The ongoing Coronavirus (COVID-19) pandemic is revealing longstanding American health and healthcare disparities yet to be addressed. While some have described COVID as a great equalizer, policing, public health, medical care, and public funds are revealing otherwise. COVID-19‘s impact on Black people in general and poor and working-class Black people in particular, has elucidated this country‘s long disparate treatment of Black people and centuries-long neglect of Black health concerns. We hope this syllabus offers insight into those historical legacies, while simultaneously paving way for equitable health for all underrepresented populations. Although the focus of this syllabus is the history of anti-Blackness in American medicine, we are aware that many of the texts are not from historians of medicine. Those scholars‘ insights, however, are invaluable to our dissertation research and theoretical approaches. The selection of texts here also reveals the gaps that remain between the histories of medicine and science and Black studies. Though this syllabus is certainly not exhaustive, it lays important groundwork for bridging this gap and illustrating that questions of race and racism should be central to studying the histories of medicine and science. We hope that this syllabus serves not as an endpoint–but as a beginning.'
Teaching Philosophy in the Time of COVID-19
Our purpose is to assess epidemiological agent-based models– or ABMs - of the SARS-CoV-2 pandemic methodologically. The rapid spread of the outbreak requires fast-paced decision-making regarding mitigation measures. However, the evidence for the efficacy of non-pharmaceutical interventions such as imposed social distancing and school or workplace closures is scarce: few observational studies use quasi-experimental research designs, and conducting randomized controlled trials seems infeasible. Additionally, evidence from the previous coronavirus outbreaks of SARS and MERS lacks external validity, given the significant differences in contagiousness of those pathogens relative to SARS-CoV-2. To address the pressing policy questions that have emerged as a result of COVID-19, epidemiologists have produced numerous models that range from simple compartmental models to highly advanced agent-based models. These models have been criticized for involving simplifications and lacking empirical support for their assumptions. In order to address these voices and methodologically appraise epidemiological ABMs, we consider AceMod (the model of the COVID-19 epidemic in Australia) as an example of the modeling practice. Our case study shows that, although epidemiological ABMs involve simplifications of various sorts, the key characteristics of social interactions and the spread of SARS-CoV-2 are represented sufficiently accurately. This is the case because these modelers treat empirical results as inputs for constructing modeling assumptions and rules that the agents follow; and they use calibration to assert the adequacy to benchmark variables. Given this, we claim that the best epidemiological ABMs are models of actual mechanisms and deliver both mechanistic and difference-making evidence. Consequently, they may also adequately describe the effects of possible interventions. Finally, we discuss the limitations of ABMs and put forward policy recommendations.
This article, which provides a general framework to think about the role of data and data science within the pandemic response, was commented upon by seven commentators (from public health, epidemiology, data science, science policy, history and politics of science) and followed by a rejoinder of the author discussing the general role of values and politics within pandemic research.
The authors 'argue that deliberative decision making that is inclusive, transparent and accountable can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.'
We are living through one of the strangest and most anxiety-provoking times that most of us can remember—in lockdown, separated from friends, lovers, colleagues, work, extended family, and in some cases immediate family, to slow the spread of this new virus, SARS-CoV-2. The threat of this virus, and the effectiveness and harms of the social policies meant to mitigate this threat, have become the most important scientific issues of a generation. So it is worth asking: what is the role, if any, of philosophy of science during this pandemic and global lockdown? Should we be trying to get in on the dispute between, say, Neil Ferguson (the most prominent epidemiologist whose models predicted dire consequences of the pandemic and who encouraged strict lockdown policies) and John Ioannidis (the most prominent epidemiologist who has criticized the dire model forecasts and lockdown policies)? I recently posed this question to colleagues on social media. The responses were insightful, and suggested that the discussion could benefit from broader engagement with our discipline. Thus, here I reproduce some of the motivation for the question and summarize several themes from the responses.
The debate over pandemic response is not only about the facts—including the grim death toll. It's also about the relationship between science and decision-making, where values inevitably play a role.
For the sake of both science and action in the COVID-19 pandemic, we need collaboration among specialists, not sects.
In spring 2020, in response to the COVID-19 crisis, many world leaders imposed universal lockdowns. We argue that these restrictions have not been accompanied by the epistemic practices morally required for their adoption or continuation. While in theory lockdowns can be justified, governments did not meet and have not yet met their justificatory burdens. We will not argue that less stringent policies were optimal or better justified. Rather, we explain how government leaders failed and have continued to fail to meet their epistemic duties by relying upon data, models, and evidence of insufficiently good quality to justify their actions.
The scientific community spent the pre-pandemic years designing faster ways of doing experiments, sharing data, and developing vaccines, allowing it to mobilize quickly when COVID19 emerged. Its goal now should be to address its many lingering weaknesses.'
There is no such thing as a true count of COVID-19 deaths. But trying to measure the pandemic‘s toll is still a useful exercise.
The IHME Covid-19 prediction model has been one of the most influential Covid models in the United States. Early on, it received heavy criticism for understating the extent of the epidemic. I argue that this criticism was based on a misunderstanding of the model. The model was best interpreted not as attempting to forecast the actual course of the epidemic. Rather, it was attempting to make a conditional projection: telling us how the epidemic would unfold, given certain assumptions. This misunderstanding of the IHME‘s model prevented the public from seeing how dire the model‘s projections actually were.
How a drug became an object lesson in political tribalism.
This discussion centers on two desiderata: the role of measurement in information-gathering and physical interaction in scientific practice. By taking inspiration from van Fraassen‘s (2008) view, we present a methodological account of perspectival measurement that addresses empirical practice where there is complex intervention, disagreeing results, and limited theory. The specific aim of our account is to provide a methodological prescription for developing measurement processes in the context of limited theory. The account should be useful to philosophers of science, who are interested in the intersection between representation and intervention; scientists, who are interested in methodological suggestions for theory-development and reliability; and interdisciplinary researchers, who are interested in the intersections between the pandemic, built environments, and social processes. We apply the process-view of measurement to COVID-19, specifically, measuring replication in the SARS-CoV-2 virus. The aim is to show that our account tracks key elements—manipulation/intervention, independence, invariance, and theory-development—by organizing unfolding measurement processes. Additionally, we use our account to make prescriptive suggestions for measurement practice in the COVID-19 context by discussing the need to broaden measurement perspective on interaction, manipulation, and production.
This paper mobilizes a transnational approach to intervene in the unfolding history of the Covid-19 pandemic, advocating for nationally based, interdependent initiatives that push back against the fragmentation of national responses and, eventually, national protectionism. Focusing on the governance of digital technologies for data sharing, and using two case studies as illustrations, we describe the emergence of transnational realms of scientific and political cooperation, that were structured to foster interdependence, to bypass insular nationalism, and to subvert digital feudalism. By critically reading these case studies through the lens of the transnational flows of knowledge across borders, we exploit the intellectual and political agendas embedded in this historiographic approach.
COVID-19 has revealed a contest between two competing philosophies of scientific knowledge. To manage the crisis, we must draw on both.
SAGE uses a set of assumptions called the ’reasonable worst-case scenario‘ in its pandemic planning. Jonathan Birch (LSE) looks at the group‘s minutes and documents from early 2020 and argues that over-reliance on these assumptions led to costly delays.
This paper explores the role of speculative anticipation in ethics during the COVID-19 pandemic and provides a structure to think about ethical decision-making in times of extreme uncertainty. We identify three different but interwoven domains within which speculative anticipation can be found: global, local, and projective anticipation. Our analysis aims to open possibilities of seeing the situatedness of others both locally and globally in order to address larger social issues that have been laid bare by the presence of SARS-CoV-2. Our account of speculative anticipation builds on the analyses of the gendered impact of anticipation in technoscience by Vincanne Adams, Michelle Murphy and Adele Clarke; studies in cultural anthropology by Ann Laura Stoler; and the recent research on speculative fiction by Esther Jones. Like theirs, ours is intended to be useful. We offer it as a tool to recast questions and revisit assumptions in the context of the COVID-19 pandemic. It is hoped that by using the frame of the ethics of speculative anticipation, one might be able to consider how to avoid those futures that reproduce inequity, and instead actively and responsibly envision those futures that are informed by equity and sustainability.
The COVID-19 pandemic in the US has inspired conversations about which features of the pandemic‘s impacts were(n‘t) unexpected, as well as why and how. Looming in the background of these discussions are political questions about the blameworthiness of particular institutions and leaders therein, and what COVID-19 disasters within US institutions mean for future discussions about how to reform those institutions. This paper will argue that the inequitable harms of the COVID-19 pandemic in four especially hard-hit US institutions—jails and prisons, meat processing plants, hospitals, and eldercare facilities—were: (1) not so unpredictable as claimed by some commentators, (2) traceable to institutional flaws known prior to the pandemic, and (3) can be fruitfully understood through the lens of fundamental cause theory, which offers a model for why and how social resources and deprivations create predictable patterns of harms from health hazards, even when the hazards are new.
Philosophy does not offer tools for solving practical problems, but looks for a sense of concrete situations through a rational reflection. In the present case this sense focuses on: 1. human fragility (the virus can kill any human being); 2. human impotence (our situation is essentially identical with that of ancient epidemics: our defence reduces us to isolation); 3. limited efficiency of techno-science (the decisive therapy for this illness has not been found yet, despite the efforts of hundreds of laboratories and pharmaceutical companies); 4. rediscovery of common good and human solidarity (the protection of the individuals is needed for the protection of society and vice versa); 5. the incumbent presence of death (in the light of which the hierarchy of values orienting human existence can be reshaped). The results of these reflections can point out responsibilities of the political power, and lead to hostility against philosophers and the effort of silencing their voice, reminding us of the example of Socrates
As policymakers debate the right response to COVID-19, they must take seriously the harms of pandemic policies, not just their benefits.
Public health in China has become a global concern as a consequence of the outbreak and worldwide spread of COVID-19. This article examines the historical place of China in international and global health. Contrary to prevalent narratives in the history of medicine, China and Chinese historical actors played key roles in this field throughout the twentieth century. Several episodes illustrate this argument: the Qing organization of the International Plague Conference in 1911; the role of China in the work of the interwar League of Nations Health Organization and postwar establishment of the World Health Organization; Cold War medical diplomacy; and Chinese models of primary health care during the 1970s. These case studies together show that Chinese physicians and administrators helped shape concepts and practices of global health even before that term rose to prominence in the 1990s, and current events are best understood in the context of this history.
Philosophy is needed to put the science of COVID-19 in perspective.
The UK government‘s ultra-cautious approach to evidence-based policy has helped cast doubt on public health interventions. The definition of good medical and public health practice must be urgently updated.
Articles from History and Philosophy of the Life Sciences*
Agent-based models (ABMs) are one of the main sources of evidence for decisions regarding mitigation and suppression measures against the spread of SARS-CoV-2. These models have not been previously included in the hierarchy of evidence put forth by the evidence-based medicine movement, which prioritizes those research methods that deliver results less susceptible to the risk of confounding. We point out the need to assess the quality of evidence delivered by ABMs and ask the question of what is the risk that assumptions entertained in ABMs do not include all the key factors and make model predictions susceptible to the problem of confounding.
What should the best practices be for modeling zoonotic disease risks, e.g. to anticipate the next pandemic, when background assumptions are unsettled or evolving rapidly? This challenge runs deeper than one might expect, all the way into how we model the robustness of contemporary phylogenetic inference and taxonomic classifications. Different and legitimate taxonomic assumptions can destabilize the putative objectivity of zoonotic risk assessments, thus potentially supporting inconsistent and overconfident policy decisions.
Even before it had been developed there had already been skepticism among the general public concerning a vaccine for COVID-19. What are the factors that drive this skepticism? While much has been said about how political differences are at play, in this article I draw attention to two additional factors that have not received as much attention: witnessing the fallibility of the scientific process play out in real time, and a perceived breakdown of the distinction between experts and non-experts.
This article discusses the role of human-created rules in our collective adapting to Covid-19 and our survival in its wake. Rules that make sense become institutionalised and play a dual role in our response to the pandemic: they provide a guide for individual behavior and they provide a mechanism for coordinating all our behaviors.
In the ongoing pandemic, death statistics influence people‘s feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization‘s rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts (causal chains) and values (the importance of prevention).
Many experts have warned that environmental degradation is increasing the likelihood of future pandemics like COVID-19, as habitat loss and poaching increase close contact between wildlife and people. This fact has been framed as a reason to increase wildlife conservation efforts. We have many good reasons to step up conservation efforts, but arguments for doing so on the basis of pandemic prevention are rhetorically, ethically, and empricially flawed. (Part of the collection Seeing Clearly Through COVID-19: Current and Future Questions for the History & Philosophy of the Life Sciences)
Pandemics like COVID-19 confront us with decisions about life and death that come with great uncertainty, factual as well as moral. How should policy makers deal with such uncertainty? We suggest that rather than to deliberate until they have found the right course of action, they better do moral experiments that generate relevant experiences to enable more reliable moral evaluations and rational decisions.
In this brief essay, we combine biological, historical, philosophical and anthropological perspectives to ask anew the question about the nature of the virus. How should we understand Sars-CoV-2 and why does it matter? The argument we present is that the virus undermines any neat distinction between the natural and the human-made, the biological and the social. Rather, to understand the virus and the pandemic we need to understand both as intimately connected to our own social and historical condition. What started as a reflection on the nature of the virus thus turns into a reflection on the human condition as refracted in this pandemic or an anthropology of the virus.
In this short paper we analyse some paradoxical aspects of France‘s Foucauldian heritage: (1) while several French scholars claim the COVID-19 pandemic is a perfect example of what Foucault called biopolitics, popular reaction instead suggests a biopolitical failure on the part of the government; (2) One of these failures concerns the government‘s inability to produce reliable biostatistical data, especially regarding health inequalities in relation to COVID-19. We interrogate whether Foucaldianism contributed, in the past as well today, towards a certain myopia in France regarding biostatistics and its relation to social inequalities in health. One might ask whether this very data could provide an appropriate response to the Foucauldian question: What kind of governance of life is the pandemic revealing to us?
The SARS-CoV-2 pandemic constituted a crisis situation in which science was very far from Kitcher‘s ideal of well-ordered science. I suggest that this could and should have been different. Kitcher‘s ideal should play a role in assessing the allocation of research resources in future crisis situations, as it provides a way to balance highly divergent interests and incorporate the common good into decision-making processes on research.
In the era of increasingly defined ontological insecurity and uncertainty driven by the ravages of COVID-19, urban informal settlement has emerged as a source of resilience. Indeed, the effects of a pandemic transcends its epidemiological characteristics to political economy and societal resilience. If resilience is the capacity of a system to adapt successfully to significant challenges that threaten the function or development of the human society, then ontological insecurity is about the lack of such capacity. Drawing on Keith Hartian‘s understanding of ’informality‘ of spaces, this policy brief attempts to identify and frame a research agenda for the future. The agenda would assist future researchers and policymakers provide responses that appropriately recognize groups and actors that define the urban informal space.
COVID-19 has been called a disaster for feminism (Lewis in The coronavirus is a disaster for feminism, 2020) for numerous reasons. In this short piece, we make sense of this claim, drawing on intersectional feminism(s) to understand why an analysis that considers gender alone is inadequate to address both the risks and consequences of COVID-19.
This note introduces a framework incorporating multiple sources of evidence into the response to COVID-19 to overcome the neglect of social and psychological causes of illness. By using the example of psychological research on loneliness and its effects on physical and mental health with particular focus on aging and disability, I seek to open further inquiry into how relevant psychological and social aspects of health can be addressed at policy level.
The Covid-19 pandemic has intensified interest in animals with superior antiviral defences. I argue that the role of such animals in biomedical research contrasts with the role of disease models.
The impact of this pandemic is not only through COVID-19 itself: the care for non-COVID-19 related conditions has been dramatically curtailed, shaking entire healthcare services around the world. Amongst the non-COVID-19 related conditions, oncology has been disproportionally affected. We discuss how oncology has changed since the acute phase of the pandemic; its impact on clinicians, trainees, and patients; and offer some medical and historical perspectives to reflect on how this impact could be reduced. (Part of 'Seeing Clearly Through COVID-19')
There are many tangled normative and technical questions involved in evaluating the quality of software used in epidemiological simulations. In this paper we answer some of these questions and offer practical guidance to practitioners, funders, scientific journals, and consumers of epidemiological research. The heart of our paper is a case study of the Imperial College London (ICL) covid-19 simulator, set in the context of recent work in epistemology of simulation and philosophy of epidemiology. (Part of 'Biomedical Knowledge in a Time of COVID-19')
This paper uses the example of the COVID-19 pandemic to analyse the danger associated with insufficient epistemic pluralism in evidence-based public health policy. Drawing on certain elements in Paul Feyerabend‘s political philosophy of science, it discusses reasons for implementing more pluralism as well as challenges to be tackled on the way forward.
Many governments have seen digital health technologies as promising tools to tackle the current COVID-19 pandemic. A much-talked example in this context involves the recent deluge of digital contact tracing apps (DCT) aimed at detecting Covid-19 exposure. In this short contribution we look at the bio-political justification of this phenomenon and reflect on whether DCT apps constitute, as it is often argued, a serious potential breach of our right to privacy. Despite praising efforts attempting to develop legal and ethical frameworks for DCT apps‘ usage; we argue that such endeavours are not sufficient to tackle the more fundamental problem of mass surveillance, which will remain largely unaddressed unless we deal with the biopolitical arguments presented and resort to a technical and structural defence.
The threats of the SARS-CoV-2 pandemic, and the effectiveness and harms of the social policies meant to mitigate these threats, rapidly became the most important scientific issues in many years. This session will analyse the pandemic and policy response from a variety of angles. Topics will include the nature and empirical basis for the relevant epidemiological models, the difficulties with exporting policies out of European contexts, and the challenges of democratic citizen science in a context of lay conspiratorial skepticism of science.
Public webinar on COVID-19 discussing the following topics: Understanding the COVID-19 crisis is critical to managing its outcome. This raises some central questions. Why is the pandemic not the same for every person in every place? How do the risks and uncertainties of the virus shape scientific, governmental and individual responses?
The second installment of Center Debates, Center Debates: COVID-19, will provide philosophical and epidemiological perspectives on the current pandemic by examining several scientific controversies, including lockdowns, facemasks, and vaccine allocation and dosing schedules. Jonathan Fuller MD, PhD (University of Pittsburgh), a philosopher of science and medicine who has written public commentaries on the pandemic, will debate Marc Lipsitch, D.Phil. (Harvard University), an infectious disease epidemiologist who has led much of the science and policy discussion around COVID-19.
UCL Professor of Philosophy James Wilson explores major philosophical public health questions that are more relevant than ever after the coronavirus, including: What does it really mean to have a "human right" to health? How should states weigh the protection of health against the value of liberty and economic activity?
Misinformation about the pandemic is like COVID-19 itself: highly contagious, destructive, and with no known treatment or vaccine. Misinformation, and its nefarious brother, disinformation, causes confusion and, in some cases, death. In this episode we consider how to separate truth from lies and stop the spread of bad information.
How should we think politically about the current global crisis? Do extreme circumstances reveal truths of political philosophy or do they reinforce whatever it is we already believe? Mark, Wes, Seth, and Dylan talk about applying philosophical insights to real-life situations rife with unknowns, John Rawls's veil of ignorance and Adam Smith on our interconnectedness, utilitarianism, libertarianism, and more.
Excellent collection of resources devoted to philosophical perspectives on COVID-19
- Syllabus: A History of Anti-Black Racism in Medicine. Antoine S. Johnson, Elise A. Mitchell, & Ayah Nuriddin
- Agent-Based Modeling for SARS-CoV-2 Epidemic Prediction and Intervention Assessment: A Methodological Appraisal. Mariusz Maziarz & Martin Zach
- Data Science in Times of Pan(dem)ic. Sabina Leonelli
- Difficult Trade-Offs in Response to COVID-19: The Case for Open and Inclusive Decision Making. Ole F. Norheim, Joelle M. Abi-Rached, Liam Kofi Bright, Kristine Bærøe, Octávio L. M. Ferraz, Siri Gloppen & Alex Voorhoeve
- Fast science and philosophy of science. Jacob Stegenga
- From pandemic facts to pandemic policies. Jonathan Fuller
- Good science is good science. Marc Lipsitch
- How Government Leaders Violated Their Epistemic Duties during the SARS-CoV-2 Crisis. Eric Winsberg, Jason Brennan & Chris W. Surprenant
- How Science Beat the Virus. Ed Yong
- How many have died?. S. Andrew Schroeder
- How to Interpret Covid-19 Predictions: Reassessing the IHME‘s Model. S. Andrew Schroeder
- Hydroxychloroquine and the Political Polarization of Science. Cailin O‘Connor, James Owen Weatherall
- Measurement Perspective, Process, and the Pandemic. Vadim Keyser & Hannah Howland
- Mobilizing the Transnational History of Knowledge Flows. COVID-19 and the Politics of Research at the Borders. John Krige and Sabina Leonelli
- Models v. evidence. Jonathan Fuller
- Science and Policy in Extremis: What Can We Learn from the UK‘s Initial Response to COVID-19?. Jonathan Birch
- The Ethics of Speculative Anticipation and the COVID-19 Pandemic. Catherine Kendig and Wenda K. Bauchspies
- The Predictable Inequities of COVID-19 in the US: Fundamental Causes and Broken Institutions. Sean Valles
- The concept of disease in the time of COVID-19. Maria Cristina Amoretti & Elisabetta Lalumera
- The role of philosophy in the pandemic era. G. Lourdes Velázquez
- The totality of the evidence. John P.A. Ioannidis
- Viral Reflections: Placing China in Global Health Histories. Mary Augusta Brazelton
- What's missing in pandemic models. Jonathan Fuller
- Will evidence-based medicine survive COVID-19?. Trisha Greenhalgh
Articles from History and Philosophy of the Life Sciences*
- Assessing the Quality of Evidence from Epidemiological Agent-Based Models for the COVID-19 Pandemic. Mariusz Maziarz & Martin Zach
- Bats, Objectivity, and Viral Spillover Risk. Beckett Sterner, Steve Elliott, Nate Upham & Nico Franz
- COVID-19 and the Power of Rules. Malcolm Brady
- COVID-19 as the Underlying Cause of Death: Disentangling Facts and Values. Maria Cristina Amoretti & Elisabetta Lalumera
- COVID-19, Other Zoonotic Diseases and Wildlife Conservation. Carlos Santana
- COVID-19, Uncertainty, and Moral Experiments. Michael Klenk & Ibo Van de Poel
- COVID-19: Rethinking the Nature of Viruses. Soraya de Chadarevian & Roberta Raffaetà
- Coronavirus Biopolitics: The Paradox of France‘s Foucauldian Heritage. Mathieu Arminjon & Régis Marion-Veyron
- How Can Science Be Well-Ordered in Times of Crisis? Learning from the SARS-CoV-2 Pandemic. Thomas A. C. Reydon
- How Urban 'Informality' Can Inform Response to COVID-19: A Research Agenda for the Future. Francis Onditi, Israel Nyaburi Nyadera, Moses Madadi Obimbo, & Samson Kinyanjui Muchina
- Identity, Politics, and the Pandemic: Why Is COVID-19 a Disaster for Feminism(s)?. Suze G. Berkhout & Lisa Richardson
- Loneliness and Negative Effects on Mental Health as Trade-Offs of the Policy Response to COVID-19. Elena Popa
- Medical Toolkit Organisms and COVID-19. Ulrich E. Stegmann
- Seeing Beyond COVID-19: Understanding the Impact of the Pandemic on Oncology, and the Importance of Preparedness. Daniele Carrieri & Fedro Alessandro Peccatori
- Software Engineering Standards for Epidemiological Models. Jack K. Horner & John F. Symons
- The COVID-19 Pandemic: A Case for Epistemic Pluralism in Public Health Policy. Simon Lohse & Karim Bschir
- The Meaning of Freedom after COVID-19. Mirko Farina & Andrea Lavazza