The global response to public health emergencies, such as pandemics, often requires enacting public health policy interventions to prevent disease and protect population health. These interventions can and do limit individual freedoms and are widely understood to be appropriate in public health emergencies.
The COVID-19 pandemic has prompted the implementation of public health measures at an unprecedented global scale. Policies such as border and school closures, face mask mandates, limitations on social gatherings, and household confinement have been shown to be effective against COVID-19 transmission and disease outcomes.
While such interventions are crucial to pandemic mitigation, their public health benefits can result in substantial trade-offs, such as limited access to medical care and public health services for the diagnosis, treatment, and prevention of other diseases, as well as the loss of livelihood and disruptions to education and socio-cultural interaction. Furthermore, public health interventions can also come at human rights costs, disproportionately impacting already vulnerable and oppressed communities.
International guidance on the rights-limiting measures allowable during states of emergency is based on the Siracusa Principles. These principles state that regardless of the nature or severity of the emergency, restrictions on human rights must meet standards of legality, legitimacy, necessity, proportionality, evidence, and nondiscrimination.
Further, there are no international principles or standards for state of emergency declarations, meaning that states are bound solely to national and local public health laws when making these declarations. Therefore, public health interventions can and have been practiced discriminatorily by restricting the social, economic, and cultural rights of specific populations, such as refugees and migrants, who are particularly vulnerable to movement restrictions.
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Blanket public health policies can be particularly challenging for disadvantaged populations. For example, people living in impoverished and densely populated urban housing or confined to refugee camps cannot realistically quarantine or avoid gatherings. Incarcerated persons do not have the capability to follow sanitation and masking guidelines without the support of prison policy and resources, and the nature of correctional facilities is not suited to social distancing. Hourly workers and day workers may not be able to afford food, medicine, or other necessities of life when COVID-19 restrictions impair their travel to work.
Viewed through a human rights lens, public health interventions are designed to protect the most vulnerable members of society but in practice, the result may be the opposite. Furthermore, policies can be designed ostensibly for pandemic control while their true goal is political--for example, by limiting assemblies and thereby suppressing anti-government demonstrations. Evaluating COVID-19 public health interventions around the needs of vulnerable populations and prioritizing their needs may allow for a pandemic response that is not only more equitable but also more practicable and sustainable for those at highest risk of disease transmission, morbidity, and mortality.
To address these concerns, we provide a global overview of public health interventions implemented during the COVID-19 pandemic and analyze their human rights dimensions.
