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?

 

Regaining a sense of proportion

Pandemic restrictions are justifiable when they are proportionate. Closing borders is a huge infringement of individual freedoms. It can be justifiable, but the expected benefit must be large enough.

Proportionality is an ethical issue, not a scientific one.

It seems throughout this pandemic we have lost our sense of proportion. We have stopped giving due consideration to costs and benefits of pandemic measures. We treat everything as an emergency. Panic prevails and we tend to be reactive rather than proactive. We adopt a ‘better safe than sorry’ approach without pausing to consider what ‘safety’ means, to what extent it is achievable, and if it is worth the costs. A prolonged state of emergency is not sustainable economically, psychologically, and socially.

It seems we are incapable of regaining that sense of proportion.  On the one hand, we have become so desensitized to the infringement of individual freedoms that we now consider it normal to prevent people from travelling and to force isolation upon them. That is not normal: it is an exceptional and rarely justifiable infringement of a basic right. On the other hand, we obsessively focus on only one, largely unattainable, good: the containment of COVID-19 spread. In the name of it, we are prepared to introduce one more restriction, and then another, and then another one, every time convincing ourselves that this would be the last sacrifice. Thus, if we can prevent Omicron from spreading in our country, we will be able to get out of this pandemic. Or we will prevent deaths. Or we will allow health care systems to get through the notoriously bumpy winter months.

From the point of view of public health ethics, four conditions must be satisfied before restricting liberty with coercive measures.  Firstly, there must be a grave threat to the public interest, such as imminent collapse of the healthcare system.  Secondly, the proposed intervention must be safe and effective.   Thirdly, it must be more effective than less-coercive alternatives. Fourthly, the extent of restriction of liberty must be proportionate to the benefits we can expect from it.

Does closing borders in response to Omicron conform to these conditions?  We doubt it. The response is not proportionate, considering its costs and the benefits that we can realistically expect. The only argument in favour of travel restrictions is one based on buying time to decide on the most effective response. But the proportionality issues rears its head again: is this time worth the costs to people?

 

What are the real benefits, and are they worth the costs?

At some point soon, nearly everyone in the UK will either have had COVID, vaccination (with the booster dose) or both. Omicron is already here and most likely in many places where it has not been detected yet. A week before South Africa reported it, Netherlands already had it. Which country detects it first and how many cases are detected largely depends on how good countries are at sequencing the virus. South Africa has been very good at doing that. Shutting them off from the rest of the world is unfair, besides pointless. It is also counter-productive in that its experience will deter other countries from making the effort to detect, or to report, new variants.

Even assuming border closures and other restrictions can slow down Omicron spread, it is not clear why we would want to do that at this stage. One year and half into the pandemic, with vaccines and treatments against COVID-19 available, we really need to ask what benefit we can expect from that.

Arguably, the answer depends on many things about Omicron we do not know much about: how transmissible it is, how dangerous it is, to what extent it evades natural and vaccine immunity. However, on the basis of what we know so far, it seems unlikely that everyone will be vulnerable.  It is more transmissible than earlier variants, yet preliminary evidence reported by the WHO suggests that Omicron symptoms are relatively mild in young people. If this was confirmed in other age groups, then border restrictions would not be justifiable. Importantly, latest evidence suggests that while 2 doses of the vaccine don’t offer good protection, the booster dose is 70-75% effective at preventing symptomatic infection, which means very good protection for the elderly. The UK has now vaccinated 40% of its eligible population (from 12 year old), particularly the elderly, with the booster. This casts doubt on whether any additional public health benefit of slowing down the spread of Omicron through other restrictions is worth the costs of such restrictions.

We assume that shutting down borders is just what a precautionary principle would recommend, given the uncertainty: better safe than sorry. But this approach counts as “precautionary” only if we disregard all the costs that restrictions impose in terms mental health, physical health, economy, social inequality, and so on (and the list is very long). These include not only border closure, but also the same old restrictions now introduced with so-called ‘plan B’, and the even more severe ones looming large with the prospect of a ‘plan C’ and yet another lockdown. Take all these costs into account and arguably the precautionary and proportionate thing to do is to avoid restrictions until we know more about the virus. Arguably, many people, especially the young, need protection from the harmful impacts of restrictions more than from Omicron.

 

What are the possible scenarios?

Let’s consider the possible worst case scenarios here.

On a worse scenario than the one currently suggested by the evidence available, Omicron might cause more severe disease than previous variants, but vaccines are still effective against serious symptoms and deaths. In such a case, the solution is to promote vaccination as much as possible. If some level of coercion is necessary, then it would need to be proportionate. A more proportionate approach than border restrictions is to mandate the booster vaccine for those at risk of serious illness, such as the elderly. Fairness and proportionality demand targeted policies, not indiscriminate mandates.

In an even worse – though less likely – scenario, Omicron might cause severe disease in vulnerable people and vaccines might not work too well at preventing serious illness. Even in such a case, there are more proportionate responses than blanket restrictions on travel. Focused-protection strategies – including selective vaccine mandates for the most vulnerable and, in the extreme, selective lockdown – strike a better balance between fairness, protection of the public health care system, and preservation of individual freedoms.

Restricting everyone’s freedom in order to protect a public good threatened by a small proportion of the population is an emergency response. But we need to stop treating every new variant as an emergency. We need a more systematic, calm, and ethical approach. We need to put individual freedoms back to where they belong, among the values that liberal societies have a duty to guarantee. Infringing upon individual freedoms, including freedom of movement, should be a measure of last resort, not our default reaction.

Sadly, nearly two years on we have still not learnt to live with the virus.

 

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2 Responses to Omicron Travel Restrictions Are Not Ethically Justified

  • horn says:

    thanks

  • Monte Makous says:

    To AG and JS: Thank you this and your other posts regarding Covid. They are a voice of rationality and calm in the fear-mongering cacophony of chaos, panic and dread. Thank you for highlighting the concept of proportionality, a useful but often ignored concept to keep in mind when contemplating the justifiability of public health recommendations. The rare instance when public health recommendations are proportionate is by accident not design. PH authorities have a strong bias toward measures that mitigate a problem, or appear to, without regard for proportionality. Their solipsistic advice on managing Covid needs much tempering by outside powers such as the political class and medical professionals who should keep a broader view of non-Covid demands and problems.

    PH authorities are apt to ignore corollary medical costs such as loss of cancer screenings and the worsened status of mental and emotional health in the population. The opportunity costs of PH recommendations on non-medical equities, such as general employment or the state of the economy are beyond their comprehension.

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