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Hello, I'm Dr. Kristen Heitman, an independent historian based outside of Bethesda, Maryland, in the US,

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and this video interview is part of an Oxford based project entitled How Epidemics,

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and directed by Dr. Eric Charters, who's associate professor of history at the University of Oxford.

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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.

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His PhD is from the University of Melbourne.

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Dr. Drew Bellini has published on several topics in bioethics and philosophy, including the ethics of vaccination, procreative choices,

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end of life decisions, the concept of conscience and the role of intuitions and moral disgust and ethical arguments.

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Welcome to. Hi, thanks for having me.

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Can you begin by explaining the work of an applied ethicist and in particular what sorts of considerations you draw on?

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Yes, so applied ethics is a branch of ethics and moral philosophy as an academic discipline.

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So you can think of ethics as a broad area where philosophers think about different issues.

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Some of these issues have to do with more abstract things, like, for example,

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what it means to make moral judgements as opposed to other types of judgements.

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So what what what do you mean to say that they should do something as opposed to.

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I'd rather do something because it's more convenient to me.

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So what's the meaning of ethics itself?

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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,

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whether the good guys should be measured in terms of sticking to certain duties, certain roles,

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whether the good should be measured in terms of making people as happy as possible.

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So different theories, different criteria for what counts as a collection and as normative theory.

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Applied ethics is a third area, and it's basically about applying these normative theories to real world problems.

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So part of it consists in identifying the morally relevant aspects, the more relevant,

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the factors that determine moral judgements in specific situations.

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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?

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What kind of duties do we have towards certain groups of people?

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So we talk about duties. We refer to normative theories that have to do with the importance of rules of moral obligations,

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where we talk about saving as many lives as possible. We have to do with what we call utilitarian normative theory.

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So maximising the number of people we save or maximising whatever measure of opportunity we have,

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so is a matter of identify morally relevant properties in real world situations and try to balance is different considerations.

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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?

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So I've been working for one year now on a grand project, which is called the exit strategy,

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which means the strategy moving from a situation of lock down or depressed takes us back to normality.

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And it's easier because this project was funded in April 2020.

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And back then, talking about the exit strategy made sense because back then we had the

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impression you were actually moving out of town then and the situation will go.

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That would improve after that. And as a matter of fact, that's not how things went.

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So we are still talking about an exit strategy one year later.

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And my work now is about how we go back to normality.

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So in a sense, how epidemics end by lifting restrictions in a way that takes into account all the more aspects I mentioned before.

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So protecting people from covid-19 as much as possible now its possible effects of vaccines.

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So vaccination is another area I've been working on,

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but also taking into account the damage that we have done through lock down and other restrictions.

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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.

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So when we start living in a way that is similar enough to what we had before the

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pandemics and we are going there now and the problem is how to do it safely,

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ethically, effectively. So one of the difficulties of of trying to make such plans with covid-19,

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as you mentioned, is that our expectations don't pan out the way we expected.

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You see those kinds of considerations as. Significant.

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Complication to the kind of work you do? Yes, so one the main challenge,

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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.

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So, for example, we don't know how long the immunity lasts, whether from catching the virus or from vaccination is a big factor.

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And one main challenge that I had was trying to catch up with new evidence and new data,

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new information, because almost every day, almost on a daily basis, you have new relevant information about covid-19,

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about how effective it is or is not about how severe cavities or certain population groups are about whether vaccines are safe.

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For certain groups like pregnant women, for example, it's been very, very difficult to keep up with new information every day.

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So uncertainty is itself an ethical consideration because part of our politics is how to deal with uncertainty and sort of forgot.

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For example, the precautionary principle is a concept used in applied ethics of say,

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to to decide to what extent we should be cautious with certain things when we don't know much.

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So, for example, about the side effect of vaccine.

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So what values do you think need to be balanced out in deciding about going back to normal, ending lockdowns?

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Yeah, I would think that we have focussed a lot. On saving or preserving life from the threat of covid-19,

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so and all these lockdowns and restrictions have been justified with the aim that we should protect vulnerable people from covid-19,

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but that's only one aspect of it. So other considerations include what, the well-being of the population.

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So life saving lives have keeping as many people alive as possible only makes sense if we make death life

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with enough meaningful and if we don't distribute the burdens in a way that affects certain groups unfairly.

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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.

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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.

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So there is an issue about fairness in the distribution of the burden. So one thing is to save as many lives as possible.

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The other thing is to do it in a way that is fair.

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And just two things, unfortunately, often can conflict with each other and aperitifs about how to strike this balance.

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There is a problem about distributing resources fairly globally.

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So, for example, vaccines, it is a big debate about multiplex nationalism.

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So should we prioritise citizens in our own country or should we send some of the vaccines elsewhere?

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So I would think that these are the main ethical considerations.

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It's not just about protecting the vulnerable people from coming into it,

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is about doing it fairly and also protecting the common good in a broader sense of the term.

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When you say young people, what age group do you have in mind? Most obviously children.

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So if you closed schools, for example, children are heavily, heavily harmed by that severely harmed.

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And children are not very high risk group with regard to community, but young people more generally.

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So parents of school age children are also young people.

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They are not at high risk from people in their 30s or 40s.

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But if their children are kept home from school. So these people need to be thinking of working schedule.

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They might have to work part time with all the consequences for well-being, welfare, economic consequences.

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So these are young age groups that are heavily affected by the restriction but do not benefit too much from from them.

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So the mortality rate for the under four is less than zero point one percent is

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incredibly low and even for under 50 is very low is like zero point four percent,

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something like that. So it's a problem about how these with the birth family you see healthy carriers is an issue.

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And even if if people are not symptomatic themselves, do you see your being an issue of them spreading the disease?

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Yes. So that's the problem. Yes.

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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.

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So the question is whether lookdown is just effective at fair.

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So there are many ways in which you can protect the elderly from younger spreaders.

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So one option that's has been discussed,

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but not not too much and not really implemented seriously is a focus protection strategy or selective lock down,

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which means keeping all the people in lock down or shielding them until they get vaccinated,

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when other people are more or less free to have a normal life.

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So do you think this will seem to strike a better balance between protecting lives from community?

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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

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collective good broadly understood in terms of keeping the economy running and keeping the system running,

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not overwhelming the system if the elderly are properly protected.

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So it is a very delicate balance in this respect. That is normal life include mask wearing and hand washing and all the rest.

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No, that's what my squad is obviously not normal in our culture, safety system in some countries, but not in our Western society.

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So that's the other thing. So normality is one aspect.

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It might be difficult to have a complete normality any time soon.

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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.

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The burden we place on people so much carrying is not a huge burden.

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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.

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In down for one year is a huge sacrifice.

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So and there is this real spectrum of possible practises and policies, and it's that the burden should be minimised.

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So I think it's so from an ethical point of view is completely justifiable to require some more sacrifice or people say,

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wearing a mask for the sake of an important good, say, protecting the vulnerable.

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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.

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So vaccination is the an example of a very, very small cost thing that people can do to benefit other people.

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So unlike lock lockdown, that is a severe limitation of freedoms of very harmful.

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So what do you see as the exit strategy at this point?

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Well, the answer now is different from the one I would have given one year ago when I was supposed to give cassocks,

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and now with vaccines, I think the exit strategy is pretty clear.

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So the UK has this road map, which I think is still too slow because now we are having something like 10,

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20 deaths per day from covid-19 this country, which is really a very, very small number.

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And we will always have covid we always have. People died of covid, unfortunately forever.

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So we have capital to the infection under control very well so far, thanks to the vaccines.

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I think this is really the time for a country, the UK. So other countries are in a different situation.

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But for a country, the UK or even the US, where vaccination rollout has been extremely successful,

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I was surprised by how well this country did with regard to vaccines.

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I think there is absolutely no reason to keep restrictions in place at this point because we are really made the

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diseases that is endemic in circulating slowly in the population but is not a grave public health threat at the moment.

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Health care systems are coping well at the moment thanks to the vaccine.

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So vaccines are really the game changer.

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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?

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So India doesn't have a very good they they're not using vaccines very well because they have not enough

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doses and a few doses they have for some reason they use them many of those doses on young people.

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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.

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And this is the worst strategy cause especially for a country where the health care system is very populated,

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heavily populated country, the health care system is struggling a lot already.

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So, yeah, it's appalling, largely because of the lack of vaccines.

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So. One thing to mention is that we do have enough of a case in this country and in many other countries,

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we have more vaccines than we need in this country and in other countries.

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And I think this is the moment to share our vaccines with other countries that are struggling because there is no point in vaccinating

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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.

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These are difficult questions to ask you about how this has been really interesting.

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Appreciate it. Thanks for having.