Ethical Exit Strategy (COVID-19)
The Ethical Exit Strategy: the path from relaxing measures to vaccination
PI: Dr Alberto Giubilini
Funded by UKRI
Duration: 10 months
Starting date: 1 June 2020
The current lockdown to contain the COVID-19 emergency, even as it is eased, implies a societal, economic, and psychological cost that is not sustainable for too long. The ‘exit strategy’ is and will be for quite a while the main focus of the public health and political debate, also in consideration of the not too remote possibility of a second wave of the virus in the coming months. But the exit strategy cannot be designed and implemented unless certain ethical decisions about trade-offs between values are made.
Although they might seem just technical decisions about epidemiology, economics, or psychology, many of the decisions in the exit strategy will actually be ethical decisions about how to weigh these different aspects against each other. This project addresses, in chronological order, three core steps of the exit strategies that require close ethical scrutiny:
- At what point, and through which steps, will it be acceptable to start the path back to some form of normality, and how should this path be affected in case of a second wave?
- What kind of contact-tracing technologies and procedures (e.g mobile app and human contact tracing) can be used during the transition, and how?
- When we have a vaccine, which vaccination policy should be adopted?
From the way talk about exit strategy is currently framed, it might appear that it will be a matter of technical decisions or, as the Government put it, a matter ‘of taking the right steps at the right time, informed by the best science’. But this is only partly true. Policy makers will need to show commitment to ethical principles and be able to justify decisions to sacrifice certain values and principles for the sake of others, which will be unavoidable
For example, they might have to increase risk of illness or even death for certain individuals for the sake the psychological or financial interest of those who are being most heavily affected by the lockdown; to sacrifice to a certain degree privacy for the sake of public health in the use of contact-tracing technologies. This is not merely about “the best science”. These are ethical decisions.
It will not be possible to make these decisions without having a plausible story about which values will at some point have to be prioritized, and why. This is not only because policy decisions need to be ethically acceptable (which is always a requirement), but also because without appealing to certain ethical values, that go beyond merely technical considerations, it will be difficult to gain people’s trust.
This research will result in a set of recommendations, in the form of policy papers addressed to the relevant Government departments as well as academic papers, about how to make these necessary trade-offs between values in a way that can inform both public health policy and public health communication strategy.
Alberto Giubilini is a Senior Research Fellow at the Oxford Uehiro Centre for Practical Ethics and at the Wellcome Centre for Ethics and the Humanities, University of Oxford. He has a PhD in Philosophy from the University of Milan, and prior to joining the Uehiro Centre he worked in Australia at Monash University, University of Melbourne and Charles Sturt University. He has published on different topics in bioethics and philosophy, with a particular focus in recent years on public health ethics (including the ethics of vaccination, of antibiotic resistance, of challenge studies, and of coerciveness of public health measures more generally). He recently published the book The Ethics of Vaccination (Palgrave MacMillan 2019). See Oxford University Research Archives for Dr Giubilini's publications.
World Health Organization Policy Brief 'COVID-19 and mandatory vaccination: Ethical considerations and caveats'
WHO Policy Brief 13 April 2021 references Alberto Giubilini's 2019 open access book 'The Ethics of Vaccination', freely available to download.
Link to policy brief COVID-19 and mandatory vaccination: Ethical considerations and caveats
Link to open access book Ethics of Vaccination
House of Commons Library Briefing Paper Number CBP 9076
Alberto Giubilini, Julian Savulescu et al (9 December 2020). UK Vaccination Policy
Authored by Cristiana Vagnoni, Elizabeth Rough and Sarah Bunn, this House of Commons Library briefing paper references several pieces of work by Alberto Giubilini and colleagues from Oxford Uehiro Centre and Oxford Martin School.
This Commons Library briefing paper provides an overview of UK vaccination policy. It includes an introduction to the science of vaccination and covers UK vaccination programmes, as well as considering the response of the Government to the UK's loss of the World Health Organization's (WHO) measles elimination status.
Download full report PDF from the Research Briefing: UK Vaccination Policy page.
Exit Statement: 'COVID-19: Ethical guidelines for the Exit Strategy'
Alberto Giubilini and Julian Savulescu (1 October 2020). Exit Statement PDF.
"The UK “Exit Strategy”, which aims at safely easing the restrictions introduced in March 2020 to contain the COVID19 epidemics in the UK, needs to balance different values and priorities, beyond protecting the population from the virus. The task will be made even more difficult by the fact that Exit Strategy will have to be responsive to likely new spikes of COVID-19 cases, if not by an actual second wave of the virus."
THIS Institute Report: 'Pandemic Ethics: Testing times: An ethical framework and practical recommendations for COVID-19 testing for NHS workers'
Expert group including Alberto Giubilini, (21 July 2020). THIS Institute Report PDF.
"The report sought to identify and characterise the ethical considerations likely to be important to the testing programme, while recognising the tension between different values and goals. The project was guided by an expert group and by an online consultation exercise held between 27 May and 8 June 2020 to characterise the range and diversity of views on this topic. The 93 participants in the consultation included NHS workers in clinical and non-clinical roles, NHS senior leaders, policy-makers, and relevant experts. The project report emphasises that getting the COVID-19 swab testing programme for NHS workers right is crucial to support staff and patient safety and broader public health. It also recognises that COVID-19 does not affect all population groups equally. People who are socio-economically disadvantaged or members of Black, Asian and Minority Ethnic (BAME) groups may face distinctive issues in relation to testing."
Bradfield, O. and Giubilini, A., (2021), 'A spoonful of honey or a gallon of vinegar? A conditional COVID-19 vaccination policy for frontline healthcare workers', Journal of Medical Ethics, Vol: 47(7): 467–472 [PMC8257552]
Freeman, D., Waite, F., Rosebrock, L., Jenner, L., Chadwick, A., Innocenti, S., McShane, H., Vanderslott, S., Vaccari, C., Loe, B. S., Pollard, A., Giubilini, A., Yu, L., Petit, A., & Lambe, S. (2020). COVID-19 Vaccine Hesitancy in the UK: The Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS) II. Psychological Medicine, 1–34.
Giubilini, A., Minerva, F., Schuklenk, U. and Savulescu, J., (2021), 'The "Ethical" COVID-19 vaccine is the one that reserves lives: religious and moral beliefs on the COVID-19 vaccine', Public Health Ethics, Vol: 14(3): 242-255 [PMC8344725]
Giubilini, A., Savulescu, J. and Wilkinson, D., (2021), 'Queue questions: Ethics of COVID-19 vaccine prioritization', Bioethics, Vol: 35(4): 348-355 [PMC8013927]
Giubilini, A. and Savulescu, J., (2021), 'Stopping exploitation: properly remunerating healthcare workers for risk in COVID-19 pandemic', Bioethics, Vol: 35(4): 372-379 [PMC8014134]
Giubilini, A., Vaccination ethics, British Medical Bulletin, forthcoming 2021
Giubilini, A. , Why you should not (be allowed to) have that picnic in the park, even if it does not make a difference Think!, forthcoming in issue 58, 2021
Grimwade O, Savulescu J, Giubilini A, et al 2020. Fair go: pay research participants properly or not at all. Journal of Medical Ethics 46 :837-839 on journal website here.
Grimwade, O., J Savulescu, A Giubilini et al 2020. Payment in Challenge Studies: Ethics, Attitudes and a New Payment for Risk Model, Journal of Medical Ethics, Vol: 46(12): 815–826 [PMC7719900]
Giubilini, A., Savulescu, J. and Wilkinson, D., (2020), 'COVID-19 vaccine: vaccinate the young to protect the old?', Journal of Law and the Biosciences, Vol: 7(1) [PMC7337759]
Giubilini, A. 2020, Using individuals as (mere) means in management of infectious disease without vaccines. Should we purposely infect young people with coronavirus? American Journal of Bioethics, 20, 9: 62-65 Open Peer Commentary on journal website here (subscription required).
Rainey, S. and A Giubilini 2020, Return to status quo ante: the need for robust and reversible pandemic emergency measures. Cambridge Quarterly of Healthcare Ethics, forthcoming.
Savulescu, J., Giubilini, A. and Danchin, M., (2021), 'Global Ethical Considerations Regarding Mandatory Vaccination in Children', The Journal of Pediatrics, Vol: 231(April): 10-16 [PMC7817402]. Authors' reply: Reply to Sprengholz and Betsch, The Journal of Pediatrics, online (17 August 2021)
Previous Related Publications
Giubilini, A., (2019), 'Ethics of Vaccination', (Palgrave Macmillan) [Freely available open access content NBK538383].
Giubilini, A. 2020 An argument for compulsory vaccination: the taxation analogy. Journal of Applied Philosophy, 37, 3: 446-466 on journal website here.
Giubilini, A. and J. Savulescu 2019. Vaccination, risks, and freedom: the seat belt analogy. Public Health Ethics, 12, 3: 237-249 on journal website here.
Giubilini, A. et al 2019 Nudging immunity. The case for vaccinating children in school and day care by default. HEC Forum, 31, 4: 325-344.
Meiring, JE, A Giubilini, J Savulescu, VE Pitzer, and AJ Pollard. 2019. Generating the Evidence for Typhoid Vaccine Introduction: Considerations for Global Disease Burden Estimates and Vaccine Testing through Human Challenge. Clinical Infectious Diseases 69 (Supplement_5): S402–S407 on journal website here.
Giubilini, A., J Savulescu, 2019. Demandingness and public health, Moral Philosophy and Politics, 1, 6: 65-87 on journal website here.
Giubilini, A. , T. Douglas, J. Savulescu, 2018. The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine, Health Care and Philosophy, 21, 4: 547-560 on journal website here.
LBC Radio: Alberto Giubilini on sending vaccines to India (27 April 2021)
Red Box (Times Radio): The Only Way Is Ethics [Dr Giubilini's contribution starts at 39:50] (25 March 2021). Matt Chorley tackles the philosophical questions behind pub passports and longer lockdowns, with AC Grayling, Baroness Deech and Alberto Giubilini.
ORF (Austrian radio), Interviewed on the suspension of the AZ vaccine in some European countries (18 March 2021)
Oxford Sparks, Who should get the vaccine first? Podcast for Oxford Sparks on vaccines and prioritization (3 February 2021)
LBC Radio, What role should vaccine passports play post-Covid? (7 February 2021)[starts at 5:00, available until Sunday 14 February 2021]
Sky News Daily Podcast, COVID vaccine priority - young before old? [Dr Giubilini's contribution starts at approx 10min] (14 January 2021). Indonesia's prioritization approach to the the covid vaccine (prioritising 18-59 year olds to boost economy, rather than the elderly).
BBC Sounds: The Real Story, 'Covid vaccines: An opportunity for science?' [Dr Giubilini's contribution appears at 37:00 - 40:00] (27 November 2020). Vaccines appear close to deployment. But how many people will be willing to get it?
The Spectator Out Loud, 'The ethics of lockdown' (7 November 2020)
The Guardian, 17 September 2020, podcast: 'Covid-19 ethics: should we deliberately infect volunteers in the name of science? (part 2)'. Listen to Part 2 on The Guardian website.
The Guardian, 15 September 2020 podcast: 'Covid-19 ethics: should we deliberately infect volunteers in the name of science?' (part 1). Listen to Part 1 on The Guardian website.
i News, NHS frontline jobs ‘should be conditional on Covid vaccination’. References Owen Bradfield's and Alberto Giubilini's open access paper 'A spoonful of honey or a gallon of vinegar? A conditional COVID-19 vaccination policy for frontline healthcare workers', Journal of Medical Ethics (online first 11 May)
Practical Ethics in the News Blog (crosspost with Lockdown Sceptics), Crosspost: Immunity Passports: A Debate Between Jay Bhattacharya and Alberto Giubilini (7 May 2021)
Sky News: quotes Alberto Giubilini, COVID-19: India's vaccine export ban could send shockwaves worldwide. Should the UK step in to help? (30 April 2021)
Corriere della Sera, Interview on vaccination and lockdown (in Italian) 'Vaccinarsi è una responsabilità etica, e per questo dovrebbe essere un obbligo' (20 March 2021)
Practical Ethics in the News Blog, What Is The Justification For Keeping Lockdown In Place? Two Questions For The UK Government (with Julian Savulescu, 3 March 2021)
Sky News Italy, Passaporto vaccinale, i dubbi del Regno Unito: Alberto Giubilini discusses with vaccination passports on Sky Italy [in Italian] (24 February 2021)
UrduPoint News/Sputnik, Lower Vaccine Efficacy Against New COVID-19 Strain Makes Wider Vaccination More Important (9 February 2021)
Reuters, As vaccines arrive, South Africa faces widespread scepticism over safety (8 February 2021)
The Wall Street Journal, Covid-19 Vaccine Shortage Sparks Fights Over Who Should Get First Shots (5 February 2021) [subscription required]
Practical Ethics in the News Blog, The UK should share the vaccine with the other countries – but only after all the vulnerable have been vaccinated (3 February 2021) [Cross-posted on The Conversation]
RT UK News, Is the UK wrong to hold a large stock of vaccines? (29 January 2021) [YouTube]
The Guardian, UK vaccine strategy 'paying off' as latest trials boost stockpiles: Pre-ordering of Janssen and Novavax means Britain has procured 247m successfully trialled jabs (29 January 2021)
The Guardian, Sharing Covid vaccines is in UK's best interests, say scientists (28 January 2021)
Practical Ethics in the News Blog, Current Lockdown Is Ageist (Against The Young) (27 January 2021)
ANews (Turkish TV), on the challenges of equitable vaccine distribution (25 January 2021) [Watch on Facebook]
BBC World News, Interviewed on global vaccine distribution (18 January 2020) [YouTube]
NewzRoom Afrika, (South African TV) Dr Zweli Mkhize has said that the Covid-19 vaccination will not be compulsory in South Africa in mandatory vaccination (13 January 2021) [YouTube]
Consulta di Bioetica (Italian think tank), LA VACCINAZIONE COVID DEVE ESSERE OBBLIGATORIA OPPURE NO (13 January 2021). Public debate on mandatory vaccination (in Italian) [YouTube]
LBC London, How bad are the kinds of lockdown breaches going on in your local area? (12 January 2021). Dr Giubilini's contribution appears at 1h:10min [available online until 18 January]
BRINK, How Do We Overcome Europe’s COVID-19 Skepticism? (7 January 2021). As Europe starts to distribute the COVID-19 vaccine, many European governments are facing high levels of vaccine skepticism among their populations. In France, polls suggest 46% of the population would reject a COVID-19 vaccine, if offered. And similar levels are found in Poland and Hungary.
CGTN Europe, Should the elderly be first in line for the vaccine? (22 December 2020). See also interview on YouTube
The Washington Post, Should a coronavirus vaccine be mandatory? In Brazil’s most populous state, it will be. (7 December 2020)
Út úr kófinu!, Covid-19 – siðferðileg álitamál [ethical issues] (10 December 2020). YouTube discussion with Dr Jón Ívar Einarsson, Þorsteinn Siglaugsson and Dr Vilhjálm Árnason. The participants discuss some of the ethical issues relating to Covid-19. Is it morally justified to ignore the consequences of antiviral measures when deciding on disease control measures? What are the ethical issues when it comes to the possible obligation to vaccinate or to infringe on the human rights of people who do not choose to be vaccinated? Is all human life equally important? Is it morally justified to consider the life of a young person more important than the life of an elderly person, as is often the case when deciding on treatment options in the health care system? See organisation Út úr kófinu! website.
The Conversation, Should COVID-19 vaccines be mandatory? Two experts discuss (25 November 2020). Alberto Giubilini and Vageesh Jain. 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?
talkRADIO, interviewed by Dan Wooton (5 November 2020) [available on YouTube, Dr Giubilini's contribution appears at 27:10]
The Spectator, 'The (absent) ethics of lockdown' (7 November 2020) [view as jpg file or listen to reading on Spectator Out Loud]
New York Times, 'In Fights Over Face Masks, Echoes of the American Seatbelt Wars' (15 October 2020). References Giubilini and Savulescu's 2019 open access paper 'Vaccination, risks, and freedom: the seat belt analogy'
Practical Ethics in the News Blog, Pandemic Ethics: Should Santa Claus deliver Christmas presents this year? Preparing for our first COVID-19 Christmas (15 October 2020)
Boston Globe, 'COVID vaccinations could use a nudge' (4 September 2020). You’re more likely to get your coronavirus shot if that’s the easier course of action.
New Scientist ,'If we ever make a covid-19 vaccine who should be first to get it?' (12 August 2020)
Amnesty International, online debate article 'Should vaccinations be mandatory?' with Louise Gunning for Dutch magazine Wordt Vervolgt (Amnesty International) (July 2020).
laRegione, article in Swiss newspaper, interview in Italian 'L’equità di un vaccino obbligatorio' [Immunity is a public good and as such everyone must contribute] (23 May 2020)
news.com.au, 'Coronavirus vaccine: French government demands equal access in COVID-19 vaccine distribution row' (17 May 2020). Tough decisions will need to be made about who should receive priority access to potential vaccines.
The Atlantic, (cross-posted with OUC's 'Ethics in the News' blog): Alberto Giubilini, Article: Is It Ethically Okay to Get Food Delivered Right Now? (16 April 2020). A guide to this and other pandemic food dilemmas.