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pandemic ethics

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’.

Read More »Should Vaccination Status Affect ICU Admission?

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.

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

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?

Read More »Vaccine Nationalism: Striking the balance

Guest Post: What Is The Case For Virtual Schooling?

Written by Thomas Moller-Nielsen

News that children in England were to switch to online schooling as part of the country’s third national lockdown in response to the Covid-19 global pandemic was met with widespread support in the British press. Doctors, public health specialists, and even teaching unions similarly applauded the decision. (Nurseries, which have remained open during the latest lockdown period, have also been put under heavy pressure to close.)

The justification for the suspension of in-person schooling during this pandemic, however, is far from obvious. Indeed, there are at least two prima facie plausible reasons for scepticism. Firstly, children are far less susceptible to serious infection or death from Covid-19 than adults are. (While the precise figures are open to dispute, the Medical Research Council Biostatistics Unit at the University of Cambridge has estimated that the infection-fatality rate for 5-14 year-olds in England is 0.0013% – which is roughly 24 times smaller than the infection fatality rate for 25-44 year-olds, and approximately 9000 times smaller than the infection-fatality rate for 75+ year-olds.) Secondly, virtual schooling – in addition to being a poor substitute for in-person schooling – is widely recognized to be a key contributing factor in students’ increased feelings of stress, depression, and anxiety during the pandemic, and has been similarly linked to many physical paediatric disorders such as juvenile hypertension and obesity.

In other words, it seems that: (i) children are not in serious danger of being (directly) harmed by Covid-19; and (ii) children are in very real danger of being harmed by online schooling. Why, then, should students be required to attend virtual school?Read More »Guest Post: What Is The Case For Virtual Schooling?

Cross Post: Pandemic Ethics: Vaccine Distribution Ethics: Monotheism or Polytheism?

Written by Alberto Giubilini, Julian Savulescu, Dominic Wilkinson

(Oxford Uehiro Centre for Practical Ethics)

(Cross-posted with the Journal of Medical Ethics blog)

Pfizer has reported preliminary results that their mRNA COVID vaccine is 90% effective during phase III trials. The hope is to have the first doses available for distribution by the end of the year. Discussion has quickly moved to how the vaccine should be distributed in the first months, given very limited initial availability. This is, in large part, an ethical question and one in which ethical issues and values are either hidden or presented as medical decisions. The language adopted in this discussion often assumes and takes for granted ethical values that would need to be made explicit and interrogated. For example, the UK Government’s JCVI report for priority groups for COVID-19 vaccination reads: “Mathematical modelling indicates that as long as an available vaccine is both safe and effective in older adults, they should be a high priority for vaccination”. This is ethical language disguised as scientific. Whether older adults ‘should’ be high priority depends on what we want to achieve through a vaccination policy. And that involves value choices. Distribution of COVID-19 vaccines will need to maximize the public health benefits of the limited availability, or reduce the burden on the NHS, or save as many lives as possible from COVID-19. These are not necessarily the same thing and a choice among them is an ethical choice.Read More »Cross Post: Pandemic Ethics: Vaccine Distribution Ethics: Monotheism or Polytheism?

Press Release: UK Approves COVID-19 Challenge Studies

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Responses to the UK COVID-19 Challenge Studies: 

“In a pandemic, time is lives.  So far, over a million people have died.

“There is a moral imperative to develop to a safe and effective vaccine – and to do so as quickly as possible.  Challenge studies are one way of accelerating vaccine research.  They are ethical if the risks are fully disclosed and they are reasonable.  The chance of someone aged 20-30 dying of COVID-19 is about the same as the annual risk of dying in a car accident.  That is a reasonable risk to take, especially to save hundreds of thousands of lives.  It is surprising challenge studies were not done sooner.  Given the stakes, it is unethical not to do challenge studies.”

Prof Julian Savulescu, Uehiro Chair in Practical Ethics, and Director of the Oxford Uehiro Centre for Practical Ethics, and Co-Director of the Wellcome Centre for Ethics and Humanities, University of Oxford

“Human challenge studies are an important and powerful research tool to help accelerate our understanding of infectious diseases and vaccine development.  They have been used for many years for a range of different infections.

“The announcement of the UK Human Challenge Program is a vital step forward for the UK and the world in our shared objective of bringing the COVID-19 pandemic to an end.  With cases climbing across Europe, and more than 1.2 million deaths worldwide, there is an urgent ethical imperative to explore and establish COVID-19 challenge trials.

“All research needs ethical safeguards.  Challenge trials need to be carefully designed to ensure that those who take part are fully informed of the risks, and that the risks to volunteers are minimised.  Not everyone could take part in a challenge trial (only young, healthy volunteers are likely to be able to take part).  Not everyone would choose to take part.  But there are hundreds of young people in the UK and elsewhere who have already signed up to take part in COVID challenge studies.  They deserve our admiration, our support and our thanks.”

Prof Dominic Wilkinson, Professor of Medical Ethics, Oxford Uehiro Centre for Practical Ethics, University of Oxford

Further Research

Read more about the ethics of challenge studies:

Read More »Press Release: UK Approves COVID-19 Challenge Studies

Pandemic Ethics: Utilitarianism and the Lockdown

by Roger Crisp

Utilitarianism is in the news. It was widely believed that the UK government’s so-called ‘herd immunity’ strategy, which involved sacrificing the important interests of a relative few for the sake of benefits for the many, was motivated by a commitment to utilitarianism. Now several commentators around the world have suggested that decisions to ease lockdowns so as to ‘open economies’ can also be seen for similar reasons as utilitarian.Read More »Pandemic Ethics: Utilitarianism and the Lockdown

Interview Series: Do Health and Social Care Workers Have a Moral Obligation to Keep Working if they Lack Protective Equipment?

    Philosopher Udo Schüklenk argues that it is morally permissible for doctors, nurses and other care workers to stop working if they lack PPE (personal protective equipment).  To listen to the interview, follow this link to the podcast: https://podcasts.apple.com/gb/podcast/is-it-morally-permissible-for-healthcare-workers-to/id1509190881?i=1000472576406