Coronavirus; Pandemic; Ethics; Public Health

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

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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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

Video Series: Covid-19 Who Should Be Vaccinated First?

After healthcare and some other essential workers, it might seem the most obvious candidates for a Covid-19 vaccine (if we have one) are the elderly and other groups that are more vulnerable to the virus. But Alberto Giubilini argues that prioritising children may be a better option as this could maximise the benefits of indirect immunity for elderly and other vulnerable groups.

Some Questions for the University of Oxford about their Covid-19 Advice

Written by University of Oxford DPhil Student, Tena Thau

 

Yesterday, Oxford sent out an email to students, informing us that we would be asked to sign this Covid-19 Student Responsibility Agreement, before the start of term in October. The email also linked to some further Covid-19 guidance. Here are some questions that I had, while reading through these materials.

  1. Given that much, if not most, transmission is asymptomatic or pre-symptomatic, what is the rationale for only testing those with symptoms, rather than frequently testing everyone (as some universities are doing, and as this recent BMJ editorial advocates)?
  2. Ventilation is important – yet it was not mentioned in the student agreement. What steps is the university taking to increase ventilation in shared indoor spaces?
  3. Given that nearly all ‘superspreader’ incidents have occurred indoors, why not emphasise the importance of moving social activities outdoors?
  4. Given that the risk of transmission via contaminated surfaces is vanishingly low, why do the guidelines emphasise wiping down surfaces? (Promoting ineffective measures, besides not being helpful, can cause net harm, if they deflect our attention from those measures that are actually useful.)
  5. The situation playing out now in the US should be warning sign for UK universities. Some universities in the US have over a thousand cases already – and classes there have only just begun. What is Oxford doing differently to prevent something like that from unfolding here?

Video Series: Why Parental Status Matters When Allocating Scarce Medical Resources

Which patients should we treat, if we can’t treat them all? The Covid-19 pandemic has brought questions about how to allocate scarce medical resources to the forefront. In this Thinking Out Loud interview with Katrien Devolder, Philosopher Moti Gorin (Colorado State University) argues that parents (or primary caregivers) of a dependent child should (sometimes) get priority. A controversial position that nevertheless has some intuitive appeal!

Video Series: (Un)fair Access to Covid-19 Treatment in Mexico?

Widespread corruption and racism in Mexico created extra hurdles for the development of Mexico’s recently published federal guidelines for deciding who gets to access scarce medical resources (e.g. ventilators in the case of Covid-19). Dr César Palacios-González (Oxford), who helped develop these guidelines,  talks about these challenges.

Video Series: Which Non-Covid-19 Patients Should Get Treatment First?

In the UK we’re past the peak of the coronavirus pandemic but new ethical issues are arising: the healthcare system is now under enormous pressure – it’s working less efficiently than before (because of precautions to protect healthcare personnel), and there’s an enormous backlog of patients whose treatments have been put on hold. Which non-Covid-19 patients should get treated first and who will have to wait?  Dominic Wilkinson, Professor of Medical ethics and Consultant in Newborn Intensive Care, sheds some light on this important question, and proposes a practical solution. (To watch with subtitles, press the ‘YouTube’ button in the video.)

 

Contact-tracing apps and the future COVID-19 vaccination should be compulsory. Social, technological, and pharmacological immunisation

Written by Alberto Giubilini

Wellcome Centre for Ethics and Humanities – Oxford Uehiro Centre for Practical Ethics

University of Oxford

 

 

Main point:

Lockdown measures to contain the spread of COVID-19 have so far been compulsory in most countries. In the same way, use of contact tracing apps should be compulsory once lockdown measures are relaxed. And in the same way, vaccination should be compulsory once the COVID-19 vaccine is available.

We can think of the lockdown as a form of ‘social immunization’, of contact tracing apps as a form of ‘technological immunization’, and of course of vaccination as pharmacological immunization. The same reasons that justify compulsory lockdown also justify compulsion in the other two cases.

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Video Series: Do Health and Social Care Workers Have a Moral Obligation to Keep Working if they Lack Protective Equipment?

This interview is now also available as a video on YouTube:

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