Coronavirus; Pandemic; Ethics; Public Health

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.

Continue reading

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:

National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic

This ethical framework is a modification of guidance developed for treatment decisions relating to adults. The principles relating to decisions for children in the setting of the pandemic are the same as those for adults. The framework emphasises that decisions should be ethically consistent and apply to patients both with COVID-related and non-COVID related illness.
The focus of the ethical framework provides guidance for a situation where there is extremely high demand and limited critical care capacity. However, it is important to note that at the time of writing (14 April 2020) there is enough paediatric critical care capacity across the UK. At the present time decisions about children in need of critical care should reflect the same fundamental ethical considerations as apply in normal times. Those decisions should be focused on the best interests of the child, and actively involve parents in decision-making.
The framework is available to read in full on the  Royal College of Paediatric and Child Health website.

Video Series: Is the Coronavirus Pandemic Worse for Women?

Dr Agomoni Ganguli Mitra talks about how pandemics increase existing inequalities in societies, and how this may result in even more victims than those from the disease itself. She urges governments and others to take social justice considerations much more into account when preparing for, and tackling, pandemics. This is an interview with Katrien Devolder as part of the Thinking Out Loud video series.
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