Combating infectious diseases is not a matter for governments and health authorities alone, but for society as a whole. The success of vaccinations is closely linked to vaccination coverage. Only when it is sufficiently high, above 95%, will young children who have not yet been vaccinated be protected. It is not for nothing that the Dutch Government has been very concerned for years about the decline in vaccination coverage.
In the case of COVID-19, too, a joint effort and discipline is required from the population. ‘Only together will we get Corona under control', was the slogan. Young people for whom the virus is not a major threat could not go to school and to their friends in order to protect older and vulnerable people. In other words, in an individualised society in which freedom of choice is a central value, when combating infectious diseases, people are asked to do something, or leave something, that does not necessarily benefit them, but that benefits the collective.
Care about the individual
‘Solidarity is a theme that attracts a lot of attention in philosophy,' says ethicist Prof. Marcel Verweij of the Philosophy (PHI) group. ‘Solidarity is a concept that connects people', he explains. ‘Solidarity means that, as a collective, we care about the individual who is ill or vulnerable. Solidarity also means that we are prepared to share burdens, benefits and risks, in a well-considered way and in all reasonableness. Solidarity is an attitude that connects the individual and the collective, because the group has compassion for the needs and desires of individuals'.
If solidarity is relevant somewhere, it is in infectious disease control, Verweij believes. He has therefore been arguing for years - both in the public debate and in all kinds of committees (including from 2001 to 2015 as a member of the Health Council of the Netherlands' Vaccination Committee) - for the concept of solidarity to be given a central role in the fight against infectious diseases.
And with results. The concept of solidarity was a central notion in policy and communication during the COVID-19 outbreak. Again, Marcel Verweij was fully involved in the public debate and was a member of several advisory committees, among others of the Medical Ethics Committee which, in June 2020, gave advice to the government on who should be given priority when IC capacity falls short ICs are full: on the basis of which criteria choices should be made?
Verweij's view that young people should have priority over the elderly, but that lifestyle cannot be a criterion, was not well received by everyone. Some people were angry that the discussion was being held at all. However, doctors, such as Diederik Gommers, chairman of the Dutch Association for Intensive Care, argued in favour of a broader discussion about choices of this kind.
‘I understand very well that people find the discussion on this subject very uncomfortable. We in the committee would also prefer it not to be necessary. But it is important,' says Verweij. He also understands that people find it difficult to show solidarity with people who knowingly put their health at risk. ‘But to what extent can risk behaviour really be traced back to individual conscious choices? And what risk behaviour do we take into account? Smoking and drinking? But what about people who suffer from heart disease because they work too hard?’
The traditional image of the scientist who first conducts research and then generates impact on the basis of that research is in any case not applicable in our group, observes Verweij. ‘Sometimes it works the other way around. On the subject of vaccination, I started with a social contribution and policy advice. The interaction with policy then resulted in a scientific research project. And now I have just completed a chapter for a book on solidarity with a number of eminent international philosophers.’