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Should Vaccination Status Affect ICU Admission?

By Ben Davies and Joshua Parker

Intensive care units around the country are full, with a disproportionate number of patients who have not had a single COVID-19 vaccination. Doctors have been vocal in describing the emotional cost of caring for critically unwell patients suffering from the effects of a virus for which there is an effective vaccine. Indeed, one doctor has gone so far as to argue that the unvaccinated should contribute financially for their care. It is easy to understand doctors’ frustrations given the relentless pressures and difficult decisions they’ve had to face. In the face of very real dilemmas about how to allocate scarce ICU beds, some might wonder whether the NHS should adopt a policy of ‘no vaccine, no ICU bed’.

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Cross Post: Is This the End of the Road for Vaccine Mandates in Healthcare?

Written by Dominic Wilkinson, Alberto Giubilini, and Julian Savulescu

The UK government recently announced a dramatic U-turn on the COVID vaccine mandate for healthcare workers, originally scheduled to take effect on April 1 2022. Health or social care staff will no longer need to provide proof of vaccination to stay employed. The reason, as health secretary Sajid Javid made clear, is that “it is no longer proportionate”.

There are several reasons why it was the right decision at this point to scrap the mandate. Most notably, omicron causes less severe disease than other coronavirus variants; many healthcare workers have already had the virus (potentially giving them immunity equivalent to the vaccine); vaccines are not as effective at preventing re-infection and transmission of omicron; and less restrictive alternatives are available (such as personal protective equipment and lateral flow testing of staff).Read More »Cross Post: Is This the End of the Road for Vaccine Mandates in Healthcare?

Cross Post: Vaccine Mandates For Healthcare Workers Should Be Scrapped – Omicron Has Changed The Game

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Written by Dominic Wilkinson, Jonathan Pugh and Julian Savulescu

Time is running out for National Health Service staff in England who have not had a COVID vaccine. Doctors and nurses have until Thursday, February 3, to have their first jab. If they don’t, they will not be fully immunised by the beginning of April and could be dismissed.

But there are reports this week that the UK government is debating whether to postpone the COVID vaccine mandate for healthcare staff. Would that be the right thing to do?

Vaccine requirements are controversial and have led to worldwide protests. Those in favour have argued that it is necessary and proportionate to protect vulnerable patients by making vaccination a condition of employment for healthcare staff. But critics have argued that vaccine mandates amount to a violation of human rights.Read More »Cross Post: Vaccine Mandates For Healthcare Workers Should Be Scrapped – Omicron Has Changed The Game

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

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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.Read More »Cross Post: Why the UK Shouldn’t Introduce Mandatory COVID Vaccination

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

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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.


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

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

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

 

Spitzi-Foto/Shutterstock
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.Read More »Cross Post: Selective lockdowns can be ethically justifiable – here’s why

Paying for the Flu Vaccine

By Ben Davies

As I do every winter, I recently booked an appointment for a flu vaccine. I get it for free in the UK. If I didn’t have asthma, I’d still get vaccinated, but it would cost me between £9 and £14.99. That is both an ethical error on the part of the government, and may be a pragmatic one too.

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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.

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

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.

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

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

person holding a mobile phone displaying a Covid-19 vaccinated message
Prostock-studio/Shutterstock
 

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.Read More »Cross Post: Vaccine passports: why they are good for society