Enabling Ethical Analysis and Public Justification in State-Level Pandemic Responses in the United States

During the COVID-19 pandemic, state governments enacted policies that profoundly affected personal and public life. These policies involved difficult trade-offs between individual freedoms, economic interests, public health, and other values.

We sought to understand how these difficult and sometimes high-stakes policy decisions were made, by interviewing people closely involved in state-level COVID-19 responses, including governors’ chiefs of staff, communication directors, advisors to governors, state health department leadership, state epidemiologists, and health information officers, as well as people from outside of government who served on COVID-19 task forces.  We interviewed 67 people from 30 states who were involved in a state-level COVID-19 response.

This research was funded by the National Science Foundation and the Greenwall Foundation.

Papers Reporting Interview Findings

• ‘Lives versus Livelihoods’: Conflict and Coherence between Policy Objectives in the COVID-19 Pandemic (Social Science & Medicine 2024) https://doi.org/10.1016/j.socscimed.2024.117188
• ‘Staying in the Lane’ of Public Health? Boundary‐work in the Roles of State Health Officials and Experts in COVID‐19 Policymaking. (Sociology of Health & Illness, 2024). https://doi.org/10.1111/1467-9566.13751
• Views From State-Level Policy Actors About the US Federal Government COVID-19 Response (Health Security, 2023)  https://doi.org/10.1089/hs.2023.0125.
• Under-Funded and Under-Pressure: State Epidemiologists During the COVID-19 Response (Disaster Medicine and Public Health Preparedness, 2025) https://doi.org/10.1017/dmp.2025.110
• Is Liberalism a Defensible Framework for Pandemic Policymaking?  (Social Research: An International Quarterly, 2025) https://doi.org/10.1353/sor.2025.a956285
• A Qualitative Exploration of the Information Sources Used at the State Level During the COVID-19 Response in the United States (Under review)

Other Project Outputs

• The Ethics of COVID‐19 Vaccine Mandates for Healthcare Workers: Public Health and Clinical Perspectives Bioethics 37, no. 4 (May 2023): 331-42 https://doi.org/10.1111/bioe.13141
• Public Health Deference: Rethinking the Judicial Enforcement of Constitutional Rights during a Pandemic (Syracuse Law Review, 2023) https://lawreview.syr.edu/wp-content/uploads/2023/03/Hutler-Macro-Draft-FIXED46.pdf
• Ethical Tradeoffs in Public Health Emergency Crisis Communication” (The American Journal of Bioethics, 2024)  https://doi.org/10.1080/15265161.2024.2308166
• The Ambiguous Legality of Religious Worship Restrictions for Pandemic Response: What we learned from COVID-19 (under review)

Project Team

From Johns Hopkins University

From Other Institutions

• Justin Bernstein, PhD
  Vrije Universiteit Amsterdam
• Katelyn Esmonde, PhD
  Western University
• Brian Hutler, PhD, JD
  Temple University
• Jeff Jones
  Ethox Centre

Related Publications

• How Should Governments Make COVID-19 Policy? (The Philosophers’ Magazine, Dec. 25, 2021)
• Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States (Johns Hopkins Center for Health Security, August 19, 2020)
• The Complex Ethics of Reopening America (Johns Hopkins University Hub, May 26, 2020)
• Digital Contact Tracing for Pandemic Response: Ethics and Governance Guidance (JHU Press, May 5, 2020)
• When to Reopen the Nation is an Ethics Question—Not Only a Scientific One (The Hastings Center, April 28, 2020)

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