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While mandatory measures can be proportionate for the elderly, they can also be disproportionate for for younger people in the pandemic.

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So many people accept that in order to protect public health, it is sometimes acceptable or even morally obligatory to restrict people's liberties,

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for example, by imposing lockdowns, work from home requirements or travel restrictions.

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But there's a lot of disagreement about how far these restrictions should go.

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There's a question of whether we should have full or partial lockdowns,

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but also about who should be subject to the restrictions everyone in society or particular groups in society.

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I'll talk about this topic to Professor Julian Savulescu, Uehiro chair in practical ethics here at the University of Oxford and also

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a professorial visiting fellow at the Murdoch Children's Research Institute in Melbourne,

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I'm Katrien Devolder from the Oxford Uehiro Centre for Practical Ethics.


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This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.

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If you'd like to see more of my interviews, don't forget to subscribe to the practical ethics channel on YouTube,

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and you can also just listen to the interviews on Apple Podcasts so you defend a selective approach to the restriction of liberty.

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So can you just explain a little bit what you mean by that? Yeah.

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So I think there are four factors that determine whether coercion or mandatory

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measures like lockdown or mandatory vaccination or vaccine passports are ethical.

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Firstly, the gravity of the problem, you have to have a severe problem.

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The safety and the effectiveness of the intervention needs to be safe and effective.

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The mandatory measure needs to be thirdly, significantly better than the less coercive measures,

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such as better information or incentives and payments.

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And lastly, there needs to be proportionality proportionality between the costs of the mandatory measure

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and the gravity of the problem and the safety and effectiveness of the interventions.

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So, you know, if if COVID was as deadly as Ebola and affected all age groups, well, we would have mandatory measures in the blink of an eye.

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The striking thing about COVID is that it affects different groups differently.

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Most markedly, it affects the elderly much more than the young and middle aged.

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So when it comes to the proportionality of a liberty restricting measure, the the elderly have a lot to gain from liberty restriction.

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Their lives are effectively saved, whereas children and young people have very little to gain.

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And so the costs of of the lockdown or the risks of vaccination loom much larger.

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So while mandatory measures can be proportionate for the elderly, they can also be disproportionate for for younger people in the pandemic.

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One obvious objection is yes, but if the health system goes down, everyone suffers.

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So we heard this slogan in the UK Stay home, save the NHS.

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I'm sorry. Stay home. Protect the NHS, save lives.

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So, you know, one could argue, Well, you know, children need to also be locked down or even vaccinated in order to protect the NHS.

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That was that was what we were told. But in fact, it's it's the elderly and other risk groups who are going to become ill and use the NHS resources.

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So and especially given that the vaccines are much better at protecting you from becoming severely ill than they are at reducing transmission.

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I think the strongest argument for mandatory measures is for those at high risk of becoming ill and not for children and young people.

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But of course, some people would argue, for example, when you think about selective lockdown, that you know.

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Lockdown not only protects the NHS,

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but it also actually protects the older people and younger people should do their share in protecting the vulnerable,

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sort of we're all in this together idea. So so what do you think about that then?

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You know, if you're talking about, we're all in this together, we all have to stop spreading the virus.

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It's become clear that vaccination has only a limited effect of reducing transmission.

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Probably at most, it sort of reduces transmission by 50 per cent.

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And that and that was prior to Omicron requiring vaccination for the whole population or locking down the whole population will.

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I think it's true maximally benefit groups such as the elderly.

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But you again have to ask whether that's proportionate because you're restricting the liberty,

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you're inflicting harms on people for the sake of, you know, a small reduction.

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Well, you know, a modest reduction in transmission and modest improvements in survival.

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So everything has to be about a balancing exercise.

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And you know, you there isn't there isn't a simple solution.

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We're all in this together.

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There will be winners and losers, and it's a matter of deciding how those costs and benefits are going to be distributed amongst the population.

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But I think the problem has been that the sole metric of the pandemic has been COVID deaths.

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So sure, if you want to maximally reduce COVID deaths, lock the population down, make it mandatory,

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make vaccination mandatory for everyone, and that will reduce the number of COVID deaths.

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But there will be non-COVID deaths that will be very high as a result of of people's cancers not being diagnosed,

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people's heart attacks not being being treated.

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And so, you know, when you just attend to that single variable, you ignore a whole lot of other relevant variables.

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And in my view, there's been the blanket policies that we are now employing at this stage of the pandemic, I think are arguably disproportionate.

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So so one objection to sort of selective measures, for example,

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selective lockdown of of vulnerable people is that that is ages said it's discriminatory for people above a certain age.

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Do you think that is a valid concern? I mean, it clearly treats people differently, but on a very relevant criterion.

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That is the probability of death. The chance of a 30 year old dying from COVID is the same as dying in a car accident each year.

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The chance of an 85 year old dying from COVID is seven percent.

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So suppose that you had ethnic minority groups that had a much higher chance of of getting Corvette's because of some genetic defect,

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not because of the fact that they're usually more in poorer areas and so on.

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Would it then be justified to impose selective measures on certain ethnic groups if they were more prone to getting COVID?

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Yeah. So there are a number of risk factors for COVID in ages. The most striking by being male, being obese or coming from a BAME minority group is.

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Are also are also high risk factors, so the argument could be extended to say, oh, well,

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then we should selectively lock down or selectively mandatory vaccinate males, the obese and people from ethnic minorities.

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You know, I've only given one argument in favour of some sort of selective lockdown.

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And clearly there are other considerations that have to be weighed, such as equality, correcting structural injustice and so on.

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But there's one feature about age that is different to all of those other characteristics.

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We will all become old. If we're lucky, we won't all become male, we won't all become obese and we won't change ethnicity.

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So in a sense, the, you know, being becoming elderly is something that will affect all of us.

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And when we've done surveys of the public and indeed other other groups who have also done similar surveys,

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a large majority of people see age as a relevant criterion for allocating limited resources.

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The aged are seen as having having already enjoyed more of life,

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and so dessert considerations push in favour of giving some priority to younger people who've had less of a chance to enjoy those limited resources.

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So I think that age is a different kind of criterion two to something like, you know,

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an ethnic minority where you've got independent reasons to think that you shouldn't be

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further imposing burdens on people who may be in this situation because of past injustice.

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So I think, you know, the elderly are not in that in this situation because of some past injustice largely there in this situation,

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because they happen to have benefited from more life.

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So you could have an age selective coercive policy and yet reject other kinds of coercive policies.

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And they're also pragmatic considerations. It would be it simply wouldn't work to lock down all Niles, just also from a practical point of view.

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So even if in theory this idea works, it seems practically really hard to only protect the vulnerable.

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I mean, the first question is, of course, who are the vulnerable? But I don't know the the numbers,

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but I would assume that maybe people above I don't know fifty five or something can be considered vulnerable when it comes to cope with.

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And then, of course, I mean, many younger people care for the elderly, so they mix and then many 50+ plus people have still have children at home.

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So practically practically sorry, I would like such a selective lockdown look like.

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Well, I think a selective lockdown is more difficult, but not impossible.

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But I think selective vaccination, for example, as Italy has selected mandatory vaccinations as Italy is now introduced, these very plausible.

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You can find people over a certain age if they're not vaccinated or vaccine passports.

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You know you have to show a vaccination certificate to enter, you know, pubs and restaurants and so on.

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In many countries, you know,

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you could require that of people who are at risk to show that they're they're not not likely to get ill if they get in that environment.

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So, you know, I want to stress, I don't think this, you know, that this this isn't going to maximally protect the elderly,

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but it's going to give liberties to people, you know, that wouldn't otherwise be available under a blanket policy.

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Now, in the end, it's a question of how much do you balance liberty versus health?

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And also, how much do you balance preventing COVID deaths from preventing non-COVID deaths?

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People will draw these lines in different places,

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but I think that we need to at least consider whether a selective approach is the right one for a particular environment.

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Yeah. So if you say I'm just thinking of New Zealand, who is sort of the, I guess,

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one of the few countries left with hardly any COVID with borders closed and they now have to decide about what sort of yeah,

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what to do, basically whether to open the borders and what sort of approach to take.

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So would you have any advice for the New Zealand government because they're sort of in a situation where they.

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Yes. So it's a it's it's a bit like at the beginning of the pandemic, except that they have vaccines, of course.

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Well, the longer you wait, the you know, the more vaccines you have, the more treatments that are being developed.

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So you have more ways of combating the virus and lowering its mortality.

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So the longer you wait, the better the position you'll be in.

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But what's pretty clear is that everyone in New Zealand will either be vaccinated or have COVID, but probably both at some point.

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So you're just delaying reaching that point.

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And you have to make a decision about whether the costs of waiting longer to get

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better treatments and better vaccines are worth the costs of remaining isolated.

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And I don't know the economic situation in New Zealand or the impact, you know, in other ways of their policies.

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But it's that kind of balancing exercise because, you know, if all you were concerned about doing again was minimising COVID deaths,

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stay locked down until there are perfect cures or perfect vaccines.

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But you know, that's going to cause a lot of other costs that you have to balance.

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And I would have thought, you know, at this point, New Zealand has reached the point that there are there's sufficient,

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you know, coverage with vaccination and sufficient treatments on the horizon to start to open up.

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So last question so so what's what do you think is sort of the most important lesson learnt from this pandemic?

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So what what's the most important thing, according to you, that we should do better when tackling the next pandemic?

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There's been policies proposed with, you know, very little discussion about the ethical opmeer premises or assumptions or values

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behind them and little discussion of the options so people haven't considered,

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you know, how to allocate limited resources like ventilators. They've stocked a very vague terms like frailty.

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They haven't openly discussed whether there should be age limitations to access to ventilators or how vaccines should be allocated.

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The vaccines were allocated in the UK in strict age bands starting from 90 to 100, then 80 to 90, and that save the most lives betterment.

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Inevitably, that some younger people died in their 60s and 70s because they had to wait to get vaccines.

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And now there are just said that was just simply a crude egalitarian approach to vaccination

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or an approach that was based on utilitarianism where just Kovar death was the only metric.

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So I think that these kinds of problems just show that we ethics has been completely absent,

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and I think we should have had a much broader approach of considering differential policies of lockdown or vaccination,

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such as selective lockdown or using incentives rather than coercion.

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But but the ethics of these sorts of issues has just been bulldozed in in this kind of slogan.

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We're just following the science as if science can somehow just dictate what your policy should be.

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Science is extremely important. We need science to develop vaccines, an incredible achievement to develop these vaccines in a year,

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and we also need ethics to decide, you know, how they deployed, how they're researched.

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It took a year or two to start a challenge trial in the world.

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I mean, this is there. There are no good ethical objections to the challenge trials that have been proposed for COVID 19.

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And you know, it's taken a year to do that. So I think it's been an ethical disaster as well as that kind of disaster in terms of human lives.

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