Ethics challenges in implementing the International Health Regulations in Pakistan during the COVID-19 pandemic

Background: Pakistan, with its diverse points of entry, faced several challenges with implementing the International Aim: To explore the perceptions of point of entry health workers regarding the ethics challenges in implementing the IHR during the COVID-19 pandemic. Methods: From December 2022 to March 2023, this qualitative study conducted 10 focused group discussions and key informant interviews with 40 participants from 10 points of entry in Pakistan and reviewed COVID-19 containment guidelines. The data generated were transcribed, translated into English and analysed manually. The thematic analysis focused on the core ethics principles, including optimization of population health versus autonomy, distributive justice versus equity, trustworthiness versus privacy and confidentiality, and the impact of sanctions and restrictions on vulnerable populations. Results: The study identified ethics challenges relating to containment policies, public health measures (testing, quarantine and isolation), travel restrictions, equitable resource distribution, and emergency operations. These challenges were grouped under 3 main categories, according to the IHR thematic areas: prevent, detect and respond. Respondents said it was difficult to balance between the public health measures and individual rights, address discrimination and stigmatization, and ensure fairness and justice in vaccine distribution and travel restrictions. Conclusion: Navigating ethics challenges relating to IHR implementation during health emergencies requires transparent communication, cultural sensitivity, and a commitment to equity and justice. It is important to incorporate ethics considerations into national emergency response plans to guide decision-making, safeguard individual rights and promote collective wellbeing.