By Mahlon Meyer
Northwest Asian Weekly
On the morning of April 22, Julia Ruan, 16, woke up with a sore throat. Her parents tested her at home and the result was negative. She went to school and a sleepover that night.
What happened next, and how the family dealt with it, was not only another lesson in the ravages that the pandemic still brings, however small, but on the other side, a lesson in perhaps what is the key to solving it.
Nancy Jecker, a professor of Bioethics at the University of Washington (UW) School of Medicine and Fulbright U.S. Scholar for South Africa, in a recently-published paper, argues that the kind of solidarity that exists in the family is a good “starting point” for the way we should think about global interdependence.
“In small solidaristic groups, like families, people’s lives are interconnected in the sense that what happens to one person profoundly impacts what happens to others. Bonds of love and caring unite members of the group, leading them to take each other’s interests into account. Yet these same interconnections do not bind strangers who have never met,” she wrote in the paper, “Global sharing of COVID-19 therapies during a ‘New Normal,’” which she co-authored with C. Atuire, published on April 25 in the journal, “Bioethics.”
Western countries, such as the United States, need to move away from an ethic in which the needs of the individual are paramount, and focus more on a group ethic, in which the welfare of every member matters.
Given that we share a biosphere in which pathogens are passed everywhere, and new variants can inflict harm on anyone, “a me-first approach” allowing other parts of the world to remain without medical treatments for COVID-19 is not only unsafe, but short-sighted.
“It fails to build the social capital needed to face down 21st century health threats,” said Jecker. “We live in a globalized world with an interconnected economy, cyber connections through the internet, and common stakes in avoiding nuclear warfare; we are more globally interconnected than ever before.”
A principle of justice follows from a recognition that all members of a group are connected, which is why Jecker and Atuire chose a family to begin their discussion, Jecker said.
During a pandemic, everyone partakes of an equality of susceptibility that forces upon them an interconnectedness.
“Such interconnectivity is apparent everywhere people meet—in schools, shops, restaurants, gyms, and workplaces, because shared spaces create pathways for disease spread and the prospect of disease and death,” they wrote. “During an infectious disease outbreak, people are more aptly thought of as ‘victims and vectors, ill because of something that came from others and could go to others.’”
In the case of Julia’s family, the crisis that emerged showed how family members went beyond their usual roles to consider the needs and wellbeing of others.
The mother, Qiong, after the crisis was over, reflected on the questions and strategies posed by Jecker’s paper and found surprising results.
After Julia had gone to the sleepover, she came home feeling worse. This time, she tested positive. Immediately, the family sprang into action.
Julia’s father, who had picked her up and been with her in the car, realized he could have been exposed, so he began to wear a mask full-time around the house.
Julia retreated to her room for a full-on quarantine.
Qiong cooked all meals and delivered them outside her bedroom door.
Each family member slept in a separate room, and none went outside.
But Qiong realized how important social contact had been for her daughter. During the first year of the pandemic, like many students, Julia had found remote learning isolating.
And when able to take part in open-air badminton games in late 2020, it made a huge difference in her mood and wellbeing.
“When school was closed, she really missed her friends,” said Qiong. “So when badminton started, even though she had played for years, she really got into it. She liked it so much that she could see her friends.”
So Qiong tried to think of ways for her daughter to get through her quarantine without feeling too isolated.
“We were all communicating with each other through FaceTime, from our separate rooms, but I worried it wasn’t enough for her,” said Qiong.
The opportunity came when Julia asked her if she could have more time on her phone connecting with her friends. Usually, the family adheres to strict schedules. If Julia gets enough sleep, Qiong will allow her one-half hour per day for gaming or socializing electronically.
But now it was different.
“She asked me if she could have an hour a day to contact her friends,” said Qiong. “I gave her two.”
This is precisely the kind of dynamic that Jecker calls for among nations. Looking out for the most vulnerable is the only way to ensure group safety.
But Jecker draws a sharp distinction between the philosophies of “bargaining to promote self-interest” that animate the West and those of cultures in the Far East and Global South that seem to prioritize the wellbeing of groups.
“In the West, you often start with the assumption that everyone is a stranger, so you want to maximize your own self-interest and protect yourself against external threats,” she said.
On the contrary, ethics that she has explored outside the West, including ubuntu ethics in sub-Saharan Africa or classical Confucianism, emphasize embeddedness in social relations.
Given the interconnectedness of 21st century globalization, there is really no other way to think about the planet, Jecker and Atuire write.
The result, they argue, is that wealthy countries, once they ensure the safety of their own most vulnerable members, must share treatments with other nations. But this should not be through acts of charity, which imply condescension to those less equal.
Rather, it should be through the principle of justice, which treats all as equal.
Qiong agrees. But she said it took her a while to fully develop her thinking on this.
“When I first met my husband, before we were married, he had gone through a lot, and he said to me, ‘We have to be selfish,’ and I remember I was shocked,” she said.
But after becoming a mother with her eldest daughter, things changed.
“It was 19 years ago, and it was very difficult to get a U.S. visa. My parents wanted to come to help but were denied. So my husband and I were on our own with the new baby. After I got home from the hospital, I tried to take care of the baby at night so my husband could sleep and he would take care of the baby during the day. Since I had to wake up at night to feed the baby anyway, I could also change diapers. But after a few days, I was in such bad shape that I could not move at all. It really scared my husband and me. That’s when I realized if I didn’t take good care of myself, I couldn’t take care of my baby,” she said.
She added, “The same ‘selfish’ logic applies to my emotional needs. When I am exhausted, depressed, and when I don’t feel loved, how can I love my children, my family, and the rest of our world? Only when I am emotionally healthy, can I regulate my emotions and behaviors and do what a mother or wife or daughter or good citizen is supposed to do.”
After finding her equilibrium, Qiong was able to devote herself to others.
At the beginning of the pandemic, as the president of an alumni association of one of China’s leading universities, that is based in Wuhan, she led a campaign that brought masks to China, and then took part in one for the Seattle region.
A coalition of multiple Chinese American groups, Chinese airlines, local delivery services, and a core group of volunteers, of which her alumni association was a part, delivered nearly 1,000,000 masks to hospitals and other health care providers in the first year of the pandemic.
Her organization raised $1.2 million for COVID-19 relief in this region.
Asked if she was influenced by Confucianism, she remarked that she didn’t know, but that it was probably “in her blood.”
“I mean what are countries made up of? They’re made up of families. And what are families made up of? They’re made up of individuals. Only after I take care of my family, can I take care of the world,” she said.
Qiong’s personal history echoes Jecker’s cry for an “all hands on deck” approach to sharing treatments.
Jecker argues that it will take virtually as many types of intra-state organizations as there are to make it possible to share medicines and distribute them.
“We need to think about global health governance beyond states,” she said. “We already have pharmaceutical companies, philanthropic foundations, civil society groups involved, healthcare institutions, local and national governments, regional groups, like the EU and the African Union, but we need to have someone in the background supporting things so they’re more coordinated together.”
Mahlon can be contacted at firstname.lastname@example.org.
This health series is made possible by funding from the Washington State Department of Health, which has no editorial input or oversight of this content.