Ethical and human rights considerations in public health in low and middle-income countries: an assessment using the case of Uganda’s responses to COVID-19 pandemic
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Medical Ethics
Abstract
In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to
contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in
China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the
measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to
formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the
ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19.
Main body: We begin by illustrating the value of ethics and human rights considerations for public health
measures including during emergencies. We then summarize Uganda’s social and economic circumstances and
some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human
rights considerations for public health, we reflect upon the ethical propriety of some of Uganda’s responses to
COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the
spread of COVID-19, the ethics and human rights considerations commonly recommended for public health
responses and their importance. Our study found that some of the measures adopted violate ethics and human
rights principles. We argue that even though some human rights can sometimes be legitimately derogated and
limited to meet public health goals during public health emergencies, measures that infringe on human rights
should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly
necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least
restrictive. We reflect on Uganda’s initial measures to combat the spread of COVID-19 and argue that many of them
fell short of these criteria, and potentially limit their effectiveness.
Conclusion: The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of
the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles
recommended for public health measures.
Description
Keywords
Public health, Human rights, Ethics, COVID-19, Low income countries, Public health emergencies
Citation
Barugahare, J., Nakwagala, F. N., Sabakaki, E. M., Ochieng, J., & K Sewankambo, N. (2020). Ethical and human rights considerations in public health in low and middle-income countries: an assessment using the case of Uganda’s responses to COVID-19 pandemic. BMC Medical Ethics, 21(1), 1-12. https://doi.org/10.1186/s12910-020-00523-0