Offline: The indisputable moral value of health

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In March 2020, chief scientific advisers from 12 countries, including the US, UK and Germany, appealed to academic publishers “to voluntarily agree to make their COVID-related publications- 19 and coronavirus, and the available data supporting them”. , immediately accessible in PubMed Central and other appropriate public repositories. That same month, more than 30 publishers, including The Lancet, agree to this request. The call reflected the urgency of the pandemic and “the associated global health crisis”. We have made all of our coronavirus-related content available free of charge through a COVID-19 Resource Center. But why stop at a pandemic? Aren’t there other global health crises that would benefit from immediate access to new scientific findings? Where should the line be drawn in deciding what scientific information is available instantly and for free? And who should draw that line?

The pandemic has accelerated massive changes in scholarly publishing. Preprints of research articles related to COVID-19 are now regularly published. Overall, the preprints were a positive step forward for science. Immediate access to new, albeit non-peer-reviewed, results has been useful for policymakers, journalists, and an audience eager to devour each new discovery. Sometimes there was unscrupulous behavior. Some institutions issued press releases publicizing the preprints in a way that gave too much credence to the tentative findings. But I’m not worried about preprints or even this pandemic. My discomfort lies with the arbitrary criteria for defining a “global health crisis” and thus with the capricious justifications for denying immediate access to new research results. Isn’t AIDS an urgent global health crisis? Or one of the many non-communicable diseases ravaging socially excluded and impoverished communities? Debates over access to scientific research usually and quickly turn into disputes over the merits of open access mandates. Or the material contributions society’s publishers make to the disciplines they champion. Or the benefits that commercial publishers bring to the wider economy. Sometimes important principles are stated: publicly funded research should be accessible to the public. But none of these arguments run counter to what I believe to be the crucial distinction this pandemic has revealed – that health and health research have a particular moral importance to society, an importance that should demand tolerance zero to any barriers limiting access to health care and health information.

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Philosopher Norman Daniels made a compelling case for the particular moral importance of health in his 2008 book, just health. The “fundamental question” he posed was: “In matters of justice, what do we owe each other to promote and protect the health of a population and to help people when they are sick or disabled? Part of his response was to establish the obligations we have to promote and ensure health, obligations that do not apply to other goods. Daniels’ contention is that health is of particular moral importance because protecting health – by enabling people to function normally by meeting their health needs – protects the opportunities available to us. By opportunity, Daniels means “the range of life plans that reasonable people are likely to develop for themselves.” Poor health diminishes these equitable opportunities. Daniels based his argument on John Rawls’ Theory of Justice. Rawls asserted that there could be no justice without fair opportunities for all. Justice demands the protection of these equitable opportunities. If therefore the equity of opportunities is a crucial dimension of justice, and if these opportunities depend on health, then justice must grant a particular moral place to health. Daniels defines health needs as adequate nutrition; hygienic, safe and unpolluted living and working conditions; A healthy lifestyle; medical services; Social Protection; and “an appropriate distribution of other social determinants of health”. To these I would add reliable health information, which forms the basis of any quality health system. The post-COVID-19 challenge for science publishers is to respond to reasoned claims that health and health research are fundamental elements of a just society, that health and health research occupy positions of particular moral importance to this society and that journal publishers have a responsibility to advocate for the removal of all barriers to access to the results of scientific research. There is no logical or ethical basis for designating COVID-19 as a special case. The argument for immediate access to new health research findings is a simple matter of justice, not opportunity. It’s time publishers said it loud and clear.

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