Crosspost: Learning to live with COVID – the tough choices ahead
By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu
This work was supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. The UK Ethics Accelerator project can be found at https://ukpandemicethics.org/
As mass vaccination continues to be rolled out, the UK is beginning to see encouraging signs that the number of COVID deaths is reducing, and that the vaccines may be reducing the transmission of coronavirus.
While this is very welcome news, a mass vaccination programme is unlikely to be enough to eliminate the virus, so we need to turn our thoughts towards the ethics of the long-term management of COVID-19.
One strategy would be to aim for the elimination of the virus within the UK. New Zealand successfully implemented an elimination strategy earlier in the pandemic and is now in a post-elimination stage.
An elimination strategy in the UK would require combining the mass vaccination programme with severe restrictions on international travel to stop new cases and variants of the virus being imported. However, the government has been reluctant to endorse an elimination strategy, given the importance of international trade to the UK economy.
One of the main alternatives to the elimination strategy is to treat coronavirus as endemic to the UK and to aim for long-term suppression of the virus to acceptable levels. But adopting a suppression strategy for the long term will require us to make a societal decision about the harms we are and are not willing to accept.
Suspending The Astra-Zeneca Vaccine and The Ethics of Precaution
By Jonathan Pugh, Dominic Wilkinson, and Julian Savulescu
The authors are working on the UK Pandemic Ethics Accelerator project – @PandemicEthics_. This project was funded by the Arts and Humanities Research Council (AHRC) as part of UKRI’s Covid-19 funding. All authors are affiliated to the University of Oxford.
Summary Points
- Preliminary Reviews suggest that the number of thrombotic events in individuals who have received the Astra Zeneca vaccine is not greater than the number we would normally expect in this population.
- It is crucial that we closely monitor these adverse events. The regulation of new medical interventions always requires us to manage uncertainty.
- A precautionary approach to managing this uncertainty may be important for ensuring continued confidence in vaccination.
- Regulators must weigh the potential risk suggested by these reports of adverse events following vaccination against the harm that suspension of the vaccine could have.
- The harm of suspending the use of the Astra Zeneca vaccine depends on how many preventable deaths we can expect by suspending its use.
- Amongst other things, this will depend on (i) how many people will be delayed in receiving a vaccine as a result (ii) the mortality risk of the people who would be prevented from receiving a vaccine, (iii) the prevalence of the virus at the time of the suspension, and (iv) the number of people who have received one dose of the Astra Zeneca vaccine, but not a second.
Cross-Post: Self-experimentation with vaccines
By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu.
This is a crosspost from the Journal of Medical Ethics Blog.
This is an output of the UKRI Pandemic Ethics Accelerator project.
A group of citizen scientists has launched a non-profit, non-commercial organisation named ‘RaDVaC’, which aims to rapidly develop, produce, and self-administer an intranasally delivered COVID-19 vaccine. As an open source project, a white paper detailing RaDVaC’s vaccine rationale, design, materials, protocols, and testing is freely available online. This information can be used by others to manufacture and self-administer their own vaccines, using commercially available materials and equipment.
Self-experimentation in science is not new; indeed, the initial development of some vaccines depended on self-experimentation. Historically, self-experimentation has led to valuable discoveries. Barry Marshall famously shared the Nobel Prize in 2005 for his work on the role of the bacterium Helicobacter pylori, and its role in gastritis –this research involved a self-experiment in 1984 that involved Marshall drinking a prepared mixture containing the bacteria, causing him to develop acute gastritis. This research, which shocked his colleagues at the time, eventually led to a fundamental change in the understanding of gastric ulcers, and they are now routinely treated with antibiotics. Today, self-experimentation is having something of a renaissance in the so-called bio-hacking community. But is self-experimentation to develop and test vaccinations ethical in the present pandemic? In this post we outline two arguments that might be invoked to defend such self-experimentation, and suggest that they are each subject to significant limitations. Continue reading
An Ethical Review of Hotel Quarantine Policies For International Arrivals
Written by:
Jonathan Pugh
Dominic Wilkinson
Julian Savulescu
This is an output of the UKRI Pandemic Ethics Accelerator project – it develops an earlier assessment of the English hotel quarantine policy, published by The Conversation)
The UK has announced that from 15th Feb, British and Irish nationals and others with residency rights travelling to England from ‘red list’ countries will have to quarantine in a government-sanctioned hotel for 10 days, at a personal cost of £1,750. Accommodation must be booked in advance, and individuals will be required to undergo two tests over the course of the quarantine period.
Failure to comply will carry strict penalties. Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country are liable to a 10-year prison sentence.
Crosspost: Is It Ethical To Quarantine People In Hotel Rooms?
Written by
Dominic Wilkinson and Jonathan Pugh,
The UK government announced that from February 15, British and Irish residents travelling to England from “red list” countries will have to quarantine in a government-sanctioned hotel for ten days, at a personal cost of £1,750. Accommodation must be booked in advance, and people will need to have two COVID tests during the quarantine period.
Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country could face a ten-year prison sentence.
Other countries have already implemented mandatory hotel quarantines for travellers, including Australia, New Zealand, China and India. When are such quarantines ethical? And who should pay for them if they are?
Ethical Considerations For The Second Phase Of Vaccine Prioritisation
By Jonathan Pugh and Julian Savulescu
As the first phase of vaccine distribution continues to proceed, a heated debate has begun about the second phase of vaccine prioritisation, particularly with respect to the question of whether certain occupations, such as teachers and police officers amongst others, should be prioritised in the second phase. Indeed, the health secretary has stated that the government will look “very carefully” at prioritising shop workers – as well as teachers and police officers – for COVID vaccines. In this article, we will discuss moral and scientific reasons for and against different prioritisation strategies.
The first phase of the UK’s Joint Committee on Vaccination and Immunisation (JCVI)’s guidance on vaccine prioritisation outlined 9 priority groups. Together, these groups accommodated all individuals over the age of 50, frontline health and social care workers, care home residents and carers, clinically extremely vulnerable individuals, and individuals with pre-existing health conditions that put them at higher risk of disease and mortality. These individuals represent 99% of preventable mortality from COVID-19. Prioritising these groups for vaccination will mean that the distribution of vaccines in a period of scarcity will save the greatest number of lives possible.
In their initial guidance, the JCVI also suggested that a key focus for the second phase of vaccination could be on further preventing hospitalisation, and that this may require prioritising those in certain occupations. However, they also note that the occupations that should be prioritised for vaccination are considered an issue of policy, rather than an issue that the JCVI should advise on.
We shall suggest that the input of the JCVI is absolutely crucial to making an informed and balanced policy decision on this matter. But what policy should be pursued? Here, we outline some of the ethical considerations that bear on this policy decision.
Even Though Mass Testing For COVID Isn’t Always Accurate, It Could Still Be Useful – Here’s Why
By Jonathan Pugh
This article was originally published here by the Conversation, on 22nd Dec 2020
The mass testing of asymptomatic people for COVID-19 in the UK was thrown into question by a recent study. In a pilot in Liverpool, over half the cases weren’t picked up, leading some to question whether using tests that perform poorly is the best use of resources.
The tests involved in this study were antigen tests. These see whether someone is infected with SARS-CoV-2 by identifying structures on the outside of the virus, known as antigens, using antibodies. If the coronavirus is present in a sample, the antibodies in the test bind with the virus’s antigens and highlight an infection.
Antigen tests are cheap and provide results quickly. However, they are not always accurate. But what do we mean when we say that a test is inaccurate? And is it really the case that “an unreliable test is worse than no test”? Continue reading
Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy
By Jonathan Pugh and Tom Douglas
Listen to Jonathan Pugh and Tom Douglas on Philosophical Disquisitions discussing Covid 19 and the Ethics of Infectious Disease Control, a podcast interview that was inspired by this blog.
Following the outbreak of the SARS-CoV-2 coronavirus, a number of jurisdictions have implemented restrictive measures to prevent the spread of this highly contagious pathogen. In January, Chinese authorities effectively quarantined the entire city of Wuhan, the epicentre of the outbreak, which has a population of around 11 million people. There has since been much discussion of various measures that might be implemented now or in the future to counter the spread, including various forms of social distancing, further mass quarantines and lockdowns, closed borders, mandatory testing and screening and even potentially forced treatment.
There are important questions about the lawfulness of infectious pathogen control (IPC) measures. Here, though, we focus on the moral justification of IPC. How can moral philosophy help us to think through when and whether different IPC measures ought to be employed?
To do so, we will briefly summarise our analysis of the different ways non-consensual medical interventions can be justified in infectious diseases control and criminal justice settings, which we originally published open access here.
Dr Neil Armstrong – Why is Mental Healthcare so Ethically Confusing
Co-authored with Daniel D’Hotman de Villiers
In the first St. Cross seminar of the term, Dr. Neil Armstrong talked about ethical challenges raised by mounting bureaucratic processes in the institutional provision of mental healthcare. Drawing on vignettes from his ethnographic fieldwork, Dr. Armstrong argued that the bureaucratization of mental healthcare has led to a situation in which the provision of care involves conflicts of the sort that make it irretrievably morally confusing. The podcast will follow shortly here.
Elizabeth Anderson’s Uehiro Lectures: Lecture 3 – Communicating Moral Concern Beyond Blaming and Shaming
In Elizabeth Anderson’s final Uehiro lecture, she tackles what she takes to be the hardest problem facing our current political discourse – How can we overcome obstacles to communicating moral concerns in order to orient policy to important values (such as public health and justice)? This is a particularly difficult and intractable problem because it concerns our moral values; in overcoming this obstacle, there is thus a considerable degree of scope for disagreement, and judgments of the moral character of others based on their moral opinions. Over the course of the lecture, Anderson refines the diagnosis of this problem, and once again expresses optimism about overcoming the obstacles she highlights. This time she outlines how we might disarm the fear, resentment, pride, and contempt that is currently derailing our political discourse, and the virtues that we must develop to do so. You can find a recording of the lecture here.
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