Costly Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in Korea

Lee, Sang-il

What are the ethical and legal issues related to various public health measures used for controlling the MERS outbreak such as surveillance, contact tracing, isolation, and quarantine? Gostin et al. [9] argued that it becomes essential to develop a set of legal and ethical recommendations, especially when scientific evidence is not enough and public health action is urgently required as in the case of severe acute respiratory syn-drome (SARS). During the MERS outbreak in Korea, difficult choices between public health needs and the protection of individual rights, which include privacy, liberty, and freedom of movement, had to be made. Gostin et al. [9] proposed four ethical values: the precautionary principle, the least restrictive option, fairness, and transparency in decision making. It is unclear that these values were fully considered in the public health actions that were taken during the MERS outbreak in Korea. The Korean government strictly restricted the movement of 16 752 individuals who satisfied the operational definition of "close contacts with a MERS patient" within designated hospitals or their homes for the maximum incubation period regardless of whether they displayed MERS symptoms [1] . According to the WHO, there is no evidence that MERS can be transmitted before symptom development or in early symptomatic stages. Therefore the WHO does not recommend quarantine nor isolation of asymptomatic contacts during this period [10] . The urgent social demand for controlling the MERS outbreak overwhelmed the issue of legitimacy of the public health interventions taken by the government. Economic issues have also been raised regarding this restriction of movement. In this situation, the people who undertake the costs incurred by movement restriction are not the same people who benefit. In principle, if those who benefited were to compensate those who were made worse off, the outcome could have been considered an improvement (known as a "Kaldor-Hicks improvement") [11] . For effective and fair implementation of public health measures against MERS or other transmissible infectious diseases that compromise individual rights, a reasonable compensation scheme for the victims, including for health care providers, should be designed to benefit those individuals and society overall.