
From The Lancet:
Individualistic approaches to health, exemplified by the CDC's May 2021 mask guidance, ignore the impacts on health inequities, which have been exacerbated by the pandemic and continue to hinder vaccination access
. Many are essential workers with high exposure risks and limited workplace protections, who face vaccination barriers due to a lack of sick leave and existing caretaking responsibilities. These inequities compound vulnerabilities for those at high risk for infection and severe outcomes, including older and disabled or chronically-ill adults and children, and institutionalized populations. Overlooked inequities yield disproportionate COVID-19 disease, disability, and death in oppressed and excluded communities—even where there is overall disease reduction. Yet, such groups have often been omitted from discussions of public health policy, with their lives treated as expendable.
Public health protection is inextricably linked with human rights promotion. The right to health has provided normative clarity in public health policy and legal accountability for public health outcomes, focusing on the need to prevent disease at the population level to ensure the highest attainable standard of health for all. In promoting individual rights to protect public health, the pandemic has shown the need for a response that prioritizes community trust and cooperative engagement. The CDC's decision to prioritize individual autonomy over public health ignores disease vulnerability, not only for at-risk individuals but the community.
Ongoing debates about CDC's mask guidance raise foundational questions about the meaning, purpose, and role of public health. Even as public health often seeks to project itself as “apolitical”, moral values permeate public health practice. Purportedly apolitical public health decisions, manifested in policy decisions that rationalize economic “reopening”, employ a cost-benefit analysis that prioritizes some lives over others and makes loss of life, sickness, and isolation seem acceptable, obscuring the reality that morbidity and mortality could be greatly decreased with appropriate structural mitigation.The current US approach continues to undermine the fundamental notion that all people are equal in dignity and rights. When the CDC Director speaks of a “pandemic of the unvaccinated”
, this implicitly assumes that those who become ill are responsible for their own suffering and that their deaths are acceptable—because they could have been vaccinated. These moral deficiencies reflect a larger neglect of collective responsibility, equity, and human rights in US public health policy. CDC guidance must consider the moral foundations of public health, providing a normative framework to support public health policy and practice.