Digital technology has gained momentum in the recent decade, with its relationships with digital entrepreneurship, digital economies, digital social interaction, green economies, etc. These have changed the perspective of business and hence digitalized the strategic policies through blockchains. The current study aims to identify such benefits that have changed the day-to-day life processes and procedures for carrying out different tasks due to the convenience of adopting digital technology. Those benefits have been classified as transparency, centralization, and access to new markets for the organizations considering their consequences, especially when using digital technology. When processes are taking place online, there are fair chances of hiding knowledge about certain products or procedures to gain particular benefits. Hence, this study has considered the moderating role of product knowledge hiding while interacting online. This study is a quantitative post-positivist cross-sectional study that has followed a survey technique for data collection. The population used in this study is the managerial staff of the telecom sector in the mainland in China. The sample size used in this study is 358. The software used in this study is Smart-PLS 3.3. The technique used in this study for data analysis is structural equation modeling with measurement modeling. The findings of this study show that digital technology has led to many benefits for organizations like centralization, access to the new markets, and transparency, which have been made possible remotely only because of the use of digital technology in business operations. However, the moderating role of product knowledge hiding has been found significant only for transparency. This research paper highlights the important benefits of the use of technological use in the corporate world. Also, it contributes to expanding the network of knowledge hiding, addressing the moderation of product knowledge hiding, and extending the known consequences of digital technology influencing knowledge hiding. It is feasible to use digital technology to solve the problem of non-competitiveness, which is one of the most serious issues. Global technology businesses and industrial behemoths have reached the point where they must pursue a platform strategy after a succession of pilot initiatives in the realm of digital solutions. When it comes to establishing Internet of Things platforms, it is crucial to consider the platform’s core features, such as data collecting, storage, processing, and modeling, and the business applications deployed as platform solutions to produce value.There are a variety of assistance structures in place in various nations to help industrial enterprises shift to more sustainable resources. Dematerialization is the instant positive environmental effect of digitization. Transitioning to electronic document control, digital services and products in trade, financial services, and organizational realms, and replacing physical logistics flows with remote means of communication based on digital technologies  have resulted in a decrease in time, economic, and information assets retrieved from the natural environment. Resultantly, the amount of garbage generated by businesses, organizations, and end-users lowers, reducing the anthropogenic strain on ecosystems dramatically.Increasing the market for smart gadgets and digital services leads to an increase in energy usage, greenhouse gases, and the buildup of electronic waste, which has negative environmental consequences. Price gouging and tactics to maximize monopolistic quasi-rent from pseudo-innovation, when marketing practices that encourage overconsumption for prestige motives replace real research and development, increase these negative results.With the benefits of using digital technology to reinforce the green economy, knowledge hiding behaviors also have a significant role in moderating the factors involved. A new cyber risk is product knowledge hiding. Misinformation, disinformation, knowledge hiding, and false information are all examples. While much has been said about the implications of product knowledge hiding, disinformation, and false information on the political process, the consequences of false information on businesses have received far less attention and have been considered to be inadequately researched . This reAcademic institutions must adjust their structures to embrace digitalization and sustainable economic approaches in an attempt to reach all of the requirements of modern labor innovation and consumer technologies in terms of access to awareness and knowledge . The eduThe country’s economic digital shift has now become apparent . From thDigital firms must build operational technologies simultaneously as they develop information technology . As a re1: Use of digital technology has an impact on the access of new markets by organizations.HThe question about balancing the political legitimacy of something like the central government and public authorities in environmental protection has long been a source of heated discussion . BecauseAwareness and developing business strategy solutions require a clear understanding of the technology, commercial, and policy components of environmental issues . WhereasDeveloping-country businesses are particularly vulnerable. Economic adaptation will result from proprietors changing their resource distribution related to the current ability to create value and pricing changes in the new environment that takes the demand, availability, and trade into account . If the 2: Use of digital technology has led to the centralization of systems in organizations.HNew technology, the digitization of the prevailing processes and procedures, and a sustainable economic approach have altered business perspectives. In recent years, the terms “digitalization,” “information technology,” and “sustainable economy” have been the most widely used terms in literature . If a coThe company must adapt and adjust its management technique in order to stay alive. In the digital era, digitalization and technological innovations for a green economy expose both potential and risks for employees and enterprises . Organiz3: Use of digital technology has led to transparency in organizations.HThe spread of internet misinformation and rumors has captivated our interest in recent years, since it has ideologically split society and resulted in social instability, weakened democracy, and other effects. Efforts to identify them on technological or behavioral aspects are widespread, but these efforts often fall short of addressing their origins, and so may not be able to prevent them from forming or spreading. The recent expansion of online news platforms has been fueled by the explosion of internet users , while mainstream outlets have begun to leverage multiple internet resources, such as online media, for reporting. As a result, online information and news are now more widely disseminated and impactful. However, the internet has aided the spread of false information and fake news, deceiving readers and attracting widespread attention .Product knowledge hiding can be defined as any incorrect information from an academic standpoint, whereas fake news relates to news stories that are purposely and indisputably untrue and deceptive. The phrase “fake news” is occasionally used to criticize media companies. Product knowledge hiding and fake news have a long history of deceiving readers, and it is not limited to the internet. Before the internet, there was the Great Lunar Conspiracy of 1835, which was an example of fake news. Even after the articles were proven to be a hoax, the New York Sun published pieces on the finding of life and civilization on the Moon, which resulted in a substantial increase in the newspaper’s circulation. Product knowledge hiding has evolved in tandem with technical advancements, particularly with the introduction of the internet. Emails containing urban legends and false warnings were widespread in the early 2000s. The growth of social media has simplified information sharing in recent years, blurring the lines between journalism and digital resources . On the Various facets of internet disinformation and fake news, such as their traits, enablers, incentives, and effects, are of interest to scholars . In factvia the media and internet. The access to information, on the other hand, does not appear to be linked to people’s improved knowledge. Information may be present, but it may not be well structured, organized, or even accessible. According to previous research, there are four main causes behind this: (1) much of the accessible information is false; (2) most of the available information is irrelevant; (3) information entropy: information is poorly organized and displayed; and (4) information overload: there is simply too much information for humans to comprehend , transparency , access to new markets , and centralization  have been adapted from Smart-PLS 3.3 was the software used for data analysis to measure the relationships among the hypotheses. The data in this study were analyzed in three stages. In the first stage, the demographic data in On the basis of the measurement model, the reliability and validity of the data were checked. For the reliability, composite reliability and Cronbach Alpha reliability were used. Moreover, average variance extracted (AVE) was also used to check the validity. The reliabilities and AVE are reported in The data were additionally validated with Fornell and Larcker criterion and HTMT (Heterotrait-Monotrait) ratio. According to literature, for data to be valid, the values of Fornell and Larcker criterion should be higher in each column at the top than the rest of the column . All theSimilarly, the HTMT ratio needs to be significant if the values of the table are much less than 0.9 . All theThe r-square values obtained above show that the variables selected for the study have been strong enough to be studied. The highest level of strength of a model is shown by the variables transparency  and access to new markets , while centralization showed an 11% value for R-square. These values show the strength of the model and significance of these variables in this framework. F-statistics obtained from the results also support the results of t-statistics. Transparency (F-square = 0.17%) and access to new markets (F-square = 0.100) have been found to be very significant factors for the benefit of using digital technology as their values are showing a very large effect . Moreovet-statistics, values of p, R-square, and f-square to check the acceptability of the hypotheses. The results can be seen in The third stage of the data analysis was the interpretation of the structural model algorithm obtained by consistent bootstrapping. The results of the algorithm can be seen in 1) addressing transparency among three benefits for the organizations was found significant with 1 and H2 were accepted. Furthermore, centralization found no contribution from the use of digital technology  the present study contributes to expanding the network of knowledge hiding, addressing the moderation of product knowledge hiding, and extending the known consequences of digital technology influencing knowledge hiding behavior, (2) the role of knowledge hiding in the online world, especially in the post-COVID scenario, has changed dramatically. Hence, the need to save online interactions from the impact of knowledge hiding is urgently needed, and (3) this study adds to the body of literature regarding knowledge hiding by finding its implications for organizations in dealing with off-shore partners.The study has practical implications, such as (1) this research has several implications for future researchers and policymakers for reinforcing the advantage of digital technology for organizations, (2) organizations, especially off-shore companies can make their policies and can access new markets by utilizing digital technology and ensuring the detainment of knowledge hiding by the personnel employed in handling these departments, (3) it is also an opportunity for researchers who are interested in repeating this research with their available resources in different regions and by adopting different factors. These can be exploited well in finding new avenues for certain studies like this.This research faced certain limitations which could be rectified in the coming projects. Some of these limitations include over-dependency on digital technologies, the huge costs of using the latest digital technologies, risk of job loss, extra favor of online businesses causing store closures, data security issues, etc. Other limitations of the study include the amount of time, which was quite small, as shifting to a green economy requires a lot of time. Overcoming the main issue of time will surely result in a worthy outcome. In future, working on similar research, these findings of the present study should be kept in mind. It is also an opportunity for researchers who want to expand this research with their available resources in different regions and are interested in adopting different factors. These can be exploited well in finding new avenues for certain studies like this.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Southeast University, China.The author confirms being the sole contributor of this work and has approved it for publication.This research received no external funding and the study was supported by Southeast University, China.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Technological progress in the twenty-first century offers real chances for economic development of the European Union (EU). The purpose of this publication is to analyse risks and threats relating to Occupational Health and Safety (OHS) considerations in the context of scientific and technological development. The article attempts the analysis of whether current legislation of the European Union enables good protection of workers’ health in the performance of their duties using robots, artificial intelligence (AI). A feature of robotisation and AI may be new challenges in OHS protection. The analysis performed aims to determine whether threats posted by working with Artificial Intelligence are serious enough for the EU Legislator to focus on implementation of new OHS regulations.The analysis was carried out on the basis of current legal regulations related to the protection of employee’s health in the European Union. The study used literature related to robotisation with artificial intelligence and health and safety at work in the working environment.Given the new psychological and physical threats related to the use of AI robots, it is necessary to expand the EU legislation with general guidelines for the use of intelligent robots in the work environment. Indeed, such robots must be defined in the applicable legal framework. Employers should also define, as part of their internal regulations, the procedures for employee communication with artificial intelligence, and relevantly update their training in the OHS area.The developments in AI-assisted robots come with inherent risks and threats to the working environment. New challenges create the need for adapting EU laws to changing reality. In order to structure European Union legislation on health and safety at work, these changes could be defined in a single piece of legislation covering robotics and AI after detailed analysis, dialogue, and debate. Ever since the dawn of the first industrial revolution in the nineteenth century, the technology has developed to become a critical part of socio-economic life of European nations . Socio-eWorking with robots may involve risks posed by their physical use at the workplace. Incorrect operation or machine error may ultimately lead to undesirable effects, in particular to workplace accidents. First, due to certain level of autonomy of AI-assisted robots, inadequate communication between a robot and a human may cause robot behaviour, which is not controlled by a human, ultimately affecting the safety of workers. A new threat relating to the occurrence of AI-assisted robots at the workplace is the risk of aggravation to the mental health of workers. Workers may become stressed by the possibility of losing their jobs or the quality of their work being monitored by robots, which might lead to competition between human workers and robots , 4. It iIt begs the question of whether EU legislation requires implementing new legal solutions with regard to protection of workers’ health and safety. The article analyses the impact of robotisation, AI on the protection of worker’s health and safety, as those very areas introduce to the work environment new phenomena affecting occupational health and safety. The afore-mentioned areas have one thing in common - they are subject to EU legislation governing OHS regulations protecting workers, in particular Council Directive 89/391/EEC . FurtherRobots can be programmed to complete new tasks. The literature defines robots as re-programmable multi-purpose devices designed for the handling of materials and tools for the processing of parts or specialised devices by means of varying programmed movements in order to complete a variety of tasks. First robots appeared at the workplace in 1960s . AccordiThe basic question is whether a robot may be a machine, or only software. The literature assumes that a robot is a physical object . Robots Artificial Intelligence is defined in a number of ways. One of the definitions specifies that it is a branch of IT dealing with simulated intelligent behaviour of computers or machines simulating the intelligent behaviour of humans . AI is bPresently, AI is used i.e. in the construction of autonomous vehicle systems. The example of such autonomous vehicle may be Google’s smart car . AI applThe European Commission maintains that the use of AI is a strategic and critical factor of economic development. AI has to serve both the European Union’s society and economy . An everThe purpose of this publication is to analyse risks and threats relating to OHS considerations in the context of scientific and technological development. The analysis performed aims to determine whether threats posted by working with Artificial Intelligence are serious enough for the EU Legislator to focus on implementation of new OHS regulations. The study attempts the analysis of whether current legislation of the European Union enables good protection of workers’ health in the performance of their duties using robots, AI.The analysis made use of literature related to robotisation using AI. Not only were the achievements of legal sciences used, but also publications dealing with occupational health and safety. The research was carried out on the basis of the current legal regulations related to the protection of workers’ health in the European Union. The publications used were verified in terms of methodology and qualified on the basis of the convergence with the subject. The literature review was based particularly on the following databases and online journals: HeinOnline, PubMed, Scopus, Web of Science, ERIH PLUS, and EBSCO. Sources were identified via keyword-based searches in such databases, as well as in online repositories and digital libraries, taking into account the publication date and author, and the paper type . The selection of literature was based on detailed analysis of specific texts in terms of individual research topics. Following the review, numerous publications were excluded because their subject turned out to be irrelevant. On the other hand, the final selection included research papers that were considered significant for answering the research questions asked in this paper. Apart from analysing the texts sharing the same perspective, the review also covered the sources presenting different positions. When working with robots equipped with artificial intelligence, the topic of health protection has not yet been comprehensively described in the literature. Nevertheless, selected publications have made it possible to identify certain directions of research on the use of AI robots in the work environment from the perspective of employee health protection.In the basic legal act on OSH, i.e., Council Directive 89/391/EEC, the employer is obliged to take the measures necessary for the safety and health protection of workers, including prevention of occupational risks and provision of information and training, as well as provision of the necessary organisation and means. Article 6(1) of the Directive provides for the employer’s obligation to adjust these measures to take account of changing circumstances and aim to improve existing situations. Furthermore, Article 6(3) of the Directive introduces a rule that the employer must, in all planned undertakings, take into account the nature of the activities of the enterprise, the risks to the safety and health of workers at work in the choice of work equipment, the chemical substances or preparations used, and the fitting-out of workplaces. Subsequent to this evaluation and as necessary, the preventive measures and the working and production methods implemented by the employer must, in the first place, assure an improvement in the level of protection afforded to workers with regard to safety and health. According to Article 9(1) of the Directive, the employer should be in possession of an assessment of the risks to safety and health at work, including those facing groups of workers exposed to particular risks, and decide on the protective measures to be taken and, if necessary, the protective equipment to be used. The employer should keep a list of occupational accidents resulting in a worker being unfit for work for more than three working days and draw up, for the responsible authorities and in accordance with national laws and/or practices, reports on occupational accidents suffered by its workers (Article 9(1) of the Directive). The basic instrument of occupational health and safety at work is risk assessment in the workplace. In the context of scientific and technological advancements, risk may take various forms.Referring to the use of robots in a work place, there are acts of law in the European Union also relating to the safety of workplace equipment. In particular, Council Directive 85/374/EEC  (with inHuman-machine interactions are governed by Directive 2006/42/EC  which imIn European Union Directive 89/391/EC defines general OHS principles applicable in every work environment utilising intelligent robots. Relevant principles with regard to machines have been provided for, also in Directive 2006/42/EC. The fact of regulating OHS matters on an EU level has to be appraised as positive. From this perspective it is vital to determine whether present EU-level legislation is considering threats and risks posed by robotisation, and artificial intelligence. EU regulations do not govern detailed new aspects of labour processes related to advancements in robotisation.The EU legislation was created in different scientific and technological reality. No principles for using AI-assisted robots considering the specificity of AI can be found there. There are no regulations governing controlling of robots with self-awareness. The definition of machine included in Directive 2006/42/EC was created in the reality with state of the art much different from today’s. It does not define levels of autonomy for robots which in the future may play a significant role in the work process of many European employers. This makes the analysis of risks and threats posed by new areas of scientific and technological progress a justified task.Recently, attention has been drawn in the European Union to principles for robot use. It is reflected in the European Commission postulating in 2018 the creation of a European framework for AI functioning. In the same year the agreement relating to AI was executed by 24 Member States and Norway . In addiThere is no doubt that the Commission has been involved for the last three years in studying the area of AI, by issuing communications , 27. In As indicated above, robotisation and AI may affect working conditions, and thus their occurrence should be subject to the analysis in the context of ensuring safe and healthy working conditions to workers. Despite a number of regulations applicable on European Union level one needs to consider the need for a review of the existing legislation governing occupational health and safety. The literature also points out future challenges, stemming from the use of artificial intelligence in work environment . The issRobots may, in turn, operate in a complementary manner at the production hall, assisting human workers. The aforementioned may, however, be connected with H&S - related threats, in particular damage or collision between a human and a robot, due to defective sensors, software or connectivity . When anDevelopment of AI generates new human and machine interactions, improves the performance, but also poses threats to privacy of employee and his or her protection against discrimination . EmployeScientific research has been conducted on relationships between humans and artificial intelligence, which focuses on improving the perception of robots . There iConsidering employee-robot interaction, the question arises whom shall be liable for damage caused by the AI. It seems that actions taken by robots, which sometimes decide on behalf of employers, cause material implications at work. The literature stresses the need for considering whether some legal framework needs to be implemented governing the risks posed by robot actions, including the scope of liability for incidents caused by certain actions of robots .How then, to evaluate European OHS legislation in the context of consequences of work with AI? The EU legislation also fails to define artificial intelligence, although such facts as the afore-mentioned resolution of the European Parliament of 16th February 2017 monitoring to regulate this area, are positive. Directive 2006/42/EC applicable to machinery failed to introduce a universal definition of AI-assisted robots having even partial self-awareness. The Directive may be useful when ensuring OHS at the workplace utilising traditional machinery. It is applicable to the principles of machine operation, without considering the impact of artificial intelligence that in certain situations may be able to make decisions independently. The above analysis demonstrates that European Union legislation does not address some new threats relating to the protection of employees’ health. In fact, EU legislator generally regulated the matters of OHS, in particular in Council Directive 89/391/EEC; however, legal standards are missing that refer directly to threats and risks relating to AI at the place of work. In particular, the issue consists in the absence of regulations governing controlling of robots with self-awareness when there are risks associated with human-robot interaction.Ever more common use of robots at the workplace may pose more risks - especially to new forms of robots’ use. Performance of workers’ duties should be so organised as to guarantee them the availability of protective measures preventing accidents at work. Workers should be adequately instructed in the observation of general OHS principles at work. Work using AI-assisted robots should be based on clearly defined principles of human-robot interactions, so as to avoid any misunderstandings with regard to specific tasks performed at work.The new risks associated with robotisation, AI in the workplace make it necessary for the EU legislator to reconsider the current rules. On the other hand, a robot equipped with artificial intelligence has a particular impact on another area of health and safety that concerns the relationship between a human being and such a robot performing certain tasks in the workplace. It is not limited to the worker’s contact with any substance, but concerns a mechanism for using artificial intelligence in the work process that can cause both psychological and communication risks.European legislation refers to OHS risks and threats, clearly indicating employers’ obligations to provide workers with adequate work conditions. Employers are often forced to define procedures mandatory to workers, by implementing in-house regulations, in order to ensure health and safety in the workplace. Obviously, no legislation should substitute the good OHS practices of employers, who should consider a host of risks posed by new technologies. Comprehensive EU legislation points out potential risks and threats to the recipients of legal standards. Therefore, it should be considered if any legislative changes on a EU-level have to apply to all above-mentioned aspects missing regulations, or if it would be sufficient to leave regulation of workplace OHS to employers, to some extent.The scale of risks analysed requires in-depth reflection. There are two ways to do it - a hard law is implemented, in the form of an EU directive or regulation, or a soft law is implemented in the form of recommendations and leaving the day-to-day management of OHS matters to stakeholders , 42.On the one hand the smallest possible intervention of the European Union is postulated. Such soft laws do not impose ready-made solutions, but only initiate undertakings by employers of their own actions, taken in their own best interest, notifying them of specific threats. In this context soft legal tools may ensure adequate protection of employees’ health at the place of work, especially when they are formulated in dialogue with personnel . AutonomOn the other hand an argument may be raised that adoption of soft laws to define the level of health protection is insufficient. In the absence of binding regulations, recommendations issued by the European Commission may result in OHS procedures being adopted by only the small number of employers . In addiAny private initiatives may be of an auxiliary nature, it should be critical to define laws based on scientific research and adequately addressing the existing state of OHS. It seems, therefore, those recommendations or other soft forms of law that do not impose binding obligations on Member States, will not play a significant role in implementation of safety procedures and measures . The staThat the need for regulation of this issue in the European Union law in the form of a directive or regulation is justified is evidenced by European experience in the implementation of OHS laws. Obviously, broadly understood healthcare of EU citizens requires, in general, a comprehensive approach of European Union, and not only by ensuring observation of workplace OHS . The Eurde lege ferenda AI-assisted robots have to be defined based on hard laws. Implementation of general european procedures for workplace use of such robots is also worth considering. Their independence, especially the potential for partial or full self-awareness requires answering the question how to treat a robot at the workplace – in the same way as a human? The problem of charging AI-assisted robots with specific OHS duties, and then enforcing such obligations from them, is questionable. Under present legislative reality it is not possible, since a robot is not a worker. This problem certainly requires additional research. It seems that implementation of general guidelines in hard laws at the EU level with regard to principles of using intelligent robots in the work process would be helpful to employers. Considering the needs of their plans and tasks assigned to robots, employers should define principles of employees’ communicating with AI on their own, as accurately as possible, under in-house regulations, taking into account also possible updates to OHS training of personnel. At this stage the employers should obligate the workers to exercise extreme caution when interacting with intelligent robot.When analysing threats related to the use of AI-assisted robots in work processes, the conclusion is justified that general OHS principles stemming from the Directive 2006/42/EC are not sufficient. As regards work involving the use of AI-assisted robot it is difficult to implement uniform principles of hard laws due to the rapidly changing technical state of the art. Certainly Summary there is no single piece of legislation that would directly and comprehensively cover new workplace scenarios related to AI. The general EU Directive 89/391/EC and Directive 2006/42/EC lay down only basic health and safety standards of a general nature. There is a need to implement specific legal solutions at the European Union level, when defining AI considering its potential level of self-awareness in the work process.To sum up, these studies indicate that AI-assisted robots’ development comes with inherent risks and threats to the working environment. Such risks and threats are physical and psychological in nature. Their occurrence should motivate further debate and pursuing the answer about the extent to which EU-level OHS regulations need to be implemented. New challenges create the need for adapting EU laws to changing reality. EU-level standards should consider new circumstances referring especially to advancements in AI in work processes. Detailed scope of possible legislative changes surely requires in-depth analysis, dialogue and debate, so as to enable precise and effective addressing of threats occurring in the work place. In order to structure European Union legislation on health and safety at work, these changes could be defined in a single piece of legislation covering robotics with AI.In the context of AI, soft law must not be forgotten. Some threats may undoubtedly be eliminated with soft laws. Employers themselves can take concrete steps to ensure that their employees have adequate working conditions, without the EU legislator imposing ready-made solutions on them.


During pandemics, the ethicists, public health professionals, and human rights advocates raise a red flag about different public health actions that should, at best, be addressed through integrated, global policies. How to rationalize the healthcare resources and prioritize the cases is not a recent challenge but the serious concern about that is how to achieve this while not increasing the vulnerability of the disadvantaged population. Healthcare professionals use different scoring systems as a part of their decision-making so the medical teams and triage committees can allocate resources for predictable health outcomes and prognosis as well as to appropriately triage the patients accordingly. However, the value of the existing scoring systems to manage COVID-19 cases is not well-established yet. Part of this problem includes managing non-COVID patients with chronic medical conditions like non-communicable diseases and addressing their medical needs during the pandemic complex context in a way to avoid worsening their conditions and, on the other hand, avoid hindering the establishment of comprehensive standards for dealing with COVID-19. In this article, we discuss this dilemma as well as how preexisting ethical standards were challenged by COVID-19. We also discuss how monitoring the consistent application of ethical standards during the medical trials of new medications, vaccines, or unproven medical interventions is also a critical issue. Health policy is a series of federal and non-governmental decisions and strategies to promote priorities in health care. Policies may be oriented toward people, hospitals, insurance providers, or health services. Examples include tobacco prevention policies and policies aimed at ensuring fair access to care. Policies are guided by the review of the legal powers and responsibilities of a country to make sure that people are healthy and to ensure that the country has the ability to limit the autonomy, freedom, privacy, and other legal interests of individuals for common good. These strategies must follow the ethical standards which require evidence-based public health rules based on comprehensive high-quality information on both legal actions and the optimal targets for health and well-being. Politicians typically have an ethical responsibility to ensure the rules of public health conforming to bioethics and accomplish their goals successfully. In order to identify the implications of the application of established legislation, a scientific research is continuously reviewed, and evidence is returned to the policy-making process to shape policy preferences on the current and future policies , 2.The modern area of bioethics arose in the 1960's, first in North America and Western Europe and finally across the globe, in response to the enormous rise in the influence of medicine and biomedical sciences in the 20th century. Bioethics remains an important area of interest, with submissions not just from moral philosophers, but also from doctors, healthcare providers, social scientists, and lawyers. The problems of organ and tissue transplantation, differential access to life-saving drugs and new contraceptive therapies, and the significant increase in the number and kind of clinical trials are debated by health practitioners, health authorities, and government prosecutors . The ethGiven the evolution of public health and the changes arising from globalization, new ethical problems have emerged in this field to pursue a coherent approach to public health regulation to deal with ethical problems. The main and classical purpose of public health is to avoid diseases rather than treat diseases. In contrast to medical practice related to patient health, the success of public health is focused on population health. The implementation of ethical standards in these two fields is distinct due to the discrepancies in clinical and public health procedures. According to public health, this sector is forever tackled by dilemmas of acceptable scope and moral conflict with personal independence in terms of its activities .The application of public health data in particular communities needs information on the effectiveness, the relative damage and the gain of public health initiatives, how the initiative can be undertaken, whether it affects the most vulnerable individuals, and the logistics involved in the implementation process .The need for a wider approach is gradually understood. The ideas of both public health ethics and health policy address the well-being, social rights, and collective concerns about social determinants. Debates proceed about the position of the sector, on legal functions, on rationing and the study of scenarios, on reactions to new technology, and on the healthcare systems .Global health is concerned with issues of national boundaries; so solutions include global coordination and ensuring health justice for all communities, irrespective of race. It is an interdisciplinary—and multidisciplinary—system, including health concerns, explicitly or indirectly. On the other hand, international health is concerned more with problems in other suffering countries, in particular in low- and middle-income countries (LMICs); so solutions include cross-border coordination between two countries. Global health seeks to support through overlap between a variety of disciplines but it is not multidisciplinary .In the massive recent pandemic we are facing, in the absence of a vaccination or effective care, people face some of the oldest and easiest ways of regulation of contagious diseases, such as quarantine, exclusion, physical separation, and construction of barriers. This condition enables one to see the value of proper diagnostic interventions, therapies, and, particularly, a vaccine as a way to restore economic and cultural life and to reunite families and friends. However, the manufacturing of a vaccine poses many public health ethics questions that are now a debate, including the implications of a quick-started search for vaccines, the equal delivery of a scarce vaccine in the beginning, and the effects of a relatively high degree of enrollment in the global immunization program .Although no common ethical public health theories exist, core principles and simple assumptions are common in all of these concepts. Based on the practical application of public health ethics, the implementation of appropriate concepts and standards into the policy-making procedures for public health is done through three main tasks as applied to the ethical framework: (1) to assess and explain the ethical questions posed; (2) to evaluate possible action paths and their impact; and (3) to address the issue by assessing the whole course of action by integrating the guiding principles and values and better combining them. The following four ethical principles will help in establishing the ethical recommendations: (1) ensure maximum benefit and minimum harm, (2) achieve justice, (3) eliminate inequality in health, and (4) achieve transparency –12. FortEnsuring an international justice lens is one of the main concepts of ethical guidelines. It is considered now—after globalization—more important than before, due to the global interdependence among countries. The health study in LMICs has been described many times as a tool for health advances to enhance global health. Benatar and Singer  proposedAlso, providing universal health coverage is one of the sustainable development goals and it ensures that everyone enjoys healthcare without undue financial difficulties regardless of their ability to pay. There is a great gap between health coverage across regions and it is crucial to strengthen the power of health policies in regions like African regions and others with poor resources . Global Another challenge is the access to affordable high-quality medicine in LMICs, particularly in dynamically challenging conditions, despite the limited resources available for putting in place clear health strategies in those countries, and despite the fact that general health-policy research is typically driven by funds rather than needs. Non-ethical promotion activities must be regulated, their impact on access to even informal pharmaceutical markets must be considered, and policymakers must devise plans to ensure the availability of high-quality medicine .Ethical obstacles for health-policy researchers, collaborating closely with stakeholders in diverse environments, to provide acceptable policy should be addressed by convening and paying attention to appropriate representation of primary stakeholders to ensure practical application of this policy in the real world. The strategy of such “partnerships” with stakeholders needs rational reflection among scientists .To sum up, collective principles like utility, evidence-based performance, distributive equity, equality and social responsibility, empowerment, engagement by population, transparency, accountability, confidence, equal representation, and effectively achieving the dimension of well-being must be fulfilled. In most cases, the final ethical appraisal after evaluating the above-mentioned principles does not lead to a definitive dismissal or acceptance of public health action, but instead to a stronger or weaker decision, for example, to enforce or to forget the intervention in case of a negative assessment. In order to improve the ethical analysis and conduct of health policy and system science, it is important to gain a more detailed understanding of various applications of ethical values on both clinical study and health policy and system research by researchers and research ethic bodies. All these lead finally to creating stable social systems, empowering the talents of people, developing their thinking skills, and enhancing the autonomy based on social justice philosophy , 25, 26.One of the most challenging ethical dilemmas facing health workers and decision-makers during pandemics is rationalizing the scarce healthcare resources. High demand for intensive care unit (ICU) during COVID-19 among different populations, makes the common rule, for example, “First come, first served first” usually is not applicable in such a context. This debatable issue is not recent , 28. In The criteria were not restricted to medical assessment only, but also to social parameters as well. Children were excluded in favor of the heads of households who could be supporting many children. In addition, as the program was supported by the tax revenues of state, they gave priority to those patients who were residents of the state of Washington . In the Another ethical debatable dilemma is the right of health workers to be among the prioritized beneficiaries when they get infected. Health workers are on the frontlines in the battle against the pandemic. They sacrifice their health for the benefit of the whole society. Risking their health in limited healthcare conditions would result in a significant deficiency of health personnel who are needed to fight and respond to the emergency. Would this justify prioritizing their access to scarce resources? As a matter of fact, health workers are one of the most essential resources in fighting the pandemic. From this perspective, they are prioritized to receive medical care and protective measures, including personal protective equipment (PPE), ICUs, ventilators, and vaccines upon availability , 33, 34.Moreover, patients with life-threatening medical conditions other than COVID-19 are also considered a priority for access to care. However, it is debatable if those with non-critical, non-COVID-related medical conditions should have similar access or not. While higher priority is given to patients with unstable conditions, the lowest priority goes to those patients who can tolerate health service delay until they pass the critical period of the pandemic .Another argument that is not completely settled is addressing the cultural perspective in framing the regulations of resource allocation and the extent to which they should be considered . The argTo conclude, it is important to establish comprehensive policy guidance for healthcare resource reallocation and rationalization in a pandemic context. This process should tackle different ethical considerations and demonstrate transparency, consistency, accountability, and inclusiveness, in which the affected community should have some degree of influence on the decision-making process. This is going to be addressed in more detail regarding COVID-19 in the following sections.It is the responsibility of healthcare systems, governments, and international agencies to make sure that the best medical care possible is delivered to all in need. Unfortunately, the capacities and resources of healthcare systems are limited which create a tremendous challenge to accommodate the surging needs of population, especially in times of crisis. The current Covid-19 pandemic is a proof for such a challenge. Healthcare systems around the world are struggling to fulfill their mission. Given these circumstances, prioritization, regulations, and ethical considerations are crucial. Limited healthcare services and resources need to be allocated in a justified and ethical manner. Medical teams can be placed in a situation where they need to give priority to some patients over others in order to have the maximum benefit from the limited resources available and save many lives . VentilaThree main considerations can guide prioritization and decision making: first, equality between all patients in the allocation of limited medical resources. Second, prioritize patients who will benefit the most from medical resources to maximize the outcome. Medical teams can be placed in a situation where they need to give priority to some patients over others in order to get the maximum benefit from the limited resources available and save many lives. Third, allocating the resources to those with the highest medical need or at the highest risk.In addition to these considerations, transparency, inclusiveness, consistency, and accountability are fundamentals to ensure the preservation of ethical values in resource allocation . There aAnother service that requires prioritization is the allocation of ventilators as life-saving devices. In Italy, which suffered a major outburst of COVID-19, a guideline for ICU resources allocation was issued by the peak society for anesthesia and critical care where they suggested some limiting criteria for the use and also for the withdrawal of ventilators, like the age limit for ventilator use, and the maximum clinical benefit to be achieved .Benefits can be achieved by using a clinical scoring system which focuses on saving “quality-of-life” years. Despite being an objective method, the clinical scoring system has a risk of giving a wrong precise outcome as it can give different mortality risks for patients showing the same clinical picture. As a result, the healthcare team must use the scoring system in conjunction with clinical judgment to make an unbiased and ethical decision . Hence, Different scoring systems are available to be used by health care professionals as a part of their decision-making in times where there is a limitation to resources. The medical teams and clinicians of the triage committees must be fully aware of the exact use of each scoring system and in order to be able to select the most appropriate too. Scoring systems can be used to help physicians decide on proceeding to operate for elective cases. This scoring system needs to be continuously adapted to the rapid ongoing changes and evolution of scientific data concerning COVID-19.Systems must be calibrated in order to establish a computerized clinical scoring system. It should then be adaptive to the continuously changing circumstances, new observations, and investigational outcomes. Scoring systems need to be finely adjusted with comorbidities as it can negatively affect vulnerable population who already suffer from diseases other than COVID-19, resulting in unfairness in limited resources allocation with these vulnerable people .A study was done in many North American hospitals to compare different ventilator triage policies, and discussed that the most common principles for ventilator allocation were clinical need and patient benefit. Aside from these two principles, there were differences in ventilator allocation criteria among hospitals, which resulted in injustice. Patients can be admitted to a hospital with unfavorable policy criteria, or they can choose a hospital with favorable policy criteria; both cases are unfair. A clear ethical ventilator triage policy with specific criteria on resource allocation is essential and must be unified to maximize patient benefit and decrease any harm due to unfairness or bias .It is highly important to have a triage officer with an experienced medical team in respiratory diseases responsible for making decisions to allocate limited resources and this should be totally separated from the medical care team providing treatment to the concerned patient, so as to avoid any bias or unfairness. Regular review of these resource allocation decisions by a higher-level committee should be done to avoid bias and inequities . In addiArguments regarding the approach of the first come first served can inevitably be used in COVID-19 treatment, Nevertheless, this method can cause discrimination toward the less advantaged with poor access to healthcare facilities and who have no means of transportation .Another ethical challenge for healthcare providers is to decide whether to provide non-essential healthcare services at the time of COVID-19. In several Canadian provinces, decisions have been taken to stop or reduce the non-essential medical interventions to the bare minimum until further notice, and to be substituted with telemedicine whenever possible. Healthcare providers are expected to make decisions about non-essential medical interventions based on specific criteria, including risk proportionality, the harm principle (minimizing harm), fairness, and reciprocity  .Moreover, due to the limited resources for patients who do not have COVID-19, standard treatment may not be available and will need to be substituted by another treatment. Most importantly, the patient must be informed by the physician of the current situation and the nature of the substitute treatment and about the type of routine treatment as well, to have well-informed consent by the patient .Meanwhile, patients with non-communicable diseases (NCDs) need to have access to the needed medical care to avoid health deterioration, especially in emergency cases or cases with the need for health services done at a medical facility . Healthcare entities need to provide the needed medical care for patients with NCDs separately from patients with COVID-19 to ensure the safety of those patients from getting COVID-19 infection. Telemedicine can be helpful for NCD patients who just need a consultation or follow-up of a physician , 49.It should be noted that patients with COVID-19 infection should not be guaranteed to have a priority in the ICU over other patients with different diseases . AnotherEmployers at healthcare facilities are required to provide enough PPE for the medical care team, since this will help them in taking care of patients safely and to avoid any harm . FurtherNurses are important pillars in the management of patients with COVID-19. It is crucial for the employers to protect nurses physically (providing sufficient PPE and treatment when needed) as well as legally by providing clear protocols on how to operate during a pandemic .The number of nurses can affect patient recovery. As per the National Health Service (NHS), six ICU patients will require care by one critical care nurse, two nurses with ICU experience for support, another two nurses with no ICU experience, and four supporting workers. Ethical and clinical issues may arise here, such as the type of nurse-to-patient ratio required during the pandemic and whether patient prioritization is valid in terms of medical team care .Meanwhile, due to the extreme load on healthcare facilities during the COVID-19 pandemic, governments need to optimize the medical work by shifting tasks, for example, using non-medical governmental staff for simple medical tasks after receiving short training .A suggested solution to handle the limited medical resources is that governments can try to relocate the needed resources to areas with the highest infection rates or where the health system suffers from lack of PPEs, ventilators, or medications. Another suggestion is that retired healthcare members who are no longer in practice should get back to work and help. In addition, non-urgent medical services or procedures can be postponed without risking the lives of the patients to free up space in the medical system to be able to accommodate emergency cases .Medical staff reallocation can be done to help with managing the COVID-19 pandemic workload. Reallocating staff should be guided by continuing to manage urgent cases, maintaining a mitigation plan, and providing the basic medical care services needed to avoid abandoning any patient, which is an ethical rule. This should be routinely reviewed in light of the updated circumstances and with complete transparency with patients. Meanwhile, the medical staff relocated to new roles must be given the needed training, support, and be fully prepared for the new role .Medical and ethical laws in each country must be followed. For example, in Egypt, it is not allowed to deny a patient the right to receive a life-saving medical service and to be replaced by another patient whose survival chance is higher .Moreover, although online consultations between physicians and patients are done to maintain social distancing and to avoid infection transmission, laws regarding online diagnosis and follow-up without a physical examination by the treating doctor must be reviewed since online diagnosis is not allowed in some countries, like Egypt .To conclude, the main challenge arising in the COVID-19 pandemic is the limitations of medical resources . Harmonized policies must be set to deal with this ethically to avoid bias and unfairness to patients.Health inequity is defined as “those inequalities in health that are deemed to be unfair or stem from some form of injustice.” Thereafter, health inequalities can be regarded as avoidable inequalities . In the Individuals with lower income are usually poor, with a lower level of education, and live in crowded areas with poor or no sanitation services , which rAs for gender, men and women face different challenges due to COVID-19. Several studies have concluded that men have higher COVID-19 mortality rates , 62. ThiEthnicity is also found to be a determining factor. Ethnic minority groups around the world are also disproportionately affected by COVID-19. Many studies performed in different countries have indicated such inequities , 69. FurThus, with COVID-19, it has become evident that in order to address the current situation, two considerations are to be taken into account: first, health inequities are at the root of the problem and need to be considered through all policies. Second, health ought to be central to all policies. Health is affected by policies across all different sectors, but it also affects other sectors. Therefore, considering the health aspect while formulating public policies is fundamental . On the Moreover, public health policies ought to concentrate on prioritizing high-risk communities in testing and treatment. Finally, adopted policies are to be evaluated depending on the equity criteria .Despite the above arguments concerning health equity as a cornerstone in all policies proposed to face COVID-19, some professionals debate that these policies on COVID 19 are to be based not only on equity aspects, but also on two other aspects, such as the scarcity of resources and the value of intervention. The ICUs and ventilator accessibility are two examples of resources that are allocated based on the availability and benefit value. The medical professionals argue that admitting these patients to the ICU and placing them on ventilators will prolong their suffering, causing harm rather than benefit. They also argue that if equity were the admission criterion, these patients would be admitted at the expense of other patients with a higher chance of recovery .Equity at the global level is another concern regarding addressing the COVID-19 crisis. An ethical global leadership is required to promote solidarity actions, protect the right of the humans with regard to health and ensure equity . Policy The breakout of the coronavirus pandemic in December 2019 in Wuhan, China, has caused a massive influence on China and the world . HealthcUnder normal conditions, the provision for new interventions for the treatment or prevention of diseases passes through a rigorous process to ensure their safety and efficacy before authorization. Usually, this is carried out by the National Regulatory Authority (NRA) and involves several procedures, starting from primary testing through research studies to produce generalized knowledge, proper allocation, and security of participants, thus leading to the proper collection of reliable data . RandomiBy the end of January 2020, WHO and PAHO have issued temporary recommendations for the confinement of the outbreak through the promotion of diverse public health measures. These measures included continuous investigations to recognize the epidemiology of the virus, its outbreak source, progress, transmission potential, and possible maneuvering measures to control it. The recommendations also emphasized the impact of global collaboration on the advancement of scientific knowledge about the virus and the disease through active participation and multisectoral collaboration, parallel to the promotion of the research for the containment of the disease and for the development of efficient and safe therapeutic and preventive interventions. In addition, it pointed to the crucial adherence to the ethical guidelines whenever unauthorized interventions are exceptionally offered beyond research settings , 92, 93.As of 28 November, 2020, and in response to the COVID-19 outbreak, the number of registered clinical trials has reached 4,029, while, on the other hand, the number of confirmed worldwide COVID-19 cases has jumped to 61.9 million . The desMaintaining the privacy protection of research participants would reduce the burden on researchers and balance the risk/benefit ratio, leading to more effective conduction and benefit of trials. Accepting oral informed consent and deferring the signed written form until after recovery would reduce the risk of infection during the research. Data could then be withdrawn in case of the signing refrainment of later participants . In addiMoreover, the implementation of multinational and multicentral trials is highly recommended in pandemic as it facilitates cross-comparison with different treatment options, allows for better-coordinated evaluation, lessens the time needed to satisfy the number of participants required to generate valid conclusions, and enable adaptations of specific countries. On the other hand, adjusting to regulatory regulations of various countries, securing official approvals, and organizing among multiple personnel present challenges to the effective execution of multicenter trials . NonetheFollowing the Ebola outbreak in 2014, when almost 30,000 humans developed the Ebola virus, the WHO formulated the “Monitored Emergency Use of Unregistered and Experimental Interventions” (MEURI), in response to the encountered extraordinary challenges , 102. It▪ When immediate initiation of clinical trials is not feasible.▪ In the absence of proven effective and successful treatments.▪ Upon the availability of supportive preliminary data on the safety and efficacy of the intervention and its use outside clinical trials has been proposed by a qualified consultative scientific committee.▪ When MEURI use has been approved by a qualified research ethics committee and by the health authorities of countries.▪ Upon the availability of reasonable resources for risk minimization.▪ When monitoring the use of interventions is achieved and proper, transparent, and accurate documentation and sharing of the outcomes among national and global stakeholders are adopted promptly and without delay.In “Expanded Access” programs—formerly named “Compassionate Use” programs—innovative medications with some relevant evidence of possible effectiveness are provided to seriously sick patients who cannot take part in clinical trials and lack access to other efficient therapeutic options. Although the use of unproven interventions under “expanded access” guidelines could be ethical during pandemics, they must not compromise efforts or resources needed to conduct clinical trials which provide scientific-based evidence for the efficient and safe authorization of innovative interventions . The corTo conclude, the high progress rate of pandemics has forced the development of new knowledge acquisition tools other than the standard clinical trial protocols. This is made possible through continuous renovation and reformation of regulatory rules and the constant improvement of the capacity of REC. Beneficence, equity, transparency, responsibility, autonomy, and efficiency must be balanced against the best therapeutic evaluations in clinical trials, and support for accessible, reasonably effective, and adequately safe therapeutic interventions with approved participant informed consent and under the management of a clinician should be guaranteed.via medical assessment and predictive outcomes. This should be clearly stated, be evidence-based, and all the health workers assigned to triage should be informed about these measures. The second aspect is prioritizing the health workers who are on the frontline of fighting the pandemic, providing them with the necessary support to be able to perform their duties efficiently. This includes the provision of PPE, training if needed, and timely information sharing, as required. The third aspect is that there should be a clear guidance of triage for patients who do not have COVID, and managing their health care needs according to the urgency of their cases. The fourth aspect is ensuring bioethical considerations in using unproven medical interventions, unregistered medications, and experimental procedures. To ensure a more efficient implementation of the policies produced, all of these aspects should involve the participation of different stockholders, undertaking transparency, and taking cultural differences into account. Furthermore, policies and guidelines for pandemic health responses should ensure that the provision of health services and triage does not exacerbate any kind of inequality, whether they are gender-based, ethnic-based, religious-based, or other discrimination.Health policies shape the entire health care landscape, including both patients and providers, where the best interests of both categories should be considered. In this regard, comprehensive and clearly defined bioethical standards should be embedded in drafting these policies, especially during pandemics. Over several decades, the world has experienced various health crises, from which public health professionals and ethicists have learned to build on and try to prepare for the next one. However, the COVID-19 outbreak reveals a lot of questions and defines regulations that need to be revised and adjusted. During pandemics, rationalizing the limited resources of the health-care system is a multifaceted decision that includes many pillars that policymakers should consider when developing international guidelines. One of the main aspects is setting specific measures to prioritize cases BS designed the concept. BS, EA, MH, RA, and WE contributed equally to conceiving, drafting, and reviewing the manuscript. MS supervised the work. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.