Study Program: Management Engineering
Course Code: 056233
Presentation: NO
Policy makers response to the pandemic crisis and the
ethics of a pandemic trade-off
Luca Fornaro
Abstract
In order to face the Covid-19 emergency, policy makers imposed drastic public health
measures, with the objective to reduce the spread of the virus. The aim of this work is
to analyze the lockdown imposed in many European countries through ethical theories
(deontological ethics and utilitarianism) and explore the ethical issues that arise from
managing the trade-off between lockdown benefits and costs through an application of
a cost-benefit analysis (CBA).
Keywords: pandemic, lockdown, deontological ethics, utilitarianism, trade-off, CBA
1. Introduction
At the beginning of April, half of the total world population was under a mandatory
lockdown: many governments shut down economic activities and forced citizens to
stay at home for a prolonged period of time. In this paper, policy makers response to
the pandemic crisis will be analyzed thanks to moral theories, namely deontological
ethics and utilitarianism and a new framework synthesizing the two theories will be
proposed: in the first phases of the emergency, policy makers actions were driven by a
deontological scheme, following the principle to save every possible life. Then, the
questioning about the rightness of a drastic lockdown led to a utilitarian way of
thinking, since the concern was that costs could outweigh benefits. In this sense, I will
implement a cost-benefit analysis (CBA) for the lockdown imposed in Italy, France
and Spain and I will discuss the ethical implications of a utilitarianism trade-off
between lockdown benefits and costs as well as the limits of applying this type of tool
to a pandemic scenario.
2. A deontological ethics approach to the pandemic crisis
According to deontological ethics every action we undertake must be compliant with
some universal principles. When making decisions, people face a moral obligation: in
the case of a pandemic scenario it will be to save every possible human life, no matter
the costs to achieve it. Thus, if policy makers decide to pursue this strategy, they will
adopt drastic public health measures to keep at the minimum the number of people
infected. Many European governments, such as the Italian one, acted in this way,
imposing a severe lockdown to contain the virus.
1
At least in the first phases of the emergency, the population seemed to react
positively to the lockdown, since people tend to develop a psychological reaction, a
sentiment of mobilized empathy that brings their feelings closer to those who are
directly suffering from the disease [1]. Indeed, during the peak of the crisis, in Italy,
one of the most affected country by the Covid-19 virus, public media were giving
dramatic news about the increase in the number of deaths, televisions were
broadcasting images of overcrowded hospitals with many people crammed into
corridors since the health-care system was about to reach the saturation of intensive
care units (ICUs). Thus, Italian physicians, who typically practice medicine according
to an ethical framework of deontology, were questioning about the necessity to ration
healthcare resources by setting some criteria to access ventilators and ICU beds, e.g.
establishing a threshold by which to deny a patient such kind of treatments [2][3]. All
this contributed to shake human sensitivity by conveying the idea that we were living
a disaster. And the shared experience of being in a dramatic situation gives origin to
an emerging sense of shared identity, concern and compassion for the other [4][5].
Leveraging on the abovepolicy makers deployed
health policies and a communication strategy that aimed at promoting
cooperative and supportive behavior [6], justifying the lockdown by urging people to
act collectively on behalf of the principle to save every possible life. In addition to this,
in all European countries like Italy, along with the lockdown there was an undeniable
effort to do everything possible to increase healthcare resources such as ICU beds.
Lastly, governments decisions at the beginning of the pandemic were made in a context
of high uncertainty since the virus was not even well understood by the scientists,
therefore they followed a cautious approach, also considering that health protection to
every citizen is enshrined in the Constitutions of European countries. Thus, to
conclude, we can argue that many policy makers in the first moments of the emergency
acted in a deontological sense, to preserve the right to health of every individual,
although such actions were also undertaken capitalizing on a typical behavioral and
social response of human beings to a collective emergency.
3. A two-step management of the pandemic
If saving every life is what must be done at all costs, there seems to be no trade-off in
making decisions for policy makers since lockdown is always justified. However, a
lockdown cannot last forever, it is impossible to prolong it until no person has the virus.
As time goes by, the lockdown starts having important social and economic costs, e.g.
goods consumption and production activities fall down, unemployment rise, businesses
shut down and social distancing causes secondary health effects. Peter Singer and
Michael Plant (2020) [7] raise a question that policy makers asked themselves during
2
the management of the emergency
.
Hereafter I am proposing a new framework to interpret European policy makers
response to the pandemic in the light of moral theories: I call it two-step approach.
As I explained in the previous section, at the beginning of the emergency, policy
makers response had a more deontological semblance also underpinned by three main
factors: (i) high uncertainty, (ii) it was easy to be justified and communicated to the
public, (iii) emotional reaction that arises during emergencies. As soon as the lockdown
produced its first positive effects, policy makers started
constraints because in the long-term the consequences of such drastic public health
policies may be devasting for the economy and
well-being. Here a
utilitarianism way of thinking prevails: a broader account of health benefits is
considered, and policy makers focus on a notion of aggregate value for society, which
is given by the interplay of several factors such as life, happiness and economic
prosperity [8] [9].
4. Utilitarianism and trade-off
Utilitarianism claims that an action is morally right if it maximizes the greatest amount
of good for the greatest number of individuals [10]. Hence, the validity of a lockdown
is challenged as soon as the net benefits for society as whole are lower than the net
costs. A clear example of benefit are the lives saved from a possible death caused by
the virus. On the other hand, as an example of cost we can think in simple economic
terms: if we keep a country closed for too long, many companies can go bankrupt,
employees lose their job and thus their income decrease and consequently their
capability to consume. All this cycle is reflected in a GDP loss. Besides economic
costs, also secondary public health effect should be considered, in fact it is likely that
a great economic downturn causes an increase of diseases other than the Covid-19
virus, such as preventable cancers [11]. This was to explain that there is probably a
troublesome trade-off for policy makers that few are able to admit: saving lives or
saving livelihoods and well-being. Measuring them in a quantitative and objective way,
especially with a standard unit of measure, and disentangling what is the good and bad
in the light of a utilitarian framework is a big challenge. A tool that is usually adopted
to analyze such scenario is the cost-benefit analysis (CBA).
5. CBA and the value of human life
CBA is a tool that helps policy makers to assess the effectiveness of a policy by
evaluating its consequences assigning a monetary value to them and it is rooted on the
fundamental principle to weight advantages against disadvantages and benefits against
3
costs. CBA embeds some philosophical problems in its application, which are
thoroughly explained in the work of Sven Ove Hansson [12]. For the purpose of this
work, the main issue he discusses is related to the incommensurability between life and
money: assigning a monetary price to the loss of a human life is controversial if we
consider life as invaluable and priceless. Nevertheless, for applying a CBA it is
necessary to find a common unidimensional metrics, and thus, from a technical point
of view we have to assign a monetary value also to things that are incommensurable
with money, such as human life.
The implementation of a CBA does not make policy choices less hard, this is
particularly true in a pandemic scenario where decisions are characterized by ethical
dilemmas: it is sufficient to think how hard can be for policy makers to consider to
neglect a life, harming an innocent person today to have some benefits in the future, in
the name of a greater good. However, this type of quantitative analysis is useful in
order to grasp policy decisions under an ethical perspective.
6. CBA application to a pandemic crisis
A comprehensive work about benefits and costs of public health measures to contain
Covid-19 has been carried out by Thunström et al (2020) [13], which applies CBA to
the evaluation of social distancing policies in the US. The benefits are computed in
terms of lives saved, translated in monetary terms, on the other hand the costs are
computed in terms of GDP loss, as the difference between the present value of GDP
lost in a scenario without social distancing to GDP lost with social distancing. The
result they obtain is that the benefits substantially outweighs the costs.
I tried to extend the model by Thunström et al (2020) [13] employing the formula
proposed by them and below reported to evaluate drastic lockdown policies undertaken
by some European countries: Italy, Spain and France. The net present value (NPV) of
such policies has been evaluated as the value of lives saved thanks to lockdown minus
the present value of GDP lost due to it.
i.
ii.
iii.
iv.
VSL is the Value of a Statistical Life (below a more detailed description)
D1 is the number of deaths if no lockdown was imposed, D2 is the numbers of
deaths with the imposed lockdown, thus (D1-D2) is the number of lives saved
thanks to the lockdown
and
are GDP forecasted at year t without and with lockdown
T is the projected time horizon that has been fixed to 5 years, and r is the discount
factor equal to 3% each year
4
In order to compute the value of a human life in monetary terms, a method that is
commonly applied is computing the Value of a Statistical Life (VSL): it represents the
marginal rate of substitution between wealth and mortality risk in a defined time period
[14]. We can view it as a
trade-off between wealth and probability of
death. The computation of this value is generally done according to revealed or stated
preferences of economic agents, though this is not object of this paper (see [14][15] for
further details). In my analysis I used the VSL estimated by Viscusi & Masterman
(2017) [15] for a wide set of countries and adjusted for the income elasticity of the
different populations
. For the estimation of lives
saved, I took the data from a research by the Imperial College of London [16].
Regarding GDP, I used the forecasts provided by the International Monetary Fund
(IMF).
Italy
Spain
benefits
France
costs
The results of this analysis confirm the ones obtained by Thunström et al (2020) [13]
for the US: policy makers of Italy, Spain and France made the correct decision
imposing the lockdown since the costs quantified as GDP loss projected in a time
horizon of 5 years are far below the benefits of saving human lives.
7. Ethical issues arising from the CBA analysis
The analysis has been conducted in the light of a trade-off between lives saved and lost
GDP: it has helped us to compare these variables in an intuitive way. However, this
trade-off is clearly an oversimplification and it poses some ethical issues that is worth
to briefly discuss:
(i) although different techniques can be adopted, there is no simple, uncontestable way
of placing a value on a human life [17].
5
(ii) CBA works in aggregate terms, comparing aggregate benefits and costs but it does
not focus on their distribution among the population [18]. For example, it does not take
into account the possible inter-generational issue that can arise from the fact that young
people will bear much of the costs of this crisis in the future. Moreover, social
inequality is neglected even if disadvantaged people are at higher risk both in
contracting the diseases and to be affected by its economic consequences [5].
(iii) GDP measure has some limitations: comparing lives saved to GDP loss is like
saying that the trade-off that policy makers face is between health and wealth, but as
proposed by Singer & Plant (2020) [7] it would be better
benefits and costs in terms of ultimate wellbeing. GDP loss can certainly indicate a
reduction of wellbeing due to a
also other factors such
as the possible increase in diseases (e.g. preventable cancers) caused by an economic
recession [11] impact on wellbeing and thus cannot be neglected in an accurate policy
analysis.
Finally, I want to highlight how the context and the living standards of different
countries can influence a CBA and how the benefits of imposing a lockdown are much
higher in European and developed countries with respect to developing ones.
Developing countries have a much lower VSL since their populations have lower level
of income: looking at the values in Viscusi & Masterman (2017) [15], Peru has a VSL
of $1.055M and South Africa $1.046M, five times lower than $5.645M of Italy or
$6.975M of France. This means that in poorer countries individuals are willing to pay
less to reduce their risk of death, indeed a consistent part of their population lives under
poverty or low living standard. Therefore, applying to these countries the above
presented methodology would narrow a lot the difference between benefits and costs
and the validity of lockdown policies may be challenged.
8. Conclusion
The first part of this work provides a framework to analyze Italian and European policy
makers response to the Covid-19 pandemic crisis
approach since two different reactions have been identified: in the first phases of the
emergency, policy makers acted according to a deontological scheme to save every
possible life at all costs, this strategy was also underpinned by a context of high
uncertainty
emotional reaction that arises during disasters. The second
step begins in the moment in which the lockdown starts having positive effects, and
policy makers calibrate their policies in utilitarianism terms, in the light of the benefits
for society as a whole and here it emerges a difficult trade-off between saving lives and
well-being. A common tool to analyze such scenario is the CBA: its application to three
European countries (Italy, Spain and France) has been carried out in order to evaluate
6
the lockdown policies. The result obtained is that benefits, measured as monetary value
of lives saved, are much higher than costs, measured as GDP lost. Then, the limits of
such approach and the related ethical issues have been investigated focusing on the
value of human life, distribution of benefits and costs and the imperfection of GDP as
a measure of wellbeing. The final advice for future researches is to try to quantify wellbeing in a broader perspective, including several dimensions such as the ones identified
in the OECD well-being framework (e.g. work and job quality, housing, safety,
environment, education and subjective well-being).
7
References
[1] Aaltola, M. (2012). Understanding the political scarcity: An introduction to Global
Polisomatics. Abingdon, Oxfordshire: Routledge.
[2] Chan, P.S., Berg, R.A, Nadkarni, V.M. (2020). Code Blue During the COVID-19
Pandemic. Circulation: Cardiovascular Quality and Outcomes. 13(5):261-263.
[3]Vergano, M., Bertolini, G., Giannini, A., Gristina, G., Livign, S., Mistraletti, G.,
Petrini, F. (2020). Clinical ethics recommendations for allocation of care of inten- sivecare treatments in exceptional resource-limited circumstances. Italian Scientific
Society of Anesthesiologists, Intensivists, and Pain Therapists.
Available at: http://www.siaarti.it/SiteAssets/News/COVID19%20%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20%20Clinical%20Ethics%20Reccomendations.pdf
[4] Drury, J., Cocking, C. & Reicher, S. (2009). The nature of collective resilience:
survivor reactions to the 2005 London bombings. International Journal of Mass
emergencies and Disasters. 27(1):66 95.
[5] Van Bavel, J.J, Baicker, K.
Willer, R. (2020). Using social and behavioural
science to support COVID-19 pandemic response. Nature Human Behaviour.
4(5):460-471.
[6] Drury, J. (2018). The role of social identity processes in mass emergency behaviour:
an integrative review. European Review of Social Psychology. 29(1):38 81.
[7] Singer, P., Plant, M. (2020, April 6). When will the pandemic cure be worse than
the disease ?. Project Syndicate. Available at: https://www.projectsyndicate.org/commentary/when-will-lockdowns-be-worse-than-covid19-by-petersinger-and-michael-plant-2020-04.
[8] Verweij, M. (2009). Moral principles for allocating scarce medical resources,
Bioethical Inquires. 6(2):159 169.
8
[9] Kass, N.E, Otto, J.,
, D., & Minson, M. (2008). Ethics and severe pandemic
influenza: mantaining essential functions through a fair and considered response,
Biosecurity and Bioterrorism: Biodefense strategy, practice and science. 6(3):227236.
[10] The History of Utilitarianism, https://plato.stanford.edu/entries/utilitarianismhistory/
[11] Maruthappu, M., Watkins, J.
Atun, R. (2016). Economic downturns,
universal health coverage, and cancer mortality in high-income and middle- income
countries, 1990 2010: a longitudinal analysis. The Lancet, (2016), 388(10045):684695.
[12] Hansson, S.O. (2007). Philosophical problems in cost-benefit analysis. Economics
and Philosophy. 23(2):163 183.
[13] Thunström, L., Newbold, S., Finnoff, D., Ashworth, M., & Shogren, J. (2020).
The Benefits and Costs of Using Social Distancing to Flatten the Curve for COVID19. Journal of Benefit-Cost Analysis. 1-17.
[14] Hammitt, J.K. & Robinson, L.A. (2011). The Income Elasticity of the Value per
Statistical Life: Transferring Estimates between High and Low Income Populations,
Journal of Benefit-Cost Analysis. 2(1):1-29.
[15] Viscusi, W., & Masterman, C. (2017). Income Elasticities and Global Values of a
Statistical Life. Journal of Benefit-Cost Analysis. 8(2):226-250.
[16] Flaxman, S., Mishra, S., Gandy, A.
. (2020). Estimating the effects of
non-pharmaceutical interventions on COVID-19 in Europe. Nature
[17] Wolff, J. (2007). What is the Value of Preventing a Fatality? In Tim Lewens (Ed),
Risk: Philosophical Perspectives (pp 54-67). Abingdon, Oxfordshire: Routledge
[18] Stephen, J. (2020, June 17). The Ethics of Lockdown: Communication,
Consequences, and the Separateness of Persons, Kennedy Institute of Ethics Journal.
Available at: https://kiej.georgetown.edu/ethics-of-lockdown-special-issue/
9