Intended for healthcare professionals

Rapid response to:


Covid-19: control measures must be equitable and inclusive

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

Read our latest coverage of the coronavirus outbreak

Rapid Response:

Re: Covid-19: control measures must be equitable and inclusive

Dear Editor,

The Australian Association of Gerontology (AAG) strongly supports the Editorial premise that policies aimed at ending the pandemic must respect and be sensitive to members of vulnerable communities.

AAG’s purpose is to improve the experience of ageing through connecting research, policy and practice. Its principles are to be evidence informed, multi-disciplinary and holistic, independent, collaborative and fair. As Australia is in the relatively early stages of dealing with the pandemic, we are in a position to learn from other countries in later stages.

Age itself is not a risk factor for vulnerability to Covid-19. Rather, age is correlated with other underlying risk factors. Researchers are still learning about the full range of risk factors for Covid-19. A simplistic use of age to determine Covid-19 vulnerability and underpin policy and rationing choices is therefore inappropriate. Policy making and public statements must not inadvertently, or explicitly, draw from or reinforce ageist stereotypes concerning the risk factors experienced by, the needs of, or the potential of “older people”.

AAG is concerned that some of the messaging around vulnerabilities, both in Australia and internationally, suggest that all “older people” above arbitrary cut-off ages would most-likely not survive a Covid-19 infection. Public health messaging must make it clear that current evidence shows the majority of people of all ages are likely to survive a Covid-19 infection. Resources must be allocated to prioritise the research required into protective factors and strategies aimed at prevention and that promote recovery from Covid-19 for people of all ages.

An ethical framework is required in order to address the rationing of resources for the pandemic (1). This framework must explicitly state under which situations rationing would be enacted, and when it would cease. This would ensure that it is not used as a tool to motivate ongoing discriminatory health resource allocation. Like all policies in response to Covid-19, this ethical framework must respect members of vulnerable communities and not reinforce negative stereotypes and generalisations. This includes not basing any ethical framework on simplistic correlated general groupings of vulnerable people (such as by age) and instead focussing on clear ethical values (such as maximising benefits through being responsive to evidence).

The ethical framework must be transparent and communicated to all members of the community in a sensitive, respectful and appropriate format. People’s value, contribution to society, and right to be heard must be acknowledged; no matter what their age.

Simultaneously boosting primary health care, disability, aged care and social services in the face of Covid-19 will ensure that peoples’ usual health care needs are addressed. This will prevent additional harm from Covid-19 and relieve pressure on the secondary- and tertiary health care systems. For example, the primary care system can be strengthened by:
• Fast-tracking models of care such as telehealth for an expanded group of primary care providers.
• Clarifying that “usual” care is an essential service and must continue to the highest extent possible, even during periods of lock-down.

Supporting health care, disability, aged care and social service workers to be able to safely provide services during the pandemic is vitally important. They need clear advice on the use of, and access to, personal protective equipment. An ethical framework should guide the allocation of these resources to different services during shortages. Health care, disability, aged care and social service workers must be assisted to address their own needs during the pandemic (such as the recent moves to allow free city parking) and be reassured through any ethical framework that their own health is a high priority.

Messaging needs to focus on the physical, not social, isolation of vulnerable people. AAG supports community and Government initiatives to reduce social isolation during periods of physical isolation, including intergenerational efforts. However, there is a risk of increased abuse and fraudulent activity so any such efforts must maintain rigorous screening, recruitment and monitoring processes.

In summary, AAG calls on the World Health Organisation, Governments, service providers, research institutions and other entities to consider how they discuss age sensitively and respectfully when developing policy responses to Covid-19; which would be supported by adopting an ethical framework to guide resource rationing.

Professor Christine Stirling
President, Australian Association of Gerontology

1. Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., . . . Phillips, J. P. (2020). Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine. doi:10.1056/NEJMsb200511

Competing interests: No competing interests

25 March 2020
Professor Christine Stirling
Australian Association of Gerontology (AAG)