Julian Savulescu’s Posts

The Ethics of Age-Selective Restrictions for COVID-19 Control

Written by: Bridget Williams1,2, James Cameron3, James Trauer2, Ben Marais4, Romain Ragonnet2, Julian Savulescu1,3

Cross-posted with the Journal of Medical Ethics blog

One of the major controversies of the COVID-19 pandemic has been disagreement about whether age-selective measures should be introduced, with greater focus on preventing infection in older people but tolerance of some transmission amongst younger people. Some have advocated a path of focusing efforts on protecting those most vulnerable and tolerating transmission in younger people. Others have argued for minimising community transmission. This debate involves important empirical uncertainties; including the feasibility of effectively isolating older people and the consequences of allowing infection in a large number of younger people, as well as the feasibility and consequences of alternative measures such as strict border control and quarantine. It also raises ethical considerations, including whether introducing age-selective restrictions is unjust, and whether it is acceptable for a policy to tolerate foreseeable harms.

Here we address these ethical questions and suggest that, although the appropriateness of age-selective approaches requires further consideration of the empirical evidence, ethical concerns should not prevent its consideration as a policy option.

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Are Immunity Passports a Human Rights Issue?

Written by Julian Savulescu

A shorter version of this post appears in The Telegraph

Imagine you are about to board a plane (remember that…) Authorities have reason to believe you are carrying a loaded gun. They are entitled to detain you. But they are obliged to investigate whether you have a gun. And if you are not carrying a gun, they are obliged to free you and allow you to board your plane. To continue to detain you without just cause would be false imprisonment.

Having COVID is like carrying a loaded gun that can accidentally go off at any time. The main ground for restricting people’s liberty is if they risk harming other people. This is the justification for quarantine, isolation, lockdown and other coercive measures in the pandemic. But if they are not a risk to other people, they should be free.

The ‘loaded gun’ analogy fails to acknowledge that most who are infected are significantly less harmed than gunshot victims: most recover swiftly and fully. However, in a pandemic, there is a second reason to restrict liberty: to decrease the number who fall ill and “save the NHS”. A person becoming ill not only threatens to harm others who become infected, but also increases the strain on the NHS themselves.

While research on immunity and transmission is ongoing, typically, immunity (natural or via a vaccine) both protects the individual from getting ill and reduces transmission to others. The Federal Drug Administration in the US has admitted as much. A recent study by Public Health England showed natural infection confers similar immunity vaccination (the SIREN study). There are also reasons to believe natural immunity might reduce transmission (by specific antibodies in the airways, called IgA).

An immunity passport would record a past infection (or presence of antibodies) or vaccination. It could be a bracelet, an app on the phone, or a certificate. An immunity passport would constitute evidence that a person was no longer a threat to herself or others. Because people have a human right of freedom of movement, they should be released from current lockdown if they are known not to be threats. There is no ethical basis to imprison people who are not a threat.

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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.

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Vaccines and Ventilators: Need, Outcome or a Right to a Fair Go?

Written by Julian Savulescu and Jonathan Pugh

The current UK approach to allocating limited life-saving resources is on the basis of need. Guidance issued by The General Medical Council states that all doctors must “Make sure that decisions about setting priorities that affect patients are fair and based on clinical need and the likely effectiveness of treatments”

This is most vividly illustrated in the JCVI’s strategy for vaccination: the prioritization order recommended by JVIC and that the UK Government is intentioned to follow is:

“1. older adults’ resident in a care home and care home workers

  1. all those 80 years of age and over and health and social care workers
  2. all those 75 years of age and over”

and then younger age groups in descending order.

The aim of this scheme is to address the greatest need and possibly also to save the greatest number of lives. Indeed, the JCVI state that their priority groups represent 99% of preventable mortality from COVID-19.[1] The downside of this strategy is that people in each lower tier will predictably and avoidably die as they wait for the tier above to be vaccinated.

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The Libertarian Argument Is the Best Argument Against Immunity Passports. But is it good enough?

Written by Julian Savulescu and Alberto Giubilini

The government has reportedly flirted with the introduction of vaccination passports that would afford greater freedoms to people who have been vaccinated for COVID-19. However, the UK’s Minister for the Cabinet Office, Michael Gove, recently announced that vaccination passports are not currently under consideration in the UK. However, the issue may linger and businesses may introduce such requirements.

One of us (JS) defended immunity passports in the context of affording people with natural immunity greater freedom during lockdown, if immunity significantly reduces the risk of infecting others.

Vaccination passports–after vaccines have been made available–can be seen as a mild form of ‘mandatory vaccination’.  Proof of vaccination could be a requirement to, for example, access certain places (e.g. restaurants, hospitals, public transport, etc, depending on how restrictive we want the mandate to be) or engaging in certain social activities (e.g. mixing with people from different households) or enable health care or other care workers to not self-isolate if in contact with a person with COVID (there were 35 000 NHS workers in isolation at the peak of the pandemic because of contact). It is worth noting that this kind of measure has already been in place globally for a long time in a more selective way, e.g. in the US where, in most states, children cannot be enrolled in schools unless they are up to date with certain vaccinations. These are also a form of “vaccination passports”, which simply do not use that term. Yellow Fever Vaccination Certificates are required to travel to certain parts of the world where Yellow Fever is endemic.

The ethical ground for restriction of liberty is a person represents a threat of harm to others. That is, the grounds for lockdown, quarantine, isolation or mandating vaccination is to reduce the risk one person poses to another. However, if a person is no longer a threat to others, the justification for coercion evaporates. If either natural immunity or a vaccine prevents virus transmission to others (and this remains to be determined), the grounds for restricting liberty disappear. This is one argument for an immunity or vaccination passport – it proves you are not a threat to others.

Moreover, if we thought there were sufficient grounds for the drastic and long lasting restrictions of individual liberties entailed by lockdowns and isolation requirements, it is at least legitimate to ask whether there are also sufficient grounds for vaccination passports, given that the individual cost imposed – getting vaccinated – is likely to be much smaller than the cost entailed by those other measures (unless the risks of vaccines are significant).

However, the more effective a vaccine is, the greater the opportunity for individuals to protect themselves. A Libertarian could then argue that the risk of harming others is nullified. If you want to protect yourself, you can vaccinate yourself. If this is true, then a vaccine doesn’t need to give us herd immunity. We can take individual responsibility.

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Mandatory Morality: When Should Moral Enhancement Be Mandatory?

By Julian Savulescu

Together with Tom Douglas and Ingmar Persson, I launched the field of moral bioenhancement. I have often been asked ‘When should moral bioenhancement be mandatory?’ I have often been told that it won’t be effective if it is not mandatory.

I have defended the possibility that it could be mandatory. In that paper with Ingmar Persson, I discussed the conditions under which mandatory moral bioenhancement that removed “the freedom to fall” might be justified: a grave threat to humanity (existential threat) with a very circumscribed limitation of freedom (namely the freedom to kill large numbers of innocent people), but with freedom retained in all other spheres. That is, large benefit for a small cost.

Elsewhere I have described this as an “easy rescue”, and have argued that some level of coercion can be used to enforce a duty of easy rescue in both individual and collective action problems. Continue reading

Cross Post: Pandemic Ethics: Vaccine Distribution Ethics: Monotheism or Polytheism?

Written by Alberto Giubilini, Julian Savulescu, Dominic Wilkinson

(Oxford Uehiro Centre for Practical Ethics)

(Cross-posted with the Journal of Medical Ethics blog)

Pfizer has reported preliminary results that their mRNA COVID vaccine is 90% effective during phase III trials. The hope is to have the first doses available for distribution by the end of the year. Discussion has quickly moved to how the vaccine should be distributed in the first months, given very limited initial availability. This is, in large part, an ethical question and one in which ethical issues and values are either hidden or presented as medical decisions. The language adopted in this discussion often assumes and takes for granted ethical values that would need to be made explicit and interrogated. For example, the UK Government’s JCVI report for priority groups for COVID-19 vaccination reads: “Mathematical modelling indicates that as long as an available vaccine is both safe and effective in older adults, they should be a high priority for vaccination”. This is ethical language disguised as scientific. Whether older adults ‘should’ be high priority depends on what we want to achieve through a vaccination policy. And that involves value choices. Distribution of COVID-19 vaccines will need to maximize the public health benefits of the limited availability, or reduce the burden on the NHS, or save as many lives as possible from COVID-19. These are not necessarily the same thing and a choice among them is an ethical choice. Continue reading

Press Release: UK Approves COVID-19 Challenge Studies

Responses to the UK COVID-19 Challenge Studies: 

“In a pandemic, time is lives.  So far, over a million people have died.

“There is a moral imperative to develop to a safe and effective vaccine – and to do so as quickly as possible.  Challenge studies are one way of accelerating vaccine research.  They are ethical if the risks are fully disclosed and they are reasonable.  The chance of someone aged 20-30 dying of COVID-19 is about the same as the annual risk of dying in a car accident.  That is a reasonable risk to take, especially to save hundreds of thousands of lives.  It is surprising challenge studies were not done sooner.  Given the stakes, it is unethical not to do challenge studies.”

Prof Julian Savulescu, Uehiro Chair in Practical Ethics, and Director of the Oxford Uehiro Centre for Practical Ethics, and Co-Director of the Wellcome Centre for Ethics and Humanities, University of Oxford

“Human challenge studies are an important and powerful research tool to help accelerate our understanding of infectious diseases and vaccine development.  They have been used for many years for a range of different infections.

“The announcement of the UK Human Challenge Program is a vital step forward for the UK and the world in our shared objective of bringing the COVID-19 pandemic to an end.  With cases climbing across Europe, and more than 1.2 million deaths worldwide, there is an urgent ethical imperative to explore and establish COVID-19 challenge trials.

“All research needs ethical safeguards.  Challenge trials need to be carefully designed to ensure that those who take part are fully informed of the risks, and that the risks to volunteers are minimised.  Not everyone could take part in a challenge trial (only young, healthy volunteers are likely to be able to take part).  Not everyone would choose to take part.  But there are hundreds of young people in the UK and elsewhere who have already signed up to take part in COVID challenge studies.  They deserve our admiration, our support and our thanks.”

Prof Dominic Wilkinson, Professor of Medical Ethics, Oxford Uehiro Centre for Practical Ethics, University of Oxford

Further Research

Read more about the ethics of challenge studies:

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COVID-19: Ethical Guidelines for the Exit Strategy

Alberto Giubilini

Julian Savulescu

Oxford Uehiro Centre for Practical Ethics

University of Oxford

Supported by the UKRI/AHRC funded project “The Ethical Exit Strategy”

(Grant number AH/V006819/1)


These are the “Main Points” and the Executive Summary of a Statement on key ethical considerations and recommendations for the UK “Exit Strategy”, that is, the strategy informing the series of measures to move the country from the state of lockdown introduced in March 2020 to a ‘new normality’.

The full Statement can be found at https://practicalethics.web.ox.ac.uk/files/covidexitstatement1octaccpdf

The document has been produced also on the basis of the discussion among academics and stakeholders from different fields (ethics, economics, medicine, paediatrics, mental health, nursing), who participated in an online workshop on the “Ethical Exit Strategy”, held on the 8th of July 2020. Continue reading

Pandemic Ethics: Good Reasons to Vaccinate: COVID19 Vaccine, Mandatory or Payment Model?

The best chance of bringing the Coronavirus pandemic to an end with the least loss of life and the greatest return  to normality seems to be the introduction of an effective vaccine. But how should such a vaccine be distributed?

To be effective, particularly in protecting the most vulnerable in the population, it would need to achieve herd immunity (the exact percentage of the population that would need to be immune for herd immunity to be reached depends on various factors, but current estimates range up to 82% of the population).

There are huge logistical issues around finding a vaccine, proving it to be safe, and then producing and administering it to the world’s population. Even if those issues are resolved, the pandemic has come at a time where there is another growing problem in public health: vaccine hesitancy.

Indeed, recent US polls  “suggest only 3 in 4 people would get vaccinated if a COVID-19 vaccine were available, and only 30% would want to receive the vaccine soon after it becomes available.”

If these results prove accurate then even if a safe and effective vaccine is produced, at best, herd immunity will be significantly delayed by vaccine hesitancy at a cost to both lives and to the resumption of normal life, and at worst, it may never be achieved.

Should it be made mandatory?

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