Research Area: Global Health Ethics

Agri-food Systems Transformation: New, Ambitious Framework Proposed to Monitor Progress

Sustainable, resilient, just, and equitable food systems that support access to healthy diets for all are possible. Realizing this potential is of utmost, urgent importance if the world is to achieve the Sustainable Development Goals by 2030, the Paris Agreement, and other global goals. The UN Food Systems Summit in 2021 highlighted both the challenge and the opportunity for food systems transformation. However, at present there is no rigorous, coordinated effort to monitor all aspects of food systems and their interactions to set priorities and track progress. In a new paper, “Viewpoint: Rigorous monitoring is necessary to guide food system transformation in the countdown to the 2030 global goals,” Dr. Jessica Fanzo of the Johns Hopkins Berman Institute of Bioethics and colleagues call attention to this need for global food systems monitoring in order to inform decisions and support accountability for and good governance of the transformation process.

Under the leadership of Dr. Fanzo, Dr. Lawrence Haddad of GAIN, and Dr. Jose Rosero Moncayo of the United Nations Food and Agriculture Organization, over 50 collaborators have come together to propose a rigorous monitoring framework for food systems populated with a clear set of relevant, high quality, interpretable, and useful indicators to support evidence-based policymaking and those who hold decision-makers to account. In this initial paper, the authors have developed an overarching framework that establishes five core thematic areas in need of monitoring: (1) diets, nutrition, and health; (2) environment and climate; and (3) livelihoods, poverty, and equity; (4) governance; and (5) resilience and sustainability. Under these areas, they have established indicator domains and will go through a rigorous process over the next year to select the indicators to be monitored within each and produce a baseline assessment of global food systems.

Learn more about Professor Fanzo’s work in Food Systems Monitoring.

Perilous Medicine: The Quest to Restore Protections for Health Workers

Pervasive violence against hospitals, patients, doctors, and other health workers has become a horrifically common feature of modern war. These relentless attacks destroy lives and the capacity of health systems to tend to those in need. Inaction to stop this violence undermines long-standing values and laws designed to ensure that sick and wounded people receive care.

In his new book Leonard Rubenstein—a human rights lawyer who has investigated atrocities against health workers around the world and core faculty member at the Berman Institute of Bieoethics —offers a gripping and powerful account of the dangers health workers face during conflict and the legal, political, and moral struggle to protect them. In a dozen case studies, he shares the stories of people who have been attacked while seeking to serve patients under dire circumstances including health workers hiding from soldiers in the forests of eastern Myanmar as they seek to serve oppressed ethnic communities, surgeons in Syria operating as their hospitals are bombed, and Afghan hospital staff attacked by the Taliban as well as government and foreign forces. Rubenstein reveals how political and military leaders evade their legal obligations to protect health care in war, punish doctors and nurses for adhering to their responsibilities to provide care to all in need, and fail to hold perpetrators to account.

Bringing together extensive research, firsthand experience, and compelling personal stories, Perilous Medicine also offers a path forward, detailing the lessons the international community needs to learn to protect people already suffering in war and those on the front lines of health care in conflict-ridden places around the world.

In an interview with Global Health Now, Rubenstein explained why he wrote the book:

“I wrote it, first and foremost, for those who take enormous risks to provide care in the midst of war, so that their commitment to health can be matched by a commitment to rights to their protection. At the same time, I wanted to enhance understanding of the pervasiveness of the violence, the logics animating it, and its devastating impacts for millions of people already suffering in war. Another goal was to seek to engage the public health, nursing, and foreign policy communities—and the wider public—in stopping it.”

Read the full Q&A.
Listen to Rubenstein’s appearance on the “Public Health On Call” podcast.
Attend (via Zoom) his Oct. 11 Berman Institute Seminar Series talk, “The Paradoxical Fragility of the Norms of Protection of Health Care in War.”

Rubenstein has spent his career, spanning four decades, devoted to health and human rights. A graduate of Harvard Law School he is now Professor of the Practice at the Johns Hopkins Bloomberg School of Public Health, and Director of the Program in Human Rights, Health and Conflict at its Center for Public Health and Human Rights. At Johns Hopkins, he is also a core faculty member of the Berman Institute of Bioethics and the Center for Humanitarian Health.

Exploring the Global Systems that Shape Diets and Nutrition for Nations Around the Globe

From the impacts of quinoa’s global popularity on small-scale Andean farmers, to challenges gaining public acceptance of genetically modified rice in the Philippines, to threats to human health from deforestation and cattle production in the Amazon, ensuring optimal diets and nutrition for the global population is a grand challenge fraught with many contentious issues. Food security for all depends on functional, equitable, and sustainable food systems, highly complex networks of individuals and institutions that rely on governance and policy leadership.

In Global Food Systems, Diets, and Nutrition: Linking Science, Economics, and Policy, a new textbook published this month by Palgrave Macmillan, authors Jessica Fanzo and Claire Davis of Johns Hopkins University explain how interconnected food systems and policies affect diets and nutrition in high-, middle-, and low-income countries. In tandem with food policy, food systems determine the availability, affordability, and nutritional quality of the food supply, which influences the diets that people are willing and able to consume.

“Global food systems touch on every aspect of society in both positive and negative ways. The challenges facing food systems are critical ones that demand urgent attention. As Covid-19 and climate change are showing, our food systems are fragile and inequitable. The book tackles why that is, and what can be done about it,” said Fanzo, the Bloomberg Distinguished Professor of Global Food Policy and Ethics at Johns Hopkins. “This book is a comprehensive evaluation of how food systems and policy intersect around the world to affect diets and nutrition. By taking a global perspective on food systems and policy, it fills a gap among existing academic textbooks”

Readers will become familiar with both domestic and international food policy processes and actors and be able to critically analyze and debate how policy and science affect diet and nutrition outcomes.

Part I provides an introduction to the key concepts of food systems and food policy. Part II explores the causes and consequences of global malnutrition, assesses the current state of global dietary patterns, and analyzes how various drivers affect food systems, diets, and nutrition. Part III covers the global policy landscape and its influence on diets and nutrition, including policies affecting the food supply chain, food environments, and consumer behavior. Part IV focuses on new challenges to achieve healthy diets for nutrition, addressing the accessibility of diets, sustainable diets amidst the threat of climate change, and new technologies shaping diets and nutrition.

“Our hope is that this book will help educate the next generation of policymakers, researchers, and public health practitioners and improve their understanding of global food policy processes and actors,” said Davis, a science writer for the Global Food Ethics and Policy Program at the Berman Institute of Bioethics.

Case studies examine experiences from Brazil, South Sudan, Malawi, Ethiopia, Mexico, Chile, India, Denmark, Pacific Island countries, United States, and many other countries from around the world. Additional features include chapter introductions and illustrative figures.

“While students enrolled in public health nutrition and policy courses are our intended audience, many chapters may also interest lay readers who want a deeper dive into food systems and policy,” said Davis.

Jessica Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World. From 2017 to 2019, Jessica served as the Co-Chair of the Global Nutrition Report and the UN High Level Panel of Experts on Food Systems and Nutrition. Claire Davis is a Science Writer for the Global Food Ethics and Policy Program. Her work focuses on the relationship between food and diets, human health, and environmental sustainability.

Global Policies on COVID-19 Vaccination in Pregnancy Vary Widely by Country

Although pregnant people are at elevated risk of severe COVID-19 disease and death, countries around the world vary widely in their policies on COVID vaccination in pregnancy, with 41 countries recommending against it. Ninety-one countries have policies that allow for at least some pregnant people to receive COVID vaccines – 45 of which broadly permit or recommend vaccines in pregnancy – according to Johns Hopkins University’s COVID-19 Maternal Immunization Tracker (COMIT), a newly launched online resource providing a global snapshot of public health policies that shape access to COVID-19 vaccines for pregnant and lactating people.

“Data about COVID vaccines’ safety for pregnant people and their offspring have generally been reassuring. But countries around the world have taken a variety of positions on COVID vaccination and pregnancy — ranging from highly restrictive policies that bar access to vaccines, to permissive positions in which all pregnant or lactating people can receive vaccine and, in some cases, are recommended and encouraged to do so,” said Ruth Karron, Director of the Center for Immunization Research at the Johns Hopkins Bloomberg School of Public Health and a professor in the School’s Department of International Health.

COMIT is the first resource that provides a global snapshot of public health policies that influence access to COVID-19 vaccines for pregnant and lactating people, enabling users to explore policy positions by country and by vaccine product. Through maps, tables, and country profiles, COMIT provides regularly updated information on country policies as they respond to the dynamic state of the pandemic and emerging evidence.

“This is an extremely valuable resource for anyone concerned with the health of pregnant women and their offspring anywhere in the world. By compiling and updating countries’ policy positions regarding COVID-19 vaccination for pregnant and lactating people, COMIT makes it possible to track at a glance the ongoing global changes in this rapidly changing sphere,” said Alejandro Cravioto, Chair of SAGE, the international panel of experts making COVID-19 vaccine recommendations to the World Health Organization.

In the past month alone, seven countries have joined the ranks of those with policies recommending COVID-19 vaccination for pregnant and lactating people.

“The variability in policy positions is in part a consequence of the absence of evidence on vaccines in pregnancy, because pregnant and lactating people are excluded from the vast majority of clinical trials. As a result, public health authorities and recommending bodies are developing guidance on COVID vaccines and pregnancy with far less evidence than they have for most other populations,” said Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics.

“Our hope is that COMIT might convince policy makers worldwide to expand access to vaccination for pregnant people. We are seeing some momentum in that direction, but we need to see more.”

The COMIT team notes that varying policies regarding vaccination of pregnant people could have serious implications for gender equity in the global rollout of COVID-19 vaccines, including among the high-priority group of health workers who would otherwise be first in line to receive vaccine.

“In many countries, the health system is hugely dependent upon female health workers in their reproductive years, many of whom are pregnant or breastfeeding. If they cannot be adequately protected from serious COVID-19 disease or death, it would not only be a threat to a gender-inclusive response, but potentially set back the health system during a crucial time in the response and for years to come,” said Carleigh Krubiner, a Berman Institute faculty member and a policy fellow at the Center for Global Development.

COMIT’s interactive global map conveys at a glance whether pregnant or lactating individuals are allowed or encouraged to receive any vaccine currently authorized for use in individual countries. Other features include:

  • Tables that enable visitors to compare vaccine policies across countries, including any special requirements (e.g. a doctor’s note), with various sort and filter features to understand how individual country policy positions compare across geography and vaccine products.
  • Maps that filter by product and policy position, with an easy toggle between pregnancy and lactation to see how recommendations differ for pregnant and breastfeeding individuals
  • Individual country pages that give a detailed account of policy positions, and changes over time, and provide links to source documents.

“The COMIT website will be an invaluable source of information for policymakers around the world as the COVID-19 vaccine rollout continues,” said Chizoba Barbara Wonodi, a faculty member in the International Health department at the Bloomberg School and Nigeria Country Director at the School’s International Vaccine Access Center. “Even as the COVID vaccination rate in the United States approaches 50 percent, only about six percent of the world’s population has been fully vaccinated to date. This inequity in access needs urgent global attention.”

The COMIT policy tracker was developed by members of the Johns Hopkins Berman Institute of Bioethics and the Johns Hopkins Center for Immunization Research, with support from the Bill & Melinda Gates Foundation and Wellcome.

Prof. Fanzo Awarded $3.8 Million to Apply Human Rights-Based Approach to Food Systems

The Berman Institute of Bioethics’ Jessica Fanzo, Bloomberg Distinguished Professor of Global Food & Agricultural Policy and Ethics at Johns Hopkins University, has received a $3.8 million grant to apply a human rights-based approach to food systems. The Swiss Agency for Development and Cooperation will contribute half of the grant funding, with the remainder funded jointly by the multidisciplinary project consortium’s member organizations. The consortium includes Johns Hopkins University, CIAT on behalf of the Alliance of Bioversity International and CIAT, The International Institute of Rural Reconstruction, and Rikolto. The award supports the first phase of a ten-year project to strengthen the capacity of governments, peasants, and other people living in rural areas to adopt and incorporate human rights frameworks such as the UN Declaration on the Rights of Peasants and other People Working in Rural Areas (UNDROP) into food policy and food systems action.

The project, “People-centered Food Systems: Fostering Human Rights-based Approaches,” aims to characterize constraints globally and within countries for peasants and other rural dwellers to claim their rights to food security, adapt to and mitigate against climate change, and preserve the agrobiodiversity fundamental to their livelihoods. Led by Dr. Fanzo, the multidisciplinary project consortium includes academics, development practitioners, ethicists, and lawyers from its member organizations.

“Small-scale farmers produce more than 80% of the world’s food, but this diverse population suffers disproportionately from hunger, poverty, discrimination, violent conflict, and climate change. Human rights instruments like UNDROP represent a major step forward in protecting their human rights, but more work is needed to integrate them into food systems policy effectively,” says Dr. Fanzo.

Dr. Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World.  With twenty years of research and program experience working in the field in sub-Saharan Africa, South and East Asia, and the United States, her area of expertise focuses on the impact of transitioning food systems on healthy, environmentally sustainable and equitable diets, and more broadly on the livelihoods of people living in resource-constrained places. Faculty joining Dr. Fanzo in this work from JHU include Drs. Leonard Rubenstein, Anne Barnhill, Swetha Manohar, Rebecca McLaren, and staff Science Writer Claire Davis.

The project team seeks to use advocacy, build capacity, and develop accountability tools to better integrate human rights frameworks within food system policy and action. Initial project activities will take place in Cambodia, Ethiopia, Honduras, and Uganda with the intention of scaling up the approach to other countries in later phases and producing global guidance on this issue.

Other members of the project consortium include CIAT on behalf of the Alliance of Bioversity International and CIAT, The International Institute of Rural Reconstruction, and Rikolto.  CIAT on behalf of the Alliance of Bioversity International and CIAT is an international research for development organization that is part of the Consultative Group on International Agricultural Research, the largest international network on agricultural public research to service the global South. The International Institute of Rural Reconstruction is an international not-for-profit organization aimed at enabling communities, and those who work with them, to develop innovative yet practical solutions to poverty through a community-led development approach, and to share widely these lessons to encourage replication. Rikolto is an experienced market system & inclusive business facilitator, using innovative approaches in co-creation with a sector-wide range of partners to find more sustainable ways of accessing, distributing, and producing nutritious food, so no one is left behind.

Nataly Pinto, Director of Sustainable Food Systems at Rikolto, says, “Rikolto charts a clear and unifying path toward sustainable food systems by focusing on interventions like these to reshape the roles of multiple food system actors from the global to the local level. We are excited to be part of this joint effort together with JHU, CIAT on behalf of the Alliance of Bioversity International and CIAT, and the International Institute of Rural Reconstruction, supported by the Swiss Agency for Development and Cooperation to enable a human rights-based approach to food systems. Access to sufficient and healthy food is a right…not a privilege.”

Bug Appetit: Why Eating Cicadas is Good for the Environment

Trillions of cicadas are poised to get their buzz on across much of the United States, with the once-every-17-year emergence of Brood X. Hope you’re hungry!

One person’s infestation is another’s free eco-friendly lunch, according to Johns Hopkins University sustainable food expert Jessica Fanzo, author of the forthcoming Can Fixing Dinner Fix the Planet?

Fanzo, who plans to collect and eat cicadas herself as soon as they hit her own backyard, can explain how the insects have as much protein as red or other factory-farmed meat, but without the harsh environmental effects, including greenhouse gases and biodiversity loss.

She can also discuss how insects are already an established source of protein around the world, including in Mexico, where people eat crickets; in Thailand, where people enjoy water bugs; and in Africa where people regularly eat locusts and crickets.

Fanzo, Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute, who has sampled most of the insect dishes of other cultures, believes the shrimp-tasting cicadas of the United States should certainly rank among them, although the North American palate might not be ready.

“There is the yuck factor but people who are looking for alternative sources of animal protein shouldn’t rule out cicadas” she says. “They’re a great natural source of protein and other nutrients, there’s going to be a lot of it in a very short period of time so, it’s a great opportunity to give them a try.

“Once you get over the look of them, they’re quite tasty.”

In Can Fixing Dinner Fix the Planet? Fanzo explores the interactions among food systems, diets, human health, and the climate crisis. Drawing upon her decades of hands-on research projects in Africa, Asia, Europe, and the Americas, Fanzo describes how food systems must evolve to promote healthy, sustainable, and equitable diets.

Recapping the Berman Institute at ASBH 2020

ASBH Conference Logo

The Berman Institute will be well represented at the 22nd annual meeting of the American Society for Bioethics and Humanities (ASBH), with a group of faculty, fellows, and students scheduled to present online.

View the full schedule and summaries of all Berman Institute presentations.

You can also follow us on Twitter: #ASBH19, featuring our @bermaninstitute, @aregenberg, @kahnethx, @tnrethx, @DiStefano_MJ, and more.

Special Events

Portrait Photo of Henrietta Lacks

Plenary: Social Justice and Bioethics through the Lens of the Story of Henrietta Lacks
October 15, 2020
1:15-2:30 p.m.

Join Jeff Kahn, Ruth Faden, Jeri Lacks (granddaughter of Henrietta Lacks), and Patricia King for a panel discussion examining social justice and bioethics through the lens of issues and challenges raised by the story of Henrietta Lacks and the HeLa cell line derived from her cells.

Zoom performance of Antigone in Ferguson

Antigone in Ferguson: Free Online Zoom Performance
October 17, 2020
6- 8:30 p.m.

A groundbreaking project that fuses dramatic readings by acclaimed actors of Sophocles’ Antigone with live choral music culminating in a powerful, healing discussion that will foreground the perspectives of people in Baltimore whose lives have been impacted by racialized police violence and health inequity

Overview: Ethical Concerns in Responding to Coronavirus

For comprehensive Covid-19 Ethics and Policy Resources, visit our dedicated webpage, bioethics.jhu.edu/coronavirus.

The ongoing coronavirus outbreak vividly demonstrates the important role of bioethicists in leading the charge for equitable and effective public health policies.

“Through years of experience and scholarship, and tested through multiple threatened and actual epidemics, there now exists a rough consensus about the ethical principles that should guide responses to this latest threat,” said Jeffrey Kahn, Andreas C. Dracopoulos Director of the Berman Institute of Bioethics. “Bioethicists from the Berman Institute have been leaders in shaping this framework.”

The Berman Institute is working to disseminate these ideas through social media, appearances in traditional news media, and through other means, as widely as possible on an ever-expanding range of issues, including:

Human Research
“For reasons of safety, efficacy, and ethics, it’s usually better to test vaccines on animals before humans. You have to have good reason to say, ‘We need to go straight to humans or go to humans at this particular point.'”

“Kahn worries about people signing up to be in the trial because they think the vaccine could give them immunity before it becomes available to everyone else. In reality, this kind of early trial is just to make sure that the vaccine is not toxic and does indeed provoke some kind of immune response in people. Participants are very unlikely to be fully immunized to the virus over the course of their participation.”

Travel Restrictions
“A critical principle in outbreak response is that governments should implement the least restrictive measure that can still achieve the public health objective. The goal is to balance the freedom of individuals against the restrictions on freedom required to achieve legitimate protections of the public’s health, with public and transparent justification of policy decisions. Quarantine is considered a measure of last resort given the severe restrictions it imposes on individual liberty.”

Inequitable Impact of School Closings
“As in all public health emergencies, poor children and poor families will suffer the most. An ethically defensible policy of school closures needs not only to meet the bar of public health necessity. Government agencies and community organizations in education, nutrition assistance and housing, as well as public health, must also be planning to take active measures to mitigate the disproportionate burden that will fall on our most vulnerable children.”

Dr. Faden’s prescient Education Week piece helped prompt discussion among K-12 educators nationwide. Officials in numerous states have sought USDA waivers that will enable them to continue providing free meals during school closures.

Allocation of Scarce Resources
“It is appropriate and accurate to reassure the public that most people who contract Covid-19 will recover fully on their own. At the same time, the public needs to be prepared for the possibility of more dire scenarios. Participants in our study were adamant that politicians, and health officials, be transparent and honest about the prospect of and plans for the rationing of ventilators and other equipment. In health emergencies, experts often ask the public to heed the advice of public health professionals; in the case of planning for situations involving scarcity, it is equally important that the experts heed the advice of the public.”

Inequitable Impact of Social Distancing
“The implications of some of these public health measures are so wildly different for people who are differently situated in the United States that the social distancing [decision] is not our only decision. It’s our first one, and then there’s a very different set of ethical dominos that follow from that.”

Kass listed a number of ethical considerations she’s concerned about, like making sure there’s adequate income replacement for workers unable to earn a living, making sure grocery stores stay open and accessible, and even making sure people have access to the creature comforts that make social distancing bearable.

Inequity of Work Requirements During Pandemic
“Income replacement for people whose employment has been curtailed by the government isn’t just an economic issue, it’s an ethical one. Likewise, we need to consider what to do for workers in jobs where sufficient protection from infection cannot be provided. While we have expectations of certain healthcare professionals, like doctors and nurses, who have taken oaths to continue working even when it puts them at personal risk, the same isn’t true for hospital support staff or grocery store checkers. We can’t simply expect those workers to continue facing risks that others can avoid.”

Equity in Vaccine Development
“Historically, the interests of pregnant women have not been adequately included in global responses to outbreaks and epidemics. As the world rushes to develop new vaccines against Covid-19, we must ensure that, this time, pregnant women and their babies will not be left behind. Developing a coronavirus vaccine that they are unable to use would be not only a tragedy but a grave injustice.

The article was included as required reading for the 38th Annual Congressional Leadership Conference of the American College of Obstetricians and Gynecologists, as physicians came to Washington from across the country to meet legislators and help shape public policy. Faden and Krubiner’s co-author of the STAT and Boston Globe article and collaborator in the PREVENT project, Ruth Karron of the Johns Hopkins Vaccine Initiative, was quoted in a March 3 New York Times article, “What Pregnant Women Should Know About Coronavirus.”

Patient Privacy and Contact Tracing
“Doctors don’t out people. Whether it’s HIV, syphilis, coronavirus or anything else, people simply won’t show up to their doctor if they feel they might be outed for a condition.”

Impact on Incarcerated Individuals
Detention and correctional spaces are the “perfect environment for the spread of COVID-19. So when we talk about social distancing, it’s almost impossible in prisons unless you have complete lockdown – basically, put everybody in solitary confinement.”

The Berman Institute continue to offer insights and expertise to aid in the response to the monumental challenges posed by the outbreak.

Related Berman Institute Resources