‘Can you lock down in a slum?’ published in Global Epidemiology

Delighted that this paper co-authored with Pieter Streicher has now been published in Global Epidemiology.

Broadbent A, Streicher P. Can you lock down in a slum? And who would benefit if you tried? Difficult questions about epidemiology’s commitment to global health inequalities during Covid-19. Global Epidemiology. 2022;4:100074. doi:10.1016/J.GLOEPI.2022.100074 (https://www.sciencedirect.com/science/article/pii/S2590113322000049)

Was lockdown racist?

Delighted to be giving a new talk this week in Cambridge and Utrecht.

Tuesday 17 May, 2.30pm BST: Cambridge Moral Sciences Club, Newnham College

Friday 20 May, 16.15 CET: Conference, Covid-19 and Public Policy, Utrecht University

Abstract

In 2016, South African learner Zulaikha Patel argued that a school rule requiring hair to be neat was racist. Even though the rule applied equally to everyone, public opinion swung behind Patel: a rule that imposed a disproportionate burden on Black learners could be racist even if it applied equally to all. The school suspended the rule. Basing itself on this case, this paper argues that global lockdowns in the first half of 2020 were racist. The paper focuses on Africa, arguing first that the lockdown strategy of implementing stringent stay-at-home regulations was externally imposed upon Africa, tracing the origins of this policy to the way that modelling results were presented so as to make just one option feasible. The resulting recommendations were promulgated globally by the World Health Organisation, and geopolitical power relations placed huge pressures on African states to comply. Next, the paper argues that locking down placed a disproportionate burden on Africa, whose population is the poorest in the world and for whom no work often means no food. At the same time, the potential benefit of the policy was small. With a median age of 19.7, much of the population was just too young for Covid ever to be a serious public health problem, and by the same token other threats to life compete for attention. Slum-dwellers cannot reduce their social contact by 75%, which is the figure used in the model upon which the recommendations were based. Most states in the region are unable to afford or implement meaningful food or grant schemes to compensate. Many African countries have no ventilators and low access to health care, so protecting the healthcare system was not a meaningful goal. And the strategy of locking down until a vaccine was available could never have been credible in a region where millions of children die annually from diseases treatable by penicillin. Where a policy originates in Europe and has disproportionate negative effect in Africa, it is impossible to ignore racial dynamics. “Black” is a colonial vestige that does not do justice to the ethnic diversity in Africa. Yet it can be legitimately used as Patel used it: for purpose of internal critique, and as an adjunct identity that does not negate other identities. Lockdown had a disproportionate negative effect on a very large number of Black people, and it was externally imposed. Therefore lockdown was racist.

An egalitarian evaluation of lockdown

I’ve started a new job and in the process not posted anything here for months, nor done a whole lot worth sharing. Now I’m dusting off my “lockdown talk” and updating it, with a view to writing it up soon. It’s now called “An egalitarian evaluation of lockdown” and I feel like it’s matured quite a bit. I also now have the benefit of being able to talk about the global vaccination mess as something totally foreseeable, which matters because awaiting a vaccine is an integral part of the strategy I criticise. Here’s the abstract:

“Lockdown” has come to designate a cluster of non-pharmaceutical interventions intended to slow or stop Covid-19. One familiar line of objection to lockdowns is libertarian: lockdowns restrict freedom of movement, association, and so forth. However, the appeal of libertarian arguments is limited to (a) moral contexts globally where individual liberty rights are a primary dimension of policy evaluation and (b) audiences that see such rights as outweighed by the dangers of Covid. Among the latter are some motivated by egalitarian considerations, who claim that Covid hits poorer people including “minorities” harder than richer people. This paper contends that there is a neglected but extremely powerful egalitarian argument against lockdown, based on the fact that most poor people live outside rich countries in circumstances where lockdowns offer no protection, where the risk posed by Covid 19 is lower both absolutely (due to demographics) and relative to other risks to life (due to these being greater), and that lockdowns greatly exacerbate these risks. This includes racial and other majorities who are routinely referred to as “minorities” by authors in rich countries. The paper argues that neglect of these facts is an instance of epistemic injustice, the victims of which are predominately so-called “persons of colour”. The paper argues further that the unfair features of lockdown are not coincidental, but that it was these very features that led to their endorsement by powerful groups, nations and international bodies, and to the persistent positive attitude to lockdowns. From an egalitarian standpoint, their actions can be interpreted as using the commanding heights of the global knowledge economy, not to reduce the global burden of Covid overall, but to transfer as much of the burden of Covid as possible from the global rich to the global poor.

“Lockdown” has come to designate a cluster of non-pharmaceutical interventions intended to slow or stop Covid-19. One familiar line of objection to lockdowns is libertarian: lockdowns restrict freedom of movement, association, and so forth. However, the appeal of libertarian arguments is limited to (a) moral contexts globally where individual liberty rights are a primary dimension of policy evaluation and (b) audiences that see such rights as outweighed by the dangers of Covid. Among the latter are some motivated by egalitarian considerations, who claim that Covid hits poorer people including “minorities” harder than richer people. This paper contends that there is a neglected but extremely powerful egalitarian argument against lockdown, based on the fact that most poor people live outside rich countries in circumstances where lockdowns offer no protection, where the risk posed by Covid 19 is lower both absolutely (due to demographics) and relative to other risks to life (due to these being greater), and that lockdowns greatly exacerbate these risks. This includes racial and other majorities who are routinely referred to as “minorities” by authors in rich countries. The paper argues that neglect of these facts is an instance of epistemic injustice, the victims of which are predominately so-called “persons of colour”. The paper argues further that the unfair features of lockdown are not coincidental, but that it was these very features that led to their endorsement by powerful groups, nations and international bodies, and to the persistent positive attitude to lockdowns. From an egalitarian standpoint, their actions can be interpreted as using the commanding heights of the global knowledge economy, not to reduce the global burden of Covid overall, but to transfer as much of the burden of Covid as possible from the global rich to the global poor.

It’s bound to be a controversial line of argument in one way, because it’s drawing a normative moral conclusion that’s pretty far-reaching. But in another way, I hope that it might prove more appealing to people who are fed up with “lockdown scepticism” based on libertarian arguments that they just don’t accept (as well as showing “lockdown sceptics” that they might have other intellectual avenues to pursue). It breaks with the familiar left/right and public health/libertarian dialectics, which I regard as rather North/West focused, and as missing an important set of points and contexts. Hopefully many can agree about at least the need for an evaluation that is both global and focused on equality, even some who reject my own evaluation.

I’ll be delivering the talk at a conference hosted by the University of Macau titled ‘The Moral Roots of Lockdown: East Meets West.’ The programme looks really interesting (setting aside my own contribution). See below. Email the organisers for a zoom link: mrqconference@gmail.com

Covid Philosophy Week, 10-13 May 2021 – Registration Open

The journal Philosophy of Medicine, the Department of HPS, Cambridge, and the Institute for the Future of Knowledge, U Johannesburg, bring you a multi-day programme of philosophical discussions responding to Covid-19. There are three events:

10-13 May, Conference: Philosophical Perspectives on Covid-19, hosted by Philosophy of Medicine and the Institute for the Future of Knowledge (UJ)

12 May, Workshop: The Individual and the Population, part of the series Rethinking the Ethics of Vaccination organized by Emma Curran and Stephen John (Cambridge HPS)

13 May, Panel: Philosophy of Medicine on Covid-19, hosted by Philosophy of Medicine and the Institute for the Future of Knowledge (UJ)

These events have been timetabled so that they do not clash and are accessible for as broad a range of time zones as possible.

Registration and further info for all three events available here: https://philmed.pitt.edu/philmed/CovidWeek

Warm regards,

The Editors, Philosophy of Medicine

https://philmed.pitt.edu/

Is lockdown right? Bioethics, global health, and COVID-19

I gave a public lecture at Virginia Commonwealth University, and it’s up on YouTube here. Bear in mind it was midnight my time… surreal but enjoyable experience.

In this talk I argue for these five claims:

  1. Several common arguments for lockdowns fail
  2. Many actual lockdowns have been unjustified and wrong: other measures would have been better
  3. Globally, lockdowns shift the burden of disease from the powerful and wealthy to the less powerful and poor
  4. The global preference for lockdowns is due to their favoring the interests of the rich and powerful
  5. Optional extra: the favoring of lockdowns by the “left” and rejection by the “right” has nothing to do with their intrinsic character: they are as much right as left and vice versa

How Should We Evaluate Lockdowns? Disentangling Effectiveness, Context, and Politics

Very pleased to share a new blog post I’ve written with Herkulaas Combrink, Benjamin Smart and Damian Walker for the Center for Global Development’s commentary and analysis section.

https://www.cgdev.org/blog/how-should-we-evaluate-lockdowns-disentangling-effectiveness-context-and-politics

Is lockdown right? Bioethics, global health and COVID-19. Talk I’m giving for PhilHEAD workshop https://philhead.org/events/ 17 Oct, 3pm SA/EU

Excited to be giving these thoughts their first outing, in what I hope will be my considered philosophical paper on the thoughts I’ve been having during 2020. The event is open and you can join here: https://bit.ly/3lnxPci

Interview – why lockdowns didn’t work in South Africa – Radio 702 https://omny.fm/shows/early-breakfast-with-abongile-nzelenzele/why-lockdown-didnt-work

https://omny.fm/shows/early-breakfast-with-abongile-nzelenzele/why-lockdown-didnt-work

Commenting on a recent piece in The Conversation, related to a paper published in Global Epidemiology recently, indicating no obvious effect of lockdown over and above mitigation in South Africa.

Lockdown didn’t work in South Africa https://theconversation.com/lockdown-didnt-work-in-south-africa-why-it-shouldnt-happen-again-147682https://theconversation.com/lockdown-didnt-work-in-south-africa-why-it-shouldnt-happen-again-147682

Latest from our ongoing research project at the Institute for the Future of Knowledge with the Center for Global Development. We are looking at indirect health effects of lockdown, meaning the effects on things other than COVID-19. But in the process, we couldn’t help but notice the direct effects too – or rather, their absence…

https://theconversation.com/lockdown-didnt-work-in-south-africa-why-it-shouldnt-happen-again-147682