Hello, I'm Dr. Kristen Heitman, an independent historian based outside of Bethesda, Maryland, in the US,
and this video interview is part of an Oxford based project entitled How Epidemics,
and directed by Dr. Eric Charters, who's associate professor of history at the University of Oxford.
With me today is Dr. Alberto Blini, who is a senior research fellow at the Hero Centre for Practical Ethics, also at the University of Oxford.
His PhD is from the University of Melbourne.
Dr. Drew Bellini has published on several topics in bioethics and philosophy, including the ethics of vaccination, procreative choices,
end of life decisions, the concept of conscience and the role of intuitions and moral disgust and ethical arguments.
Welcome to. Hi, thanks for having me.
Can you begin by explaining the work of an applied ethicist and in particular what sorts of considerations you draw on?
Yes, so applied ethics is a branch of ethics and moral philosophy as an academic discipline.
So you can think of ethics as a broad area where philosophers think about different issues.
Some of these issues have to do with more abstract things, like, for example,
what it means to make moral judgements as opposed to other types of judgements.
So what what what do you mean to say that they should do something as opposed to.
I'd rather do something because it's more convenient to me.
So what's the meaning of ethics itself?
A different branch is some is what is called normative ethics, and it is about what criteria should guide more our moral actions, for example,
whether the good guys should be measured in terms of sticking to certain duties, certain roles,
whether the good should be measured in terms of making people as happy as possible.
So different theories, different criteria for what counts as a collection and as normative theory.
Applied ethics is a third area, and it's basically about applying these normative theories to real world problems.
So part of it consists in identifying the morally relevant aspects, the more relevant,
the factors that determine moral judgements in specific situations.
For example, in the case of the pandemic, we must think that ethically relevant aspects are how many people can we save with different measures?
What kind of duties do we have towards certain groups of people?
So we talk about duties. We refer to normative theories that have to do with the importance of rules of moral obligations,
where we talk about saving as many lives as possible. We have to do with what we call utilitarian normative theory.
So maximising the number of people we save or maximising whatever measure of opportunity we have,
so is a matter of identify morally relevant properties in real world situations and try to balance is different considerations.
That's very interesting. So can you tell us about your work on covid-19 and in particular with respect to how epidemics end yet?
So I've been working for one year now on a grand project, which is called the exit strategy,
which means the strategy moving from a situation of lock down or depressed takes us back to normality.
And it's easier because this project was funded in April 2020.
And back then, talking about the exit strategy made sense because back then we had the
impression you were actually moving out of town then and the situation will go.
That would improve after that. And as a matter of fact, that's not how things went.
So we are still talking about an exit strategy one year later.
And my work now is about how we go back to normality.
So in a sense, how epidemics end by lifting restrictions in a way that takes into account all the more aspects I mentioned before.
So protecting people from covid-19 as much as possible now its possible effects of vaccines.
So vaccination is another area I've been working on,
but also taking into account the damage that we have done through lock down and other restrictions.
So epidemics and in the sense I'm not just when the WTO says that it ended, but epidemic and as a matter of social cultural phenomenon.
So when we start living in a way that is similar enough to what we had before the
pandemics and we are going there now and the problem is how to do it safely,
ethically, effectively. So one of the difficulties of of trying to make such plans with covid-19,
as you mentioned, is that our expectations don't pan out the way we expected.
You see those kinds of considerations as. Significant.
Complication to the kind of work you do? Yes, so one the main challenge,
not one the main challenge in working on this project is that there is so much uncertainty around covid-19 we don't know much about many things.
So, for example, we don't know how long the immunity lasts, whether from catching the virus or from vaccination is a big factor.
And one main challenge that I had was trying to catch up with new evidence and new data,
new information, because almost every day, almost on a daily basis, you have new relevant information about covid-19,
about how effective it is or is not about how severe cavities or certain population groups are about whether vaccines are safe.
For certain groups like pregnant women, for example, it's been very, very difficult to keep up with new information every day.
So uncertainty is itself an ethical consideration because part of our politics is how to deal with uncertainty and sort of forgot.
For example, the precautionary principle is a concept used in applied ethics of say,
to to decide to what extent we should be cautious with certain things when we don't know much.
So, for example, about the side effect of vaccine.
So what values do you think need to be balanced out in deciding about going back to normal, ending lockdowns?
Yeah, I would think that we have focussed a lot. On saving or preserving life from the threat of covid-19,
so and all these lockdowns and restrictions have been justified with the aim that we should protect vulnerable people from covid-19,
but that's only one aspect of it. So other considerations include what, the well-being of the population.
So life saving lives have keeping as many people alive as possible only makes sense if we make death life
with enough meaningful and if we don't distribute the burdens in a way that affects certain groups unfairly.
So, for example, young people have not much to gain from McDonald's because they're not a high risk for covid everything to lose.
But we keep them in lockdown or we closed schools, for example, in order to preserve our health care system and to protect the elderly.
So there is an issue about fairness in the distribution of the burden. So one thing is to save as many lives as possible.
The other thing is to do it in a way that is fair.
And just two things, unfortunately, often can conflict with each other and aperitifs about how to strike this balance.
There is a problem about distributing resources fairly globally.
So, for example, vaccines, it is a big debate about multiplex nationalism.
So should we prioritise citizens in our own country or should we send some of the vaccines elsewhere?
So I would think that these are the main ethical considerations.
It's not just about protecting the vulnerable people from coming into it,
is about doing it fairly and also protecting the common good in a broader sense of the term.
When you say young people, what age group do you have in mind? Most obviously children.
So if you closed schools, for example, children are heavily, heavily harmed by that severely harmed.
And children are not very high risk group with regard to community, but young people more generally.
So parents of school age children are also young people.
They are not at high risk from people in their 30s or 40s.
But if their children are kept home from school. So these people need to be thinking of working schedule.
They might have to work part time with all the consequences for well-being, welfare, economic consequences.
So these are young age groups that are heavily affected by the restriction but do not benefit too much from from them.
So the mortality rate for the under four is less than zero point one percent is
incredibly low and even for under 50 is very low is like zero point four percent,
something like that. So it's a problem about how these with the birth family you see healthy carriers is an issue.
And even if if people are not symptomatic themselves, do you see your being an issue of them spreading the disease?
Yes. So that's the problem. Yes.
So young people can be carriers of the disease, can spread the virus, and that's why we do need some strategy to protect the elderly.
So the question is whether lookdown is just effective at fair.
So there are many ways in which you can protect the elderly from younger spreaders.
So one option that's has been discussed,
but not not too much and not really implemented seriously is a focus protection strategy or selective lock down,
which means keeping all the people in lock down or shielding them until they get vaccinated,
when other people are more or less free to have a normal life.
So do you think this will seem to strike a better balance between protecting lives from community?
In a way, it is fair because those who are not at high risk can have a normal life in a way that might maximise the
collective good broadly understood in terms of keeping the economy running and keeping the system running,
not overwhelming the system if the elderly are properly protected.
So it is a very delicate balance in this respect. That is normal life include mask wearing and hand washing and all the rest.
No, that's what my squad is obviously not normal in our culture, safety system in some countries, but not in our Western society.
So that's the other thing. So normality is one aspect.
It might be difficult to have a complete normality any time soon.
But the other thing is that if we deviate from what we used to consider normality, we need to do it in a way that minimises as much as possible.
The burden we place on people so much carrying is not a huge burden.
It depends. For some people it is. So if there are some medical conditions that are acceptable, generally wearing a mask is not a huge sacrifice.
In down for one year is a huge sacrifice.
So and there is this real spectrum of possible practises and policies, and it's that the burden should be minimised.
So I think it's so from an ethical point of view is completely justifiable to require some more sacrifice or people say,
wearing a mask for the sake of an important good, say, protecting the vulnerable.
So the balance seems reasonable in that respect. But what is more problematic is asking people to do huge sacrifices for the sake of other people.
So vaccination is the an example of a very, very small cost thing that people can do to benefit other people.
So unlike lock lockdown, that is a severe limitation of freedoms of very harmful.
So what do you see as the exit strategy at this point?
Well, the answer now is different from the one I would have given one year ago when I was supposed to give cassocks,
and now with vaccines, I think the exit strategy is pretty clear.
So the UK has this road map, which I think is still too slow because now we are having something like 10,
20 deaths per day from covid-19 this country, which is really a very, very small number.
And we will always have covid we always have. People died of covid, unfortunately forever.
So we have capital to the infection under control very well so far, thanks to the vaccines.
I think this is really the time for a country, the UK. So other countries are in a different situation.
But for a country, the UK or even the US, where vaccination rollout has been extremely successful,
I was surprised by how well this country did with regard to vaccines.
I think there is absolutely no reason to keep restrictions in place at this point because we are really made the
diseases that is endemic in circulating slowly in the population but is not a grave public health threat at the moment.
Health care systems are coping well at the moment thanks to the vaccine.
So vaccines are really the game changer.
So, I mean, there are places like India where they're not they're not quite coping well, do you put that down to not having the vaccine?
So India doesn't have a very good they they're not using vaccines very well because they have not enough
doses and a few doses they have for some reason they use them many of those doses on young people.
India had the strictest looked down at the beginning and then they kept having some lock down the stage of opening up and then locking down again.
And this is the worst strategy cause especially for a country where the health care system is very populated,
heavily populated country, the health care system is struggling a lot already.
So, yeah, it's appalling, largely because of the lack of vaccines.
So. One thing to mention is that we do have enough of a case in this country and in many other countries,
we have more vaccines than we need in this country and in other countries.
And I think this is the moment to share our vaccines with other countries that are struggling because there is no point in vaccinating
40 year old people in the UK and the US when there are old people who are dying because they don't have the vaccine just now.
These are difficult questions to ask you about how this has been really interesting.
Appreciate it. Thanks for having.