An ethics account of global health security

Frances undertook her doctorate at the Ethox Centre between 2019 and 2023. Her DPhil was supervised by Professor Michael Parker and Professor Patricia Kingori and supported by a Wellcome Trust Fellowship for Health Professionals in Humanities and Social Science (Award reference: 217706/Z/19/Z).

Abstract

Global health security is defined by World Health Organization as “the activities required…to minimize vulnerability to acute public health events that endanger the collective health of populations” (2007). Despite this definition, global health security is a contested area because of concerns about the focus and beneficiaries of the enterprise. The aim of this thesis was to explore the scope, limits, and ethical issues within the global health security enterprise, in the context of infectious disease outbreaks.

The first stage of the thesis examined ethics in the global health security literature both before and during the COVID-19 pandemic. The findings from the critical interpretive review undertaken show that although ethical terms are frequently called for in global health security, there is little ethics analysis of what they mean, nor perspectives from those that work in this area.

To address this gap, a study utilising symbiotic empirical bioethics methods was undertaken. Thirty-eight qualitative interviews with professionals working in global health security, or in related areas, were completed. The thematic analysis of this data illustrates that those working in global health security operate in a complex moral landscape. This landscape involves everyday ethical considerations in the work of global health security, as well as wider concerns that can be understood as moral boundaries and borders. These moral boundaries include definitional boundaries about what global health security means; boundaries about dividing resources, roles and responsibilities by whether an outbreak is natural in origin, as opposed to accidental or deliberate; and geopolitical boundaries concerning the nature and limits of nationalism.

The final stage of the thesis brings together the findings from the qualitative analysis and compares it to relevant concepts in the ethics literature. I conclude that 1) current arguments for expanding the scope of global health security may not be the solution to moral concerns in the enterprise, 2) there needs to be care around the use and implications of ‘natural’ outbreaks, and 3) there is room for reclaiming a globally just nationalism as a moderate framework for how global health security should operate.  I then situate these findings within the practice and policy context of global health security.

This thesis presents one of, if not, the first, empirical ethics studies on global health security, and argues that global health security must be acknowledged as a moral enterprise in order to fulfil its potential to protect persons globally.

References

World Health Organization (WHO). 2007. Global public health security in the 21st Century: A safer future. Geneva: World Health Organization.