Global Health Ethics in der COVID-19-Pandemie. Komparative Studien zur guten Praxis im Gesundheitswesen

Objectives: The COVID-19 pandemic had a particular impact on older people, who are classified as vulnerable. On the one hand, older people are at a high risk of suffering a severe course of the disease, on the other hand, protection of well-being threatened by a COVID-19 infection is to be ensured primarily by restricting social contacts. However, this has huge negative consequences, such as social isolation and loneliness, which in turn also increase the risk of morbidity and mortality. Especially affected are older people in nursing homes or hospitals. Geriatric patients can often even be attributed the two most relevant COVID-19 risk factors: old age and comorbidities. In addition, long-term care facilities and hospitals combine a very high risk of infection due to essential nursing and medical contacts and a high risk of social isolation and loneliness due to strict visiting restrictions. In the context of preventive measures fighting the global COVID-19 pandemic, contact regulations in nursing homes and hospitals as well as fast and equitable distribution of effective vaccines worldwide are challenges faced by global society that require in-depth scientific research in real time focusing on a medical ethics perspective. Design & Methods: The first article consists of a detailed comparison of the situation in care homes in five different countries during the first year of the pandemic in 2020. It analyses current data published by the authorities and includes various international publications. The second article discusses the legal provisions on visiting restrictions and bans within European hospitals in 2021 and their impact on mental and physical health of older patients dealing with data of the Organisation for Economic Cooperation and Development (OECD), regulations of the respective authorities as well as current publications. The third article presents a detailed analysis of the first year of COVAX’ global vaccine distribution in 2021, identifying problematic aspects of its allocation framework regarding the implementation of its fundamental ethical principles. Therefore, data out of the respective organizations as well as publications on alternative distribution models and criticism of the COVAX concept were gathered. Based on the analysis, we present the idea of an alternative allocation framework. Observations & Results: The comparative international perspective in real time helps us learn from the successful measures, concepts, etc. of other (federal) countries. A detailed analysis can also form the basis for concepts in future global health crises. Based on the analysis of the situation in nursing homes and hospitals the best practices for prevention have been identified and the importance of mitigating measures to avoid social isolation and loneliness has been highlighted. Nevertheless, a generally low spread of COVID-19 in a country, i.e., outside the facility, is crucial for low infection rates in nursing homes, which emphasises the importance of a societywide approach combatting COVID-19. The need for an international surveillance system as a tool for public health has been identified. Issues of global equity could also be addressed, as fair and rapid vaccine distribution could not be achieved through COVAX. Based on our analysis we developed the 'Prioritized Distribution of Equal Shares' allocation framework, which combines the concepts of equality (proportional allocation) and equity (weighted allocation) right from the outset, in order to achieve both main principles: ethical and practical feasibility. Conclusions: Combining the expertise of all publications, a general lack of medical ethics in the scientific and political discourse during the pandemic was revealed. The severity of the encroachments on fundamental and human rights, which was unprecedented in Germany, requires intensive monitoring of the measures taken, which has so far been neglected.