Abstract

The COVID-19 pandemic has been a public health emergency on a global scale, impacting all nations and peoples. As previous health emergencies demonstrated, even when the infectious agent is nonselective, people and contexts are affected differently. Frequently these differences are not due to individual characteristics but to precarious contexts that became even less safe during emergencies, and exacerbate inequalities. An unknown disease that affects the world in a rapid manner brings many challenges. These range from an initial lack of knowledge about the biological effects of the viral infection and how to treat it, to its impacts on resources and economies. Inequitable COVID-19 vaccine distribution can be understood as a categorical example of how the pandemic has had different impacts on different countries and populations, and has exacerbated vulnerabilities. The importance of a comprehensive and considered account of vulnerability in research ethics has been discussed for decades, and this chapter provides an overview of the concept of vulnerability by outlining three dimensions of vulnerability discussed in the literature: the individual, the structural and the relational. These dimensions can overlap and intersect in dynamic and relational ways, especially during public health emergencies such as the COVID-19 pandemic, highlighting the importance of paying attention to vulnerability and inclusion in research, and to the development of protections that account for vulnerabilities in research. The cases presented in this chapter provide examples of how the COVID-19 pandemic exacerbates pre-existing vulnerabilities and show why it is important to reflect on this. Specifically, they prompt consideration of ethical issues associated with excluding populations such as pregnant women and people with disabilities from research, conducting research with psychiatric patients, and conducting research in impoverished settings with heighted food insecurity during the COVID-19 pandemic.