Ethical Exit Strategy (COVID-19)

Alberto Giubilini

PI:  Dr Alberto Giubilini

The ethical Exit Strategy: the path from relaxing measures to vaccination

  • 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).

Resources

covid 19 ethical exit strategy globe and text

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

To follow.

Related Publications

Giubilini, A., (2019), 'Ethics of Vaccination', (Palgrave Macmillan) [Freely available open access content NBK538383].

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., J Savulescu, A Giubilini et al 2020. Payment in Challenge Studies: Ethics, Attitudes and a New Payment for Risk Model, Journal of Medical Ethics, Published Online First: 25 September 2020. Open access paper  on journal website here.

Giubilini A, J. Savulescu, D. Wilkinson 2020, COVID-19 vaccine: vaccinate the young to protect the old? Journal of Law and the Biosciences, 7, 1: lsaa050, Paper on journal website here.

 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.

Interviews

New York Times 'In Fights Over Face Masks, Echoes of the American Seatbelt Wars' (references Giubilini and Savulescu's 2019 open access paper 'Vaccination, risks, and freedom: the seat belt analogy')

Boston Globe article '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 article '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 article '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.#

Podcasts & Blogs

Practical Ethics in the News Blog, 15 October 2020, Pandemic Ethics: Should Santa Claus deliver Christmas presents this year? Preparing for our first COVID-19 Christmas

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.

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).

 

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.