 | Jonathan Marks Director of Bioethics Program - The Pennsylvania State University |
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03.09.2025-30.09.2025
Pandemic Lotteries, Structural Injustice, and the Public Health Emergency Pyramid
During the COVID-19 pandemic, ethicists have been called upon to help draft triage policies and guidelines to determine who lives or dies when there are not enough resources (such as ventilators, antivirals, or monoclonal antibodies). Many policies employ lotteries to break a tie between patients who are awarded equal “scores” in the algorithms applied to determine who will receive crisis care. When vaccines became available, many governors and employers in the United States and Canada also launched prize lotteries as incentives for people who were reluctant to get vaccinated. I argue that lotteries often mask both historic and current structural injustice. For example, lotteries for the allocation of scarce medical resources (resource lotteries) can make the consequences of choice—notably, policymakers’ failure to adequately prepare for the pandemic—appear to be chance. Similarly, prize lotteries might promote vaccination but fail to address the reasons for the reluctance of some marginalized populations to get vaccinated—in particular, distrust resulting from unjust treatment in medical research and practice (both historic and present). In addition, prize lotteries prime populations to think about self-interest, rather than public health and the common good. This priming is problematic if we wish to encourage voters to support politicians who favor increased public health funding.
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28.02.2015-30.03.2015
Public-Private Partnerships to Promote Public Health and Health-Related Research: An Analysis of the Systemic Effects, Ethical Issues, and Policy Implications
The purpose of the project is: (1) to make policymakers and administrators more sensitive to the systemic effects, ethical challenges, and policy implications of partnerships with industry; (2) to provide them with the concepts and language that will help them identify and articulate the these effects, challenges, and implications; (3) to provide them with some tools to better assess the ethics of public-private partnerships; and (4) to foster policy discussion about how public actors (including international organizations) can best meet their goals in constrained funding environments. In addition, I hope to broaden the scholarly literature and discourse about interactions between industry on the one hand and the public sector on the other. Much of the work in this arena focuses on relationships with the pharmaceutical industry in the context of drug research. Although this is important work, in my view it is also important to focus attention on interactions with other industry actors (notably, multinational food corporations) in the context of research that is intended to promote public health and/or health policy interventions.
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