Public Health

The double ethical mistake of vaccinating children against COVID-19

 

Alberto Giubilini

Oxford Uehiro Centre for Practical Ethics

University of Oxford

 

Against the Joint Committee on Vaccination and Immunisation (JCVI)’s advice that did not recommend COVID-19 vaccination for children, the four Chief Medical Officers in the UK have just recommended that all children aged 12-15 should be vaccinated with the mRNA Pfizer/BioNTech vaccine.

This is a double ethical mistake, given our current state of knowledge.

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Philosophical Fiddling While the World Burns

By Charles Foster

An unprecedented editorial has just appeared in many health journals across the world. It relates to climate change.

The authors say that they are ‘united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.’

Climate change, they agree, is the major threat to public health. Here is an excerpt: there will be nothing surprising here:

‘The risks to health of increases above 1.5°C are now well established. Indeed, no temperature rise is “safe.” In the past 20 years, heat related mortality among people aged over 65 has increased by more than 50%.Hi gher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.’ Continue reading

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.

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The end of the COVID-19 pandemic

 

Alberto Giubilini, Oxford Uehiro Centre for Practical Ethics and WEH, University of Oxford

Erica Charters, Faculty of History and WEH, University of Oxford

 

 

A discussion on the end of the COVID-19 pandemic is overdue. We keep hearing that ‘we are in the middle of a pandemic’. However, it is not clear what it means to be in the middle of a pandemic if we don’t know what it means for a pandemic to end.  How can we know what the middle is if we don’t know what the end is?

We were given a clear date by the WHO for the start of the pandemic (11 March 2020). A few days earlier the WHO Director-General had for the first time used the term ‘epidemic’ to refer to COVID-19 outbreaks in some countries (5 March 2020). A disease is categorized as an epidemic when it spreads rapidly, with higher rates than normal, in a certain geographical area. A pandemic is an epidemic spreading over more than one continent. Thus, declaring epidemic and pandemic status is a decision based on epidemiological criteria.

By contrast, the end of an epidemic is not determined by epidemiological factors alone. Historically, epidemics end not with the end of the disease, but with the disease becoming endemic – that is, accepted and acceptable as part of normal life.

However, when and how a disease becomes normal or acceptable is primarily a social, cultural, political, and ethical phenomenon, rather than scientific or epidemiological.  It is a more subtle phenomenon – and less precise – than the start of the epidemic.  The end depends on how a society decides to respond to a pathogen that keeps circulating.  We might well find ourselves out of this pandemic without realising when and how it happened.

So, when will this pandemic end?

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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.

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Crosspost: Immunity Passports: A Debate Between Jay Bhattacharya and Alberto Giubilini

By Alberto Giubilini (University of Oxford) and

Jay Bhattacharya (Stanford University)

 

crosspost with Lockdown Sceptics

 

[Prof Jay Bhattacharya (Professor of Medicine, Stanford University) and I collaborate on Collateral Global, a new project that aims to evaluate the impact of lockdowns and other pandemic restrictions. We have the same view on lockdown and pandemic restrictions, but we do have our own internal, healthy disagreement. Most people who are skeptical and critical of lockdowns (as both Prof Bhattacharya and I are) are also against immunity passports (as he is), often for the same reasons. I disagree on this point and I think some form of immunity passport should be introduced. In this exchange published on Lockdown Sceptics, we try to explore exactly where our disagreement lies and try to identify possible areas of agreement on the matter. AG]

 

The Case For Immunity Passports

by Alberto Giubilini

Having read the excellent piece in the Wall St Journal by Prof. Bhattacharya and Prof. Kulldorff, I have the impression that they take many of the reasons against lockdowns to also be reasons against immunity passports. Among these, individual liberty is prominent.

I disagree.

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Lockdown Erodes Agency

By Charles Foster

A couple of lockdown conversations:

  1. The other day I met a friend in the street. We hadn’t seen one another for over a year. We mimed the hugs that we would have given in a saner age, and started to talk. ‘There’s nothing to tell you’, she said. ‘Nothing’s happened since we last saw you. And that’s just as well, because, as you’ll find, I’ve forgotten how to talk, how to relate, and how to read ordinary cues. We’ve not been out. We’ve not changed anything. I wonder if we’ve been changed?’
  1. Another friend. ‘Zoom’s great, isn’t it? You switch off your camera and your microphone, and the meeting just goes on perfectly happily without you. Everyone thinks you’re there. Your name’s up on their screen. But you are just getting on with your own business.’

And a lockdown fact: Lockdown has been great for book sales. 2020 saw an estimated rise of 5.2% in volume sales of print books in the UK compared with 2019 sales. This was the biggest annual rise since 2007: 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?

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