2020 ends with the first people in the United Kingdom being given the vaccine that might – just – if rolled out across the whole population spell the beginning of the end of the COVID-19 pandemic. It is good to be able to hope for such a prospect after an unbelievably difficult and painful year.
It seems churlish then to ask questions about the vaccine but we must do so and seek answers. Some of these questions concern the safety and efficacy of the vaccine. Answering them is important if people are to feel confident about taking the vaccine. We know already that there is a significant degree of ‘vaccine hesitancy’, not as widespread as in the United States where nearly half of the population have indicated they will not be vaccinated, but nevertheless worrying in its extent and possible growth. Some of this is of course supported by absurd anti-vaxxer conspiracy theories. But some of it rests on reasonable fears about possible side effects; and some of it may be supported by understandable moral objections to the ways in which the vaccine may have been developed and produced. These worries need to be addressed and done so in a way that ensures the Government can be trusted in the claims it makes for the vaccine alongside other measures to combat the pandemic. That, given the last nine months of policy making, is no mean feat.
Yet that is only half the story. For, although the Government has repeatedly insisted that in everything it does it is led by the science, we know that there are also major ethical questions to be answered. We know, for instance, that the pandemic has disproportionately impacted on BAME communities, even if it is not entirely clear why this is so; we are now also being told that the pandemic has exposed and exacerbated existing social inequalities; we know that policies of isolation and social distancing have adversely affected the old, single people, and children.
These considerations broach issues of fairness and of equality of treatment which we cannot ignore. In respect of the vaccine roll-out and the question of who gets vaccinated first the Government has chosen to follow the advice of its Joint Vaccination and Inoculation Committee. But this advice is barely morally justified and seems to rest on a very simple principle of prioritising those most in need. Yet do we vaccinate front-line workers only because we think of them as at risk and want them healthy to treat patients? Or do we think that they deserve to be vaccinated early because of what they have done, their sacrifices and work being above and beyond the call of duty, all in the name of the rest of society? Why do we now give priority to the old when back in March and April when it was question of deciding who got access to life-saving ventilators many ethical guidance documents advised that the young should be given precedence over the aged and frail?
These are ethical questions, and they merit informed, considered and fully justified answers. Now of course the public – and our Government – could simply rely on advice from a high-level ethics committee. Indeed, it did commission guidance from a Moral and Ethical Advisory Group (MEAG) set up towards the end of last year and I chair the Nuffield Council on Bioethics that has for 30 years produced independent reports on those social and ethical issues that have arisen from new developments in medical and biological research.
Yet what we also need is a space within which there can be popular deliberation on pressing ethical matters. And we need the means to ensure that the public can discuss and debate these matters in an intelligent, informed and interested way. Here the United Kingdom compares unfavourably with other European countries, such as most notably France and Germany.
In preparation for the revision of the national bioethics legislation, the French Comité Consultatif National d’Éthique in 2018 organized a massive nation-wide public engagement and consultation exercise that resulted in its report, and recommendations, to Government. Its title is wonderfully ambitious: what world we do want for tomorrow? Its sub-titular banner: Participate! Get Informed!
The German ethics committee, Deutscher Ethikrat, alongside Germany’s standing committee on vaccination and academy of sciences, produced last month a wonderfully clear and authoritative set of recommendations on the ethical framework for prioritising access to the vaccine. Importantly, the legal duties of the Ethikrat extend beyond providing advice to the Government to ‘informing the public and encouraging discussion in society’ which it does through regular open and online meetings.
Other examples are easy to find and I will only mention the Irish Citizens Assembly set up in 2016 to address constitutional issues, and which famously broke years of political deadlock by making recommendations on the legalization of abortion that were eventually approved in a referendum and adopted as law.
Ensuring that there is proper, full, and transparent public discussion of these ethical issues is not an academic luxury. It is essential if any democracy is to discharge its duty of ensuring that its laws and policies are understood, supported, and trusted in by the public. This is all the more vital in an emergency public health crisis. Let’s start talking about COVID ethics!
This piece is part of the "Democratic Response to COVID-19" series curated by Involve and the Centre for the Study of Democracy at Westminster University.
Dave Archard is a Professor of Philosophy who has taught at the Universities of Ulster, St Andrews, Lancaster and Queen's Belfast, and has written extensively on issues in applied ethics, political philosophy and philosophy of law. He is Honorary Vice-President of the Society of Applied Philosophy and the current Chair of the Nuffield Council on Bioethics.