Medical Citizenship and Pandemic Preparedness

Abstract

Keynote Speaker: Nikolas Rose, Australian National University / King's College London "Vital citizenship and the limits of pandemic preparedness" The socio-historical concept of medical citizenship, which in pluralistic and democratic societies is based on the right of groups and individuals to participate in medical treatment and medical progress, is centered on these categories of difference. In response to SARS since 2005, above all in view of possible influenza pandemics, research on public health ethics and the ethics of medicine have discussed the moral problems of the distribution of scarce resources such as healthcare (triage) as well as the allocation, rationing, and distribution of vaccines. Contagion control measures, such as school closures or social distancing, were also reflected on from ethical as well as legal points of view. In the 1960s, contagions and infectious diseases in Western industrial countries were common experiences and claimed fatalities every year. In the following decades, the continuous improvement and expansion of vaccination and prevention programs increasingly eliminated contagions from everyday life, at least in the global North, to ultimately result in the (ideal) image of an “immune society” (Malte Thießen). It was not until the 1980s, when HIV/AIDS appeared and spread in pandemic proportions, that trust in medicine began to unravel in Western societies. New infectious diseases that have since appeared in rapid succession, such as BSE or the Creutzfeldt-Jakob disease in the early 1990s, the avian influenza H5N1 since 1997, SARS in 2002/03, MERS in 2012, and Ebola since 2014 and SARS-CoV-2 since 2019, confirmed and heightened the sense of danger. Pandemic preparedness was increasingly associated with issues of social and economic, national and international security as well as medical risk. At the same time, pandemic planning also has to be taken into account as a central issue of risk research: The heightened perception of risk generates measures for the “taming of the future” without there being valid knowledge about future viruses. What then remains are probabilities, prognoses, and scenarios. And under conditions of ignorance knowledge conflicts become value conflicts. Therefore, medico-, cultico-, and sociohistorical issues are being increasingly connected in historical studies. Contagion events are being investigated in order to track down the communication processes, expectations, and fears of complex societies. The central questions therefore are: Which measures of prevention seem to be adequate in the anticipation of future pandemics? Which costs are societies willing to take if only certain groups are affected by a pandemic (like age became one of the central factors in the discourses about the corona pandemic)? Who is included in pandemic preparedness and who is maybe left out? Whose voices are heard in the planning process and who is merely regarded either as a factor of contagion and therefore as a risk for the whole society or as an object of governmental actions? Could contagion prevention and control be understood as citizenship projects within plural and increasingly globalized societies and described as social practices?

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