Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19

Solidarity and reciprocity during the COVID-19 pandemic: a longitudinal qualitative interview study from Germany

BACKGROUND

While solidarity practices were important in mitigating the Coronavirus Disease 2019 (COVID-19) pandemic, their limits became evident as the pandemic progressed. Taking a longitudinal approach, this study analyses German residents' changing perceptions of solidarity practices during the COVID-19 pandemic and examines potential reasons for these changes.

METHODS

Adults living in Germany were interviewed in April 2020 (n = 46), October 2020 (n = 43) and October 2021 (n = 40) as part of the SolPan Research Commons, a large-scale, international, qualitative, longitudinal study uniquely situated in a major global public health crisis. Interviews were analysed using qualitative content analysis.

RESULTS

While solidarity practices were prominently discussed and positively evaluated in April 2020, this initial enthusiasm waned in October 2020 and October 2021. Yet, participants still perceived solidarity as important for managing the pandemic and called for institutionalized forms of solidarity in October 2020 and October 2021. Reasons for these changing perceptions of solidarity included (i) increasing personal and societal costs to act in solidarity, (ii) COVID-19 policies hindering solidarity practices, and (iii) a perceived lack of reciprocity as participants felt that solidarity practices from the state were not matching their individual efforts.

CONCLUSIONS

Maintaining solidarity contributes to maximizing public health during a pandemic. Institutionalized forms of solidarity to support those most in need contribute to perceived reciprocity among individuals, which might increase their motivation to act in solidarity. Thus, rather than calling for individual solidarity during times of crisis, authorities should consider implementing sustaining solidarity-based social support systems that go beyond immediate crisis management.

Solidarity during the COVID-19 pandemic: evidence from a nine-country interview study in Europe

Calls for solidarity have been an ubiquitous feature in the response to the COVID-19 pandemic. However, we know little about how people have thought of and practised solidarity in their everyday lives since the beginning of the pandemic. What role does solidarity play in people's lives, how does it relate to COVID-19 public health measures and how has it changed in different phases of the pandemic? Situated within the medical humanities at the intersection of philosophy, bioethics, social sciences and policy studies, this article explores how the practice-based understanding of solidarity formulated by Prainsack and Buyx helps shed light on these questions. Drawing on 643 qualitative interviews carried out in two phases (April-May 2020 and October 2020) in nine European countries (Austria, Belgium, France, Germany, Ireland, Italy, The Netherlands, German-speaking Switzerland and the UK), the data show that interpersonal acts of solidarity are important, but that they are not sustainable without consistent support at the institutional level. As the pandemic progressed, respondents expressed a longing for more institutionalised forms of solidarity. We argue that the medical humanities have much to gain from directing their attention to individual health issues, and to collective experiences of health or illness. The analysis of experiences through a collective lens such as solidarity offers unique insights to understandings of the individual and the collective. We propose three essential advances for research in the medical humanities that can help uncover collective experiences of disease and health crises: (1) an empirical and practice-oriented approach alongside more normative approaches; (2) the confidence to make recommendations for practice and policymaking and (3) the pursuit of cross-national and multidisciplinary research collaborations.

"Look After Each Other"- Ethical Concerns in the Use of Communicative Appeals to Solidarity in the Face of a Pandemic

During the recent COVID-19 pandemic international organizations and national and local governments employed appeals to solidarity or "we-messages" for the purpose of encouraging the public to adopt mitigation measures and to help more vulnerable others. Since appeals to solidarity inherently aim to influence people's views and practices, they raise ethical concerns similar to concerns associated with health communication persuasive campaigns (e.g. respect for autonomy, personal responsibility, stigmatization) and concerns more specifically associated with appeals to solidarity (e.g. divisiveness). The first part of the paper introduces a conceptual distinction between two types of approaches to solidarity according to an instrumental or moral emphasis. Appeals to solidarity according to this distinction are illustrated with examples from the COVID-19 pandemic. The second part summarizes normative justifications and advantages for employing appeals to solidarity. The third part presents ethical concerns associated with appealing to solidarity in the time of a pandemic. Drawing on these concerns, the final part presents propositions for normative conditions for employing solidarity appeals in a time of a pandemic and notes the importance of research needed to identify additional ethical concerns and conceptions of solidarity in multicultural societies. It concludes with noting the importance of employing appeals to solidarity that go beyond mitigating the pandemic and of conducting a critical discourse on the mandate of the state to make "top-down" moral demands.

Towards a less voluntary vaccination policy in the Netherlands? Findings from an expert interview study

BACKGROUND

The Netherlands traditionally favours a voluntary approach to vaccination. However, during the COVID-19 pandemic multiple European countries drastically altered their vaccination policies, which fuelled societal and political debate about the need to make the Dutch vaccination policy less voluntary, particularly by utilising pressure or coercion.

AIM

To provide insight in expert's views on main normative issues concerning a less voluntary vaccination policy (for adults). Our study adds to the existing debate by addressing this topic from a multidisciplinary viewpoint.

METHODS

We conducted 16 semi-structured interviews with legal, medical and ethical experts on the Dutch vaccination policy, between November 2021 and January 2022. We analysed interview transcripts through inductive coding.

RESULTS

Most experts believe a less voluntary vaccination policy is of added value under certain circumstances, as exemplified by the outbreak of COVID-19. For such a policy, a legislative approach might be most effective. However, different views exist on the desirability of a less voluntary approach. Main arguments in favour are based on epidemiological circumstances and a duty towards the collective health interest, whilst arguments against are based on the questionable necessity and adverse effectiveness of such policy.

CONCLUSIONS

If implemented, a less voluntary vaccination policy should be context-specific and take into account proportionality and subsidiarity. It is recommendable for governments to embed such policy (a priori) in flexible legislation.

Newspaper coverage on solidarity and personal responsibility in the COVID-19 pandemic: A content analysis from Germany and German-speaking Switzerland

Solidarity and personal responsibility have been repeatedly called upon during the COVID-19 pandemic. This study quantifies and contextualizes the use of these terms in newspaper coverage in Germany and German-speaking Switzerland based on n = 640 articles from six functionally equivalent newspapers. The term solidarity in the context of the COVID-19 pandemic was mentioned in 541/640 articles (84.5%) and was primarily used during phases with high death rates and comparatively stringent policies in place, supporting the idea that solidarity was used to explain restrictive measures to the population and motivate people to comply with these measures. German newspapers published more articles on solidarity than Swiss-German newspapers, consistent with more stringent COVID-19 policies in Germany. Personal responsibility was mentioned in 133/640 articles (20.8%), meaning that the term was less frequently discussed than solidarity. Articles covering personal responsibility included more negative evaluations during phases of high infection rates as compared to phases of low infection rates. Findings indicate that the two terms were, at least to some extent, used in newspaper reporting to contextualize and justify COVID-19 policy during phases of high infection rates. Moreover, the term solidarity was used in a high variety of different contexts and the inherent limits of solidarity were rarely mentioned. Policymakers and journalists need to take this into account for future crises to not jeopardize the positive effects of solidarity.

Solidariedade, cidadania e justiça social: percepções de atores sociais sobre as respostas públicas à COVID-19

Resumo Trata-se de uma análise qualitativa das percepções de atores sociais sobre as respostas públicas durante a pandemia de COVID-19. Foram conduzidas entrevistas semiestruturadas com 11 representantes da sociedade civil indicados por lideranças de movimentos sociais. Para garantir a análise de uma diversidade de vozes, também realizamos a sistematização de artigos de opinião de autoria de organizações humanitárias e lideranças da sociedade civil, publicados em jornais de grande circulação. Nossa análise se inspirou nos princípios éticos da justiça social, solidariedade e cidadania. Utilizamos da análise temática, na qual dois temas principais emergiram: 1) as populações desproporcionalmente afetadas seguem invisibilizadas para cuidados e proteções; 2) há um projeto intencional de aniquilamento das populações consideradas indesejáveis. Para cuidados e mitigação dos efeitos durante emergências sanitárias, os movimentos comunitários devem ser incorporados como parte essencial das respostas. Cuidado, solidariedade e participação cidadã são centrais para a construção de respostas para proteção em saúde dentro do marco da justiça social. As respostas para transformação do futuro pós-pandêmico se localizam nas iniciativas da sociedade civil e de lideranças comunitárias dentro dos territórios.

The reception of public health messages during the COVID-19 pandemic

Understanding the reception of public health messages in public-facing communications is of key importance to health agencies in managing crises, pandemics, and other health threats. Established public health communications strategies including self-efficacy messaging, fear appeals, and moralising messaging were all used during the Coronavirus pandemic. We explore the reception of public health messages to understand the efficacy of these established messaging strategies in the COVID-19 context. Taking a community-focussed approach, we combine a corpus linguistic analysis with methods of wider engagement, namely, a public survey and interactions with a Public Involvement Panel to analyse this type of real-world public health discourse.

Our findings indicate that effective health messaging content provides manageable instructions, which inspire public confidence that following the guidance is worthwhile. Messaging that appeals to the audience's morals or fears in order to provide a rationale for compliance can be polarising and divisive, producing a strongly negative emotional response from the public and potentially undermining social cohesion. Provenance of the messaging alongside text-external political factors also have an influence on messaging uptake. In addition, our findings highlight key differences in messaging uptake by audience age, which demonstrates the importance of tailored communications and the need to seek public feedback to test the efficacy of messaging with the relevant demographics. Our study illustrates the value of corpus linguistics to public health agencies and health communications professionals, and we share our recommendations for improving the public health messaging both in the context of the ongoing pandemic and for future novel and re-emerging infectious disease outbreaks.

Solidarity, citizenship and social justice: perceptions of social actors about public responses to COVID-19

Abstract This qualitative study aimed to analyze the social actors’ perceptions of public responses during the COVID-19 pandemic. We conducted semi-structured interviews with eleven civil society representatives and social movement leaders. We also performed triangulation based on the systematization of opinion papers authored by humanitarian organizations and civil society leaders and published in large-circulation newspapers. Our analysis was inspired by the ethical principles of social justice, solidarity, and citizenship. Two main themes emerged from the thematic analysis: 1) disproportionately affected populations remain invisible to care and protection; 2) there is an intentional project to annihilate “undesirable” populations. Community movements must be incorporated as an essential part of the responses to provide care and protection and mitigate the effects during health emergencies. Care, solidarity, and social participation are central to building health protection responses within the framework of social justice. The responses to transforming the future in the aftermath of the pandemic will occur through the initiatives of civil society and community leaders within the territories.

Solidarity and Public Health

We argue that an unqualified use of the term solidarity in public health is not only equivocal but problematic toward the ends of public health. The term may be deployed normatively by public health advocates to strengthen the bonds among public health practitioners and refer to an ideal society in which the importance of interdependence among members ought to be acknowledged throughout the polity. We propose an important distinction between partisan solidarity and societal solidarity. Because any moralized belief in a vision of a broad societal solidarity will be a contested political ideal, political reality would limit solidarity based on such a vision to partisan solidarity. An idealized vision of societal solidarity is simply not politically feasible in pluralistic, liberal, democratic societies. However, although societal solidarity is unlikely with respect to any particular policy, it might be hoped for with respect to constitutional procedures that provide boundaries for the agon of the political process. We suggest that moralizing assertions of a solidaristic ideal in a pluralistic society might be counterproductive to generating the political support necessary for public health per se and establishing legitimate public health policy. A pragmatic political approach would be for public health advocates to generate sufficient strong political support for those public health policies that are most amenable to the political and social realities of a time and place.

Epistemic solidarity in medicine and healthcare

In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, on solidarity’s relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions.

COVID-19 Vaccination Passports: Are They a Threat to Equality?

In several countries, governments have implemented so-called 'COVID passport' schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.

Levels, Predictors, and Distribution of Interpersonal Solidarity during the COVID-19 Pandemic

Since introducing the first non-pharmaceutical interventions (NPIs) to decelerate the spread of the virus, European governments have highlighted the role of “solidarity”. However, the role and levels of solidarity, especially during the past lockdowns, is uncertain. The present study thus explores the levels, the role, and the distribution of received and demonstrated interpersonal solidarity during the COVID-19 pandemic. This pooled cross-sectional study was conducted from March 2020 to March 2021 in Germany, including 19,977 participants. Levels of solidarity between the first and the second lockdowns in Germany were compared, possible predictors were examined, and three clusters were defined to unveil distributional patterns of solidarity reception and/or demonstration. To compare solidarity levels between the first and the second lockdowns in Germany, a dummy-coded lockdown variable was introduced and regressed on the two solidarity items. To identify predictors of received and demonstrated solidarity, two multiple linear regression models were computed, testing several demographic and psychological factors. For further exploratory analyses, clusters of “helpers”, “non-helpers”, and “help-receivers and helpers” were computed based on a k-means cluster analysis. Results revealed a lower level of solidarity during the second lockdown compared with the first one. Demonstrated solidarity was positively predicted by adherent safety behavior to avoid COVID-19 infection and by middle age, and negatively by depression symptoms, male gender, and high age. Received solidarity was positively predicted by higher age, by both adherent and dysfunctional safety behavior in avoidance of COVID-19 infection, and by lower educational level. “Helpers” reported little received solidarity but demonstrated high solidarity, “non-helpers” showed both little demonstrated and received solidarity, and “help-receivers and helpers” showed middle–high received and demonstrated solidarity. The three clusters differed the most regarding the variables of age, adherent and dysfunctional safety behavior, fear of COVID-19, subjective risk perceptions regarding contraction of COVID-19 and the respective consequences, and trust in governmental interventions in response to COVID-19. The decrease in interpersonal solidarity over the course of the COVID-19 pandemic, as well as its predictors, should be considered regarding prospective impositions. Furthermore, as depressive symptoms were identified to negatively predict interpersonal solidarity, the adequate provision of mental health services, especially during the COVID-19 pandemic, becomes even more important.

Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics

Mandatory vaccination has been a highly disputed policy for tackling infectious diseases. Here I argue that a universal mandatory vaccination policy for the general public against the COVID-19 pandemic is ethically preferable when grounded in the concept of solidarity, which is defined by Barbara Prainsack and Alena Buyx as an enacted commitment to a relevant respect recognized by a group of individuals with equal moral status. This approach is complementary to utilitarian accounts and could better address other reasonable oppositions to mandatory vaccination. From a solidaristic account, the recognized relevant respect is to end the COVID-19 pandemic as soon as possible. This group of individuals would be willing to carry costs to assist each other in this respect, and a mandatory vaccination policy could be their institutionalized mutual assistance. The costs to be carried include both the financial costs of vaccination and the health costs stemming from potential adverse events and scientific uncertainties. The proposed social health insurance similarity test suggests the degree of coercion the mandatory vaccination policy could undertake within each state's specific legal and judicial context. (Am J Public Health. 2022;112(2):255-261. https://doi.org/10.2105/AJPH.2021.306578).

"Salus Populi Suprema Lex": Considerations on the Initial Response of the United Kingdom to the SARS-CoV-2 Pandemic

In several countries worldwide, the initial response to coronavirus disease 2019 (COVID-19) has been heavily criticized by general public, media, and healthcare professionals, as well as being an acrimonious topic in the political debate. The present article elaborates on some aspects of the United Kingdom (UK) primary reaction to SARS-CoV-2 pandemic; specifically, from February to July 2020. The fact that the UK showed the highest mortality rate in Western Europe following the first wave of COVID-19 certainly has many contributing causes; each deserves an accurate analysis. We focused on three specific points that have been insofar not fully discussed in the UK and not very well known outside the British border: clinical governance, access to hospital care or intensive care unit, and implementation of non-pharmaceutical interventions. The considerations herein presented on these fundamental matters will likely contribute to a wider and positive discussion on public health, in the context of an unprecedented crisis.

Destination image during the COVID-19 pandemic and future travel behavior: The moderating role of past experience

This study investigates the effects of cognitive destination image shaped by media during the COVID-19 pandemic on willingness to support and post-pandemic travel intention. Drawing upon the concept of cognitive destination image and through an online self-administered survey, the effects of four factors including trust, crisis management, healthcare system, and solidarity on travel behavioral intention are compared based on tourists’ prior experience of a given destination. To achieve this aim, ten countries with different coping strategies, numbers of positive cases and mortality rate were studied. A total number of 518 useable questionnaires were collected from the prospect international tourists who followed news related to COVID-19 for one of the selected countries and plan to travel in the future. Partial least squares – structural equation modeling and multi-group analysis were used to test the model and hypotheses. The results showed the high predictive power of the model on post COVID-19 travel behavioral intention. The findings revealed the strong and positive effects of trust and healthcare system on behavioral intention of respondents without past experience to visit a destination, whereas the effect of solidarity on behavioral intention was identified much stronger for the prospect tourists with past experience of visiting a destination. This research provides unique theoretical contributions by investigating the effects of trust, crisis management, healthcare system, and solidarity shaped by media during COVID-19 outbreak as the components of cognitive destination image on future behavioral intention across past experience of visiting a destination. This study also provides insights on post-crisis recovery factors affecting travel behavioral intention and demand.

Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review

OBJECTIVE

To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS).

DESIGN

A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government's Pandemic Flu Ethical Framework to identify underpinning ethical principles. The strength of normative engagement and the quality of the sources were also assessed.

SETTING

NHS maternity and paediatric surgery services in England.

RESULTS

Searches conducted 8 September-12 October 2020, and updated in March 2021, identified 48 sources meeting the inclusion criteria. Themes that arose include: staff safety; collaborative working - including mutual dependencies across the healthcare system; reciprocity; and inclusivity in service recovery, for example, by addressing inequalities in service access. Embedded in the theme of staff and patient safety is embracing new ways of working, such as the rapid roll out of telemedicine. On assessment, many sources did not explicitly consider how ethical principles might be applied or balanced against one another. Weaknesses in the policy sources included a lack of public and user involvement and the absence of monitoring and evaluation criteria.

CONCLUSIONS

Our findings suggest that relationality is a prominent ethical principle informing resetting NHS non-COVID-19 paediatric surgery and maternity services. Sources explicitly highlight the ethical importance of seeking to minimise disruption to caring and dependent relationships, while simultaneously attending to public safety. Engagement with ethical principles was ethics-lite, with sources mentioning principles in passing rather than explicitly applying them. This leaves decision makers and healthcare professionals without an operationalisable ethical framework to apply to difficult reset decisions and risks inconsistencies in decision making. We recommend further research to confirm or refine the usefulness of the reset phase ethical framework developed through our analysis.

Developing an ethical framework for asymptomatic COVID-19 testing programmes in higher education institutions

Background: Mass asymptomatic COVID-19 testing programmes are being introduced in a range of settings, including in higher education institutions (HEIs). We aimed to produce an ethical framework to identify the range of ethical considerations relevant to HEI testing programmes and to support organisational decision-making. Methods: We conducted a mixed-method consultation (survey and semi-structured interviews) with students and staff at a case study university that was running a student testing programme. Survey data were analysed descriptively; data analysis for interviews was based on the Framework method. The findings of the consultation were combined with literature review, legal/ethical analysis and expert views to produce an ethical framework. Results: A total of 239 people took part in the consultation: 213 completed surveys (189 students, 24 staff) and 26 (16 students, 7 staff) participated in interviews. The survey identified clear support (99% of survey respondents) for the testing programme. Around two-thirds (62%) supported non-mandatory participation. Over half (54%) felt that the programme would need to be at least moderately effective to be acceptable. Over three-quarters (76%) felt the university had some responsibility to run a testing programme. Synthesis of consultation findings and further analysis identified nine areas of ethical consideration for HEIs looking to implement mass asymptomatic testing programmes: design and operation; goals; properties of the test; enabling isolation; choices about participation; benefits, harms and opportunity costs; responsibilities between students and institutions; privacy, confidentiality and data-sharing; and communication. The ethical framework includes recommendations in each of these areas, with illustrative examples of how they might be put into practice. Conclusions: By identifying ethical considerations relevant to university student testing programmes using analysis and consultation, the framework we developed has potential to facilitate deliberation about ethical aspects of such programmes, as well as informing decision-making about their introduction, design and delivery.