Pandemic Ethics

Shaming unvaccinated people has to stop. We’ve turned into an angry mob and it’s getting ugly

Written by Alberto Giubilini and Julian Savulescu. Cross-Posted from The Conversation 
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Julian Savulescu, University of Oxford and Alberto Giubilini, University of Oxford

Unvaccinated mother, 27, dies with coronavirus as her father calls for fines for people who refuse jab.

This is the kind of headline you may have seen over the past year, an example highlighting public shaming of unvaccinated people who die of COVID-19.

One news outlet compiled a list of “notable anti-vaxxers who have died from COVID-19”.

There’s shaming on social media, too. For instance, a whole Reddit channel is devoted to mocking people who die after refusing the vaccine.

COVID-19 vaccinations save lives and reduce the need for hospitalisation. This is all important public health information.

Telling relatable stories and using emotive language about vaccination sends a message: getting vaccinated is good.

But the problem with the examples above is their tone and the way unvaccinated people are singled out. There’s also a murkier reason behind this shaming.

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Cross post: Why COVID passes are not discriminatory (in the way you think they are)

Alberto Giubilini

(This article is republished from The Conversation under a Creative Commons license. Read the original article)
The Conversation

UK health secretary Sajid Javid’s plans for vaccination requirements for frontline NHS workers has reignited the political and ethical debate over COVID passes.

The requirement constitutes a kind of vaccine pass; without proof of vaccination, healthcare workers are prevented from continuing working in the NHS in a frontline role. Other types of COVID passes have been introduced elsewhere, such as the so-called “green pass” used in many European countries.

COVID passes are certificates intended to limit the access to certain spaces – including, in some cases, the workplace – to people who are vaccinated, or who are thought to have immunity from previous COVID infections, or who have had a recent negative COVID test, or some combination thereof (depending on the type of pass). The aim is to minimise the risk that people in those spaces can infect others.

A common objection to COVID passes is that they are discriminatory because they would create a two-tier society with vaccinated people enjoying more freedom than the unvaccinated.

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NHS and Care Home Mandates Should Take Account of Natural Immunity to COVID

by Dominic Wilkinson, Jonathan Pugh, Julian Savulescu

 

Yesterday, the health secretary, Sajid Javid announced that COVID vaccines would become mandatory for frontline NHS staff from April.

Meanwhile, from tomorrow care home workers in the UK will not be able to work if they don’t have a vaccine certificate and are not medically exempt. This vaccine mandate has been controversial, with providers raising concerns that as many 70’000 employees could leave the sector putting beds and care at risk. However, its advocates have argued that it is a proportionate public health measure due to the need to protect vulnerable care home residents.

Proportionality is one key ethical criterion in public health ethics; public health interventions are only permissible if their benefits outweigh their costs. However, another key ethical criterion is necessity; public health interventions are only permissible if they are necessary for achieving a certain benefit.

One striking feature of the current UK care home and NHS staff mandate is that it does not allow an exemption for those who have proof of natural immunity.

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Ethics of Vaccine Passports

Vaccine Passports as a Human Right

The main way to control the pandemic, as we have all painfully found out, has been to restrict the movement of people. This stops people getting infected and infecting others. It is the justified basis for quarantine of people who have been in high risk areas, lockdown, isolation and vaccine passports.

It is the foundational ethical principle of any liberal society like Australia that the State should only restrict liberty if people represent a threat of harm to others, as John Stuart Mill famously articulated. This harm can take two forms. Firstly, it can be direct harm to other people.

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. But if vaccines remove the bullets from the gun, they are not a risk to other people and should be free.

Vaccine passports are thus a human rights issue under conditions of lockdown like Melbourne and Sydney are experiencing (the situation is different in Europe where lockdowns have been relaxed), if vaccines reduce transmission to other people sufficiently. Vaccination removes the authority and justification to restrict people’s liberty.

It is not discrimination to continue to restrict the liberty of the unvaccinated – it is just like quarantining those who have entered from high risk countries overseas. Their liberty is restricted because they are a threat to others. Discrimination occurs when people are treated differently on morally irrelevant grounds – differential treatment on the basis of differential threat is morally relevant. For example, to enter some countries, travellers must be vaccinated against Yellow Fever and receive a card as a vaccine passport. No card, no travel.

Are COVID Vaccine Passports a Human Right?

Do COVID vaccines fit into this justification for vaccine passports?

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We Should Vaccinate Children in High-income Countries Against COVID-19, Too

Written by Lisa Forsberg, Anthony Skelton, Isra Black

In early September, children in England, Wales and Northern Ireland are set to return to school. (Scottish schoolchildren have already returned.) Most will not be vaccinated, and there will be few, if any, measures in place protecting them from COVID-19 infection. The Joint Committee on Vaccination and Immunisation (JCVI) have belatedly changed their minds about vaccinating 16- and 17-year olds against COVID-19, but they still oppose recommending vaccination for 12-15 year olds. This is despite considerable criticism from public health experts (here, here, and here), and despite the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) declaring COVID-19 vaccines safe and effective for children aged 12 and up—Pfizer/BioNTech in the beginning of June, and Moderna the other week.

In Sweden, children returned to school in the middle of August. As in the UK, children under 16 will be unvaccinated, and there will be few or no protective measures, such as improved ventilation, systematic testing, isolation of confirmed cases, and masking. Like the JCVI in the UK, Sweden’s Folkhälsomyndigheten opposes vaccination against COVID-19 for the under-16s, despite Sweden’s medical regulatory authority, Läkemedelsverket, having approved the Pfizer and Moderna vaccines for children from the age of 12. The European Medicines Agency approved Pfizer and Moderna in May and July respectively, declaring that any risks of vaccine side-effects are outweighed by the benefits for this age group.

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The end of the COVID-19 pandemic

 

Alberto Giubilini, Oxford Uehiro Centre for Practical Ethics and WEH, University of Oxford

Erica Charters, Faculty of History and WEH, University of Oxford

 

 

A discussion on the end of the COVID-19 pandemic is overdue. We keep hearing that ‘we are in the middle of a pandemic’. However, it is not clear what it means to be in the middle of a pandemic if we don’t know what it means for a pandemic to end.  How can we know what the middle is if we don’t know what the end is?

We were given a clear date by the WHO for the start of the pandemic (11 March 2020). A few days earlier the WHO Director-General had for the first time used the term ‘epidemic’ to refer to COVID-19 outbreaks in some countries (5 March 2020). A disease is categorized as an epidemic when it spreads rapidly, with higher rates than normal, in a certain geographical area. A pandemic is an epidemic spreading over more than one continent. Thus, declaring epidemic and pandemic status is a decision based on epidemiological criteria.

By contrast, the end of an epidemic is not determined by epidemiological factors alone. Historically, epidemics end not with the end of the disease, but with the disease becoming endemic – that is, accepted and acceptable as part of normal life.

However, when and how a disease becomes normal or acceptable is primarily a social, cultural, political, and ethical phenomenon, rather than scientific or epidemiological.  It is a more subtle phenomenon – and less precise – than the start of the epidemic.  The end depends on how a society decides to respond to a pathogen that keeps circulating.  We might well find ourselves out of this pandemic without realising when and how it happened.

So, when will this pandemic end?

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COVID: Media Must Rise Above Pitting Scientists Against Each other – Dealing With the Pandemic Requires Nuance

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Trish Greenhalgh, University of Oxford and Dominic Wilkinson, University of Oxford

At the start of the pandemic, there was a striking sense of shared resolve and solidarity. Facing a public health crisis greater than any in living memory, people were largely united in their support of difficult measures to protect the vulnerable, safeguard the health system and sustain key workers.

There were, of course, differences of opinion. For example, some disagreed about the severity of the threat posed by COVID, about the wisdom of different national approaches to lockdown, about the timing of restrictions, and the effectiveness face masks.

More recently, there has also been disagreement on how vaccines should be distributed, whether vaccine passports are a good idea, and whether vaccination should be mandatory for certain occupations)

Throughout the pandemic, scientists attempting to explain their findings have had to deal with unprecedented levels of dissent, anger and abuse from the lay public and occasionally from other scientists.

Since the government lifted COVID restrictions on July 19, views on how best to handle the pandemic have become more polarised than ever, broadly splitting into two camps: the “open up” camp and the “not yet” camp. Continue reading

COVID: Why We Should Stop Testing in Schools

Dominic Wilkinson, University of Oxford; Jonathan Pugh, University of Oxford, and Julian Savulescu, University of Oxford

Education Secretary Gavin Williamson has announced the end of school “bubbles” in England from July 19, following the news that 375,000 children did not attend school for COVID-related reasons in June.

Under the current system, if a schoolchild becomes infected with the coronavirus, pupils who have been in close contact with them have to self-isolate for ten days. In some cases, whole year groups may have to self-isolate.

Such mass self-isolation is hugely disruptive. Yet despite the clamour to switch to other protective measures, such as rapid testing of pupils who have been in close contact with an infected pupil, the public service union Unison has supported self-isolation as “one of the proven ways to keep cases under control”. Continue reading

Mandatory Vaccination for Care Workers: Pro and Con

By Dominic Wilkinson and Julian Savulescu
An edited version of this was published in The  Conversation 

The UK government is set to announce that COVID-19 vaccination will become mandatory for staff in older adult care homes. Staff will be given 16 weeks to undergo vaccination; if they do not, they will face redeployment from frontline services or the loss of their job. The government may also extend the scheme to other healthcare workers.

It is crucial to achieve a high vaccine uptake amongst older adult care home staff due to the high mortality risk faced by residents. ONS Data suggest that there has been a 19.5% increase in excess deaths in care homes since the beginning of the pandemic, with COVID-19 accounting for 24.3% of all care home resident deaths.

According to SAGE, 80% of staff working in care homes with older adult residents (and 90% of the residents themselves) need to be vaccinated in order to confer a minimum level of protection to this vulnerable population. In mid-April, only 53% of older adult care homes in England were meeting these thresholds, whilst, as of the 10th June, 17% of adult care home workers in England have not had a single dose of the COVID-19 vaccine.

Mandating vaccination would increase vaccine uptake in care home workers, but would be a significant intrusion into individual freedom. Is it ethically justifiable?

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