A public health ethics perspective on age-based COVID-19 preventive measures in Southern Switzerland: the epidemiologic subject and vulnerability

Camporesi, Silvia and Corna, Laurie and Maciariello, David and Cavalli, Stefano (2022) A public health ethics perspective on age-based COVID-19 preventive measures in Southern Switzerland: the epidemiologic subject and vulnerability. In: 19° Biennial European Society for Health and Medical Sociology Conference, 25.08.2022, Forlì, Italia. (Unpublished)

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Abstract

Early in the pandemic, age was identified as an important risk factor for health complications and mortality in individuals infected with SARS-CoV-2. In Switzerland, federal authorities quickly implemented public health measures to contain the spread of the virus, while allowing individual cantons to implement even stricter policies. In southern Switzerland, which borders the hard-hit Lombardy region of Italy, the Canton Ticino legislated additional measures during the first lockdown which targeted those 65 or older (e.g., a ban on grocery shopping). Such measures were not unique to Ticino, with some US grocery stores implementing less severe, but still restrictive, shopping hours for older adults. Protective measures targeting older populations ignited fierce debate which is ongoing, and which has public health repercussions beyond the SARS-CoV-2 pandemic. On the one hand, some have decried targeted measures as ageist, unfair and dismissive of the enormous heterogeneity among those 65 and older. Others defended their implementation, citing the early epidemiological evidence on the virus and the necessity to swiftly protect those deemed vulnerable, the health care system in general. These opposing positions are exemplified by the John Snow and Great Barrington memoranda, position papers signed by scientific leaders based on the same evidence, but with opposing conclusions regarding broad vs targeted measures. In the context of this debate, we reflect on the measures targeting older adults from a public health ethics perspective and recommend a problematisation of the concept of ‘vulnerability’. We argue that, in part, there is a tension in reconciling early epidemiological evidence (the ‘epidemiologic subject’) and understandings of vulnerability, itself a complex and layered concept that some argue should not be applied to groups, but only to individuals. More broadly, we reflect on the conceptualisation of, and value accorded to, older adults in times of public health crises, but also beyond.

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