Ethical justifications for the need for pandemic preparedness from sars to SARS-CoV-2: a scoping review

Abstract

Background and objective: The 21st century has seen numerous epidemics with pandemic potential, and during these years literature has been published urging competent authorities to prepare regions for a future pandemic. However, the crisis caused by SARS-CoV-2 has been devastating and marked by improvisation. We ask what part of this literature clarified the ethical justifications for choosing to prepare and what arguments were present in it. The objective of this overview review is to describe the ethical justifications for pandemic preparedness proposed in the period between 2004 and 2020. Methods: Any type of literature published between 2004 and 2019 in whose title or abstract the ethical justification for pandemic preparedness is described as the main topic was included. The sources of information searched were PubMed and Cochrane. The literature available in full text was examined for eligibility. Finally, data (curation) was extracted. Results: From an initial identification of 120 articles, 13 were finally included for analysis. That is, although some texts deal with the ethical obligation to be prepared for a pandemic, these are scarce and rarely develop this ethical justification beyond how this preparation should be fulfilled. Ethical guidance is even presented in an instrumental manner (as a way to improve citizen collaboration), without going into the discernment (principles, assumptions...) that underpins these moral proposals. Conclusion: The disparity between the insistences of the last 15 years before the SARS-CoV-2 pandemic and the response capacity and preparedness that were available at the beginning of the crisis is an area for improvement in risk communication. Moreover further reflection on the ethical justifications could help authorities and society as a whole to focus their efforts, during this inter-pandemic period, on preparing for future pandemics. A need to involve the population in preparedness and to make decisions in a transparent manner was shown.