Ethical Exit Strategy (COVID-19)

Dr Alberto Giubilini

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

Overview

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:

  1. 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?
  2. What kind of contact-tracing technologies and procedures (e.g mobile app and human contact tracing) can be used during the transition, and how?
  3. When we have a vaccine, which vaccination policy should be adopted?

Relevance

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.

Investigator

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.

Resources

covid 19 ethical exit strategy globe and text

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."

Project Publications

Giubilini, A., Wilkinson, D., & Savulescu, J. (forthcoming 2021). Queue questions: ethics of COVID-19 vaccine prioritization. Bioethics.

Savulescu, J.,Giubilini, A.,Danchin, M. (forthcoming 2021). Mandatory vaccination in children? Journal of Pediatrics.

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., J. Savulescu, Stopping exploitation: properly remunerating healthcare workers for risk in COVID-19 pandemic. Bioethics, forthcoming 2021

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.

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.

Podcasts

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.

Interviews/Articles/Blogs

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 BlogPandemic 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.

RT UK: Vaccine passports 

Alberto Giubilini argues that individual liberties shouldn't take precedent over public health when it comes to the Covid vaccine (23 March 2021)


TRT World​ Roundtable: EU VACCINE PASSPORTS: Will they get off the ground?

Going anywhere this summer? You might need more than one passport if you plan to leave Europe, or if you want to visit the continent from elsewhere. What are Europe’s plans - for vaccine passports? (11 March 2021)


BBC World News: Vaccine passports

Watch interview with Dr Giubilini, discussing vaccination passports (25 February 2021)


The ethical implications of vaccine passports and COVID status apps

Ada Lovelace Institute (11 February 2021)

The third of Ada's public evidence events on vaccine passports and COVID status apps, in which we explore the ethical questions surrounding them, from the acceptability of discrimination on the basis of immunity status to the question of whether governments can continue to restrict the liberties of those who may no longer pose a risk to others.


Why You Should Take The COVID Vaccine Despite The New Variants

Going Underground on RT (10 February 2021)

Dr Alberto Giubilini discusses why it is a moral imperative for governments to approve and roll out COVID-19 vaccines as fast as possible, why it is a moral imperative for people to take them, why people still should take the Oxford/AstraZeneca Coronavirus Vaccine to protect themselves from hospitalisation from the South African coronavirus variant, ‘irresponsibility’ and alarmism by the mainstream media throughout the pandemic, the reasons for the mistrust of governments, health officials, vaccines and much more!


How much short-term damage has the EU done to its citizens by falling so far behind other countries in the West in Covid vaccinations

Interview for TRT World Roundtable (4 February 2021)


Is the UK wrong to hold a large stock of vaccines?

In this interview for RT UK News, Dr Alberto Giubilini explains why a balance between national and global interest is needed when it comes to vaccine distribution (29 January 2021).


BBC World News: Global Vaccine Distribution

Watch BBC World News interview with Dr Alberto Giubilini on global vaccine distribution and vaccine nationalism (18 January 2021).


Dr Zweli Mkhize has said that the Covid-19 vaccination will not be compulsory in South Africa in mandatory vaccination

Health Minister Zweli Mkhize has said that getting the Covid-19 vaccination will not be compulsory in South Africa. But with just 53% of respondents in a recent poll saying they are willing to get innoculated some are asking whether it would be necessary to make the vaccination mandatory. Is there a case for making the Covid-19 vaccine mandatory and where do we draw the line between personal liberty and public health?(13 January 2021).

NewzRoom Afrika (South African TV).


LA VACCINAZIONE COVID DEVE ESSERE OBBLIGATORIA OPPURE NO

Public debate on mandatory vaccination, in Italian (13 January 2021).

Consulta di Bioetica (Italian think tank).


Should the elderly be first in line for the vaccine?

Should key workers and the young be ahead of the elderly when it comes to administering COVID-19 vaccines? Oxford University’s Albert Giubilini argues the case. He believes that with the vaccine in short supply it needs to be considered whether those at greatest risk of catching the virus need to be at the top of the list to receive it. Interview on CGTN Europe (22 December 2020).

Read accompanying article on CGTN website.


Covid-19 – siðferðileg álitamál [ethical issues]

Dr Jón Ívar Einarsson, Þorsteinn Siglaugsson, Dr Alberto Giubilini and Dr Vilhjálm Árnason discuss some 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? (10 December 2020).

See organisation website Út úr kófinu!


The pros and cons of mandatory COVID-19 vaccination

Should the UK government require people to get vaccinated for COVID-19? Online discussion/survey with Alberto Giubilini and 'Bad Boy of Science' Samuel Gregson (4 December 2020).


talkRADIO with Dan Wootton

Interviewed on lockdown ethics. Dr Giubilini's contribution appears at 27:10 (5 November 2020)


Covid-19: who should be vaccinated first?

Alberto Giubilini interviewed by Katrien Devolder (21 September 2020)

After healthcare and some other essential workers, it might seem the most obvious candidates for a Covid-19 vaccine (if we have one) are the elderly and other groups that are more vulnerable to the virus. But Alberto Giubilini argues that prioritising children may be a better option as this could maximise the benefits of indirect immunity for elderly and other vulnerable groups.


Should vaccinations be compulsory?

Alberto Giubilini interviewed by Katrien Devolder (5 March 2019)

Why do some people refuse to have their child vaccinated? Are there any good reasons not to vaccinate one’s child? Why should one have one's child vaccinated if this doesn't make a difference to whether the community is protected? Why is vaccinating one’s child an ethical issue? In this interview with Dr Katrien Devolder, Dr Alberto Giubilini (Philosophy, Oxford) discusses these and other questions, which he addresses in his new book 'The Ethics of Vaccination' (downloadable for free from Springer website).


Health vs Choice? The Vaccination Debate

Debate at the Battle of Ideas Festival, Barbican Centre, London, with Alberto Giubilini (3 November 2019)

Governments in some countries, like Italy and France, have introduced new measures to compel vaccination against specified diseases, linking proof of vaccination to children’s access to state-provided schooling. These measures are presented as a necessary expression of the public good, of the right of children to be protected from serious and sometimes life-threatening diseases, and of the need to uphold truth against lies. However, the turn to compulsion has led some commentators, even some who support vaccination, to raise questions about these measures. Over 200 years since Edward Jenner’s use of cowpox to provide immunity from smallpox, what should we make of the situation now? Is there a legitimate right for individuals or parents to refuse vaccination? Or are claims for the public good and for the right of children to good health, expressed if necessary through compulsion, more ethically persuasive?