Intended for healthcare professionals


Covid-19: control measures must be equitable and inclusive

BMJ 2020; 368 doi: (Published 20 March 2020) Cite this as: BMJ 2020;368:m1141

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  1. Zackary D Berger, associate professor1,
  2. Nicholas G Evans, assistant professor2,
  3. Alexandra L Phelan, adjunct professor3,
  4. Ross D Silverman, professor4
  1. 1Johns Hopkins School of Medicine and Johns Hopkins Berman Institute of Bioethics, Baltimore, USA
  2. 2University of Massachusetts Lowell, USA
  3. 3Georgetown University, Washington, DC, USA
  4. 4Richard M Fairbanks School of Public Health and Robert H McKinney School of Law, Indiana University, Indianapolis, USA
  5. Correspondence to: Z Berger

Failure to respect the needs of vulnerable groups will seriously undermine response efforts

The global spread of covid-19 has generated aggressive medical and public health responses, including testing, screening, contact tracing, social distancing, travel restrictions, and orders to stay at home when sick or exposed.1 Yet many members of society have reason to distrust public health systems. Containment, mitigation, and suppression plans must be as inclusive as possible or risk undermining response efforts. A commitment to inclusion means responding to covid-19 in a way that is sensitive to our most vulnerable communities, including homeless people, those without adequate insurance or employment, communities of colour, indigenous communities, immigrant communities, people with disabilities, and certain frontline healthcare workers and emergency responders.

Trust begins with communication, and communicating information during outbreaks is challenging, especially as our knowledge of a disease evolves.2 Inclusive messaging should be tailored and available in a variety of languages, including sign languages. Honest, transparent communication is vital; confusing or contradictory health messaging engenders mistrust and leads people to seek information from unreliable alternative sources. Underserved communities are rightly distrustful …

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