Issues and Insights on COVID-19

“During the COVID-19 pandemic, we recognize the need for knowledge to shape behavior, evidence to influence policies, and frameworks to guide decision making. My colleagues at Penn and I offer our insights and experience to help you navigate these times from an informed perspective.”
~ Ezekiel J. Emanuel, MD, PhD

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Ethics, Policy, and COVID-19 is a special production from the faculty and online education team of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. 

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Current Content

Vaccine Incentives

Perspective: Incentives for Immunity — Strategies for Increasing Covid-19 Vaccine Uptake” by Kevin G. Volpp, MD, PhD, and Carolyn C. Cannuscio, ScD, New England Journal of Medicine.

Published May 26, 2021

Creative incentives, such as lotteries for cash, aim to drive vaccine uptake. However, the sustainability of incentives should be taken into account. Kevin Volpp and his co-author offer behaviorally informed strategies designed to protect health and economic health.

Opinion: Is It OK to Offer a Shot at Lottery Money to Get People Vaccinated? As Bioethicists We Say Yes” by Emily A. Largent, JD, PhD, RN, and Holly Fernandez Lynch, JD, MBe, Philadelphia Inquirer.

Published May 24, 2021

Bioethicists Emily Largent and Holly Fernandez Lynch evaluate the ethics of offering vaccine payments and other incentives for Americans as the pace of COVID-19 vaccination slows.

Related Materials

Perspective: A Hundred Bucks or a Chance at $1 Million: What’s the Better Vaccine Incentive?” by Kevin Volpp, MD, PhD, Washington Post. May 17, 2021.

Perspective: Yes, It’s Legal for Businesses and Schools to Require You to Get a Coronavirus Vaccine” by Holly Fernandez Lynch, JD, MBe, Washington Post. May 4, 2021.

States Are One-Upping Each Other with Vaccine Rewards — But Will It Work?” by Elizabeth Yuko, Rolling Stone. May 18, 2021. Experts interviewed include Emily A. Largent, JD, PhD, RN.

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Research, Racism, and Health Inequities

Understanding and Mitigating Health Inequities — Past, Current, and Future Directions” by Risa J. Lavizzo-Mourey, MD, MBA; Richard E. Besser, MD; and David R. Williams, PhD, MPH New England Journal of Medicine. 

Published May 6, 2021

This NEJM Perspective piece recounts the history of research on health disparities in the U.S. and the role of systems of structural racism in health disparities. Emerita professor Risa Lavizzo-Mourey and co-authors call for more effective interventions to address bias and advance health equity. 

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A Mitigation Strategy for Schools

Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School” by Kevin G. Volpp, MD, PhD; Bruce H. Kraut, MD, PhD; et al. MMWR Morbidity and Mortality Weekly Report

Published March 19, 2021

Frequent testing, universal masking, technology-enhanced contact tracing, quarantine protocols, and an enforced behavioral agreement helped prevent spread of COVID-19 in a New Jersey high school. Kevin Volpp and co-authors conclude that adhering to such a strategy demonstrates the feasibility of mitigating spread in academic settings.

Related Materials

Testing, Contact Tracing and Consequences for Not Following Rules Reduced COVID-19 Spread in NJ School” by Hannah Kanik. Philly Voice. March 19, 2021.

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Vaccine Distribution: Age and Ethics

Opinion: Age-based vaccine distribution is not only unethical. It’s also bad health policy.by Emily A. Largent, JD, PhD, RN; Ezekiel J. Emanuel, MD, PhD; and Govind Persad, JD, PhD, Washington Post

Published March 9, 2021 

In this op-ed, Penn professors Emily A. Largent and Zeke Emanuel, along with Govind Persad, advocate for equitable distribution of vaccines by considering various high-risk factors—not only age—when crafting ethical policy for vaccine distribution. “Simplicity and speed are valuable,” they state, “but equity and fairness should not be abandoned in the pursuit.” 

Related Materials 

Rationing Care – A free, 2-hour continuing education course by Zeke Emanuel and MEHP Online Education.

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Disadvantage Indices and Equitable Vaccine Allocation

Disadvantaged communities have been hit disproportionately hard by COVID-19. Vaccination offers an opportunity to address both social justice and public health needs—if policies and distribution practices make equity and allocation central issues. Faculty member Harald Schmidt shares a way to move forward using disadvantage indices to address 1) how vaccines are allocated to states and 2) how vaccines are allocated to the population with states.

Harald Schmidt, PhD, an Assistant Professor of Medical Ethics and Health Policy at Penn, focuses his research on improving opportunity and reducing disadvantage for marginalized populations in health promotion and health care priority setting.

Disadvantage Indices and Equitable Vaccine Allocation

Posted February 26, 2021

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Related Material

Disadvantage Indices Can Help Achieve Equitable Vaccine Allocation” by Harald Schmidt, PhD. STAT. February 1, 2021.  

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Strategies for National COVID-19 Vaccine Promotion

Behaviorally Informed Strategies for a National COVID-19 Vaccine Promotion Program” by Kevin G. Volpp, MD, PhD; George Loewenstein, PhD; Alison M. Buttenheim, PhD, MBA, JAMA Network

Published December 14, 2020

The COVID-19 vaccine is rolling out slowly and unevenly across the US. In this viewpoint from JAMA Network, faculty member Kevin G. Volpp, MD, PhD and co-authors propose five strategies informed by behavioral science to promote COVID-19 vaccination nationwide. They share implementation considerations to help drive safe and effective uptake and acceptance.

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COVID-19: Transmissions, Risks, and Reopenings

What have we learned in the several months since COVID-19 was declared a pandemic by the WHO? Zeke Emanuel answers the following questions:

  • How does COVID-19 spread?
  • What risk factors increase exposure of COVID-19 transmission—and what activities have lower or higher risk?
  • What are superspreader events?
  • How can schools and businesses be reopened safely?

Zeke Emanuel is a highly sought-after expert in health care, advising the Obama Administration and the WHO. He is a global voice of knowledge and reason during the pandemic—and a visionary in online education for health care professionals.

COVID-19: Transmissions, Risks, and Reopenings

Posted October 30, 2020

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Related Material

COVID-19 Risk Index (graphic mentioned in the video)

K-12 Relative Risk Index

School Opening and COVID-19: Medical, Educational, and Policy Considerations (panel discussion moderated by Holly Fernandez Lynch, JD, MBe, recorded December 18, 2020)

CDC “Choosing Safer Activities” Infographic, May 2021 

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COVID-19 Vaccine Emergency Use Authorization

The Pfizer-BioNTech Vaccine Emergency Use Authorization: Five takeaways” by Katherine Unger Baillie, Penn Today

Published December 11, 2020

The COVID-19 vaccine by Pfizer-BioNTech was the first to receive approval by the FDA for distribution in the U.S. In this article from Penn Today, Medical Ethics faculty member Holly Fernandez Lynch, JD, MBe, answers questions about the emergency use authorization (EUA) process and its impact.

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Leadership in a Time of Uncertainty and Change

Starting with the evidence-based statement that during times of uncertainty and change, leaders’ decisions have greater impact, Mike Useem offers expert guidance for leaders today. Topics include: 

  • Personal leadership strategies for making effective decisions
  • How organizational architecture and culture drive strategy
  • Creating a mission-driven plan 
  • The qualities of a complete leader

Michael Useem, PhD, is a Professor of Management and Faculty Director of the Leadership Center and McNulty Leadership Program at the Wharton School. 

Atul Kalanuria, MD, FACP, MHCI, is a neurointensivist at the University of Pennsylvania and an alumnus of the Master of Health Care Innovation at Penn.

Leadership in a Time of Uncertainty and Change

Posted November 10, 2020

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Related Material

It’s Your Leadership Momentfrom Knowledge@Wharton by Michael Useem, PhD, published March 30.

In this opinion piece published by Knowledge@Wharton, Michael Useem, PhD, addresses:

  • the potential for leadership at all levels 
  • the three most essential leadership actions, with recent examples from various industries and government 
  • a personal checklist for exercising your own leadership.
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Other Relevant Resources

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