Pandemic Ethics

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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This Machine Kills Viruses

Written by Stephen Rainey

If we had a machine that could eradicate coronavirus at the press of a button, there would likely be a queue to do the honours. Rather than having such a device, we have a science-policy interface, and a general context of democratic legitimacy. This isn’t a push-button, but a complex of socio-political liberties and privations. We can’t push the button, but we can learn how to use the technology we do have – by collectively following policies like staying inside, wearing masks outside, and keeping distance from others.

Because of the coronavirus pandemic a novel form of this scientific research, technological application, and influence or control of nature (including humans) is emerging. In this case, the application is public policy, as based on multitudes of scientific advice. That over which control is sought is twofold: the virus, and people. Control of the virus is not really possible without some control over the people. Likewise, control of the people becomes harder where the virus is not controlled. Public trust in tough policies wanes if there is no end in sight, or no clear rationale in place. Continue reading

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

Could vaccine requirements for entering pubs be wrong, while closing pubs altogether is OK?

By Tom Douglas

Suppose that, before you could enter a pub, you had to produce a ‘vaccine passport’ showing that you had been vaccinated against the new coronavirus. 

Vaccine requirements like this are controversial. In the UK, the government has been keen to deny that it is even considering their use. This is in some ways puzzling, for closing pubs altogether has not been that controversial, and preventing people from entering pubs without exception seems, at first sight, to be a greater imposition on liberty than preventing people from entering pubs without first being vaccinated. As my colleagues Julian Savulescu and Alberto Giubilini recently noted, it seems better, in terms of liberty, to have some choice than none. 

This raises the question, could a vaccination requirement for entering pubs be wrong, while closing pubs altogether is not?

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DNACPR Orders in a Pandemic: Misgivings and Misconceptions.

by Dominic Wilkinson @Neonatalethics

This week, the Care Quality Commission (CQC) published an interim report into resuscitation decisions during the COVID-19 pandemic. According to a number of media outlets, the report found that in the first wave of the crisis inappropriate and possibly unlawful ‘do not resuscitate’ orders were used “without the consent of patients and families” (see eg Telegraph, Sky).

There are real concerns and important questions to answer about policies and care for patients in care homes and in the community during the pandemic. However, the media stories, and the CQC report itself appear to illustrate two ethical misconceptions.

 

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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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Cross post: Pandemic Ethics: Should COVID-19 Vaccines Be mandatory? Two Experts Discuss

Written by Alberto Giubilini (Oxford Uehiro Centre for Practical Ethics and WEH, University of Oxford )

Vageesh Jaini (University College London)

(Cross posted with the Conversation)

 

To be properly protective, COVID-19 vaccines need to be given to most people worldwide. Only through widespread vaccination will we reach herd immunity – where enough people are immune to stop the disease from spreading freely. To achieve this, some have suggested vaccines should be made compulsory, though the UK government has ruled this out. But with high rates of COVID-19 vaccine hesitancy in the UK and elsewhere, is this the right call? Here, two experts to make the case for and against mandatory COVID-19 vaccines.

 

Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of Oxford

COVID-19 vaccination should be mandatory – at least for certain groups. This means there would be penalties for failure to vaccinate, such as fines or limitations on freedom of movement.

The less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it.
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Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Written by Rebecca Brown

 

During the pandemic, many healthcare services have been reduced. One instance of this is the antenatal care of expectant mothers. Ordinarily, partners of pregnant women are permitted to attend appointments. This includes the 12 week scan: typically the first opportunity expectant parents get to see the developing foetus, to discover whether it has a heartbeat and is growing in the right place. This can be very exciting and, if there’s bad news, devastating. It also includes scans in mid pregnancy and (for first-time mothers) at 36 weeks, as well as the entirety of labour.

During the pandemic, many healthcare providers have restricted attendance at antenatal appointments as well as labour and postnatal care. Even when lockdown restrictions were eased, with pubs, zoos and swimming pools re-opening and diners in England being encouraged to Eat Out to Help Out, some hospitals continued to exclude partners from all antenatal appointments and all but the final stage of labour, requiring them to leave shortly after birth. This included cases where mother and newborn had to remain on wards for days following delivery. With covid cases rising, it seems likely that partners will once again be absent from much antenatal, labour, and postnatal care across the country. Continue reading

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