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WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal
  1. Abha Saxena1,2,
  2. Paul André Bouvier3,4,
  3. Ehsan Shamsi-Gooshki5,
  4. Johannes Köhler6,
  5. Lisa J Schwartz7
  1. 1 Institute Éthique Histoire Humanités, University of Geneva, Geneva, Switzerland
  2. 2 Independent Bioethics Consultant, Geneva, Switzerland
  3. 3 Institute of Global Health, University of Geneva, Geneva, Switzerland
  4. 4 Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
  5. 5 Department of Medical Ethics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  6. 6 Department of Anesthesiology and Critical Care Medicine, Kantonsspital Münsterlingen, Munsterlingen, Thurgau, Switzerland
  7. 7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Abha Saxena, Institute Éthique Histoire Humanités, University of Geneva, 1211 Geneva, Switzerland; abhas{at}


In 2016, following pandemic influenza threats and the 2014–2016 Ebola virus disease outbreaks, the WHO developed a guidance document for managing ethical issues in infectious disease outbreaks. In this article, we analyse some ethical issues that have had a predominant role in decision making in response to the current COVID-19 pandemic but were absent or not addressed in the same ways in the 2016 guidance document. A pandemic results in a health crisis and social and political crises both nationally and globally. The ethical implications of these global effects should be properly identified so that appropriate actions can be taken globally and not just in national isolation. Our analysis, which is a starting point to test the broader relevance of the 2016 WHO document that remains the only available guidance document applicable globally, concludes that the WHO guidance should be updated to provide reasoned and thoughtful comprehensive ethics advice for the sound management of the current and future pandemics.

  • allocation of health care resources
  • public health ethics
  • COVID-19
  • policy guidelines/inst. review boards/review cttes
  • public policy

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  • Contributors I hearby confirm that all authors have confirmed that the following is true regarding their contribution to this paper: substantial contributions to the conception and design of the work, drafting the work or revising it critically for important intellectual content, final approval of the version published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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