The Traditional Definition of Pandemics, Its Moral Conflations, and Its Practical Implications: A Defense of Conceptual Clarity in Global Health Laws and Policies

Acknowledgements: The author is grateful to Mark Eccleston-Turner and Iain Brassington for comments on earlier drafts of the paper. Special thanks are due to Mary Clare Enright for critical feedback and proofreading, and to Tiffanie Cappello-Lee for her research assistance and many conversations on this topic.

Introduction

Some global health experts claim that conceptual definitions, such as those of pandemics, are useless for global health fieldwork. Rather than relying on set definitions—they claim—policies and laws on pandemic preparedness and response should be based on dynamic answers to the emerging global health problem under consideration.¹ For them, “fewer, not more ‘pandemic preparedness’ plans and definitions” are the solution to pandemic fieldwork problems. Yet, other global health experts claim that theoretical definitions do matter and they play a role in solving such pandemic fieldwork problems. They claim, however, that the existing and internationally accepted definition of pandemic is “straightforward and well-known,”² rather than “elusive,”³ being therefore clear enough for theoretical purposes and useful enough for fieldwork purposes.

This paper will show that the standard definition of pandemics is inadequate for both theoretical and practical purposes. More specifically, this paper will argue that the existing and internationally accepted definition of pandemic is not nuanced enough: it conflates two different realities of global health, namely global health emergencies (i.e., severe communicable diseases that spread across national borders) and nonemergencies (i.e., communicable or noncommunicable diseases that spread across national borders and that may or may not be severe). I call this the conflation problem. And the crux of the conflation problem is that the existing and internationally accepted definition of pandemics is predicated on the criterion of spread alone, rather than on the criteria of spread and severity conjointly. In disregarding this distinction between global health emergency and nonemergency, the standard definition of pandemic fails to capture significant distinctions relevant for sound decisionmaking.

Clarifying the definition of pandemics is a moral dilemma that remains hidden from pandemics discourse and unacknowledged in mainstream global health literature. This is the knowledge gap that this paper aims to tackle. This ethical challenge brought by the definitional ambiguities regarding the concept of pandemics has substantial practical implications on decisionmaking in global health fieldwork. That is to say, the moral distinction between...