Elizabeth Fenton

Dominant models of prioritising resources in intensive care unit (ICU) settings under conditions of severe resource scarcity, such as a pandemic, are likely to replicate and potentially exacerbate existing health inequities. One proposal is to advance equity by reserving a proportion of ICU resources, such as beds, for members of specific groups. This qualitative study explored the ethical acceptability of a reserve bed system (RBS) for healthcare workers and for indigenous Māori in the Aotearoa New Zealand context. Participants included Māori and non-Māori clinicians working in ICU settings, and non-clinical staff with expertise in ICU management and policy. Although there was a consensus on the urgency of addressing health inequities in New Zealand, especially for indigenous Māori, participants identified critical ethical challenges in implementing an RBS in the ICU setting. These findings contribute to the broader literature on the ethics of reserve systems for priority-setting.

The COVID-19 pandemic has revealed the complex interplay between national self-interest and global cooperation. Media communication can contribute to the formation of national identity and promote nationalist themes, particularly in times of crisis. Media portrayals of the nation during a pandemic are informative, since nationalism, specifically health nationalism, may undermine the popular appetite for and effectiveness of global response efforts. We sought to investigate whether nationalist sentiment was present in COVID-19 reporting in New Zealand media. Using qualitative and quantitative thematic analysis, we identified nationalist themes in the New Zealand media during the COVID-19 pandemic and observed how they changed over the course of the pandemic. We randomly selected 1300 articles from 19 New Zealand newspapers from January 2020 to June 2022. We identified four nationalist themes in New Zealand media reporting during the pandemic: domestication, unification, securitization, and separation. The emergence of nationalism in New Zealand media during the COVID-19 pandemic is an important consideration when developing public health policy. While nationalist sentiments in New Zealand media during the COVID-19 pandemic provided a foundation for domestic solidarity, we argue that balancing these approaches with cosmopolitan appeals to collective humanity would support policies and responses that address both local needs and global inequities.

Background: The World Health Organization's convention, agreement or other international instrument on pandemic prevention, preparedness, and response, often referred to as the 'pandemic treaty', was established with principles to guide implementation. The treaty's underlying ethic was cosmopolitan in intent, emphasizing equal value of all people with obligations stemming from shared humanity.

Methods: The principles of the working draft of 13 July 2022 and the proposed agreement of 22 April 2024 were compared by textual analysis for content and sequence. Changes were analysed using the ethical framework of cosmopolitanism and associated public health implications identified.

Results: Compared with the working draft, the proposed agreement consolidated principles such as solidarity and reduced specific obligations, weakening ethical demands. Sovereignty was elevated to the cardinal principle, while obligations tied to equity and human rights were less specific, reflecting a shift from cosmopolitan intentions and a reduced emphasis on cooperation for shared public health goals.

Conclusions: Changes made through the pandemic treaty negotiation process suggest ethical amnesia, undermining global equity, justice, and solidarity with consequences for public health and pandemic preparedness. Strengthening obligations in the treaty text is essential to embed a collective motivation for cooperation necessary for effective public health before the next pandemic.

Wastewater surveillance (WWS) provides valuable information about infectious disease trends in communities. The Centers for Disease Control and Prevention (CDC) created the National Wastewater Surveillance System (NWSS) in 2020 to coordinate and inform WWS programs in state, tribal, local, and territorial (STLT) health departments. As this system grew from eight initial implementing partner jurisdictions to implementers in all 50 states, seven territories, and some tribal communities, so too did ethical questions and a need for clear, shared priorities for the WWS field. Geographic coverage and pathogen testing capabilities expanded quickly over time, emphasizing the need for a standard set of ethical priorities at a national level. These priorities are essential to ensure the responsible use of WWS data for public health action while addressing potential ethical risks. Academic, international, and independent implementers have previously defined ethical priorities and considerations for WWS. This foundation of work also highlighted the need for a practical, applied ethical framework for WWS that incorporates the perspectives of WWS expert groups.

Gaps in funded cancer medicines between New Zealand and Australia can have significant implications for patients and their families. Pharmac, the New Zealand pharmaceutical funding agency, has been criticised for not funding enough cancer medicines, and a 2022 review identified ethical concerns about its utilitarian focus on efficiency. However, as the costs of new cancer medicines rise along with public and political pressure to fund them, questions about value for money remain critical for health systems worldwide. In this paper, we compare funding for cancer medicines in New Zealand and Australia, specifically medicines for non-small cell lung cancer. We argue that the ethical imperatives on funding agencies to get value for money and provide medicines for patients with cancer underscore the importance of transparent decision-making processes, including identifying and explaining intercountry differences in funded medicines.

IntroductionAotearoa New Zealand (NZ) plans to introduce a smoke-free generation (SFG) policy, alongside denicotinisation and reducing the availability of tobacco products. The SFG has a clear rationale, yet we know little about how young people, those the policy targets, perceive it. To inform policy design, communication and implementation, we explored how NZ youth perceived the SFG.MethodsWe undertook in-depth interviews with a sample of 20 youth aged 17 or 18 and explored their knowledge of the SFG, and how they perceived its individual and societal implications. We interpreted the data using a reflexive thematic analysis approach.ResultsWe identified two overarching themes. The first theme, ‘societal good and protection from harm’, reflected benefits participants associated with the SFG, which outweighed perceptions of lost freedoms. The second theme, ‘privileging personal choice’, corresponded to two small groups within the sample. The first preferred measures they considered less restrictive, such as increasing the purchase age, and some came to support the SFG as they rationalised their views. The second subgroup expressed more entrenched opposition and felt the SFG deprived them of a choice.ConclusionsYoung people’s deep reflection on the SFG led most to view it as liberating rather than restrictive. Communications that avoid prompting heuristic-based responses could encourage youth to reflect on the policy and elicit strong support from the group the SFG aims to benefit.

Objective: The aim of this study was to compare past New Zealand immunization strategies with the New Zealand coronavirus disease 2019 (COVID-19) immunization roll-out.Methods: Using the READ document analysis method, 2 New Zealand immunization strategies (for influenza and measles) were analyzed for how the disease, context, vaccine supply and demand, ethical principles (equity, individual autonomy, and maximizing benefits), and the Treaty of Waitangi impacted the immunization programs. The findings were compared with the ongoing COVID-19 mass immunization program in New Zealand, as of October 15, 2021.Results: Several themes common to the case-studies and the COVID-19 pandemic were identified including the importance of equity, obligations under the Treaty of Waitangi, ethical mandates, and preparedness.Conclusions: Future emergency planning should integrate learnings from other infectious disease responses and immunization programs to avoid repeating mistakes and to create better health outcomes. This study has provided a basis for ongoing research into how an appropriate immunization plan can be developed that incorporates ethical values, the Treaty of Waitangi (in the NZ context), and evidence-based research to increase trust, equity, health, and preparedness for future outbreaks.

Abstract Responses to the COVID‐19 pandemic have been widely criticized for being too delayed and indecisive. As a result, the precautionary principle has been endorsed, applauded, and proposed to guide future responses to global public health emergencies. Drawing from controversial issues in response to COVID‐19, especially in Vietnam, this paper critically discusses some key ethical and legal issues of employing the precautionary principle in public health emergencies. Engaging with discussions concerning this principle, especially in environmental law where the precautionary principle first appeared as a guiding principle with objective content(s), this paper formulates the precautionary principle as ‘in dubio pro salus’, which is about advising, justifying and demanding states to proactively prepare for scenarios arising out of any public health emergency. It distinguishes the precautionary principle into moderate and hard versions. A moderate version largely takes a holistic approach and fulfils a series of criteria specified in this paper, while a hard version either permits restrictive measures to be deployed primarily on a hypothetic basis or expresses an instrumental mentality. The hard version should be rejected because of the ethical and legal problems it raises, including risk‐risk tradeoffs, internal paradoxes, unjustified causing of fear and unreasonable presupposition. Ultimately, this paper defends the moderate version.