The double banality of evil in public health: institutional protocols and psychic numbing in the COVID-19 pandemic

The COVID-19 pandemic has left profound biological, social, and moral scars. In Spain, two groups remain on the margins of the official narrative: the 7,291 older adults who died in care homes in the Madrid region during the first wave without being transferred to hospital (1), and the citizens reporting severe sequelae following vaccination, often administered under perceived obligation (2,3).Beyond their suffering, these groups illustrate what this article refers to as a double banality of evil in the public health sphere. Drawing on Arendtian theory and contemporary moral psychology, the essay examines how systemic mechanisms render certain victims invisible. Hannah Arendt (4) described how ordinary people, sheltered by procedural compliance, can become involved in immense atrocities. This is not spectacular evil, but the grey evil of the efficient bureaucrat. This essay argues that these victims have undergone a dual process of banalisation. The first is an institutional banalisation, where their lives are managed through bureaucratic protocols that render decision-making opaque and complex, thereby diluting accountability. The second is a social banalisation, where their suffering is absorbed into public consciousness as statistical mass, a phenomenon aligned with the "psychic numbing" effect (5), which weakens sustained empathy. Public health cannot settle for technical efficiency at the expense of moral memory, and this lens helps to make those ethical failures visible.Arendt observed that modern evil takes the form of impersonal processes where moral responsibility dissolves among protocols. In Madrid's care homes, this manifested through decisions that profoundly affected individuals, yet were taken as administrative formalities.The case is extensively documented. Between March and April 2020, at least 9,470 resident deaths were recorded, of which 7,291 (approximately 77%) occurred without hospital transfer (1). Preexisting structural factors were compounded by specific political decisions, including "non-referral" protocols for certain clinical profiles (6). The institutional response has been characterized by systematic denial and legal impunity. As of 2025, at least 143 criminal cases have been dismissed, with courts validating the thesis that "everything humanly possible was done" (7). The Supreme Court further ruled that the regional government had no legal obligation to medicalise care homes, merely to establish guidelines (8). This situation be interpreted as form of institutional 38 banalisation. Not because the courts the substantive of the taken, but 39 because framing them as matters of administrative discretion in an emergency context effectively 40 limited legal accountability, rendering potentially preventable deaths non-justiciable. 41 A comparable logic applies to those reporting severe vaccine adverse effects. The core problem is not 42 the existence of risks but the extreme difficulty in obtaining recognition and redress within a system 43 that consistently communicated these medical products as unequivocally "safe and effective" (9). 44This construction of an official narrative functions as a bureaucratic filter that preventively 45 delegitimizes individual claims of harm by framing them as threats to public confidence rather than 46 as clinical realities. This creates a fundamental contradiction: when individuals experience adverse 47 events, they encounter a system that perceives them not as persons with complex clinical histories, 48 but as files that must fit narrow diagnostic categories. Furthermore, unlike countries such as 49 Denmark, France, or the United Kingdom (10), Spain established no specific no-fault compensation 50 system for COVID-19 vaccines, despite state liability through indemnity clauses with pharmaceutical 51 companies. The first compensation ruling for a vaccine-injured patient did not occur until May 2024, 52with others remaining exceptional. The institutional language of population risk, while 53 communicating epidemiological truths, relegates individual suffering to statistical insignificance 54 against a backdrop of official certainty. 55The second banalisation occurs not within the halls of power, but in the sphere of public 57 consciousness. It is here that the psychic numbing described by Slovic (5) takes hold, where the mind 58 becomes anaesthetised to mass suffering. The tragedy of the care homes was absorbed into the public 59 discourse as abstract numbers (e.g. 53% excess mortality, 7,291 deaths), a statistical framing that, 60 while epidemiologically necessary, inherently dampens emotional response. The identifiable victim 61 effect, which shows that a single, identifiable individual elicits far greater empathy than a statistical 62 abstraction, was systematically neutralised. 63This social banalisation was compounded by official denial. When the regional president of Madrid 64 publicly dismissed the documented death toll as "an invention" (11), it actively eroded the social 65 reality of the harm, creating a narrative fog that further discouraged public engagement and 66 solidarity. The result was an attenuated social response; the scale of the tragedy never triggered a 67 sustained and massive societal demand for accountability commensurate with the number of lives 68 lost. Similarly, for vaccine adverse effects, the relentless public messaging of safety and efficacy 69 created a cognitive environment where individual claims of harm were often perceived not as tragic 70exceptions, but as threats to a collective salvation narrative, thereby limiting the emergence of broad 71 public advocacy. This dynamic reflects a form of Tocqueville's 'Tyranny of the Majority,' where the 72 narrative of the surviving majority silences the minority. The suffering of the few is actively 73 suppressed by the argumentum ad populum of collective success, rendering their reality invisible 74 within the public sphere. 75The double banality of evil helps to link these two dynamics rather than treating them as separate 77 problems. Institutional banalisation -through protocols, legal impunity, and denial-creates the factual 78 and narrative conditions for social banalisation. By blocking official recognition and reducing 79 victims to statistics or disputed figures, institutions deprive the public sphere of the concrete, 80 identifiable stories normally sustain empathy moral outrage. 81 Conversely, social banalization, through psychic numbing a collective response, a 82 permissive environment in which institutional banalisation can persist with little political cost. The 83 absence of strong public pressure allows impunity and denial to stand. In the case of care homes, this 84 meant residents disappeared twice: first from hospital wards because of protocols, and then from 85 public discourse through abstraction and denial. For those affected by vaccines, it meant being 86 invisible first as an exception to the safety narrative within healthcare, and then as a statistically 87 negligible outlier in the public imagination. 88Raising these issues does not negate the complexity of pandemic management. Precisely for this 90 reason, ethical reflection is even more necessary: the greater the appeal to the greater good, the more 91 care is required in treating those who pay a disproportionate cost. 92 A mature public health system must assume three basic obligations if it is to break this cycle of 93 banalisation. First, an obligation of memory, actively preserving and making visible the names and 94 stories behind the statistics. Second, an obligation of recognition, with formal channels for 95 institutional listening and apology, independent of the outcome of litigation.