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The ‘haves’ and ‘have-nots’ of personal protective equipment during the COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare workers
  1. Clifford Shelton1,2,
  2. Kariem El-Boghdadly3,4,
  3. John B Appleby1
  1. 1 Lancaster Medical School, Lancaster University, Lancaster, UK
  2. 2 Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
  3. 3 Department of Anaesthesia and Perioperative Medicine, Guys and St Thomas’ NHS Foundation Trust, London, UK
  4. 4 Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
  1. Correspondence to Dr Clifford Shelton, Lancaster University, Lancaster LA1 4YW, UK; cliff.shelton{at}


The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.

  • ethics
  • clinical ethics
  • COVID-19
  • health workforce

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Data availability statement

All data relevant to the study are included in the article.

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  • Twitter @DrCliffShelton, @elboghdadly, @JohnBAppleby

  • Contributors All authors contributed to the conceptual ideas and design of the paper. CS and JBA wrote the full draft of the manuscript and incorporated comments from KE-B, all authors edited and approved the final version. CS is the guarantor.

  • 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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