On a global scale, saving lives can be dazzlingly complex, involving international policy decisions to prepare for the next pandemic, manufacture drugs for neglected but serious diseases or provide healthcare to those in need. Tax structures, financing, corporate incentives - there's a lot to weigh.
But at heart is something simple, Binghamton University Philosophy Professor Nicole Hassoun finds. Empathy. We need to care about one another and let that care inform our societal decision-making.
Hassoun's latest book, A Minimally Good Life: What We Owe to Others and What We Can Justifiably Demand, centers on social safety nets and respect for our common humanity.
Its central question: How can we help others live decent lives without sacrificing our own ability to do so?
"I argue that we should put ourselves in each other's shoes. You know the saying: 'But for the grace of God go I,'" said Hassoun, a social and political philosopher and ethicist. "What if I had to live that life? What would I need to be okay as that person, with that psychology or history or circumstances?"
She spent part of this year at the Helsinki Collegium for Advanced Studies in Finland, which hosted her book launch. While in Europe, she saw firsthand the opportunities and sense of security provided in a social democracy, which transformed the way she thinks about what constitutes a good life, she said.
A life well-lived is a good-enough life, she argues in her book - and we can't get there solely on our own efforts.
American philosopher John Rawls proposed a thought experiment known as the "veil of ignorance," in which citizens make choices about the structure of society without knowing what identity or position they will have in that society. Hassoun demonstrates this principle in her classes, where students are arbitrarily assigned identities, such as an impoverished individual in Gabon, a wealthy person in New Zealand, a gay individual, a refugee, people with various health conditions and more.
And then she challenges them to think: If you don't know who you will be, what society will you create? What rules will people live by, with what protections and social safety nets? If you choose to forgo national health insurance to maximize personal income, what happens?
"Literature, the arts and humanities can give us insight into other people's perspectives and worldviews, but it's a complicated and long process for people to learn," Hassoun said. "And honestly, the people with the most empathy are those who have suffered the greatest."
To understand someone else's life, we must operate from a position of care; then, we begin to understand their needs, whether for food, shelter, education, healthcare, employment opportunities or respect. At its core, a good life requires a modicum of security: not fearing a roof collapse or whether you can afford car repairs, find a decent job or send your children to college.
Empathy builds community solidarity, in which people work together for common goals - something seen more readily in European countries with strong safety nets. She closes the book with an exploration of creative resolve: a fundamental commitment to overcoming tragedy whenever we can, in whatever way works.
She pointed to the role of women in ending civil war in Liberia: They simply refused to let the men leave negotiations until they reached a solution. To overcome problems, we need a well-informed ethical perspective that goes beyond surface appearances and a commitment to working together.
"We face a lot of challenges in our time, from climate change to pandemics to war, and yet people have done the most amazing things," she said.
Preparing for the next pandemic
As a philosopher, Hassoun considers the obligations of pharmaceutical companies and individual consumers to foster a better, more caring world. But it's more than just a theoretical call for ethical living: She takes a detailed look at the policies and concrete proposals that would put these plans into action.
In a recent article in Health, Economics, Policy and Law, Hassoun addresses mechanisms to ensure timely access to vaccines and other health technologies during pandemics, particularly for developing nations that typically lack such access. Co-authors of "Pandemic preparedness and response: A new mechanism for expanding access to essential countermeasures: include Kaushik Basu, former chief economist of the World Bank in India, and Lawrence Gostin, who runs the O'Neill Institute for National and Global Health Law at Georgetown University.
Countries are working on a pandemic preparedness agreement through the World Health Organization, although some issues - such as technology transfer and vaccine access - haven't yet been resolved. Nationalist politicians tend to resist these sorts of measures as threats to sovereignty, which can jeopardize lives by making it difficult for poorer nations to access vaccines.
"The core idea of this proposal is to tie incentives for new innovations, technologies and vaccines to the health consequences of those innovations, and then make sure we actually own that technology as an international community," Hassoun explained. "If we're going to provide money for vaccine development, then we should own that technology so that we can ensure everyone has access in a timely manner."
Currently, the international community funds organizations that pay for phase one and phase two clinical trials; after that, the technology is then handed off to pharmaceutical companies. Hassoun, on the other hand, proposes that the international organizations fund the additional phase three trials themselves, and then ensure that the open-access technology goes to manufacturers, bringing down costs.
Rich countries can pay market rates for the vaccine, while poorer countries would pay lower but reasonable prices, recouping the investment. This would also allow the future investment of resources in essential medicines, rather than focusing on non-life-threatening conditions particular to wealthier populations.
In fact, some of this is already being done. About a third of research and development is already performed by universities, some of whom will even conduct phase three trials, she pointed out. Initiatives already exist to fund drugs for neglected diseases, which promotes open-access licenses that allow these medicines to be produced at reasonable costs in countries that need them.
"Then the question is: How do we recoup those costs? How do we use them to invest in basic health systems that really matter?" she asked. "Because it's one thing to have a vaccine; it's another thing to get it in somebody's arm."
Innovative financing mechanisms exist, including taxes on financial transactions, airline travel or items deemed to have low social value, such as social media. Proceeds can support pandemic preparedness and help set up basic health systems around the globe.
Solving the supply chain problem is essential to planning for the next pandemic, which could be far worse than coronavirus, she cautioned. While the coronavirus pandemic cost 7 million lives globally, the 1918 flu caused around 50 million deaths, AIDS claimed around 25 million, and smallpox another 50 million, all when the global population was smaller.
The global community also must consider the economic consequences of pandemics; citizens of poorer countries lacked financial support during COVID, which led to severe consequences, including inflation and food insecurity. The coronavirus pandemic alone had an estimated $12.5 trillion in economic impact.
"It can mean the collapse of governments. It can mean international conflict," Hassoun said. "We need to pay attention globally to how we're addressing vulnerability not only in the health sphere, but the economic sphere."
While caring about other people is fundamentally an ethical issue, there are real-world incentives to making the world a better place: Fewer pandemics and deaths, economic prosperity and, above all, a life worth living.
"We're all vulnerable, so recognizing the ways that we stand up for each other can help us through the darkness," Hassoun said. "We need to step in and build institutions so nobody falls through the cracks."
