A powerful prescription for what ails us.
By Amy Gutmann
“The bitter truth was that AIDS did not just happen to America—it was allowed to happen …”
—Randy Shilts, And the Band Played On: Politics, People, and the AIDS Epidemic
Though it describes a viral pandemic that erupted more than four decades ago, And the Band Played On speaks to us even today. This bestseller presents an eerily familiar assessment: faced with a lethal nationwide contagion, too many Americans, too many political leaders among them, willingly downplayed the crisis or just turned away.
Subsequent epidemics from H1N1 to Ebola have each spawned reports that add up to a grim litany of missteps. Stack one report atop the next and they may leave us wondering, if not despairing: Will pandemic missteps be ours to repeat forever? Or can the United States help sow the seeds of a better response not only to this COVID-19 crisis, but to future threats that touch us all?
The answer to this last question is yes, provided that enough Americans take both science and solidarity to heart. As Penn’s president, I am devoted to steering our University through these challenging times while protecting lives. I also bring to bear on this pandemic my scholarship and teaching in moral and political philosophy and bioethics. Our society’s approach to COVID-19 and similar threats is fractured, haphazard, and unjust, at a tragic and unnecessarily high cost in lives and livelihoods—a cost that falls harder upon the most vulnerable among us. We need a scientifically and ethically sound roadmap for navigating such public health crises now and into the future. My coauthor Jonathan Moreno (the David and Lyn Silfen University Professor) and I have proposed one such roadmap, which we call pandemic ethics. Paved by science and the ethics of mutual respect, its pathways lead us to affirm some enduring truths that pandemics lay bare.
Among them, that global health is local health. Contagions such as COVID-19 respect no borders or cultural differences. A virus afflicting a stranger’s family halfway around the world can (and increasingly does) wind up in our own neighborhood.
Another is that issues of health equity affect us all. COVID-19 exacts a disproportionate toll from Black, Hispanic, Native, and low-income Americans, who are being hospitalized and dying at a staggering two to five times the rate of their peers. Addressing this systemic injustice—born of longstanding health inequities—is essential to any effective societal response to the pandemic. The pandemic peels back other layers of systemic racism as well, both within and beyond the immediate health emergency. The largest mass movement for racial justice in generations comes amid the pandemic, sparked by the horrific killing of George Floyd—following that of Breonna Taylor, Ahmaud Arbery, and many others.
Still another truth is that public health policy is only as successful as it is effective, safe, and trustworthy. Expertise—not political expedience—must guide our pandemic policies. Getting it right the first time is essential to maintaining public trust. In this sense, pandemic responses are like first impressions: you may not get a second chance to make a good one.
These three truths call for a renewed commitment to science and social solidarity. From developing safe and effective COVID-19 vaccines and treatments, to getting testing and contact tracing up to speed, to enacting preventive measures such as face masks and social distancing, we must broadly support good science, which goes hand in hand with good ethics.
Just as essential, every one of us needs to care about and invest in people we may never know. We depend on the World Health Organization for tracking global public health, but the WHO needs to become more nimble while also being more adequately funded. A renaissance in cooperative and robust US diplomacy—directed with laser-like strength at improving public health—would be a superb start.
We must redress injustices that render too many people so terribly vulnerable. The massive Black Lives Matter movement shows, among other things, that the seeds for such social solidarity still thrive in America. In a public health crisis, that sense of solidarity—a shared commitment to safeguarding the health and well-being of others everywhere—is one of the surest ways we can in turn protect our closest loved ones and friends.
While examining pandemic ethics with Jonathan, we both cannot help but notice that so many of the world’s greatest assets for fostering science and solidarity are already here in our backyard. Look no further than the world’s great research and teaching universities, Penn prime among them.
Solidarity is not a seasonal jacket one can squeeze into when a crisis hits, then shrug off when danger passes. We must practice this virtue perennially and universally. This year-round, all-in-it-together ethos needs to be taught and cultivated. A broad, interdisciplinary Penn education is designed to do exactly that.
Penn fosters a diverse, inclusive academic community because it is both the right thing to do and the best way for students from different backgrounds to learn from one another and from their faculty how to think globally, plan empathetically, and engage civically. I have written in the past about how important it is to cultivate interpersonal relationships to achieve good results in governance: familiarity breeds attempt. We become more attuned to the needs of others when we ourselves live and learn in diverse communities and make the value of solidarity explicit.
Just like solidarity, science—and expertise across all disciplines—flourishes at Penn. No other institution today surpasses the global research university for long-term investments in expertise despite uncertain short-term dividends. Pre-COVID-19, who cared about coronaviruses in bats? After the pandemic struck, media worldwide wanted to talk to Penn professor and coronavirus expert Susan Weiss, who marveled, “I knew the same thing a year ago, but nobody cared. So from my life it’s been crazy.”
From pursuing basic research to developing the standard of care for coronavirus patients, there you will find Penn people. As I write this, for example, there is no approved medication for treating COVID-19. Penn Medicine has a Phase 3 study underway that seeks to change this by investigating the potential efficacy of the antiviral drug Remdesivir. In pursuit of improved testing, Penn Presidential Professor César de la Fuente just won the inaugural Nemirovsky Engineering and Medicine Opportunity prize (established by Penn alum Ofer Nemirovsky EE’79 W’79) for a proposed paper-based COVID diagnostic, imbedded in face masks, that would detect the virus on a person’s breath and offer test results in seconds.
On the pandemic and far beyond, faculty across all of Penn’s 12 eminent schools comprise an invaluable global storehouse of knowledge with a commitment to the common good. Though we know the contours of the challenges—and opportunities—our world faces right now, we cannot know the exact shape of what lies ahead. Penn’s enduring investment in broad and deep faculty expertise is the surest way to meet whatever may come.
Not often in life do we get to have the final word on a subject, and surely the definitive analysis of what went wrong—and what we got right—with COVID-19 will not be written for some years yet. By framing a pandemic ethics in the first six months of the most devastating pandemic in over a century, Jonathan and I occupy a space dissimilar to that of Shilts, who analyzed the national response to AIDS several years into that epidemic. But with many public health opportunities already missed, policies mangled, and lives lost with many more at risk, we do not have years to do this work. We bring our best ideas and expertise to bear now in the hopes that together we can help map a better path forward for all people.
That same ethos is what drives everything Penn has done and will continue doing far in the future. Since science coupled with solidarity is one powerful prescription for what ails us, so much of the medicine our world desperately needs can be found at Penn.
Portions of this column are adapted from a new afterword on pandemic ethics, featured in the forthcoming paperback edition of Amy Gutmann’s and Jonathan Moreno’s book, Everybody Wants to Go to Heaven but Nobody Wants to Die: Bioethics and the Transformation of Health Care in America, out this fall.