Post-Normal Challenges of Covid
Written by Stephen Rainey
How to manage the inevitable disruptions to life brought about by the emergence of a viral pandemic – a question that for many seemed remote has now had us all preoccupied for well over a year. With our just-published article, entitled The Post-Normal Challenges of COVID-19: Constructing Effective and Legitimate Responses, in the Journal Science and Public Policy, Maru Mormina, Sapfo Lignou, Joseph Nguyen, Paula Larsson and I set out to investigate some of the perplexing difficulties especially relating to effectiveness and legitimacy. We examine these in the light of pandemics as wicked problems and lay out how ‘post-normal science’ can contribute to a sound pandemic response.
In any pandemic response, the measures undertaken by authorities must effective in the sense of actually addressing the viral threats. A strategy that didn’t slow the rate of viral spread, for instance, wouldn’t work and for that reason would be due criticism. The concept of legitimacy is one perhaps less easy to cash out. In any pandemic response, the measures undertaken by authorities must be legitimate in the sense of fairly and justifiably constraining liberties enjoyed prior to the viral outbreak. A strategy that placed undue or disproportionate burdens on societal sub-groups, for instance, wouldn’t be legitimate and for that reason would be due criticism. For effectiveness in a medical crisis particularly, science is an essential element of any response. Continue reading
Cross Post: Vaccine passports: why they are good for society
Written by Barbara Jacquelyn Sahakian, University of Cambridge; Christelle Langley, University of Cambridge,
and Julian Savulescu, University of Oxford
As more and more people get vaccinated, some governments are relying on “vaccine passports” as a way of reopening society. These passports are essentially certificates that show the holder has been immunised against COVID-19, which restaurants, pubs, bars, sports venues and others can use to grant them entry.
Israel currently operates a “green pass” system, which allows vaccinated people access to theatres, concert halls, indoor restaurants and bars. The UK government, had to roll back plans to trial vaccine passports after some of the venues involved experienced significant backlash against the proposals.
This is perhaps not surprising – vaccine passport schemes are controversial, with some arguing that they will reinforce inequalities. But there is an ethical case for using some form of certification of COVID status, as long as it is designed properly and as long as everyone has access to vaccines.
Let’s look at the ethics of vaccination and certification. Continue reading
Vaccine Nationalism: Striking the balance
Written by Owen Schaefer and Julian Savulescu
This is an updated cross-post of an article published in MediCine
On 2 February 2021, the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, issues a broadside against COVID-19 vaccine nationalism, calling it “morally indefensible” and “tantamount to medical malpractice at a global scale.” Rich countries representing 16% of the global population have snapped up 60% of the global supply of COVID-19 vaccines. [1] Meanwhile, India, which has only vaccinated 10% of its population, is facing a catastrophic COVID-19 surge.[2] And the COVAX facility – an international effort to get COVID-19 vaccines equitably distributed around the world – currently only projects capacity to offer vaccines amounting to about 3% of participating countries’ populations by mid-year.[3]
COVID-19 vaccine nationalism is not the exception to normal practice. In almost all matters, countries spend the vast majority of budgets on local needs, and only a small fraction of that foreign aid, even when the latter represents much greater need. But the fact that this is normal or expected does not amount to a moral defense.
Here, we explore a question of practical ethics: what is the appropriate extent to which a country can prioritize its own people over those in other countries in the securing of vaccines for COVID-19?
Cross Post: COVID: Is it OK to manipulate people into getting vaccinated?
Written by Maximilian Kiener, University of Oxford
When the doctor realised that he wouldn’t be able to dissuade her of her beliefs, he decided to present her with another one:
Have you considered the possibility that anti-vaccine propaganda could be an attempt by the Russians or the Chinese to weaken the health of the United States population?
The doctor deliberately deceived the woman and probably reinforced her belief in conspiracy theories by pretending to find them plausible himself. But the tactic worked. The mother consented to have her child vaccinated.
Right now, vaccination is key to overcoming the COVID-19 pandemic and regaining safe individual freedom. Yet a minority of people, like the woman in our example, still refuse vaccination on mistaken beliefs. But how far can we go to change their minds?
Would the doctor be justified in using similar tactics to make the woman consent to her own COVID-19 vaccination? Continue reading
Mandating COVID-19 Vaccination for Children
Written by Lisa Forsberg and Anthony Skelton
In many countries vaccine rollouts are now well underway. Vaccine programmes in Israel, the United Kingdom, Chile, United Arab Emirates, Bahrain and the United States have been particularly successful. Mass vaccination is vital to ending the pandemic. However, at present, vaccines are typically not approved for children under the age of 16. Full protection from COVID-19 at a population level will not be achieved until most children and adolescents are inoculated against the deadly disease. A number of pharmaceutical companies have started or will soon start clinical trials to test the safety and efficacy of COVID-19 vaccinations in children and adolescents. Initial results of clinical trials seem promising (see also here and here).
There are strong reasons to inoculate children. COVID-19 may harm or kill them. It disproportionately affects already disadvantaged populations. For example, a CDC study published in August 2020 found the hospitalisation rate to be five times higher for Black children and eight times higher for Latino children than it is for white children. In addition, inoculating children is necessary for establishing herd immunity and (perhaps more importantly), as Jeremy Samuel Faust and Angela L. Rasmussen explained in the New York Times, preventing the virus from spreading and mutating ‘into more dangerous variants, including ones that could harm both children and adults’. Continue reading
Cross Post: There’s no Need to Pause Vaccine Rollouts When There’s a Safety Scare. Give the Public the Facts and Let Them Decide
Written By: Julian Savulescu, University of Oxford; Dominic Wilkinson, University of Oxford;
Jonathan Pugh, University of Oxford, and Margie Danchin, Murdoch Children’s Research Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
For instance, reports of blood clots associated with the AstraZeneca vaccine led to several European countries suspending their vaccination programs recently, only to resume them once these clots were judged to be a coincidence. However, authorities couldn’t rule out increased rates of a rare brain blood clot associated with low levels of blood platelets.
There are also problems with the Pfizer and Moderna vaccines. By early February 2021, among the over 20 million people vaccinated in the United States, there have been 20 reported cases of immune thrombocytopenia, a blood disorder featuring a reduced number of platelets in the blood. Experts suspect this is probably a rare vaccine side-effect but argue vaccination should continue.
So what happens with the next safety scare, for these or other vaccines? We argue it’s best to give people the facts so they have the autonomy to make their own decisions. When governments pause vaccine rollouts while investigating apparent safety issues, this is paternalism, and can do more harm than good. Continue reading
Cross Post: COVID vaccines: is it wrong to jump the queue?
Written by Dominic Wilkinson and Jonathan Pugh
This article is republished from The Conversation under a Creative Commons license. Read the original article.
In the UK, an Oxford city councillor has been suspended after mentioning on social media that she had received a COVID vaccination from a private doctor. Meanwhile, media reports suggest that two Spanish princesses, who did not yet qualify for vaccination in Spain were vaccinated while visiting their father in the United Arab Emirates. They are among a number of ultra-wealthy people getting vaccinated in that country.
There have also been reports of people accessing vaccines early in the UK, despite not being in any of the groups prioritised for vaccination at the time.
So how concerned should we be about these cases? Continue reading
Cross Post: Vaccine Passports: Four Ethical Objections, and Replies
Written By Tom Douglas
This is a (slightly modified) cross-post from The Brussels Times.
Should we all be required to produce a ‘vaccine passport’—proving that we have been vaccinated against Covid-19—before being allowed to enter a cafe, travel abroad, or work in a high-risk job?
Some governments are taking tentative steps in this direction. Belgium may require that its soldiers be vaccinated before travelling abroad on peace-keeping missions. In other countries, companies are introducing requirements of their own. Air New Zealand will begin trialling vaccine passports in April.
Many governments have been reluctant to go down this route. Yet the case for vaccine passports is clear: they could allow us to end some lockdown and distancing measures for vaccinated individuals sooner than it would be safe to end them for everyone. This would be a large benefit, since these measures involve severe interference with freedom of movement, and we know that they have serious economic and psychological costs. Continue reading
What Is The Justification For Keeping Lockdown In Place? Two Questions For The UK Government
Written by Alberto Giubilini and Julian Savulescu
Oxford Uehiro Centre for Practical Ethics, University of Oxford
Given the success of the vaccine roll out in the UK and the higher than expected drop in COVID-19 deaths, it is legitimate to ask whether lockdown should continue to be the key strategy to contain the pandemic or whether the ‘roadmap’ announced by the UK Government should be adjusted. Because lockdown is a very exceptional measure, the burden of proof is on the Government to provide answers as to why the easing of lockdown is proceeding at the current pace and not faster. The impact of lockdown is devastating for the economy, mental health, and employment rates and the cost and benefits are in many cases very unevenly distributed. For instance, the young are at highest risk of redundancy, but benefit less from lockdown because COVID-19 pose a very low risk on them. There is a serious concern around the rise of referrals for mental health assistance for children and teenager over the past year. If the lockdown is justified at this stage, the Government has the burden of proof of providing a strong justification for this.
Such justification might need to be updated with respect to the one offered when the roadmap was announced on 22 February. That justification was centred on the target of “keeping infections rates under control” as determined by 4 tests: successful vaccine deployment program; vaccines being successful at reducing hospitalizations and deaths in the vaccinated; infection rates not putting unsustainable pressure on the NHS; and the risk assessment not being significantly altered by new variants.
Even assuming those criteria are fair, the justification now needs to take into account the “very very impressive” and “spectacular” results of vaccine rollout, to quote a lead researcher from Public Health Scotland. As we shall see below, there are reasons to think that the vaccines are producing better results than those expected by the Government and assumed by the modelling used to inform the roadmap. Plausibly also because of the vaccine roll out, the drop in COVID-19 deaths in the UK is now three weeks ahead of the estimates of the modelling that the Government has used to design its roadmap: while the modelling estimated that COVID-19 deaths would fall below 200 a day after mid-March, we reached that point on 25 February. The model suggested we would have as few as 150 deaths per day by 21 March, but we are at that point now.
In light of these data, the Government would need to justify using indiscriminate lockdowns to achieve something – protection of the vulnerable and the NHS – which data suggest is now achievable without overburdening the whole society (as lockdown is doing) and possibly even without burdening those who need protection the most (as selective shielding would do). Vaccines are offering a level of protection to the vulnerable (roughly 80-90% drops in hospitalizations and deaths) that, if it was achieved through measures like selective shielding, would plausibly justify considering selective shielding successful. But vaccines do this without the downsides of indiscriminate lockdown or of selective lockdown.
Priority Vaccination for Prison and Homeless Populations
Written by Ben Davies
Last week brought the news that an additional 1.7m people in the UK had been asked to take additional ‘shielding’ measures against COVID-19, following new modelling which considered previously ignored factors such as ethnicity, weight and deprivation. Since many of this group have not yet been vaccinated, they were bumped up the priority list for vaccine access, moving into group 4 of the government’s vaccine plan.
Two other groups, however, have not yet been incorporated into this plan despite appeals from some quarters that they should be. First, new figures reinforced the sense that the virus is disproportionately affecting prisoners, with one in eight of the prison population having had COVID-19, compared with roughly one in twenty in the wider population (in the United States, the prison figure has been estimated to be one in five).
Second, some GP groups and local councils have offered priority vaccination to homeless residents, despite their not officially qualifying for prioritisation on the government’s plan. There have also been calls for the government to incorporate this into national plans, rather than being left to more local decision-making.
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