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.
- health policy
- prevention strategies
- control strategies
- health systems evaluation
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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.
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