An Ethical Comparison of the COVID-19 National Disease Control Performance of China, Canada and the U.S. in the First Year of the Pandemic

Abstract

Objective: First year government pandemic control performance is compared in China, Canada and the USA to understand the ethical bases of different population outcomes achieved. Methods: Comparative analysis of ethical underpinnings and implications of pandemic performance includes degree of authoritarian power deployed to mitigate disease spread; benefits of single payer health care; impact of socioeconomic, racial/ethnic and health care inequities; anti-government sentiment/distrust; national leadership engagement; and science denial. Results: National COVID-19 response efforts vary according to the extent to which they leveraged autocratic tactics, from China whose highly autocratic first year pandemic performance was emulated, through liberal democracies like Canada where ethical compromises were largely avoided, to the USA where federal government abandonment of public health ethics produced one of the deadliest pandemic first year performances. Conclusions: Examining the ethics of pandemic disease control practices can lessen risk of repeated pandemic performance failures, and associated avoidable morbidity/mortality in future pandemics.