10. 1056/NEJMp2210173-t1
Table 1. Role of values in decision-making in public fitness emergencies.
Fairness, justice, solidarity, trust, security and transparency are all examples of values explicitly invoked by decision-makers.
Values reflect judgments about what is vital or valuable, which can shape the basis of moral action. Ethics refers to the systematic examination of the values that underpin or underpin pandemic response options.
• What does equity in vaccine allocation require?
• Does solidarity mean making sure that other people in low- and middle-income countries get the first doses of the vaccine before other people in high-income countries get booster doses?
• What does a commitment to transparency or inclusion mean for decision-making processes?
Since political goals reflect judgments about what is vital or valuable, they are strongly connected to values, even if this link is not made explicit. Science alone cannot tell us which goals are vital or valuable; Value judgments are necessary.
• When implementing a vaccine, is our goal to minimize deaths, protect frontline workers, or protect critical infrastructure (p. e. g. , facilities critical to the physical condition and welfare of the public)?
When two or more goals conflict, the values come into conflict. Decision makers will have to give weight to certain values and assess whether the promotion of one or more values deserves to be arbitrated through the promotion of other values.
• Should we prioritize eliminating a pandemic virus even if it can only harm the economy?
• Should we jeopardize in-person schooling for the sole purpose of cutting off network transmission of a pandemic virus?
When decisions have to be made in a context of uncertainty, they can turn out to be wrong. Values count the weight we give to the consequences of those imaginable mistakes and our judgments about the point of threat to accept.
• Should other vaccinated people be exempted from public health measures, such as isolation and quarantine?
• Should the period between vaccine doses be extended so that more people get the first doses more quickly?
10. 1056/NEJMp2210173-t2
Table 2. Core values that affect the allocation of scarce resources.