Jonny Pugh’s Posts

Cross-Post: Self-experimentation with vaccines

By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu.

This is a crosspost from the Journal of Medical Ethics Blog.

This is an output of the UKRI Pandemic Ethics Accelerator project.

 

A group of citizen scientists has launched a non-profit, non-commercial organisation named ‘RaDVaC’, which aims to rapidly develop, produce, and self-administer an intranasally delivered COVID-19 vaccine. As an open source project, a white paper detailing RaDVaC’s vaccine rationale, design, materials, protocols, and testing is freely available online. This information can be used by others to manufacture and self-administer their own vaccines, using commercially available materials and equipment.

Self-experimentation in science is not new; indeed, the initial development of some vaccines depended on self-experimentation. Historically, self-experimentation has led to valuable discoveries. Barry Marshall famously shared the Nobel Prize in 2005 for his work on the role of the bacterium Helicobacter pylori, and its role in gastritis –this research involved a self-experiment in 1984 that involved Marshall drinking a prepared mixture containing the bacteria, causing him to develop acute gastritis. This research, which shocked his colleagues at the time, eventually led to a fundamental change in the understanding of gastric ulcers, and they are now routinely treated with antibiotics. Today, self-experimentation is having something of a renaissance in the so-called bio-hacking community. But is self-experimentation to develop and test vaccinations ethical in the present pandemic? In this post we outline two arguments that might be invoked to defend such self-experimentation, and suggest that they are each subject to significant limitations. Continue reading

An Ethical Review of Hotel Quarantine Policies For International Arrivals

Written by:

Jonathan Pugh

Dominic Wilkinson

Julian Savulescu

 

This is an output of the UKRI Pandemic Ethics Accelerator project – it develops an earlier assessment of the English hotel quarantine policy, published by The Conversation)

 

The UK has announced that from 15th Feb, British and Irish nationals and others with residency rights travelling to England from ‘red list’ countries will have to quarantine in a government-sanctioned hotel for 10 days, at a personal cost of £1,750. Accommodation must be booked in advance, and individuals will be required to undergo two tests over the course of the quarantine period.

Failure to comply will carry strict penalties. Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country are liable to a 10-year prison sentence.

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Crosspost: Is It Ethical To Quarantine People In Hotel Rooms?

Written by

Dominic Wilkinson and Jonathan Pugh,

 

The UK government announced that from February 15, British and Irish residents travelling to England from “red list” countries will have to quarantine in a government-sanctioned hotel for ten days, at a personal cost of £1,750. Accommodation must be booked in advance, and people will need to have two COVID tests during the quarantine period.

Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country could face a ten-year prison sentence.

Other countries have already implemented mandatory hotel quarantines for travellers, including Australia, New Zealand, China and India. When are such quarantines ethical? And who should pay for them if they are?

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Cross Post: Not Recommending AstraZeneca Vaccine For The Elderly Risks The Lives Of The Most Vulnerable

Jonathan Pugh, University of Oxford and Julian Savulescu, University of Oxford

Regulators in Europe are at odds over whether the Oxford/AstraZeneca vaccine should be given to the elderly. In the UK, the vaccine has been approved for use in adults aged 18 and up, but France, Germany, Sweden and Austria say the vaccine should be prioritised for those under the age of 65. Poland only recommends it for those younger than 60. Italy goes one step further and only recommends it for those 55 and younger.

It is only ethical to approve a vaccine if it is safe and effective. Crucially, the reluctance to approve the AstraZeneca vaccine in the elderly is grounded only in concerns about its efficacy.

The concern is not that there is data showing the vaccine to be ineffective in the elderly, it’s that there is not enough evidence to show that it is effective in this age group. The challenge is in how we manage the degree of uncertainty in the efficacy of the vaccine, given the available evidence. Continue reading

Ethical Considerations For The Second Phase Of Vaccine Prioritisation

By Jonathan Pugh and Julian Savulescu

 

As the first phase of vaccine distribution continues to proceed, a heated debate has begun about the second phase of vaccine prioritisation, particularly with respect to the question of whether certain occupations, such as teachers and police officers amongst others, should be prioritised in the second phase. Indeed, the health secretary has stated that the government will look “very carefully” at prioritising shop workers – as well as teachers and police officers – for COVID vaccines. In this article, we will discuss moral and scientific reasons for and against different prioritisation strategies.

The first phase of the UK’s Joint Committee on Vaccination and Immunisation (JCVI)’s guidance on vaccine prioritisation outlined 9 priority groups. Together, these groups accommodated all individuals over the age of 50, frontline health and social care workers, care home residents and carers, clinically extremely vulnerable individuals, and individuals with pre-existing health conditions that put them at higher risk of disease and mortality. These individuals represent 99% of preventable mortality from COVID-19. Prioritising these groups for vaccination will mean that the distribution of vaccines in a period of scarcity will save the greatest number of lives possible.

In their initial guidance, the JCVI also suggested that a key focus for the second phase of vaccination could be on further preventing hospitalisation, and that this may require prioritising those in certain occupations. However, they also note that the occupations that should be prioritised for vaccination are considered an issue of policy, rather than an issue that the JCVI should advise on.

We shall suggest that the input of the JCVI is absolutely crucial to making an informed and balanced policy decision on this matter. But what policy should be pursued? Here, we outline some of the ethical considerations that bear on this policy decision.

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Vaccines and Ventilators: Need, Outcome or a Right to a Fair Go?

Written by Julian Savulescu and Jonathan Pugh

The current UK approach to allocating limited life-saving resources is on the basis of need. Guidance issued by The General Medical Council states that all doctors must “Make sure that decisions about setting priorities that affect patients are fair and based on clinical need and the likely effectiveness of treatments”

This is most vividly illustrated in the JCVI’s strategy for vaccination: the prioritization order recommended by JVIC and that the UK Government is intentioned to follow is:

“1. older adults’ resident in a care home and care home workers

  1. all those 80 years of age and over and health and social care workers
  2. all those 75 years of age and over”

and then younger age groups in descending order.

The aim of this scheme is to address the greatest need and possibly also to save the greatest number of lives. Indeed, the JCVI state that their priority groups represent 99% of preventable mortality from COVID-19.[1] The downside of this strategy is that people in each lower tier will predictably and avoidably die as they wait for the tier above to be vaccinated.

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Even Though Mass Testing For COVID Isn’t Always Accurate, It Could Still Be Useful – Here’s Why

By Jonathan Pugh

This article was originally published here by the Conversation, on 22nd Dec 2020

 

The mass testing of asymptomatic people for COVID-19 in the UK was thrown into question by a recent study. In a pilot in Liverpool, over half the cases weren’t picked up, leading some to question whether using tests that perform poorly is the best use of resources.

The tests involved in this study were antigen tests. These see whether someone is infected with SARS-CoV-2 by identifying structures on the outside of the virus, known as antigens, using antibodies. If the coronavirus is present in a sample, the antibodies in the test bind with the virus’s antigens and highlight an infection.

Antigen tests are cheap and provide results quickly. However, they are not always accurate. But what do we mean when we say that a test is inaccurate? And is it really the case that “an unreliable test is worse than no test”? Continue reading

Pandemic Ethics: Compulsory treatment or vaccination versus quarantine

By Thomas Douglas, Jonathan Pugh and Lisa Forsberg

Governments worldwide have responded to the Covid-19 pandemic with sweeping constraints on freedom of movement, including various forms of isolation, quarantine, and ‘lockdown’. Governments have also introduced new legal instruments to guarantee the lawfulness of their measures. In the UK, the Coronavirus Act 2020 gives the government new powers to detain individuals in order to prevent them from infecting others.

Interestingly, one measure that recent legislative changes in the UK leave off the table, at least for the time being, is the use of compulsory medical interventions—whether treatments or vaccinations. We surmise, however, that once treatments or vaccines for Covid-19 become available, there will be political interest in making them mandatory, since this may allow for the quickest and safest route out of the lockdown. In the case of vaccines, there will be a need to ensure that enough people are vaccinated to confer herd immunity. There may also be an argument for mandating vaccination of people who have contact with many others, such as teachers, retail staff and health care workers. In the case of treatments, we might hope that widespread use of anti-viral therapies will lighten the burden on the NHS by reducing the number of infected individuals who require intensive care. And there may be a need to ensure that people take the treatment even after their symptoms have resolved, to reduce their infectiousness.

From a legal point of view, there are clear barriers to compulsory treatments and vaccinations in the UK. The right of individuals with decision-making capacity to refuse any medical intervention that involves interference with their bodies is, for instance, robust and well-established in English law. This right persists even when the individual’s reasons for refusing the intervention are bizarre, irrational, or non-existent, and when the refusal would certainly lead to her death. The individual’s right to make her own medical decisions, and in particular to refuse interventions that interfere with her body, also enjoys robust protection in human rights law.
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Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy

By Jonathan Pugh and Tom Douglas

Listen to Jonathan Pugh and Tom Douglas on Philosophical Disquisitions  discussing  Covid 19 and the Ethics of Infectious Disease Control, a podcast interview that was inspired by this blog.

Following the outbreak of the SARS-CoV-2 coronavirus, a number of jurisdictions have implemented restrictive measures to prevent the spread of this highly contagious pathogen. In January, Chinese authorities effectively quarantined the entire city of Wuhan, the epicentre of the outbreak, which has a population of around 11 million people. There has since been much discussion of various measures that might be implemented now or in the future to counter the spread, including various forms of social distancing, further mass quarantines and lockdowns, closed borders, mandatory testing and screening and even potentially forced treatment.

There are important questions about the lawfulness of infectious pathogen control (IPC) measures. Here, though, we focus on the moral justification of IPC. How can moral philosophy help us to think through when and whether different IPC measures ought to be employed?

To do so, we will briefly summarise our analysis of the different ways non-consensual medical interventions can be justified in infectious diseases control and criminal justice settings, which we originally published open access here.

 

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Dr Neil Armstrong – Why is Mental Healthcare so Ethically Confusing

Co-authored with Daniel D’Hotman de Villiers

In the first St. Cross seminar of the term, Dr. Neil Armstrong talked about ethical challenges raised by mounting bureaucratic processes in the institutional provision of mental healthcare. Drawing on vignettes from his ethnographic fieldwork, Dr. Armstrong argued that the bureaucratization of mental healthcare has led to a situation in which the provision of care involves conflicts of the sort that make it irretrievably morally confusing. The podcast will follow shortly here.

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