Defining the problem of pandemic resource allocation: perspectives from healthcare providers and civil society advocates in South Korea

Abstract

Abstract Background The COVID-19 pandemic raised ethical questions about how scarce medical resources should be defined and allocated. Existing debates have largely focused on triage criteria and distributive principles, with less attention to how different social and institutional actors understand the allocation problem itself. This study examined how healthcare providers and civil society advocates in South Korea understood the problem of pandemic resource allocation, and how their perspectives diverged across four dimensions: scarcity, fairness, survival, and preparedness. Methods This qualitative study included 31 participants: 16 healthcare providers with direct experience treating patients during the COVID-19 pandemic and 15 civil society advocates supporting socially marginalized populations. Providers participated in semi-structured individual interviews, while advocates participated in focus group interviews. Both methods incorporated written vignettes based on ethically contested resource-allocation policies implemented in South Korea. Data were collected from August 2025 to March 2026 and analyzed primarily inductively using reflexive thematic analysis. Results Four interrelated themes were identified. First, providers understood scarcity mainly in terms of beds, personnel, and treatment capacity within clinical settings, while advocates emphasized barriers that prevented marginalized populations from entering or remaining connected to the healthcare system. Second, providers foregrounded clinical need and clinical judgment, whereas advocates explicitly incorporated structural vulnerability and unequal access into their understanding of fair allocation. Third, providers framed survival largely through mortality prevention and treatment capacity, while advocates emphasized social survival, including continuity of care, livelihood, and everyday support. Fourth, both groups stressed the need to establish ethical principles and institutional preparedness before future crises, with advocates calling for standing participatory bodies that include patients, civil society, and healthcare professionals. Conclusions Pandemic resource allocation was shaped by differing understandings of what counted as a resource, who qualified as a legitimate subject of allocation, and what outcomes counted as survival. Equitable preparedness requires ethical principles, equity safeguards, and participatory governance to be institutionalized before a public health emergency occurs.