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In his latest book, “Pandemic Bioethics,” philosophy professor Greg Pence, Ph.D., examines allocation of scarce medical resources, immunity passports, vaccines, discrimination and more. It is available as an e-book now and will be in print June 18.Greg Pence, Ph.D., a professor at the University of Alabama at Birmingham Department of Philosophy, has released his latest book, “Pandemic Bioethics,” which offers readers a comprehensive timeline of the various ethical challenges encountered as the coronavirus emerged and ravaged worldwide. The book serves as a resource for educating health care professionals, governmental leaders and the general public on evaluating the ethical issues surrounding public health crises.
Pence says, when the city of Wuhan, China, quarantined 11 million people in January 2020 after the outbreak of a deadly novel coronavirus, he knew something big was coming. He told his students that the SARS-CoV-2 virus, the virus that causes what would become known worldwide as COVID-19, likely would be an “epic” historical event.
“Even a parent I was meeting with asked if I thought the virus would come to Alabama,” Pence said. “I said, ‘Yes, it will.’”
COVID-19 hit Alabama hard, bringing with it more than 541,000 diagnosed cases and 11,000 deaths to date. But for Pence, a professor of philosophy who has studied bioethics since the 1970s, it brought something more — the chance to explore what he considers to be the most significant bioethical issue in a century.
Pence compiled his research into his new book, “Pandemic Bioethics,” which examines relevant issues such as the fair allocation of scarce medical resources, immunity passports, vaccinations, discrimination against minorities and more. It is available from Broadview Press as an e-book now on the Google Play store and from other vendors in the coming weeks and in print beginning June 18.
The book opens with explorations of historic pandemics such as the 1918 Spanish flu and modern viral pandemics such as HIV and the swine flu outbreaks in 1976 and 2009, then examines SARS2 viruses, containment methods, vaccines, privacy, structural inequality and leadership, plus a look into a future shaped by the COVID-19 pandemic.
“A lot of issues in bioethics are esoteric, such as the question ‘Who gets a heart transplant?’ But this virus, and how to deal with it, made everyone a bioethicist,” Pence said. “There are tons of philosophical issues in fighting this virus and setting public policy, and I wanted to make sure they were put out there.”
Some of the most pressing questions posed by COVID-19 that Pence tackles in the book center on its long-term effects on population health, the emergence of viral variants and American leadership’s impact on public health decision-making during the pandemic.
Vaccine development and implementation also pose unique issues, Pence says, from the process of emergency use authorization by the U.S. Food and Drug Administration to mandatory vaccinations, distribution to underserved populations and what he calls “status certificates.”
“If 32 million people are known to have been infected with COVID-19, with perhaps an additional 32 million infected but unaware, the United States has a large pool of citizens with prior exposure, and therefore antibodies. Another 160 million people have full or partial vaccination status,” Pence said. “Some app or document is going to be needed to cover all these Americans.”
Pence says calling it a vaccination passport or vaccination certificate does not work for the unvaccinated Americans who were exposed but have suitable antibodies. But those antibodies will fade over time, especially in seniors, and some vaccine-induced antibodies may fade faster than others. Even the term immunity certificate does not work because it will not be an all-or-nothing thing, but rather a matter of degree. The term status certificate will be needed to cover all these possibilities.
Ethical takeaways
Pence says he hopes readers of “Pandemic Bioethics” take away a few key lessons. “First, be wary of victim-blaming those who have been or are infected with COVID-19,” Pence said. Discrimination against overweight people of color who contracted COVID-19 is one example he cites.
The Centers for Disease Control and Prevention notes that some racial and ethnic minority groups face multiple barriers to health care, such as lack of insurance, transportation, childcare or the ability to take time off work.
“Constantly linking deaths from COVID to an individual’s weight, high blood pressure or other health issues can be code for, ‘Well, they deserve what they get for their unhealthy lifestyle,’” Pence said. “We have to be very careful about that.”
He also hopes people are more aware of what he terms “amplification systems,” or crowded, high-traffic locations such as airports or the mass food-production sites that can magnify the spread of germs.
“We live in a very interconnected world,” Pence said. “We assume that everything is safe and inspected and regulated, but a lot of those systems have fallen apart in the last few decades due to deregulation.”
The third lesson, according to Pence, is that we must begin preparing for pandemics to come, which starts with improving public health systems both in the United States and globally.
“We weren’t ready this time, and we need to be ready next time,” Pence said.
Changing education
When Pence puts on his philosopher’s hat, he believes that everyone who lived through the COVID-19 pandemic has been changed fundamentally, from students who realized they prefer an online education experience to people who would instead work remotely rather than in a traditional office setting. Even something as casual as dating might undergo procedural changes such as discussion of vaccination status before meet-ups, he explains.
At UAB, students have expressed interest in learning more about pandemics and how those events may affect the future. This summer, Pence is again teaching PUH 690, “Ethical and Political Issues of Pandemics.” The first iteration was taught during the 2020 summer semester when the pandemic was fairly new. The course follows a structure similar to “Pandemic Bioethics,” including spending the first third of the class discussing historical pandemics and ethics, law and public policy issues.
“With every bioethical issue I write about, I try to present it in historical context, whether it’s allocating organs to recipients or AIDS,” Pence explained. “We’ve been through all this before with the Spanish flu, with cholera, when we scapegoated the victims of AIDS. Hopefully, we can learn from our mistakes — and we did make some big mistakes.”