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Ethics-driven policy framework for implementation of movement restrictions in pandemics
  1. Siddhesh Zadey1,2,
  2. Surabhi Dharmadhikari1,3,
  3. Pradeeksha Mukuntharaj1,4
  1. 1Association for Socially Applicable Research, Pune, India
  2. 2Duke Global Health Institute, Duke University, Durham, North Carolina, USA
  3. 3Rajashree Chatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra, India
  4. 4Urban Health and Training Centre India, Mumbai, India
  1. Correspondence to Mr Siddhesh Zadey; sidzadey{at}asarforindia.org

Abstract

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

  • COVID-19
  • health policy
  • prevention strategies
  • control strategies
  • health systems evaluation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjgh-2021-005202

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Handling editor Seye Abimbola

    • SD and PM contributed equally.

    • Contributors Study concept and design—SZ. Acquisition, analysis or interpretation of data—PM and SD. Drafting of the manuscript—SZ. Drafting of the supplement—PM. Literature review—PM and SD. Critical revision of the manuscript for important intellectual content—all authors. Administrative, technical or material support—SZ and SD. Study supervision—SZ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.