1. Clinical, cost and inequity toll of COVID-19

The COVID-19 pandemic caused by SARS-CoV2 alarmingly spread to over 77.2 million people globally and claimed the lives of nearly 1.7 million people by December 21, 2020 ⁽¹⁾, while costing $28 trillion globally in lost output over the subsequent 5 years ⁽²⁾. COVID transmission has continued to surge despite even extreme measures in the first pandemic months including lockdowns affecting up to 90% of the global population, which the United Nations (UN) World Economic Situation and Prospects mid-2020 report highlighted as primarily driving the initial year $8.5 trillion cost and 10 year extreme poverty growth by 164.3 million people or double the current COVID case totals ⁽³, ⁴⁾.

The pandemic’s growing socioeconomic and racial disparities are increasingly clear. The World Bank has identified COVID-19 restrictions as a major contributor in the current inflicting disproportionate clinical and financial harm on the principally non-White low and middle income nations ⁽⁵⁾. Even in high income nations like the United States (US), COVID-19 restrictions and related lockdowns may cause significantly greater morbidity and mortality on racial minorities including Black and Hispanic versus White populations amid societal structural inequities ⁽⁶⁾. Such disparities include only 37% of US jobs are able to be done completely online and usually are higher-paying positions ⁽⁷⁾ filled by White workers, leaving non-White workers amid lockdowns to face greater likelihoods of losing jobs, health insurance, housing and food security, and their social networks ⁽⁸⁾.

Though COVID survival rates may exceed 99.7% (based on global median corrected COVID-19 infection fatality rate based detailed by the World Health Organization Bulletin) ⁽⁹⁾, the current lack of effective therapeutic-based pharmaceutical interventions for hospitalized COVID-19 cases as of December 2020 ⁽¹⁰⁾ (aside from the less than 3% absolute risk reduction with dexamethasone, of which lower income health systems and nations have greater difficulty in stably securing sufficient doses) ⁽¹¹⁾ places urgent importance on effective public health countermeasures -both preventive pharmaceutical and non-pharmaceutical interventions- for harm mitigation in COVID-19 and related future pandemics.

This paper briefly reviews how the limited medical and public health pandemic countermeasures may be accelerated by artificial intelligence (AI) paired with adequate ethical guidelines, effective and respectful of our pluralistic globalized world, to save lives and societal equity.

2. Limited public health countermeasures for COVID-19

Amid the early pandemic uncertainty and rising death rate, over 90 nations imposed lockdowns affecting nearly 4 billion people or half the global population by March 2020 ⁽¹²⁾.The stated hope supporting the above was that the improved technology and communication internationally could overturn the last century of broadly accepted public health principles advising against indiscriminate lockdowns which have demonstrated no historical success supporting the net benefit of such aggressive countermeasures, including the RAND study authorized by the United States Department of Health and Human Services under President Obama for the biologically related pandemic influenza ⁽¹³⁾ and for COVID-19 per the recent WHO assessment ⁽¹⁴⁾. Since the early days of the virus, there is further growing worldwide caution regarding justification for lockdowns as the most dominant non-pharmaceutical countermeasures to the point that the WHO recommended more «targeted interventions» ⁽¹⁵⁾. Recent American Medical Association and John Hopkins University-supported debates featured advocates for a global return to the historic standard of focused protections for pandemic responsiveness, which would promote respect for the autonomy of the majority of the global population to continue their lives without lockdowns (thus continuing the needed economic and resource production for the following) concurrent with particular precautions for higher risk elderly and immunocompromised populations including reduced contact, improved sanitation, and early vaccination when available ⁽¹⁶, ¹⁷⁾.

The improved technical effectiveness and authorization streamlining of the global medical community has made early vaccination more feasible as the US Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUAs) for two COVID-19 vaccines (Pfizer and Moderna) following two phase 3 multi-center randomized placebo-controlled trials together including 65,793 human subjects in the same year COVID-19 became a pandemic ⁽¹⁸, ¹⁹⁾. Both vaccines had their designs identified two months before it was even declared a pandemic, including Moderna which completed its final vaccine design two days after the virus’ sequenced genome was released online and three weeks before the first COVID lockdown in China’s Wuhan region ⁽²⁰, ²¹⁾. This process was in parallel with multiple vaccines in various stages of development, authorization, and production globally including with the United Kingdom, Russia, and China. India’s Serum Institute, which produced nearly 2 billion vaccines annually pre- COVID-19, in early 2021 began producing AstraZeneca COVID-19 immunizations for richer Western nations after it exceeded its quota for developed nations amid India’s decades-long dominance in cost and time efficient massive scale inoculation production to the point of producing already half of the world’s vaccines; this dominance was leveraged in March 2021 as the richer nations of the United States, Japan, and Australia committed nearly $200 million to boost global COVID-19 vaccines to one billion including for developing nations ⁽²²⁾. This historic level of safety, efficacy, and speed from development to production to post-authorization distribution for these vaccines according to the above studies prompt the question if more prompt roll-out of these vaccines through streamlined populationlevel studies earlier on in this and future pandemics can produce greater net benefit for patients and nations compared to lockdowns and related measures. Drawing on this growing optimism, the 2021 Summit for the Group of Seven (G7), or the planet’s largest advanced economies, signed the Carbis Bay Health Declaration which replaced lockdowns as the main pandemic countermeasure in favor of accelerated vaccine development, approval, production, and distribution. Though despite the above optimism for immunization, it should be noted that traditional global resistance and access disparities create technical and cultural challenges to widespread inoculation, fueled by both scientific and philosophical barriers ⁽²³⁾. Artificial intelligence (AI) thus has been proposed as a unique tool to slice through the above gridlock in effective and equitable COVID-19 responses locally and internationally to enhance the net benefit of these countermeasures.

3. Current and future promise of pandemic AI

AI may be uniquely suited to helping solve this global crisis and above related challenges through the science and ethics to unite diverse stakeholders and belief systems in effective and equitable shared action according to three main considerations, which are both locally personalized and culturally sensitive: a) pandemic prevention; b) countermeasure application, and c) political cooperation.

4. PSC ethical analysis of COVID-19 recovery

Since we have covered a common scientific and ethical methodology, let us now analyze COVID-19 countermeasures to facilitate as effective and equitable recovery as possible. Considering the above PSC principles supported by broad support from the world’s diverse belief systems, we can argue for the real and foundational need to respect personal and population dignity and pluralism and thus the resultant human rights proportional to their needs in solidarity with the global human family. Scientifically, there is robust evidence supporting the unique cost and time efficient role AI can play accelerating the research to practice pipeline identifying, testing, and applying effective and safe public health and medical countermeasures for COVID-19 (and by extension, future pandemics). There is growing evidence further for the superior role AI may play doing so relative to more traditional analytic methods. Thus, states and health systems’ optimal ethical response to COVID-19 is to where possible apply AI to the following countermeasures:

Such de-identified data infrastructure of note should include not just medical and public health outcomes (such as infected cases, mortality, and medical and hospital costs), but also economic data including production, supply-chain, and distribution barriers which can not only be harmed by a patchwork of conflicting COVID-19 health policies at the regional, state, and international level but also can in turn harm COVID-19 countermeasures (i.e., the economic productivity to afford the above and the global distribution of vaccines to poorer nations due to conflicting quarantine and vaccine policies imposed on factories, seafarers, port workers, and ground transportation workers).

Scientifically in the above cases, these research and operational developments can produce accelerated but still trusted results. Ethically, they respect human dignity and thus each person’s rights of «life, liberty ad security of person» (UDHR, Article 3), to «share in scientific advancement and its benefits» (Article 27), and have «equal access» to these advancements as a «public service» (Article 21), being good ethics and thus true justice requires the above since «all human beings are born free and equal in dignity and rights» (Article 1) (28).

5. Conclusion

COVID-19 not only revealed the devastating destruction of a deadly global pandemic in both clinical and financial terms, but also the structural inequities that accelerate the above that disproportionately leaves the world’s most vulnerable peoples to shoulder their greater share of its burden. Yet COVID-19 also manifest a historic opportunity for the global human family to unite science and ethics through the emerging tools of AI and such global ethics as the PSC to recognize our common humanity and capacity to deploy such sophisticated tools humanely for the benefit of each person. The AI already has demonstrated its novel utility being able to predict and model (thus suggesting it can even help prevent) pandemics through better inter-nation and inter-community communication and coordination, while developing faster, cheaper, and more efficacious medical and public health countermeasures to respond with its inevitable consequences.

Yet like any technology, AI can be a weapon or a tool. It can amplify the best in humanity, or the worst. Its very development and deployment require coordination among diverse stakeholders and communities, thus lending itself naturally to what the PSC can articulate and defend as a naturally knowable and shared understanding of what makes an AI application just and ethical. And this ethics system can unify the world’s richly different belief systems to inform, nourish, correct, and optimize such a technical roll out to help ensure it is effective and equitable. Such an ethical system already is operating in the world’s political systems through the UN, international law, and states’ varied legal systems as reflective of their underlying cultures and ethics (which can still find converging consensus which the PSC can uniquely identify, strengthen, and clarify in its concrete application and technical details).

Yet this review begs the question of how can the above actually happen? How do we go from theory to practice? From academics and government papers to real progress? Additional collaboration of diverse disciplines, stakeholders, and belief systems is required to advance this topic, which is evidently manifest in COVID-19 but is not restricted to it, as additional global and local challenges inevitably will continue coming. Yet when we actively rather than reactively engage seriously with AI and global ethics, is it possible for us to together glimpse a future more humane? A future we face through the unique individuality of each person, united in a global family that leaves no one orphan.