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The Lancet

Human rights scrutiny in the COVID-19 pandemic has largely focused on limitations of individual freedoms to protect public health, yet it is essential to look at the broader relevance of realising human rights to promote public health in the COVID-19 response. The human right to the enjoyment of the highest attainable standard of physical and mental health provides binding normative guidance for health-care systems, broader social responses, and global solidarity. As recognised in the International Covenant on Economic, Social and Cultural Rights, the right to health requires that states take steps for the "prevention, treatment and control of epidemic, endemic, occupational and other diseases" and to assure "medical service and medical attention in the event of sickness".1UN. International Covenant on Economic, Social and Cultural Rights (ICESCR), G.A. Res. 2200A (XXI), article 12 (1966).Google Scholar The right to health requires that health goods, services, and facilities are available in adequate numbers; accessible on a financial, geographical, and non-discriminatory basis; acceptable, including culturally appropriate and respectful of gender and medical ethics; and of good quality.2UN Committee on Economic, Social, and Cultural Rights. General Comment no. 14 the Right to the Highest Attainable Standard of Health (Article 12 of the International Covenant on Economic, Social, and Cultural Rights). Aug 11, 2000, E/C.12/2000/4.Google Scholar However, many states have faced difficulties in ensuring the availability and accessibility of COVID-19-related health coverage, leading to shortages in essential medical care, including diagnostic tests, ventilators, and oxygen, and in personal protective equipment for health-care workers and other front-line staff.3WHOAddressing human rights as key to the COVID-19 response. World Health Organization, Geneva2020Google Scholar In some countries, austerity measures, structural adjustment programmes, and user fees have rendered essential services inaccessible for some vulnerable populations.4Thomson M Kentikelenis A Stubbs T Structural adjustment programmes adversely affect vulnerable populations: a systematic-narrative review of their effect on child and maternal health.Public Health Rev. 2017; 38: 13Crossref PubMed Scopus (73) Google Scholar Implementation of the right to health through health systems requires that treatment is based on medical evidence; that testing and care are not withheld on the basis of disability, age, or inability to pay; and that states devote maximum resources to health care and recovery.5Gostin LO Meier BM Thomas R Magar V Ghebreyesus TA 70 years of human rights in global health: drawing on a contentious past to secure a hopeful future.Lancet. 2018; 392: 2731-2735Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar In providing this care in the context of COVID-19, these emergency responses must guard against interruptions to other essential health-care services, including sexual and reproductive health care, antiretrovirals for people living with HIV, immunisation campaigns, and community-based care and support, including mental health care.6Council of EuropeCommissioner for Human RightsLearning from the pandemic to better fulfil the right to health.https://www.coe.int/en/web/commissioner/-/learning-from-the-pandemic-to-better-fulfil-the-right-to-healthDate: April 24, 2020Date accessed: May 27, 2020Google Scholar, 7UNICEFOver 13 million children did not receive any vaccines at all even before COVID-19 disrupted global immunization.https://www.unicef.org/press-releases/over-13-million-children-did-not-receive-any-vaccines-all-even-covid-19-disruptedDate: April 24, 2020Date accessed: May 27, 2020Google Scholar, 8UNAIDSUNAIDS urges countries to stay focused on HIV prevention during the COVID-19 pandemic.https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/may/20200506_preventionDate: May 6, 2020Date accessed: May 27, 2020Google Scholar Undertaking immediate and progressive steps to prevent the rising public health threat of COVID-19, states must additionally "take measures to prevent, or at least to mitigate" the impact of the disease, drawing these measures from "the best available scientific evidence to protect public health", as reflected in the guidance from WHO.9UN Committee on Economic, Social, and Cultural Rights. Statement on the Coronavirus Disease (COVID-19) Pandemic and Economic, Social, and Cultural Rights. April 17, 2020, E/C.12/2020/1.Google Scholar Even as states limit individual freedoms to address this public health emergency—assuring that such limitations are reasonable, proportionate, non-discriminatory, and grounded in law10UN Commission on Human Rights. The Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights. Sept 28, 1984, E/CN.4/1985/4.Google Scholar—it is crucial to consider the population-level impacts of the disease and give special attention to the disproportionate risks faced by marginalised and disadvantaged populations.3WHOAddressing human rights as key to the COVID-19 response. World Health Organization, Geneva2020Google Scholar Lessons learned from the HIV response highlight the importance of engaging and prioritising—and not further marginalising—these populations in disease prevention responses.11UNAIDSRights in the time of COVID-19: lessons from HIV for an effective, community-led response.https://www.unaids.org/sites/default/files/media_asset/human-rights-and-covid-19_en.pdfDate: 2020Date accessed: May 27, 2020Google Scholar Beyond the health system, social determinants of health, including adequate housing, safe drinking water and sanitation, food, social security, and protection from violence, are central elements of the right to health and protected under international law as interconnected rights. Physical distancing measures impact these fundamental rights, with inequalities in social determinants translating into differentiated risks of infection and death.3WHOAddressing human rights as key to the COVID-19 response. World Health Organization, Geneva2020Google Scholar As seen in the HIV response, marginalised and disadvantaged populations are among those most at risk, including women, children, racial and ethnic minorities, lesbian, gay, bisexual, transgender, and queer (LGBTQ) people, refugees, migrants, displaced persons, people with disabilities, older persons, incarcerated populations, and those living in poverty, working in the informal economy, or lacking stable housing.3WHOAddressing human rights as key to the COVID-19 response. World Health Organization, Geneva2020Google Scholar In the absence of rights-based protections, government orders to "stay at home" (or other restrictions as lockdown measures are adjusted) are impoverishing vulnerable communities, keeping children from school, preventing individuals from purchasing basic necessities, closing off necessary support services, increasing gender-based violence, and widening health inequities across populations. These public health risks underscore the imperative for a coordinated human rights-based response to COVID-19 that protects health by realising rights. Human rights provide the necessary principles for effective COVID-19 responses.3WHOAddressing human rights as key to the COVID-19 response. World Health Organization, Geneva2020Google Scholar Equality and non-discrimination require disaggregated data and attention to the rights of vulnerable groups. The participation of all affected communities supports equitable responses, facilitating community-led action and targeted interventions that respect rights.12Pūras D Šimonović D Shaheed A et al.No exceptions with COVID-19: "everyone has the right to life-saving interventions" UN experts say.https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=25746&LangID=EDate: March 26, 2020Date accessed: May 26, 2020Google Scholar Participation of civil society in the COVID-19 response supports the contextualisation of responses to national and local circumstances.13Kenya Legal & Ethical Issues Network on HIV & AIDSKatiba InstituteAfrican Institute for Children Studies, et alAdvisory note on ensuring a rights-based response to curb the spread of COVID-19.https://www.kelinkenya.org/wp-content/uploads/2020/03/letter2-min-1.pdfDate: March 28, 2020Date accessed: May 26, 2020Google Scholar Further, responses must be transparent, clearly communicated, and subject to accountability, including monitoring, independent review, and appropriate remedies. Independent review allows for the assessment of responses and improvement of health systems, with courts, national human rights institutions, parliamentary procedures, and regional and international human rights bodies providing a web of accountability to assure the realisation of health throughout the pandemic response.14Meier BM Huffstetler H Bueno de Mesquita JR Monitoring and review to assess human rights implementation.in: Gostin LO Meier BM Foundations of global health and human rights. Oxford University Press, New York, NY2020: 155-176Google Scholar Aligned with the UN Secretary-General's call for global solidarity,15UN Secretary-GeneralOpening Remarks on "COVID-19 Pandemic Calls for Coordinated Action, Solidarity, and Hope". United Nations University News, New York2020Google Scholar the right to health recognises international assistance and cooperation as central to the COVID-19 response. This international obligation requires that all states in a position to assist: share research, medical equipment, supplies, and best practices; coordinate to reduce the economic and social impacts of the pandemic; limit economic sanctions, debt obligations, and intellectual property regimes that impede access to needed resources; and, in all this, focus on vulnerable and disadvantaged groups, fragile countries, and conflict and post-conflict situations.9UN Committee on Economic, Social, and Cultural Rights. Statement on the Coronavirus Disease (COVID-19) Pandemic and Economic, Social, and Cultural Rights. April 17, 2020, E/C.12/2020/1.Google Scholar However, despite repeated pleas from WHO for global solidarity in the COVID-19 response, many states have failed to provide sufficient international assistance and cooperation, threatening the health and human rights of the most marginalised populations. WHO governance provides a path for shared responsibility to realise global solidarity. With WHO holding a vital role in coordinating the international response, states must not take deliberately divisive actions that seek to undermine global health governance. State support for WHO remains essential through contributions to the WHO budget and adherence to WHO guidelines.16Global Health Law Committee of the International Law AssociationStatement of the Global Health Law Committee of the International Law Association regarding the COVID-19 pandemic.https://www.ila-hq.org/index.php/news?newsID=164Date: April 5, 2020Date accessed: May 28, 2020Google Scholar Beyond WHO, these international obligations require support for global governance through the UN's COVID-19 Global Humanitarian Response Plan17UN Office for the Coordination of Humanitarian AffairsGlobal humanitarian response plan COVID-19: United Nations coordinated appeal April–December 2020.https://www.unocha.org/sites/unocha/files/Global-Humanitarian-Response-Plan-COVID-19.pdfDate: 2020Date accessed: May 27, 2020Google Scholar and the UN Framework for the Immediate Socio-Economic Response to COVID-19;18UN Sustainable Development GroupA UN framework for the immediate socio-economic response to COVID-19.https://unsdg.un.org/resources/un-framework-immediate-socio-economic-response-covid-19Date: 2020Date accessed: May 27, 2020Google Scholar coordination in the development and, if successful, distribution of a "people's vaccine" that is accessible throughout the world;19UNAIDSUniting behind a people's vaccine against COVID-19.https://www.unaids.org/en/resources/presscentre/featurestories/2020/may/20200514_covid19-vaccine-open-letterDate: May 14, 2020Date accessed: May 26, 2020Google Scholar and engagement with the UN human rights system to facilitate accountability for human rights in global health. The COVID-19 pandemic has been exacerbated by human rights failures, yet the right to health can provide a framework for assuring that the COVID-19 response serves to realise the right to the highest attainable standard of physical and mental health for all. DP is the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. We declare no other competing interests. The views expressed herein are personal and do not necessarily reflect the views of the UN.

The right to health must guide responses to COVID-19