Pandemics present a number of daunting ethical challenges to the economic and social wellbeing of any country, as well as a serious risk to the health of its population. Sensible and proportionate preparation and response by the government, businesses, the media and communities can help to mitigate its effects, however there are many important ethical issues that need to be considered, such as priority of access to healthcare resources with increased demand and possible shortages; obligations of healthcare workers in light of risks to their own health; and the fine balance between reducing disease spread through isolation and travel measures whilst protecting the right of individuals to freedom of movement.
On 31 December 2019, The World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China. The coronavirus disease (COVID-2019) was identified as the causative virus by Chinese authorities on 7 January. On 11 March, WHO officially declared COVID-19 a pandemic. Within seven months the number of COVID-19 cases surpassed 33 million confirmed cases globally, with more than 1 million deaths reported to WHO.
Below are links to online resources, blogs, interviews etc that OUC Researchers have posted in response to the outbreak.
Written evidence from the Wellcome Centre for Ethics and Humanities (COV0156)
On maintaining public health whilst upholding human rights
Contributors from OUC include Dr Jonathan Pugh, Dr Stephen Rainey and Joseph Nguyen
Link to report: https://committees.parliament.uk/writtenevidence/8681/html/
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) 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.
Link to report: https://www.thisinstitute.cam.ac.uk/research-articles/testing-times-ethical-framework/
Schaefer G, Tam CC, Savulescu J, Voo TC. Covid-19 vaccine development: time to consider Sars-Cov-2 challenge studies? SSRN Electronic Journal. January 2020. Link to paper on SSRN.com - SSRN REGISTRATION REQUIRED (FREE)
Bambery B, Douglas T, Selgelid MJ, Maslen H, Giubilini A, Pollard AJ et al. Influenza vaccination strategies should target children. Public Health Ethics. 2018;11(2):221–34. Link to paper on OUP website - OPEN ACCESS
Bambery B, Selgelid M, Weijer C, Savulescu J, Pollard AJ. Ethical criteria for human challenge studies in infectious diseases. Public Health Ethics. 2015;9(1):92–103. Link to paper on OUP website - FREE
Sky News Daily Podcast: Alberto Giubilini, 14 January 2021 COVID vaccine priority - young before old? [Dr Giubilini's contribution starts at approx 10min] Indonesia's prioritization approach to the the covid vaccine (prioritising 18-59 year olds to boost economy, rather than the elderly).
NewzRoom Afrika (South African TV): Alberto Giubilini, 13 January 2021
Dr Zweli Mkhize has said that the Covid-19 vaccination will not be compulsory in South Africa in mandatory vaccination [YouTube]
Consulta di Bioetica (Italian think tank): Alberto Giubilini, 13 January 2021
LA VACCINAZIONE COVID DEVE ESSERE OBBLIGATORIA OPPURE NO. Public debate on mandatory vaccination (in Italian) [YouTube]
The Lancet (news item): written by Tony Kirby, cites Julian Savulescu, 30 October 2020 COVID-19 human challenge studies in the UK The Human Challenge Consortium is an expert group exploring the feasibility and ethics of human challenge trials to accelerate the development of COVID vaccines. “The greatest concern about challenge studies is both the safety of the participants and the impact of a death on trust in science and medicine”, says Professor Julian Savulescu
CNN: Julian Savulescu, updated 24 April 2020 The dangerous morality behind the 'Open it Up' movement A healthcare worker in green scrubs stands in the middle of an intersection, staring down a traffic jam of screaming protesters demanding a return to their livelihoods and...
BBC Radio 4 Sunday: Dominic Wilkinson, 5 April 2020 Covid ethical dilemmas; Plants for Passion; Holy Howlers [approx 34 mins on the clock]. The Covid pandemic has created ‘battlefield’ conditions for UK doctors who may soon have to make very difficult decisions about who to prioritise for life-saving treatment.
Al Jazeera Inside Story: Dominic Wilkinson, 5 April 2020 How long does immunity last? Some countries are considering issuing 'immunity passports' for those who have recovered from the coronavirus. But would that work?
Der Spiegel: Roger Crisp, 28 March 2020 Die Jüngeren sollten den Vorzug erhalten The UK Government's strategy on Covid-19 - younger people should be prioritised for life-saving treatment.
Subscription required for online edition or read/download PDF here (in German).
ABC Radio The Religion and Ethics Report: Xavier Symons, 25 March 2020 Who lives and who dies? If the Coronavirus overwhelms our health system – which, as we discussed last week, it’s done in Italy – what sort of choices could face Australia’s medical professionals?
El Pais: Carissa Véliz, 24 March 2020 La privacidad en tiempos de coronavirus Privacy in times of coronavirus: The most effective measures against the pandemic do not go through apps that affect our rights.
Wall Street Journal: Article by Denise Roland, quotes Julian Savulescu, 19 March 2020 Wanted: People Willing to Get Sick to Find Coronavirus Vaccine Thousands of people have volunteered to be infected in the hope of finding a vaccine for the new coronavirus."There's a positive ethical rationale for doing challenge study experiments," said Julian Savulescu, who leads research on collective responsibility in infectious disease at the University of Oxford. "This kind of research is one of the arrows in the quiver of tackling this kind of catastrophe."
The Sydney Morning Herald: Xavier Symons, 13 March 2020 Rationing care to cope with COVID-19 should never be based on age alone As Australia’s coronavirus outbreak worsens, health authorities are bracing for an unprecedented increase in hospital admissions and demand for acute care. Authorities in NSW are anticipating as many as 1.5 million people in the state to be infected with COVID-19. Hospitals are being asked to double their intensive care capacity in anticipation of a surge of patients.
pri.org: Alberto Giubilini, 06 March 2020 As Italy's students rejoice over school closures, families worry about economic toll “The government is adopting a ‘better safe than sorry’ approach, choosing to impose the most extreme measures. I think it is justified in this case, even though it will be disastrous for many families and for the economy. But the priority right now is public health, so even harsh measures are justified. [...] The government should invest money into compensating the victims of these measures, even if this will worsen the financial crisis already caused by the virus. But if it does not, it is just using people as mere means to an end, which is not ethically acceptable. These people are not necessarily responsible for carrying the disease, but they pay the price.”
BBC Radio 4 Moral Maze: Dominic Wilkinson, Released: 04 Mar 2020 Should we do everything we can to protect the most vulnerable in our society, even if the knock on effect to the global economy has the potential to cause suffering and death for many more people further down the line? With Dr. Tony Booth, Dr. Norman Lewis, Julian Sheather & Professor Dominic Wilkinson. Chaired by Michael Buerk.
Available on BBC Sounds for over a year.
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).
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).
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).
Giubilini, A., (2020) REPORT: Pandemic Ethics: Testing times: An ethical framework and practical recommendations for COVID-19 testing for NHS workers "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."
Controlled human challenge studies involves the deliberate infection of healthy volunteers. They are particularly useful for testing multiple vaccine candidates quickly and efficiently, as well as providing data on the processes of transmission, infection and immunity. Aimed at scientists, policy-makers and regulators, the report outlines the criteria that would need to be met for human challenge studies on COVID-19 to be ethically acceptable.
Thinking Out Loud provides audio-podcasts based on a series of videos produced by OUCs Katrien Devolder in which she talks to leading philosophers from around the world on topics related to practical ethics. The podcast and videos are meant for a non-specialist audience. You can watch the videos on the Practical Ethics Channel or subscribe to the iTunes and/or Oxford Podcasts audio album here.
Interviewees include Alberto Giubilini, Carissa Véliz, Moti Gorin, César Palacios-González, Dominic Wilkinson, Udo Schüklenk, Agomoni Ganguli Mitra, Marco Vergano and Peter Singer.
KCRW’s LIFE EXAMINED: Julian Savulescu, 12 December 2020 Are mandatory vaccinations ethical?
Jonathan Bastian talks with philosopher Julian Savulescu about the anti-vax movement, personal liberty, and the ethics of mandatory vaccinations.
BBC Sounds:Alberto Giubilini, 27 November 2020
The Real Story 'Covid vaccines: An opportunity for science?' [Dr Giubilini's contribution appears at 37:00 - 40:00] Vaccines appear close to deployment. But how many people will be willing to get it?
Oxford Arts Blog: Dominic Wilkinson, 25 August 2020 The philosophy of COVID-19: is it even possible to do the ‘right thing’? For the first time, in a very long time, philosophical considerations have become the stuff of political debate and everyday conversation. Is it right to deprive people of their liberty or not; to dictate personal behaviour or not; to close borders or not; to protect life or the health service or the economy, or not?
OUP blog: Guest post by Alberto Giubilini and Julian Savulescu, 4 April 2020 Why vaccines should be compulsory Vaccines are like a seat belt against infectious diseases, and that vaccination mandates are justified for the same reasons seat belt mandates are [...] if you fail to vaccinate yourself or your children there is a much larger risk of harming other people who are not vaccinated (for example those who are immunosuppressed, young children or those whose immunity has waned over time), besides imposing an easily preventable risk on you and your children.
Stockholm Centre for the Ethics of War and Peace: Tom Douglas, 24 March 2020 Flouting Quarantine The outbreak has brought the ethics of quarantine, isolation and enforced social distancing to public attention.
animalpolitico.com: César Palacios González, 21 March 2020 Coronavirus: los escenarios para México The [Mexican] government has not been clear about the number of deaths it expects or the effects its public health policies will have on the death rate.
(1) The ethical Exit Strategy: the path from relaxing measures to vaccination
UKRI funded project
Investigator: Alberto Giubilini
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)