Public Health

Crosspost: Learning to live with COVID – the tough choices ahead

By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu

This work was supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. The UK Ethics Accelerator project can be found at https://ukpandemicethics.org/

 

As mass vaccination continues to be rolled out, the UK is beginning to see encouraging signs that the number of COVID deaths is reducing, and that the vaccines may be reducing the transmission of coronavirus.

While this is very welcome news, a mass vaccination programme is unlikely to be enough to eliminate the virus, so we need to turn our thoughts towards the ethics of the long-term management of COVID-19.

One strategy would be to aim for the elimination of the virus within the UK. New Zealand successfully implemented an elimination strategy earlier in the pandemic and is now in a post-elimination stage.

An elimination strategy in the UK would require combining the mass vaccination programme with severe restrictions on international travel to stop new cases and variants of the virus being imported. However, the government has been reluctant to endorse an elimination strategy, given the importance of international trade to the UK economy.

One of the main alternatives to the elimination strategy is to treat coronavirus as endemic to the UK and to aim for long-term suppression of the virus to acceptable levels. But adopting a suppression strategy for the long term will require us to make a societal decision about the harms we are and are not willing to accept.

 

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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

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.

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Inoculate to Imbibe? On the Pub Landlord Who Requires You to be Vaccinated against Covid

Written by Isra Black and Lisa Forsberg

Elsewhere on the blog Tom Douglas has discussed vaccine requirements for commonplace activities, such as going to the pub, created by the state in the form of law or guidance. Let’s call these vaccine requirements ‘state-originating’. Also on the blog, Julian Savulescu has discussed whether ‘immunity passports’ are a human rights issue. In our view, vaccine requirements or similar raise important issues of human rights in a legal, as well as ethical and rhetorical sense. Legally, since the action of public authorities would be implicated in state-originating vaccine requirements, the measures would be evaluated for their compliance with, among other things, the Human Rights Act 1998 (and therefore the rights protected by the European Convention on Human Rights) and the Equality Act 2010. The legality of state-originating vaccine requirements would depend on issues of principle (eg how should we trade-off interference with personal life and the freedoms to pursue economic and social activities?), scope (what sectors or activities?), and implementation (eg how to handle any exemptions?)

In this post, we take a different angle. We consider the legal human rights and equality dimensions of private-originating vaccine requirements—for example, ‘inoculate to imbibe’: your local pub requiring you to have had a coronavirus vaccine to enjoy a pint.

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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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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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Video Series: How To Prevent Future Pandemics

First interview in the new  Thinking Out Loud series on ‘Animals and Pandemics’: Katrien Devolder in conversation with Jeff Sebo, Associate Professor of Environmental Studies at NYU, on how our treatment of animals increases the risk of future pandemics arising, and on what we should do to reduce that risk!

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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The UK Should Share The Vaccine With The Other Countries – But Only After All The Vulnerable Have Been Vaccinated

Written by Alberto Giubilini, Oxford Uehiro Centre for Practical Ethics, University of Oxford

Cross posted with The Conversation

“We are all in this together”, except that we are not. One of the most widely used slogans of the pandemic might need to be adjusted. Maybe: “We are all in this together, until there is a way out.”

The way out is the COVID-19 vaccine. Or more precisely, the many COVID-19 vaccines. The UK has already approved three, with two more pending a decision by the drugs regulator.

Of these, one has been developed in the UK by the University of Oxford, with millions of pounds of funding from the UK government (aka, UK taxpayers), and made by the British/Swedish company AstraZeneca. Part of its manufacturing is in Europe, where Belgian plants have had production problems that have threatened the future supply to the EU.

Three vaccines are produced by US pharmaceutical companies (Pfizer, Moderna and Novavax), although the Pfizer vaccine has been developed in partnership with the German biotechnology company BioNTech, and the Novavax one is being made in the UK. One vaccine is made by Janssen, based in Belgium but owned by the American firm, Johnson & Johnson.

These geographical details might seem superfluous, but they are already making post-Brexit vaccine distribution more complicated than it should be. In the meantime, the World Health Organization has expressed concerns over the fading commitment to Covax, the programme set up to guarantee equitable access to COVID-19 vaccines around the world.

This is the moment countries part ways in their fight against COVID-19. We are no longer in this together. That is because we never chose to be in it together. We just happened to find ourselves in a pandemic that didn’t spare anyone. Now that we do have some choice, each country is taking care of their own first. Continue reading

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