While mandatory measures can be proportionate for the elderly, they can also be disproportionate for for younger people in the pandemic.
So many people accept that in order to protect public health, it is sometimes acceptable or even morally obligatory to restrict people's liberties,
for example, by imposing lockdowns, work from home requirements or travel restrictions.
But there's a lot of disagreement about how far these restrictions should go.
There's a question of whether we should have full or partial lockdowns,
but also about who should be subject to the restrictions everyone in society or particular groups in society.
I'll talk about this topic to Professor Julian Savulescu, Uehiro chair in practical ethics here at the University of Oxford and also
a professorial visiting fellow at the Murdoch Children's Research Institute in Melbourne,
I'm Katrien Devolder from the Oxford Uehiro Centre for Practical Ethics.
This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.
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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.
So can you just explain a little bit what you mean by that? Yeah.
So I think there are four factors that determine whether coercion or mandatory
measures like lockdown or mandatory vaccination or vaccine passports are ethical.
Firstly, the gravity of the problem, you have to have a severe problem.
The safety and the effectiveness of the intervention needs to be safe and effective.
The mandatory measure needs to be thirdly, significantly better than the less coercive measures,
such as better information or incentives and payments.
And lastly, there needs to be proportionality proportionality between the costs of the mandatory measure
and the gravity of the problem and the safety and effectiveness of the interventions.
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.
The striking thing about COVID is that it affects different groups differently.
Most markedly, it affects the elderly much more than the young and middle aged.
So when it comes to the proportionality of a liberty restricting measure, the the elderly have a lot to gain from liberty restriction.
Their lives are effectively saved, whereas children and young people have very little to gain.
And so the costs of of the lockdown or the risks of vaccination loom much larger.
So while mandatory measures can be proportionate for the elderly, they can also be disproportionate for for younger people in the pandemic.
One obvious objection is yes, but if the health system goes down, everyone suffers.
So we heard this slogan in the UK Stay home, save the NHS.
I'm sorry. Stay home. Protect the NHS, save lives.
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.
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.
So and especially given that the vaccines are much better at protecting you from becoming severely ill than they are at reducing transmission.
I think the strongest argument for mandatory measures is for those at high risk of becoming ill and not for children and young people.
But of course, some people would argue, for example, when you think about selective lockdown, that you know.
Lockdown not only protects the NHS,
but it also actually protects the older people and younger people should do their share in protecting the vulnerable,
sort of we're all in this together idea. So so what do you think about that then?
You know, if you're talking about, we're all in this together, we all have to stop spreading the virus.
It's become clear that vaccination has only a limited effect of reducing transmission.
Probably at most, it sort of reduces transmission by 50 per cent.
And that and that was prior to Omicron requiring vaccination for the whole population or locking down the whole population will.
I think it's true maximally benefit groups such as the elderly.
But you again have to ask whether that's proportionate because you're restricting the liberty,
you're inflicting harms on people for the sake of, you know, a small reduction.
Well, you know, a modest reduction in transmission and modest improvements in survival.
So everything has to be about a balancing exercise.
And you know, you there isn't there isn't a simple solution.
We're all in this together.
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.
But I think the problem has been that the sole metric of the pandemic has been COVID deaths.
So sure, if you want to maximally reduce COVID deaths, lock the population down, make it mandatory,
make vaccination mandatory for everyone, and that will reduce the number of COVID deaths.
But there will be non-COVID deaths that will be very high as a result of of people's cancers not being diagnosed,
people's heart attacks not being being treated.
And so, you know, when you just attend to that single variable, you ignore a whole lot of other relevant variables.
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.
So so one objection to sort of selective measures, for example,
selective lockdown of of vulnerable people is that that is ages said it's discriminatory for people above a certain age.
Do you think that is a valid concern? I mean, it clearly treats people differently, but on a very relevant criterion.
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.
The chance of an 85 year old dying from COVID is seven percent.
So suppose that you had ethnic minority groups that had a much higher chance of of getting Corvette's because of some genetic defect,
not because of the fact that they're usually more in poorer areas and so on.
Would it then be justified to impose selective measures on certain ethnic groups if they were more prone to getting COVID?
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.
Are also are also high risk factors, so the argument could be extended to say, oh, well,
then we should selectively lock down or selectively mandatory vaccinate males, the obese and people from ethnic minorities.
You know, I've only given one argument in favour of some sort of selective lockdown.
And clearly there are other considerations that have to be weighed, such as equality, correcting structural injustice and so on.
But there's one feature about age that is different to all of those other characteristics.
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.
So in a sense, the, you know, being becoming elderly is something that will affect all of us.
And when we've done surveys of the public and indeed other other groups who have also done similar surveys,
a large majority of people see age as a relevant criterion for allocating limited resources.
The aged are seen as having having already enjoyed more of life,
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.
So I think that age is a different kind of criterion two to something like, you know,
an ethnic minority where you've got independent reasons to think that you shouldn't be
further imposing burdens on people who may be in this situation because of past injustice.
So I think, you know, the elderly are not in that in this situation because of some past injustice largely there in this situation,
because they happen to have benefited from more life.
So you could have an age selective coercive policy and yet reject other kinds of coercive policies.
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.
So even if in theory this idea works, it seems practically really hard to only protect the vulnerable.
I mean, the first question is, of course, who are the vulnerable? But I don't know the the numbers,
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.
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.
So practically practically sorry, I would like such a selective lockdown look like.
Well, I think a selective lockdown is more difficult, but not impossible.
But I think selective vaccination, for example, as Italy has selected mandatory vaccinations as Italy is now introduced, these very plausible.
You can find people over a certain age if they're not vaccinated or vaccine passports.
You know you have to show a vaccination certificate to enter, you know, pubs and restaurants and so on.
In many countries, you know,
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.
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,
but it's going to give liberties to people, you know, that wouldn't otherwise be available under a blanket policy.
Now, in the end, it's a question of how much do you balance liberty versus health?
And also, how much do you balance preventing COVID deaths from preventing non-COVID deaths?
People will draw these lines in different places,
but I think that we need to at least consider whether a selective approach is the right one for a particular environment.
Yeah. So if you say I'm just thinking of New Zealand, who is sort of the, I guess,
one of the few countries left with hardly any COVID with borders closed and they now have to decide about what sort of yeah,
what to do, basically whether to open the borders and what sort of approach to take.
So would you have any advice for the New Zealand government because they're sort of in a situation where they.
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.
Well, the longer you wait, the you know, the more vaccines you have, the more treatments that are being developed.
So you have more ways of combating the virus and lowering its mortality.
So the longer you wait, the better the position you'll be in.
But what's pretty clear is that everyone in New Zealand will either be vaccinated or have COVID, but probably both at some point.
So you're just delaying reaching that point.
And you have to make a decision about whether the costs of waiting longer to get
better treatments and better vaccines are worth the costs of remaining isolated.
And I don't know the economic situation in New Zealand or the impact, you know, in other ways of their policies.
But it's that kind of balancing exercise because, you know, if all you were concerned about doing again was minimising COVID deaths,
stay locked down until there are perfect cures or perfect vaccines.
But you know, that's going to cause a lot of other costs that you have to balance.
And I would have thought, you know, at this point, New Zealand has reached the point that there are there's sufficient,
you know, coverage with vaccination and sufficient treatments on the horizon to start to open up.
So last question so so what's what do you think is sort of the most important lesson learnt from this pandemic?
So what what's the most important thing, according to you, that we should do better when tackling the next pandemic?
There's been policies proposed with, you know, very little discussion about the ethical opmeer premises or assumptions or values
behind them and little discussion of the options so people haven't considered,
you know, how to allocate limited resources like ventilators. They've stocked a very vague terms like frailty.
They haven't openly discussed whether there should be age limitations to access to ventilators or how vaccines should be allocated.
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.
Inevitably, that some younger people died in their 60s and 70s because they had to wait to get vaccines.
And now there are just said that was just simply a crude egalitarian approach to vaccination
or an approach that was based on utilitarianism where just Kovar death was the only metric.
So I think that these kinds of problems just show that we ethics has been completely absent,
and I think we should have had a much broader approach of considering differential policies of lockdown or vaccination,
such as selective lockdown or using incentives rather than coercion.
But but the ethics of these sorts of issues has just been bulldozed in in this kind of slogan.
We're just following the science as if science can somehow just dictate what your policy should be.
Science is extremely important. We need science to develop vaccines, an incredible achievement to develop these vaccines in a year,
and we also need ethics to decide, you know, how they deployed, how they're researched.
It took a year or two to start a challenge trial in the world.
I mean, this is there. There are no good ethical objections to the challenge trials that have been proposed for COVID 19.
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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