Coronavirus; Pandemic; Ethics; Public Health

Cross Post: Why the UK Shouldn’t Introduce Mandatory COVID Vaccination

Written by Julian Savulescu, Dominic Wilkinson, and Jonathan Pugh

As coronavirus infections surge across Europe, and with the threat of the omicron variant looming, countries are imposing increasingly stringent pandemic controls.

In Austria, citizens will be subject to a vaccine mandate in February. In Greece, meanwhile, a vaccine mandate will apply to those 60 and over, starting in mid-January.

Both mandates allow medical exemptions, and the Greek mandate allows exemptions for those who have recently recovered from COVID.

Other countries, including Germany, may soon follow suit, and the European Commission has raised the need to discuss an EU vaccine mandate. In contrast, the UK health secretary, Sajid Javid, has been clear that the UK will not consider a general mandatory vaccination policy. Continue reading

Omicron Travel Restrictions Are Not Ethically Justified

Written by: Alberto Giubilini, Julian Savulescu

*A version of this blogpost appears as an article in the Spectator*

 

Governments are at it again. It has become an involuntary reflex. A few days after South Africa sequenced and identified the new Omicron variant, England placed some South African countries back in the ‘red list’. Quarantine has been imposed on all incoming passengers until they show evidence of a negative test. Some European countries banned incoming flights from that region. Switzerland introduced quarantine for passengers arriving from the UK, but also banned all the unvaccinated passengers from the UK from entering the country. The domino effect we have seen so many times during this pandemic has kicked in again.

Is closing borders ethical? We don’t think so. At the beginning of the pandemic, border closures were, arguably, too little too late. Angela Merkel sealed off Germany’s borders in March 2020 less than a week after having declared that, in the name of solidarity, EU countries should not isolate themselves from one another, as the situation was out of control and extremely uncertain. The UK was also criticized for closing borders and locking down too late. In fact, countries that closed borders relatively early, such as Australia and New Zealand, fared better in terms of keeping the virus at bay.

However, we are at a very different stage of the pandemic now.  The disease is endemic, vaccination has been introduced, and we have treatments available. Why do we think the same measures that might have been appropriate in March 2020 are the best response in this very different context?

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Cross Post: Omicron: Better To Be Safe (And Quick) Than Sorry

Written by: Dominic Wilkinson, and Jonathan Pugh

On discovering the omicron variant, many countries moved quickly to impose travel restrictions and other public health measures, such as compulsory mask wearing. But, given the lack of data, is this the best course of action?

These measures have tangible costs, and some have argued that they are an over-reaction. Critics of the travel ban claim that new measures will not significantly prevent the spread of the variant. Indeed, World Health Organization (WHO) officials have urged countries not to hastily impose travel curbs, instead advocating a risk analysis and science-based approach. Continue reading

Event Summary: Vaccine Policies and Challenge Trials: The Ethics of Relative Risk in Public Health

St Cross Special Ethics Seminar, Presented by Dr Sarah Chan, 18 November 2021

In this St Cross Special Ethics Seminar, Dr Sarah Chan explores three key areas of risk in ‘challenge trials’ – the deliberate infection of human participants to infectious agents as a tool for vaccine development and improving our knowledge of disease biology.  Dr Chan explores a) whether some forms of challenge trials cannot be ethically justified; b) why stratifying populations for vaccine allocation by risk profile can result in unjust risk distribution; and c) how comparing these cases and the evaluation of relative risk reveals flaws in approach to pandemic public health.


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Cross Post: Selective lockdowns can be ethically justifiable – here’s why

Written by: Jonathan Pugh, Dominic Wilkinson, and Julian Savulescu

 

COVID is surging in some European countries. In response, Austria and Russia are planning to reimpose lockdowns, but only for the unvaccinated. Is this ethical?

Some countries already have vaccine passport schemes to travel or enter certain public spaces. The passports treat those who have had vaccines – or have evidence of recent infection – differently from those who have not had a vaccine. But the proposed selective lockdowns would radically increase the scope of restrictions for the unvaccinated.

Lockdowns can be ethically justified where they are necessary and proportionate to achieve an important public health benefit, even though they restrict individual freedoms. Whether selective lockdowns are justified, though, depends on what they are intended to achieve. Continue reading

Cross Post: Should You Stop Wearing A Mask Just Because the Law Gives You Permission To Do So?

Written by Maximilian Kiener

On December 1 1955, in Alabama, Rosa Parks broke the law. But Parks was no ordinary criminal trying to take advantage of others. She merely refused to give up her seat on a bus to a white person and was arrested for this reason alone. Parks is a hero because she stood up, or rather sat down, for the rights of black people.

Among other things, Parks taught us that we shouldn’t take the law too seriously, since a legal prohibition does not always imply a moral prohibition. In fact, there can be cases where we should actually do what the law forbids.

But we can extend Parks’ lesson and add another scenario where we shouldn’t take the law too seriously. Just as legal prohibitions (such as not to occupy seats reserved for white people) do not always determine what we should do, legal permissions, or rights, cannot determine what we should morally do either.

Consider the UK government, which now permits its citizens to visit public places without wearing masks, despite surging COVID infection rates. Does that permission mean that people in England now have good reasons to abandon their masks? Continue reading

The double ethical mistake of vaccinating children against COVID-19

 

Alberto Giubilini

Oxford Uehiro Centre for Practical Ethics

University of Oxford

 

Against the Joint Committee on Vaccination and Immunisation (JCVI)’s advice that did not recommend COVID-19 vaccination for children, the four Chief Medical Officers in the UK have just recommended that all children aged 12-15 should be vaccinated with the mRNA Pfizer/BioNTech vaccine.

This is a double ethical mistake, given our current state of knowledge.

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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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No jab, no job? Vaccination requirements for care home staff

Written by Lisa Forsberg and Isra Black

Last night the Guardian was first to report that staff working in older adult care homes will be required to get vaccinated against Covid-19. According to BBC News, ‘Care staff are expected to be given 16 weeks to have the jab—or face being redeployed away from frontline care or losing their jobs’. This announcement follows news reports over the last few months that the government have been considering making Covid-19 vaccination mandatory for staff working in older adult care homes in England. As part of this process, an open consultation on vaccination for older adult care home staff was held in April and May of this year, to which we responded.

While we think a vaccination requirement for older adult care home staff may be a necessary and proportionate measure, we nevertheless have concerns about the government’s proposed policy.

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