On March 11, 2020, the World Health Organization (WHO) declared that an outbreak of the viral disease COVID-19 – first identified in December 2019 in Wuhan, China – had reached the level of a global pandemic. Citing concerns with “the alarming levels of spread and severity,” the WHO called for governments to take urgent and aggressive action to stop the spread of the virus.
International human rights law guarantees everyone the right to the highest attainable standard of health and obligates governments to take steps to prevent threats to public health and to provide medical care to those who need it. Human rights law also recognizes that in the context of serious public health threats and public emergencies threatening the life of the nation, restrictions on some rights can be justified when they have a legal basis, are strictly necessary, based on scientific evidence and neither arbitrary nor discriminatory in application, of limited duration, respectful of human dignity, subject to review, and proportionate to achieve the objective.
The scale and severity of the COVID-19 pandemic clearly rises to the level of a public health threat that could justify restrictions on certain rights, such as those that result from the imposition of quarantine or isolation limiting freedom of movement. At the same time, careful attention to human rights such as non-discrimination and human rights principles such as transparency and respect for human dignity can foster an effective response amidst the turmoil and disruption that inevitably results in times of crisis and limit the harms that can come from the imposition of overly broad measures that do not meet the above criteria.
Protect freedom of expression and ensure access to critical information
Under international human rights law, governments have an obligation to protect the right to freedom of expression, including the right to seek, receive, and impart information of all kinds, regardless of frontiers. Permissible restrictions on freedom of expression for reasons of public health, noted above, may not put in jeopardy the right itself.
Governments are responsible for providing information necessary for the protection and promotion of rights, including the right to health. The Committee on Economic, Social and Cultural Rights regards as a “core obligation” providing “education and access to information concerning the main health problems in the community, including methods of preventing and controlling them.” A rights-respecting response to COVID-19 needs to ensure that accurate and up-to-date information about the virus, access to services, service disruptions, and other aspects of the response to the outbreak is readily available and accessible to all.
In a number of countries, governments have failed to uphold the right to freedom of expression, taking actions against journalists and healthcare workers. This ultimately limited effective communication about the onset of the disease and undermined trust in government actions:
China’s government initially withheld basic information about the coronavirus from the public, underreported cases of infection, downplayed the severity of the infection, and dismissed the likelihood of transmission between humans. Authorities detained people for reporting on the epidemic on social media and internet users for “rumor-mongering,” censored online discussions of the epidemic, and curbed media reporting. In early January, Li Wenliang, a doctor at a hospital in Wuhan where infected patients were being treated, was summoned by police for “spreading rumors” after he warned of the new virus in an online chatroom. He died in early February from the virus.
In Iran, the outbreak emerged after authorities had severely damaged public trust by brutally repressing widespread anti-government protests and lying about shooting down a civilian airliner. As a result, Iranian authorities have struggled to assure the public that government decision-making around the COVID-19 outbreak has been in the public’s best interests. The unusually high rate of reported cases of government officials contracting the virus, as well as the inconsistency in figures announced by officials and domestic media sources, have heightened concerns that the data is either being deliberately underreported or poorly collected and analyzed.
In Thailand, whistleblowers in the public health sector and online journalists have faced retaliatory lawsuits and intimidation from authorities after they criticized government responses to the outbreak, raised concerns about a possible cover-up, and reported alleged corruption related to the hoarding and profiteering of surgical masks and other supplies. Some medical personnel were also threatened with disciplinary action – including termination of employment contracts and revocation of their licenses – for speaking out about the severe shortage of essential supplies in hospitals across the country.
A few countries prioritized open communication and transparent reporting on the number of cases:
Taiwan took swift steps to combat the virus, including promptly making credible information widely available to the public. Daily press briefings by health officials and public service announcements aim to counter misinformation and have helped to calm panic, restore public confidence, and encourage people’s assistance in the crisis.
Singapore’s government published and regularly updated detailed statistics on the number and rate of infections and recoveries.
South Korea’s government also published health data and health officials gave two daily briefings to establish public confidence and promote citizen vigilance.
In Italy, inconsistent messages from public officials, including for domestic political reasons, may initially have diluted the impact of public service announcements about proper hygiene and social distancing. The government has held daily news conferences to share data and implemented an aggressive public campaign about better practices to protect oneself and others from spreading the virus.
Governments should fully respect the rights to freedom of expression and access to information, and only restrict them as international standards permit.
Governments should ensure that the information they provide to the public regarding COVID-19 is accurate, timely, and consistent with human rights principles. This is important for addressing false and misleading information.
All information about COVID-19 should be accessible and available in multiple languages, including for those with low or no literacy. This should include qualified sign language interpretation for televised announcements, as Taiwan has done; websites that are accessible to people with vision, hearing, learning, and other disabilities; and telephone-based services that have text capabilities for people who are deaf or hard of hearing. Communications should utilize plain language to maximize understanding. Age appropriate information should be provided to children to help them take steps to protect themselves.
Health data is particularly sensitive, and the publication of information online can pose a significant risk to affected persons and in particular people who are already in positions of vulnerability or marginalization in society. Rights-based legal safeguards should govern the appropriate use and handling of personal health data.
Reliable and unfettered access to the internet should be maintained and steps should be taken to ensure internet access be available to people with low incomes. The US Federal Communications Commission’s “Keep Americans Connected” pledge commits participating companies not to terminate service to customers who are unable to pay their bills due to the disruptions caused by the coronavirus pandemic, to waive any late fees, and to open Wi-Fi hotspots to any American who needs them. Further steps could be taken to lift data caps, upgrade speeds, and eliminate eligibility requirements for any low-income targeted plans during the pandemic.
Ensure quarantines, lockdowns, and travel bans comply with rights norms
International human rights law, notably the International Covenant on Civil and Political Rights (ICCPR), requires that restrictions on rights for reasons of public health or national emergency be lawful, necessary, and proportionate. Restrictions such as mandatory quarantine or isolation of symptomatic people must, at a minimum, be carried out in accordance with the law. They must be strictly necessary to achieve a legitimate objective, based on scientific evidence, proportionate to achieve that objective, neither arbitrary nor discriminatory in application, of limited duration, respectful of human dignity, and subject to review.
Broad quarantines and lockdowns of indeterminate length rarely meet these criteria and are often imposed precipitously, without ensuring the protection of those under quarantine – especially at-risk populations. Because such quarantines and lockdowns are difficult to impose and enforce uniformly, they are often arbitrary or discriminatory in application.
Freedom of movement under international human rights law protects, in principle, the right of everyone to leave any country, to enter their own country of nationality, and the right of everyone lawfully in a country to move freely in the whole territory of the country. Restrictions on these rights can only be imposed when lawful, for a legitimate purpose, and when the restrictions are proportionate, including in considering their impact. Travel bans and restrictions on freedom of movement may not be discriminatory nor have the effect of denying people the right to seek asylum or of violating the absolute ban on being returned to where they face persecution or torture.
Governments have broad authority under international law to ban visitors and migrants from other countries. However, domestic and international travel bans historically have often had limited effectiveness in preventing transmission, and may in fact accelerate disease spread if people flee from quarantine zones prior to their imposition.
In China, the government imposed an overly broad quarantine with little respect for rights:
In mid-January, authorities in China quarantined close to 60 million people in two days in an effort to limit transmission from the city of Wuhan in Hubei province, where the virus was first reported, even though by the time the quarantine started, 5 million of Wuhan’s 11 million residents had left the city. Many residents in cities under quarantine expressed difficulties obtaining medical care and other life necessities, and chilling stories have emerged of deaths and illnesses: A boy with cerebral palsy died because no one took care of him after his father was taken to be quarantined. A woman with leukemia died after being turned away by several hospitals because of concerns about cross-infection. A mother desperately pleaded to the police to let her daughter with leukemia through a checkpoint at a bridge to get chemotherapy. A man with kidney disease jumped to his death from his apartment balcony after he couldn’t get access to health facilities for dialysis. Authorities have also reportedly used various intrusive containment measures: barricading shut the doors of suspected infected families with metal poles, arresting people for refusing to wear masks, and flying drones with loudspeakers to scold people who went outside without masks. The authorities did little to combat discrimination against people from Wuhan or Hubei province who traveled elsewhere in China.
In Italy the government has imposed a lockdown but with greater protections for individual rights. The Italian government adopted progressively restrictive measures since the first major outbreak of COVID-19 cases in the country in late February. Authorities initially placed ten towns in Lombardy and one in Veneto under strict quarantine, prohibiting residents from leaving the areas. At the same time, they closed schools in affected regions. Citing a surge in cases and an increasingly unsustainable burden on the public healthcare system, the government on March 8 imposed a slew of new measures on much of the country’s north that put in place much more severe restrictions on movement and basic freedoms. The next day, the measures were applied across the country. Further measures imposed included restrictions on travel except for essential work or health reasons (upon self-certification), closure of all cultural centers (cinemas, museums), and cancellation of sports events and public gatherings. On March 11 the government closed all bars, restaurants, and stores except food markets and pharmacies (and a few other exceptions) across the country. People who disobey the travel restrictions without a valid reason can be fined up to 206 euros and face a three-month prison term. All schools and universities were closed throughout the country. People have been allowed out to shop for essential items, exercise, work (if unable to perform work from home), and for health reasons (including care for a sick relative).
Other governments, such as those in South Korea, Hong Kong, Taiwan, and Singapore have responded to the outbreak without enacting sweeping restrictions on personal liberty, but have reduced the number of travelers from other countries with significant outbreaks. In South Korea, the government adopted proactive and ramped-up testing for COVID-19. It focused on identifying infection hotspots, conducting a large number of tests on at-risk people without charge, disinfecting streets in areas with high numbers of infections, setting up drive-through testing centers, and promoting social distancing. In Hong Kong, there have been concerted efforts to promote social distancing, handwashing, and mask-wearing. Taiwan proactively identified patients who sought health care for symptoms of respiratory illness and had some tested for COVID-19. It also set up a system that alerts the authorities based on travel history and symptoms during clinical visits to aid in case identification and monitoring. Singapore adopted a contact-tracing program for those confirmed to have the virus, among other measures. However, the government’s decision to deport four foreign workers for violating a mandatory 14-day leave of absence from work and ban them from working in the country raises concern of disproportionate penalties.
Governments should avoid sweeping and overly broad restrictions on movement and personal liberty, and only move towards mandatory restrictions when scientifically warranted and necessary and when mechanisms for support of those affected can be ensured. A letter from more than 800 public health and legal experts in the US stated, “Voluntary self-isolation measures [combined with education, widespread screening, and universal access to treatment] are more likely to induce cooperation and protect public trust than coercive measures and are more likely to prevent attempts to avoid contact with the healthcare system.”
When quarantines or lockdowns are imposed, governments are obligated to ensure access to food, water, health care, and care-giving support. Many older people and people with disabilities rely on uninterrupted home and community services and support. Ensuring continuity of these services and operations means that public agencies, community organizations, health care providers, and other essential service providers are able to continue performing essential functions to meet the needs of older people and people with disabilities. Government strategies should minimize disruption in services and develop contingent sources of comparable services. Disruption of community-based services can result in the institutionalization of persons with disabilities and older people, which can lead to negative health outcomes, including death.