe indoor air quality levels. But even though L.A. ranks number 4 on the American Lung Association’s annual “State of the Air” report, it has actually made great strides in improving air quality in recent years. Much, however, still has to be done. Los Angeles Mayor Eric Garcetti himself recognizes the dangers of air pollution on the health of his constituents, so much so that in 2017, he ordered city building inspectors to inspect whether air filtration systems were being installed in homes and buildings located along freeways, where air pollution tends to be the worst. Teams from L.A.’s Department of Building Safety were deployed to determine whether buildings and dwellings were outfitted with the proper-strength air filters to prevent occupants and residents from pollutants found in car and truck exhaust. City Council also beefed up its building inspection systems to keep staff updated with air filtration and containment standards. City Planning May Reduce Need for Commercial High Efficiency Air Filtration Systems Los Angeles’s example of requiring commercial high efficiency air filtration systems in homes and buildings along freeways highlights the importance of city planning. For example, a look at Oakland’s air quality maps shows that air pollution tends to vary from one location to the next. Local governments can leverage air quality information and emissions data to guide their city planning decisions in ways that protect residents from exposure to air pollution, for example, by ensuring that housing developments, hospitals, and schools among others are located away from places with high levels of air pollution—think freeways and industrial facilities. Planning on this level could have prevented students in Camden, New Jersey from being exposed to high levels of disease-causing airborne pollutants. This type of exposure to students is an effect of the practice of constructing public schools on the cheapest plots of land, which are often next to industrial and manufacturing facilities, which produce pollution emissions. Local and regional governments can also leverage air pollution data to guide their transportation planning efforts, while private companies can use this information in managing their freight activities. Lastly, local governments can use this information and provide funding for the installation of air filtration systems in buildings located in highly polluted areas, just as Los Angeles has been doing. Going Beyond Commercial Air Filtration Systems Aside from the installation of commercial air filtration systems, it’s important to address the challenges that communities and countries face when trying to improve outdoor air quality, especially in urbanized areas. As with many policy challenges, the key is knowledge. Sure, there’s a large body of literature on the health effects of outdoor air pollution as well as the possible policies to mitigate the problem altogether. But the common obstacle to policy development, especially when it comes to the problem of air pollution in cities, is the lack of access to information on air pollution levels and air pollution sources. When it comes right down to it, there’s often a lack of awareness
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about the health dangers of outdoor air pollution in urban communities. It can be due to a gap in data from air quality monitoring, or a lack of appreciation of the possible solutions to improve air quality. In other words, governments need to do a better job of arming their constituents with the information they need to make informed decisions about their lifestyles, which in turn, can help solve the air pollution problem. One web site that addresses this problem is AirNow, developed by the United States Environmental Protection Agency (EPA). Residents of areas can view in almost real time the criteria pollutants in their area from monitoring stations located in most urban areas throughout the country. The Importance of Not Settling for Commercial Air Purification Systems While reducing exposure to air pollution—which is what commercial air purification systems do—is important and presents several critical benefits, cutting pollution emissions at the source is still the most powerful tool for protecting both the environment and public health over the long run. As the federal government, EPA, and other government agencies have shown, it’s policies and initiatives like the Clean Air Act and its related programs that have done the most to reduce levels of airborne pollutants. In other words, there needs to be a bedrock of regulation and policies in place before real change can happen. When you have a top-level call for change, everything else falls into place. If you are interested in learning about improving your indoor air quality with commercial air filtration systems from Camfil USA, contact us today and browse our catalog of air filtration systems.
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AT: PHE Efforts Solve / Work *Government collaboration is insufficient, as each level attempts to deflect blame to another and scapegoat Kapiriri & Ross 20 [Lydia Kapiriri, associate professor in McMaster’s Department of Health, Aging and Society, & Alison Ross, Professor in the Centre for Health Sciences at George Brown College, 2020, “The Politics of Disease Epidemics: a Comparative Analysis of the SARS, Zika, and Ebola Outbreaks”, Global Social Welfare, https://doi.org/10.1007/s40609-018-0123-y] /Triumph Debate
Inadequate collaboration between the various levels of government in Canada was blamed for the apparent inefficiencies and inadequacies in the functioning of the health care system and the response to public health crises. This led to disorganized contact tracing, quarantining, and communication to the public (MacDougall 2007). Financial challenges within the Canadian Health Care System further enhanced Toronto’s vulnerability to the SARS epidemic, including a lack of resourcing towards public health infrastructure and acute care (Salehi and Ali 2006). Similar to MacDougall (2007), Salehi and Ali (2006) point to a lack of cooperation and collaboration between the three levels of government to explain this public health crisis—ownership of responsibility and duty to respond was deflected between each level and remained unclear (MacDougall 2007; Salehi and Ali 2006). Another sub-theme that emerged from the literature was the impact of globalization on local preparedness, prevention strategies, but more importantly, on the attribution of blame for the spread of the outbreak. While there is emphasis, in the narrative on SARs, for municipal governments to consider the globalized nature of the outbreak; (Keil and Ali 2007), consistent with the politics of epidemics literature, which asserts that blame is typically placed on cultural and ethnic minority groups, significant blame was placed on the Asian-Canadian community. According to the literature, SARS quickly became a profoundly racialized disease and inflamed racial tensions in the Greater Toronto Area ultimately leading to the social exclusion of a racial minority— the Asian-Canadian group (Jacobs 2007). Such avoidance and stigmatization is reported to have played out in several spaces, such as on public transit and other public spaces, and families advising children to avoid Chinese peers in school (Jacobs 2007). Some of the literature posits that this racialized stereotyping could have been prevented with denunciation from leaders in government and public health (Jacobs 2007).On the other hand, according to Ali (2008), individualized health behaviors aimed at preventing SARS contraction—for instance, wearing a face mask—may have justified the avoidance of the stigmatized of the Asian- Canadians (Ali 2008). Culture and ethnicity functioned not only as a risk factor for discrimination but also as a facilitator in the response to the outbreak. The Chinese-Canadian community in Toronto employed numerous strategies to combat SARS and ease social anxieties, including fundraising for research, the dissemination of health promotion materials, and launching a SARS support line, among other activities (Dong 2008). The mobilization of spiritual leaders was also found to be an effective means of disseminating public health information (Faust et al. 2009). While it is important to recognize the contributions of cultural and ethnic groups, we assert that cultural and ethnic minority groups are more often targets of blame, as was the case for SARS in Toronto.
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Overly coercive measures can undermine government trust UNAIDS 20 [UNAIDS, 2020, “RIGHTS IN A PANDEMIC Lockdowns, rights and lessons from HIV in the early response to COVID-19,” UNAIDS, https://www.unaids.org/sites/default/files/media_asset/rights-in-a-pandemic_en.pdf/] /Triumph Debate
One of the main lessons learned from the HIV response is that human rights-based approaches and community empowerment must be at the centre of any pandemic response. Discrimination, overreliance on criminal law, curtailing civil society operating space, and failing to take proactive measures to respect, protect and fulfil human rights can hamper mobilization of communities to respond to health issues—a necessary ingredient for an effective response. Overly restrictive responses— especially those that do not take the lived realities of communities into account— and violent and coercive enforcement can undermine trust rather than support compliance. The COVID-19 pandemic is one of the gravest threats facing society today. Within a short period of time, it has reached every corner of the globe and it has touched every aspect of our lives. The socioeconomic impacts of this pandemic will be deep and long-lasting, and swift and coordinated action is needed to reduce transmission and protect against the broader impacts of the virus. At the same time, the HIV pandemic is not over. With 1.7 million new infections in 2019 and 38 million people living with HIV worldwide, we are living in a time of two parallel pandemics. Not only should the lessons from one pandemic inform the other, but the responses must mutually support each other, taking care not to harm the progress that has been made thus far. The protection and promotion of human rights has been central to the approach and success of the HIV response. UNAIDS has a responsibility to monitor, review and provide normative guidance on human rights concerns that impact upon the HIV response in any way. The United Nations Economic and Social Council (ECOSOC), in its 2019 resolution on the UNAIDS Joint Programme, called for “a reinvigorated approach to protect human rights and promote gender equality and to address social risk factors, including gender-based violence, as well as social and economic determinants of health” (1). In 2016, the United Nations (UN) General Assembly requested the UNAIDS Joint Programme “to support Member States within its mandate in addressing the social, economic, political and structural drivers of the AIDS epidemic, including through the promotion of gender equality and the empowerment of women and human rights, in achieving multiple development outcomes” (2). This includes those related to the elimination of poverty and the provision of social protection, food security and stable housing. As the UN SecretaryGeneral put it in his report on human rights and COVID-19, “we are all in this together,” and it is the responsibility of all agencies to support the efforts of the World Health Organization (WHO) in their own respective areas of expertise (3). In order to fulfil this obligation, UNAIDS is drawing on lessons learned in the HIV response to review how COVID-19 public health orders that restrict movement have impacted human rights in the period leading up to mid-May, paying particular attention to people living with HIV and those most affected by HIV, including key populations (sex workers, people who use drugs, gay men and other men who have sex with men, transgender people and prisoners) and women and girls. 7 It therefore provides insights and recommendations that build upon and utilize the knowledge gained in the HIV response about the impacts that public health measures have on the most vulnerable. Governments are facing enormous challenges in responding to the COVID-19 pandemic: economies are in decline, airports and borders are closed, unemployment is growing and health-care systems are overstretched. In many cases, they have responded quickly to the enormous task of protecting their populations from COVID-19 and the broader socioeconomic fallout, and they have answered the call for international solidarity and assistance by helping neighbouring and sometimes distant countries. Social protection schemes have been expanded or created, food packages have been distributed and community groups have been mobilized to ensure the continuation of health services. The International Monetary Fund (IMF) estimated that countries had mobilized approximately US$ 9 trillion globally by 20 May (4). As can happen when a significant new infectious disease emerges—and as was the case in the early days of the AIDS epidemic because modes of transmission were unknown—attempts to contain the spread of COVID-19 have resulted in human rights concerns and violations, despite calls for a focus on rights. This has, at least in some cases, had devastating consequences for communities that may be vulnerable to COVID-19, HIV or the broader socioeconomic consequences of the pandemic. While some human rights may be limited for a legitimate purpose, such as protecting public health, a human rights-based approach mandates that restrictions must be lawful, necessary, proportionate, evidence-based, time-limited and— importantly— that they do not discriminate either in policy or implementation. In contexts that are constantly changing, policies must also change, as new evidence arises or human rights impacts are uncovered. Restrictions can have a disproportionate impact on marginalized or stigmatized communities, especially if they are enforced in ways that magnify stigma and discrimination. Cosponsors of the UNAIDS Joint Programme have put forward guidance and recommendations for countries on ensuring a human rights-based response. This report builds on those—and on the UNAIDS publication, Rights in the time of COVID-19: lessons from HIV for an effective, community-led response—to explore how lessons from the HIV response have been taken up in practice during the early response to COVID-19 and how the various lockdown policies have affected people living with or vulnerable to HIV. Given the urgency of the situation, it was not possible to undertake a global review. Rather, the policies and practices reviewed in the 16 countries in this report should be seen as examples of a much broader global phenomenon.1 Due to the necessity of sustaining services for HIV—and in light of UNAIDS’ responsibility to monitor human rights concerns affecting people who are living with or vulnerable to HIV—the regions highlighted in this report were chosen because they contain countries with some of the highest HIV prevalence in the world. While there are many good practices that give us reason for hope, other findings are deeply concerning. Many governments at the national and subnational levels are taking action to affirm human rights protections and empower communities. For example, some governments are extending access to water, providing social protection, adapting health service delivery, providing emergency food supplies, instructing police to hand out masks and supporting community health workers to reach those likely to be left behind
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Rising political mistrust in England is increasing the prevalence of conspiracy theories which in turn lower COVID restriction compliance and vaccine uptake Freeman et al 20 [Daniel Freeman, Professor of Clinical Psychology at Oxford, Felicity Waite,clinical research psychologist at Oxford, Laina Rosebrock, clinical research psychologist at Oxford, Ariane Petit- Project Co-Ordinator (Clinical Trial Manager) with the Oxford Cognitive Approaches to Psychosis (O-CAP) team, Chiara Causier, Trainee Clinical Psychologist at University of Oxford, Anna East, Trainee Clinical Psychologist at University of Oxford, Lucy Jenner, Research Assistant in the Oxford Cognitive Approaches to Psychosis team, Ashley-Louise Teale, assistant Psychologist with the Oxford Cognitive Approaches to Psychosis Team, Lydia Carr, Trainee Clinical Psychologist at University of Oxford, Sophie Mulhall, research intern at the Oxford Cognitive Approaches to Psychosis (O-CAP) group, Emily Bold, Research Assistant and Trial Therapist in the Oxford Cognitive Approaches to Psychosis (O-CAP) team, and Sinéad Lambe, research clinical psychiatrist at Oxford, May 2020, “Coronavirus Conspiracy Beliefs, Mistrust, and Compliance with Government Guidelines in England,” Psychological Medicine, pp. 1–13. PubMed Central, doi:10.1017/S0033291720001890] /Triumph Debate
There were no significant differences in levels of specific, t(df = 2451.5) = 1.89, p = 0.056, or general, t(df = 2466.3) = 0.69, p = 0.491, coronavirus conspiracy beliefs by gender. Younger participants held higher levels of both specific, r = −0.42, p < 0.001, and general, r = −0.35, p < 0.001, coronavirus conspiracy beliefs. There were lower levels of both specific, df = 407.0, t = −9.44, p < 0.001, and general, df = 426.8, t = −8.21, p < 0.001, coronavirus conspiracy concerns in those of white ethnicity (n = 2160) compared to individuals of other ethnicities (n = 341). There were no significant associations of specific, r = 0.02, p = 0.25, or general, −0.02, p = 0.418, coronavirus conspiracy concerns with household income. General conspiracy, r = −0.06, p = 0.002, but not specific, r = −0.01, p = 0.526, coronavirus conspiracy concerns, were associated with lower levels of education. Specific and general coronavirus conspiracy beliefs were significantly higher in those who thought it not worth voting in a general election (n = 195) compared with individuals who thought you should only vote if you care who wins (n = 512), with the latter scoring significantly higher for coronavirus conspiracy beliefs than individuals who consider it everyone's duty to vote (n = 1794). Individuals (n = 1825) who obtained most of their information about coronavirus from the BBC had lower levels of specific, df = 934.8, t = 11.91, p < 0.001, and general, df = 1058.2, t = 12.09, p < 0.001 coronavirus beliefs compared with those who did not (n = 676). Whereas individuals (n = 453) who obtained most of their information about coronavirus from friends had higher levels of specific, df = 602.6, t = −5.77, p < 0.001, and general, df = 618.61, t = −6.24, p < 0.001 coronavirus beliefs compared with those who did not (n = 2048). Similarly, individuals (n = 808) who obtained most of their information about coronavirus from social media had higher levels of specific, df = 1263.6, t = −12.27, p < 0.001, and general, df = 1345.61, t = −12.73, p < 0.001 coronavirus beliefs compared with those who did not (n = 1693). Individuals (n = 382) who obtained most of their information about coronavirus from YouTube had higher levels of specific, df = 470.73, t = −10.39, p < 0.001, and general, df = 494.11, t = −11.06, p < 0.001 coronavirus beliefs compared with those who did not (n = 2119). The degree to which participants adhere to government coronavirus guidance and willingness to accept future diagnostics and vaccination is summarised in Table 3. Generally, rates of adhering to the guidelines were high, though approximately 20% adhered to a lower extent. Endorsement of specific or generic coronavirus conspiracy beliefs is significantly associated with less self-reported adherence to each government recommendation (Table 4). Conspiracy beliefs were also associated with less likelihood to accept future diagnostic tests or a vaccination. As illustrations of these associations, respondents who endorsed to any degree that ‘Coronavirus is a bioweapon developed by China to destroy the West’ were much more likely to also not adhere (defined as less than most of the time) to the guidance to stay at home, odds ratio (OR) 4.57, 95% CI 3.62–5.79, and endorsing to any degree that ‘Jews have created the virus to collapse the economy for financial gain’ was highly associated with not adhering to the guidance to stay at home, OR 14.34, 95% CI 11.26–18.25. Respondents were more likely to report that they would not accept a COVID-19 vaccine (possibly not, definitely not) if they endorsed the bioweapon belief, OR 2.11, 95% CI 1.65–2.70, or the belief about Jewish people, OR 2.70, 95% CI 2.08–3.50. Coronavirus conspiracy concerns were associated with all other forms of mistrust, notably paranoia, general vaccination conspiracy beliefs and climate change conspiracy belief (Table 5). Holding specific or general coronavirus conspiracy beliefs was associated with higher levels of religiosity, slightly more right wing political orientation, and being more likely to share information and opinions about coronavirus (Table 6). Although there is a small association of coronavirus conspiracy beliefs with degree of right wing views, there was also evidence for a quadratic relationship, with those who rated themselves as at the extreme ends of either left or right holding higher levels of conspiracy thinking. A hierarchical regression showed that both the linear political item, B = −0.28, standard error = 0.05, t = −5.92, p < 0.001, and a quadratic term (the political item squared), B = 0.064, standard error = 0.01, t = 8.63, p < 0.001 were significant predictors of specific coronavirus conspiracy scores. A similar finding was found for holding general coronavirus conspiracy beliefs. There was little indication of an association of coronavirus conspiracy beliefs with psychological well-being. The endorsement of positive experiences from the pandemic is summarised in Table 7. These show that at a personal and local level there have been positive aspects appraised by most people. Higher levels of specific coronavirus conspiracy beliefs, r = 0.20, p < 0.001, and general coronavirus conspiracy beliefs, r = 0.21, p < 0.001, were associated with higher levels of endorsement of the positive statements. The results are illuminating but dispiriting: a substantial minority of the population endorses unequivocally false ideas about the pandemic. Only half the population showed little evidence of conspiracy thinking. The idea that the current crisis may be especially fertile ground for conspiracy beliefs may well be correct. The coronavirus conspiracy ideas ascribe malevolent intent to individuals, groups, and organisations based on what are likely to be long-standing prejudices. For instance, almost half of participants endorsed to some degree the idea that ‘Coronavirus is a bioweapon developed by China to destroy the West’ and around one-fifth endorsed to some degree that ‘Jews have created the virus to collapse the economy for financial gain’. The conspiracy beliefs were connected to a number of markers of excessive mistrust: paranoia, endorsement of other conspiracy
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beliefs, mistrust in institutions and experts, and a conspiracy mentality. Conspiracy beliefs are likely to be both indexes and drivers of societal corrosion. They matter in this context because they may well have reduced compliance with government social distancing guidelines, thereby contributing to the spread of the disease. One consequence of this national crisis may be to reveal fully the harmful effects of mistrust and misinformation.
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Governments use health emergencies for political advantages, thereby reducing public trust and making it harder to solve the problem Orzechowski et. Al 21 [Marcin Orzechowski, Maximilian Schochow, Florian Steger. All three authors work in the Institute of the History, Philosophy and Ethics of Medicine at Ulm University. 01-18-2021, “Balancing public health and civil liberties in times of pandemic”, Journal of Public Health Policy, https://link.springer.com/article/10.1057/s41271- 020-00261-y] /Triumph Debate
Balancing public health and civil liberties These two examples highlight an ongoing concern among political commentators and scientists around the world: how far can governments go in using pandemic for their political advantage? [29, 30] Containing a pandemic sometimes requires drastic measures that go against the very core of civil liberties [31]. Compulsory quarantine, isolation, and social distancing serve the goal of decreasing the number of new infections. Such extreme means need to follow rigorous safeguards such as parliamentary and judicial oversight. Governments should not impose or remove strong infection control measures based on the political interests of the regime in control of the government, without scientifc assessment of risks and efectiveness. For more than 2 months starting in March 2020, Poland experienced some of the most severe restrictions among European countries on freedom of movement, association or travel. For example, the government prohibited essential travel with exception of travel to work or to home. It also closed parks, forests, and boulevards. It obliged individuals walking in public to keep a distance of at least two meters. It prohibited minors from leaving their homes unaccompanied by a legal guardian. Although the infection rate in Poland still did not decreased substantially by mid of June 2020, the Polish Ministry of Health canceled most of the restrictions in the few weeks before the election day on 28 June 2020 (and then 12 July 2020). This allowed the government to argue that the situation is ‘back to normal’ and that nothing should stand in the way of holding the election. The right to vote is fundamental for any democratic system. It should not, however, take precedence over the protection of voters’ health. Numerous experts in Poland and around the world are concerned that holding elections during a pandemic can be dangerous for public health, especially if there are no scientifc data showing it is safe to do so [32]. Public gatherings for political meetings are associated with risks for individuals’ health and thus should preclude candidates from conducting electoral campaigns. Observing rules of social distancing in polling stations may delay the process and prevent many voters from taking part in an election. Yet, the Polish government was reluctant to introduce a state of emergency, that would constitutionally permit postponing the vote until a later (and safer) date. The right to free speech is essential and should not be limited in a democratic system, especially in such an extraordinary situation as presented by the COVID19 pandemic of 2020. An important foundation for trust is the structure of government—with checks and balances for limiting certain actions by government and for assuring that individuals may freely express their opinions. The role of free media is indisputable; it should not be limited by any democratic government. Prohibiting medical professionals from criticizing actions of hospitals or taking part in public discussion contradicts their human rights and the very core of professional medical ethics. In Poland, as in many other countries, the Code of Medical Ethics specifes the obligation of every physician to draw the attention of the public, authorities, and every patient to the importance of protecting human health. In pursuit of any patient’s wellbeing, a doctor should not succumb to social pressure or administrative requirements. Denying medical professionals the right to freely express their opinions, even if dictated by fear of misinformation, erodes fundamental democratic values. Democracy and pandemic‑caution! Misusing public health for political objectives may be dangerous, not only for the health and lives of people but also for the political systems under which we live. Success in limiting the spread of infections depends on voluntary compliance of citizens to rigorous epidemiologic rules, not on compulsion. Voluntary compliance is only possible with widespread mobilization in a society based on trust that governmental actions are indeed aimed at containing danger. If people endure severe restrictions of their liberties for several weeks—then see them removed for political reasons, they will lose confidence in future measures. If governments use the pandemic to excuse seizing or consolidating political power, they will squander popular confidence and lose legitimacy for combatting the pandemic. Efforts of medical professionals should not be mishandled for political gain. Frontline doctors, nurses, and medical staff daily risk their lives and health to help patients. Abusing their dedication to containing the disease is highly immoral. Political decisions to stem the spread of pandemics should be limited and strictly proportionate to the situation at the time. Not only Hungary or Poland should be under a special scrutiny. Several important political events will take place around the world, among them, a presidential election in the USA. Some political leaders have called for their countries to reopen as soon as possible, fearing that a declining economy would decrease their chances to win an election. Such decisions should not be based on political strategy, but on scientific data. It should be the moral obligation of politicians, medical professionals, and also of the public to guarantee that the COVID-19 pandemic of 2020 is not misused for political goals.
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Restricting civil liberties and undermining rights fails to produce benefits. People avoid testing and other measures instead of complying Farr 20 [Christina Farr, technology and health reporter for CNBC, 4/18/20, “The Covid-19 response must balance civil liberties and public health – experts explain how”, CNBC, https://www.cnbc.com/2020/04/18/covid-19-response-vs- civil-liberties-striking-the-right-balance.html] /Triumph Debate
Undermining our individual rights might not even help public health in achieving its goals, some experts have noted. Tools that are overly intrusive to people’s civil liberties can backfire. During the HIV/AIDS epidemic of the 1980s and 1990s, for instance, Bayer argued in his research papers that public health and privacy rights did not need to be in opposition. Because of the stigma surrounding the disease, he explained, “good public health respects civil liberties, and anything that advances human rights and civil liberties would advance public health.” One of the big issues at the time was the idea of doctors reporting the names of HIV patients to the states. Some states refused to accept name-based reporting so for years because they feared that it would discourage people from getting tested. Another controversial topic was the effort around so-called contact tracing, which is being proposed as way to fight Covid-19 today. In many cases, public health officials would notify an HIV patient’s past sexual partners that they may have been in contact with somebody who had the disease, but never identified or named them. “We learned that if you intrude on privacy you will be counter productive in terms of controlling the epidemic,” Bayer recalled. He stressed that officials made decisions they thought were “necessary” for public health, not just those they thought might feasibly slow the spread of the disease. These lessons remain relevant today. One present-day example comes from South Korea, which introduced an electronic system that sends out an automatic alert to people living nearby a known Covid-19 case. Reports found that the information includes age, gender, a log of their whereabouts, and in some cases credit card transactions. Sharing that level of detail could help friends and neighbors pinpoint the specific individual with the virus. As such, many medical experts worry that people with symptoms will choose not to get tested because of the potential for stigma in their community.
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