Library of Congress Scholars Council member Ruth Faden is the founder of the Johns Hopkins Berman Institute of Bioethics. Dr. Faden’s scholarship focuses on justice theory and its power to identify and find ways to mitigate structural injustices in public policy and social life. Currently, her work is concentrated almost exclusively on structural injustice and the COVID-19 pandemic, including essential workers, vaccine development and deployment, women’s health, the ethics of reopening and social distancing policies, and K-12 education. Dr. Faden has co-authored several OpEds and commentaries on the disproportionate impact of school closures on low-income children and children of color, and how school reopening policies run the risk of exacerbating these inequities. She is the co-founder of the E-SCHOOL+ Initiative, an interdisciplinary effort to bring attention to questions of ethics and equity in school reopening policies, and the co-author of the Ethics Framework for the COVID-19 Reopening Process, which also focuses on equity issues.
I spoke with Faden about the societal impact of Covid-19 and the recent protests following the death of George Floyd.
The record of our conversation was edited for length and clarity.
Dan Turello (DT): For several weeks, race issues took center stage on the news cycle and COVID was not as intensely in the spotlight, yet there are many ways in which these two dynamics intersect. What connections do you see between the intensified movement for racial justice and how people of color have suffered during the pandemic?
Ruth Faden (RF): I think the connections are inescapable and profound. It’s a counterfactual. We’ll never know if we would have had the same intensity of response to the murder of George Floyd if we were not in the midst of a pandemic. But I think it’s reasonable to underscore that what the pandemic has done, before we got to police brutality, was take all of the cracks that we have in American society, and the way in which our basic structures in this country are organized—our legal system, our political system, our economic system, our education system—and laid them bare. The cracks became fault lines and they exploded. It’s like we had simultaneous earthquakes happening all over the country.
As the differential in the burden of disease among African Americans, and Hispanics, and Native Americans gathered attention, the first response was to attribute the disparity to bias in our healthcare system and poor access to health care. But it’s more complicated than that. It also has to do with the fact that people of color and people of poverty have higher rates of the chronic illnesses that put people at increased risk for serious COVID-19 disease. It has to do with the fact that many of our lowest paid essential workers are also people of color and people living in poverty. That’s part of the reason they’re having more exposures. And while from the beginning Americans recognized how much we owe professional healthcare workers, who are risking their lives to take care of people who become ill with COVID disease, we were way slower to come to recognize that a lot of other people that we rely on in the healthcare system and in other sectors of economy, that make it possible for the rest of us to be safer, are not professionals but people earning sometimes no more than minimum wage. And many of them are people of color and people in or at risk of poverty.
I have been thinking and writing about structural injustice for many years, and so I am not surprised at all, deeply saddened but not surprised, by the profoundly different impact of this pandemic on people in poverty and people of color. It’s hard not to be struck by the unfairness of it all. Here I am, sitting snug in my house, getting my salary for doing my job, because I can do it online while other people, who can’t do their jobs on-line, are bringing food and packages to my door, and behind them are people working in supermarkets and Amazon fulfillment centers. And there are still others packaging our meats and taking care of our elderly. All these people are getting sick and people like me are staying safe.
Then comes the George Floyd murder. It’ll take many historians, political scientists, and sociologists probably decades of scholarship to help us understand why this became the moment that it has become. There’s no question that we had seen graphic images of Black men and women suffering from police brutality and racism before this. But that murder came at a time when there was so much frustration and so much anger and so much hurt, even down to who was losing their jobs and which businesses were going under. It was just too much, and, combined with the fact that people had been home for a long time, the frustration and the anger and hurt couldn’t be contained.
Police brutality is not new. The COVID crisis is new. But, in my view, the root causes for why both of them are as bad as they are, are the same. If we had a more inclusive society, we would not be where we are with COVID-19. And I don’t think there’s any other way to put it than that. And if we were that kind of society, we would never be in a position where people are subjected to the kind of day to day racial injustices at the hands of the police.
DT: Generational perspectives are interesting too, in terms of ethics, responsibility, and disease burdens. Younger folks generally may be less impressed by the descriptions of risk and the mortality statistics, and perhaps feel like some of the lockdowns have been too draconian. How do you see these tradeoffs?
RF: The epidemiology of this particular disease raises interesting questions about intergenerational justice. It’s certainly the case that the bulk of the burden of disease is falling on people who are older as well as people with certain preexisting health conditions. And it’s also the case that many of the older people who are dying are people of color or in poverty.
The question comes up how to fairly distribute the burden associated with trying to contain this pandemic. There are some people who had been arguing we just need to open up and we have to tell the people who are at elevated risk that they have to stay home until we get a vaccine or a cure, because we can’t keep up this sort of thing anymore. And there’s some argument to be made for that. You can see the logic of it. But going that route is very difficult from the standpoint of something else that is important to us, which is caring for one another. How many years is it going to be before people can see their parents, or grandparents can see their grandchildren? For some older folks, this could be the rest of their life.
More to the point, however, we are seeing play out in real time now what happens when policy makers and people conclude that it’s time to get on with our lives, open up the economy, and forget about the pandemic. Some states are on the brink of health care system and human disasters, forcing leaders to retrench on their reopening plans. As much as the people in this country need to be working and the children in this country need to get back to school in a school building, we are being utterly naïve if we think that getting back to “normal” can truly happen before the pandemic is under some kind of reasonable control, which is one of the reasons why I get upset about the mask conversation. I know it’s uncomfortable. I hate wearing mine. But go ahead, and, you know, wear your mask when you’re outside and in a store. It’s not only utterly irresponsible and callous not to, it’s also so shortsighted. What’s at stake is not solely the moral obligation we all have to protect others and the health care workers who care for them. When people don’t wear masks, they are increasing the likelihood that exactly what they want to protect—their freedom, to not wear masks, yes, but also to go to stores, restaurants, bars and beaches—will once again have to be curtailed.
I want to return to children for a moment. I’m especially worried about our children. They need to be in school for so many reasons, not only because distance education just doesn’t cut it in terms of learning. Children need school for their socioemotional development, and sometimes for their physical health as well. Also, the equity issues are staggering. All children are suffering, but the children who are suffering the most are the children from low income families, children of color, children with disabilities, children where English is a second language. Every kid who was worse off before the pandemic has become way worse off during the pandemic, as best as we can tell. The gaps that existed before the pandemic were already in my view unjustifiable from an ethics point of view. And now these gaps are bigger.
I believe there are some good arguments on the side of saying we need to make sure that we don’t unfairly burden younger parts of our society, especially children. Whether going back to college is as important as going back to third grade is an open question. There are developmental issues here that can be debated and discussed. But it’s clear that school closures have been really difficult for K-12 aged children, difficult on their parents and families as well.
DT: We’re slowly developing treatments. At some point we may have a vaccine. When that happens, what kind of equity and access issues will that create?
RF: Depending on which experimental therapies turn out actually to work, there will be more or less of a shortage issue. With vaccines, we can be certain of a shortage, at least in the beginning. Even though investments are being made now to get vaccines ready for market, there will still be a period of time when we’ll have less vaccine than we will need. And that requires establishing priorities—which groups of people should be offered vaccine first, and for what reasons. Health care workers have typically been at the front of the line in these kinds of situations. Layered into that is an additional set of considerations. Shouldn’t it be all essential workers, especially with an equity lens now, and a racial equity lens? That could turn out to be a lot of people, so there may be a need to triage among essential workers. What should our objectives for a vaccine program be? Getting a lot of people working without concern? Getting schools going again? Protecting the lives of those at greatest risk of serious COVID-19 disease? Some combination of these? We have to figure out what the objectives should be and then allocate accordingly.
Deciding how to prioritize vaccine allocation within the US engages complex questions about equity and about other values, especially if the vaccine strategies that are most likely to get the epidemic under control, and thus the economy and social life back to something like normal, end up requiring a greater emphasis on slowing transmission than on preventing deaths among those at greatest risk.
Whatever challenges we face in wealthy countries like the US, they pale against the challenges of equitable access to vaccines globally. There are people who live in parts of the world where governments have zero capacity to manufacture vaccines, or even to purchase them on the open market. Active efforts are under way to address this incredibly serious problem. But that’s a whole other conversation.