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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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PRESS RELEASE: Racial Justice Requires Ending Drug War, Say Leading Bioethicists

PRESS RELEASE: Free all non-violent criminals jailed on minor drug offences, say experts

Non-violent offenders serving time for drug use or possession should be freed immediately and their convictions erased, according to research published in the peer-reviewed The American Journal of Bioethics.

More than 60 international experts including world-leading bioethicists, psychologists and drug experts have joined forces to call for an end to the war on drugs which they argue feeds racism.

All drugs currently deemed illicit – even crack cocaine and heroin – should be decriminalized as a matter of urgency, according to this new alliance. Legalisation and regulation should then follow with restrictions on age, advertising and licensing, they say.

They have analysed evidence from over 150 studies and reports, concluding that prohibition unfairly affects Black and Hispanic people, damages communities, and violates the right to life as illustrated by the killing of medical worker Breonna Taylor in March last year.

“The ‘war on drugs’ has explicitly racist roots and continues to disproportionately target certain communities of color,” say lead study authors Brian D. Earp from Yale University and the University of Oxford and Jonathan Lewis from Dublin City University.

“Drug prohibition and criminalization have been costly and ineffective since their inception. It’s time for these failed policies to end.

“The first step is to decriminalize the personal use and possession of small amounts of all drugs currently deemed to be illicit, and to legalize and regulate cannabis. Policymakers should pursue these changes without further delay.”

Their research adds to growing calls for drug policy reform at a time of renewed focus on injustices faced by Black people, and cannabis legalisation for recreational use by a growing list of US states.

The study is based on evidence from existing research into how drug prohibition affects users, communities and human rights, and the impact of decriminalisation by governments.

The authors found that prohibition creates conditions for individuals to commit offences such as burglaries to fund their habit. This lowers life expectancy because people end up in prison, and triggers a ‘multitude’ of health-related costs from unsafe drug use.

Communities are damaged by illicit markets which undermine drug purity, with Black and Hispanic men more likely to end up in the criminal justice system. The war on drugs makes people more vulnerable to violations of their rights including what they choose to put in their bodies.

In contrast, the study highlights the liberal approach of countries such as Portugal where drug-related deaths have fallen and where users are encouraged to seek treatment.

An estimated £43.5bn ($58bn) could be generated in federal, state and local tax revenues through the legalization of drugs, according to the findings. This compares with an annual federal, state and local spend of more than £35bn ($47bn) on prohibition.

The authors stress that non-violent prisoners found with a small amount of illegal substances should be released.

Further Information

The study’s senior author Carl L. Hart was Columbia University’s first tenured African American professor of sciences. He is open about the fact he uses recreational drugs and his book Drug Use for Grown Ups is set for publication in January 2021.

For an interview, please contact:

Brian D. Earp (brian.earp@yale.edu), Jonathan Lewis (Jonathan.Lewis@dcu.ie), or Carl L. Hart (c.hart@columbia.edu)

For a copy of the paper, visit: https://newsroom.taylorandfrancisgroup.com/embargoed-releases/ 

For a copy of the journal article, please contact:
Simon Wesson, Press & Media Relations Executive
Email: newsroom@taylorandfrancis.com
Tel.: +44 (0)20 701 74468
Follow us on Twitter: @tandfnewsroom

The article will be freely available once the embargo has lifted via the following link: https://www.tandfonline.com/doi/full/10.1080/15265161.2020.1861364

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

Dementia, Pagal, or Neurocognitive Disorder: What Is In a Name?

By Doug McConnell

 

A recent BBC news story has drawn attention to the fact that there isn’t a word for “dementia” in many South Asian languages and some South Asian people living in the UK still use the stigmatising Punjabi word “pagal”, meaning “crazy” or “mad”. The news story implicitly assumes that the word “dementia” is non-stigmatising but this is disputed. If the word “dementia” is itself stigmatizing, are anglophones really in a position to criticize other languages? Can we adopt a non-stigmatising word for dementia? Continue reading

Cross post: Pandemic Ethics: Should COVID-19 Vaccines Be mandatory? Two Experts Discuss

Written by Alberto Giubilini (Oxford Uehiro Centre for Practical Ethics and WEH, University of Oxford )

Vageesh Jaini (University College London)

(Cross posted with the Conversation)

 

To be properly protective, COVID-19 vaccines need to be given to most people worldwide. Only through widespread vaccination will we reach herd immunity – where enough people are immune to stop the disease from spreading freely. To achieve this, some have suggested vaccines should be made compulsory, though the UK government has ruled this out. But with high rates of COVID-19 vaccine hesitancy in the UK and elsewhere, is this the right call? Here, two experts to make the case for and against mandatory COVID-19 vaccines.

 

Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of Oxford

COVID-19 vaccination should be mandatory – at least for certain groups. This means there would be penalties for failure to vaccinate, such as fines or limitations on freedom of movement.

The less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it.
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Pandemic Ethics: Should Santa Claus Deliver Christmas Presents This Year? Preparing For Our First COVID-19 Christmas

Written by: Alberto Giubilini; Oxford Uehiro Centre for Practical Ethics, &

Wellcome Centre for Ethics and Humanities, University of Oxford

It’s that time of the year again, when Christmas decorations start to appear way too early in shopping malls. It’s beginning to look a bit too much like Christmas. Except that, being it 2020, of course this year “it will be different”.

Pubs are very optimistically accepting bookings for Christmas dinners, but many Christmas markets are (un)fortunately being cancelled. You might still see your distant relatives on Christmas day, but (un)fortunately no more than 6 of them at any one time.

Amidst the inevitable confusion, one obvious question is whether Santa Claus should deliver presents this year.

There are various factors to consider when deciding what Santa – but indeed everyone else – should be allowed to do over Christmas. The most relevant are probably the following:

  1. COVID-19 infection rate over Christmas.
  2. Risks and benefits for others of Santa’s job.
  3. Risks and benefits for Santa

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COVID-19: Ethical Guidelines for the Exit Strategy

Alberto Giubilini

Julian Savulescu

Oxford Uehiro Centre for Practical Ethics

University of Oxford

Supported by the UKRI/AHRC funded project “The Ethical Exit Strategy”

(Grant number AH/V006819/1)

https://practicalethics.web.ox.ac.uk/ethical-exit-strategy-covid-19

These are the “Main Points” and the Executive Summary of a Statement on key ethical considerations and recommendations for the UK “Exit Strategy”, that is, the strategy informing the series of measures to move the country from the state of lockdown introduced in March 2020 to a ‘new normality’.

The full Statement can be found at https://practicalethics.web.ox.ac.uk/files/covidexitstatement1octaccpdf

The document has been produced also on the basis of the discussion among academics and stakeholders from different fields (ethics, economics, medicine, paediatrics, mental health, nursing), who participated in an online workshop on the “Ethical Exit Strategy”, held on the 8th of July 2020. Continue reading

Video Series: Which Non-Covid-19 Patients Should Get Treatment First?

In the UK we’re past the peak of the coronavirus pandemic but new ethical issues are arising: the healthcare system is now under enormous pressure – it’s working less efficiently than before (because of precautions to protect healthcare personnel), and there’s an enormous backlog of patients whose treatments have been put on hold. Which non-Covid-19 patients should get treated first and who will have to wait?  Dominic Wilkinson, Professor of Medical ethics and Consultant in Newborn Intensive Care, sheds some light on this important question, and proposes a practical solution. (To watch with subtitles, press the ‘YouTube’ button in the video.)

 

Forced Medical Feeding

By Roger Crisp

At a recent New St Cross Special Ethics Seminar Prof. Noam Zohar of the Dept. of Philosophy, Bar Ilan University and a member of Israel’s National Bioethics Council, spoke on ‘Debating Forced Medical Feeding: A Critical Examination of Israeli Responses to Hunger Strikes’. Continue reading

Following the Science Without Forgetting Values

Written by Stephen Rainey

It is presently feared that ‘lockdown’ may be beginning to fray at the edges, as people tire of their restrictions. From the start of the emergency, discussion focussed upon the ability of the public to stay the course where restrictions were at stake. This neatly ignores the public’s being ahead of the government in acknowledging the severity of the situation before the 23rd March announcement to restrict social freedoms. At any rate, concerns over policy effectiveness were addressed through faith in behavioural science (via ‘Behavioural Insights’, née ‘The Nudge Unit’), and communications devices such as the repeated phrase, ‘following the science’.

‘Following the science’ raises reasonable questions including, which science and why? In what sense ‘follow’? To what degree? The idea of creating arguments ‘from science’ for any given policy is presumed sufficient as a motivation, or a reason for citizens to submit themselves to policy demands. However, given the expert basis for these arguments, it is not a safe bet that any given citizen will share the assumptions or knowledge base of the experts, let alone adopt them as straightforward reasons to alter their behaviour. Few people like to be told what to do without at least understanding what is being asked of them and why, so this can be a problem.

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