1 00:00:11,070 --> 00:00:15,480 Hello, I'm David Edmonds and this is the Pandemic Ethics Accelerator Podcast. 2 00:00:15,990 --> 00:00:21,420 The UK Pandemic Ethics Accelerator was a project funded by the Arts and Humanities Research 3 00:00:21,420 --> 00:00:28,080 Council in 2021 22 to examine the ethical challenges faced during the COVID pandemic, 4 00:00:28,710 --> 00:00:36,930 it combined expertise from the University of Oxford, Bristol, Edinburgh University College, London and the Nuffield Council on Bioethics. 5 00:00:37,470 --> 00:00:42,420 This six part podcast series covers some of the themes that emerged from the research. 6 00:00:48,670 --> 00:00:52,510 Vaccines to combat COVID were developed in record time. 7 00:00:52,990 --> 00:00:59,020 But policymakers then faced a tricky question. It was impossible to vaccinate everyone immediately. 8 00:00:59,380 --> 00:01:04,630 So who to inoculate first? Jonathan Pugh of Oxford University's U. 9 00:01:04,630 --> 00:01:08,530 Healer Centre for Practical Ethics, says there were complex trade offs. 10 00:01:09,280 --> 00:01:11,440 Jonny Pugh, welcome. Thanks for having me, Dave. 11 00:01:11,770 --> 00:01:20,110 Before we get to the substance of the argument about how to prioritise vaccines, let's remind ourselves of some of the background. 12 00:01:20,410 --> 00:01:24,610 When the virus vaccines were introduced, we knew who the most vulnerable people were. 13 00:01:25,150 --> 00:01:30,880 Mostly risk was correlated with age, and the older you were, the more at risk you were. 14 00:01:31,030 --> 00:01:37,060 But did we have robust data on how effective the vaccines would be with the various age groups? 15 00:01:37,720 --> 00:01:41,410 So that's a really important question. Start thinking about prioritisation. 16 00:01:41,440 --> 00:01:48,250 So we first saw the vaccines being approved in late 2020 on the basis of Phase three trials. 17 00:01:48,730 --> 00:01:56,740 And these trials were effectively designed to tell us how effective the vaccines were going to be in reducing severe disease. 18 00:01:57,130 --> 00:02:01,840 Now, a couple of the trials gave us some limited clues about the effectiveness in different subgroups, 19 00:02:02,290 --> 00:02:06,280 but they didn't have enough participants to give us robust data on that point. 20 00:02:06,820 --> 00:02:12,640 So we didn't know enough about the vaccines to be certain about just how effective they would be in different age groups. 21 00:02:13,090 --> 00:02:19,900 Another thing we didn't know much about is whether they would be effective in preventing onward transmission. 22 00:02:20,080 --> 00:02:27,730 So again, we had some limited clues in some of the studies. We had some data about the vaccines potentially preventing asymptomatic cases. 23 00:02:28,030 --> 00:02:34,510 But again, this was in very small numbers. The key takeaway from the phase three trials from which the vaccines were approved 24 00:02:34,750 --> 00:02:39,280 was that they were effective at reducing severe disease across all age groups. 25 00:02:40,000 --> 00:02:45,489 So there was obviously a fair amount of uncertainty. Can you just remind us how the UK ran its program? 26 00:02:45,490 --> 00:02:49,630 There was a phase one and a phase two. Start with phase one. Yes, that's right. 27 00:02:49,660 --> 00:02:53,530 Phase one was initiated almost as soon as the vaccines were approved. 28 00:02:53,890 --> 00:03:01,690 And the idea here was that the prioritisation was aiming to prevent 99% of COVID related mortality. 29 00:03:02,140 --> 00:03:10,500 So to that end, the UK outlined nine prioritisation groups with groups one and two representing those at greatest risk. 30 00:03:10,510 --> 00:03:16,000 So these included those in aged care, home facilities and frontline care home staff. 31 00:03:16,240 --> 00:03:20,470 Second group, those aged over 85 and frontline healthcare workers. 32 00:03:20,650 --> 00:03:28,600 And each group went down in age bands of about five years, all the way down to age 50, about halfway down that prioritisation group. 33 00:03:28,840 --> 00:03:34,660 There were other individuals included, such as those suffering from immuno compressed conditions. 34 00:03:35,050 --> 00:03:43,840 So that was phase one. Phase two. So phase two started once all those had been offered a vaccine in the first phase, right down to those over age 50. 35 00:03:44,500 --> 00:03:51,880 Now, there's a lot more debate when we started phase two because we'd already aim to prevent 99% of COVID related mortality in the first phase. 36 00:03:52,360 --> 00:03:56,469 How the UK decided to press on with this age based prioritisation. 37 00:03:56,470 --> 00:04:06,100 So essentially the first age group offered vaccinations in phase two where those aged over 45 and we continue right down to those aged over 18. 38 00:04:06,340 --> 00:04:09,999 It's worth pointing out at this stage an unspoken assumption in the debate, 39 00:04:10,000 --> 00:04:15,879 and that is that practically we couldn't vaccinate everyone immediately and spontaneously. 40 00:04:15,880 --> 00:04:19,150 We had to choose. We had to privatise for logistical reasons. 41 00:04:19,150 --> 00:04:26,140 There was a limited supply of people qualified to administer the vaccine and also because there was a limited availability of vaccines themselves. 42 00:04:26,620 --> 00:04:33,160 Yeah, and that's absolutely essential to thinking about prioritisation, because if it was possible to vaccinate everyone immediately, 43 00:04:33,400 --> 00:04:36,790 we wouldn't really be faced with these difficult ethical questions because we could 44 00:04:36,790 --> 00:04:41,020 simply make the vaccine available to everyone who wanted it at the same time. 45 00:04:41,170 --> 00:04:45,460 But as you mentioned, there are significant logistical challenges in manufacturing, 46 00:04:45,700 --> 00:04:51,450 that vast number of vaccines, doses that we needed, as well as delivering those vaccines in good time. 47 00:04:51,460 --> 00:04:55,060 So this is the reason why we face such pressing challenges. 48 00:04:55,630 --> 00:05:02,410 So that's some of the background. Those are the facts. Let's talk about the normative issues, the issues of morality. 49 00:05:02,980 --> 00:05:09,100 Now, Britain chose to start by vaccinating the oldest, as you've mentioned, and certainly one can see the rationale behind that. 50 00:05:09,550 --> 00:05:13,720 But I guess another way of distributing vaccines would have been at random. 51 00:05:13,810 --> 00:05:17,080 You might think that that was a fair way of dealing with vaccine distribution. 52 00:05:17,320 --> 00:05:18,459 That's absolutely true. 53 00:05:18,460 --> 00:05:27,010 And some scholars have defended this idea that in a pandemic situation, we should be adopting a lottery, if you like, in allocating vaccines. 54 00:05:27,700 --> 00:05:31,779 The rationale for a lottery would be that it is one way in which to ensure equality. 55 00:05:31,780 --> 00:05:36,250 Everyone has an equal chance of accessing this scarce medical good. 56 00:05:36,760 --> 00:05:40,390 It would also have the virtue of being easy and quick to implement. 57 00:05:40,930 --> 00:05:44,770 The problem with that overall system, though, is that it is very inefficient. 58 00:05:44,860 --> 00:05:47,890 It would have led to many preventable deaths. So. 59 00:05:47,980 --> 00:05:54,219 Given what we knew about the virus at that stage, we knew that unvaccinated eight year old is a far, 60 00:05:54,220 --> 00:05:57,940 far higher risk of death from COVID than an 18 year old. 61 00:05:58,240 --> 00:06:02,290 So if we simply allocated in accordance with the lottery procedure, 62 00:06:02,650 --> 00:06:08,680 we would have a system where the 18 year old has an equal chance to an eight year old, despite that vastly different risk. 63 00:06:09,160 --> 00:06:13,450 You draw a distinction, in other words, between fairness and benefit. 64 00:06:13,750 --> 00:06:16,960 I mean, the benefit is pretty obvious. The benefit is that you get to live. 65 00:06:17,890 --> 00:06:22,360 Yes, that's absolutely right. And that's one useful way of framing the debate. 66 00:06:22,840 --> 00:06:28,120 We're likely to face trade-offs in prioritisation between ensuring that people have an equal chance 67 00:06:28,120 --> 00:06:34,419 to access this scarce good and achieving certain kinds of benefit with our allocation in this case, 68 00:06:34,420 --> 00:06:41,170 perhaps saving as many lives as possible. So the ethical question about vaccine prioritisation is really about how we should 69 00:06:41,170 --> 00:06:45,190 strike a balance between these two values of ensuring fairness on the one hand, 70 00:06:45,400 --> 00:06:49,900 but also achieving certain kind of benefit. The benefit is complicated, though, isn't it? 71 00:06:49,900 --> 00:06:54,190 Because you might think that if you save a five year old's life, 72 00:06:54,190 --> 00:07:03,430 you're giving this child another 85 years of hopefully happy existence, whereas an 85 year old obviously doesn't have another 85 years. 73 00:07:04,510 --> 00:07:05,409 That's also true, 74 00:07:05,410 --> 00:07:13,570 and it speaks to a broader range of philosophical questions about how we should understand the relevant benefits in a prioritisation system. 75 00:07:13,930 --> 00:07:20,170 So the U.K. and other countries, I should mention, appear to adopt a broadly consequentialist principle, 76 00:07:20,380 --> 00:07:23,650 essentially seeking to maximise the benefit of saving the most lives. 77 00:07:24,280 --> 00:07:27,460 That's a principle that can be supported by a wide range of theories. 78 00:07:27,490 --> 00:07:33,040 Other things being equal, I think a lot of various would agree that it's better to save more lives from fewer. 79 00:07:33,340 --> 00:07:40,000 It's also a principle that accommodates this broadly egalitarian point that all lives matter equally. 80 00:07:40,450 --> 00:07:45,279 Now, during the pandemic, this principle is sometimes described as a utilitarian approach, 81 00:07:45,280 --> 00:07:49,980 but that's perhaps a little misleading, and it speaks to some of the points you are raising in the question, Dave. 82 00:07:50,470 --> 00:07:56,460 So utilitarianism is the view that we should bring about the greatest happiness for the greatest number for the utilitarian. 83 00:07:56,470 --> 00:08:01,090 It's not lives per say that matter morally, but rather happiness or well-being. 84 00:08:01,270 --> 00:08:08,650 So the utilitarian is going to be interested in a range of other factors beyond the number of lives prioritisation strategy will save. 85 00:08:08,980 --> 00:08:13,630 So they might first be interested in the expected length of the lives that will be saved, 86 00:08:13,930 --> 00:08:19,450 on the assumption that saving those who will live longer will lead to greater expected well-being. 87 00:08:19,480 --> 00:08:25,030 So that approach would speak in favour of perhaps prioritising the youngest at risk patients, 88 00:08:25,030 --> 00:08:31,840 such as clinically compromised 18 year olds, for instance, over the elderly, even if they're at considerable risk themselves. 89 00:08:32,350 --> 00:08:39,100 Perhaps even more controversially, though, a true utilitarian approach would be interested in the well-being of those whose lives are saved. 90 00:08:39,490 --> 00:08:45,070 Now, that approach is controversial because it perhaps fails to accommodate this idea that all lives matter equally, 91 00:08:45,250 --> 00:08:49,840 and it would require us to make complex judgements about how good someone's life is for them. 92 00:08:50,530 --> 00:08:59,620 In other words, it might suggest that you should save a happier life over a less happy one, because for the utilitarian, it's happiness that counts. 93 00:09:00,130 --> 00:09:03,160 Absolutely on that true utilitarian perspective. 94 00:09:03,220 --> 00:09:08,980 Now, that was, in fact, a considerable debate about this kind of utilitarian thinking in the pandemic. 95 00:09:09,010 --> 00:09:13,930 There were some public figures appearing on media shows arguing against lockdowns 96 00:09:13,930 --> 00:09:19,630 by invoking this idea that we should be really adopting a utilitarian mindset. 97 00:09:20,290 --> 00:09:25,389 That provoked a lot of public debate. One point that we didn't fully acknowledge, 98 00:09:25,390 --> 00:09:32,860 and that is that this kind of broadly utilitarian thinking does play some role in health resource allocation elsewhere. 99 00:09:32,870 --> 00:09:39,070 So the U.K. has an advisory body called Nice, which advises on the use of treatments in the NHS, 100 00:09:39,370 --> 00:09:45,820 and they said decisions on how much a new treatment costs per quality of life gained or quality. 101 00:09:46,210 --> 00:09:49,210 So actually is a generic measure of disease burden, 102 00:09:49,210 --> 00:09:56,200 including both the quality and quantity of a life lived where one quality amounts to one year of healthy life, 103 00:09:56,410 --> 00:10:04,510 whereas a score below one but above zero amounts to one year of life lived with a disease burden that undermines quality of life. 104 00:10:05,050 --> 00:10:05,950 So that's very interesting. 105 00:10:05,950 --> 00:10:16,870 So colleagues are used by this organisation, nice to adjudicate on which drugs should be paid for by the National Health Service. 106 00:10:17,200 --> 00:10:21,370 But we didn't smuggle in this idea of quality into pandemic thinking. 107 00:10:21,550 --> 00:10:28,570 That's absolutely true. I think the first thing to say is that the use of colleagues in Nice is itself highly controversial amongst ethicists. 108 00:10:28,570 --> 00:10:36,010 So that's perhaps one reason. The second reason is that it's far from clear that the role that niceness playing in medical resource 109 00:10:36,010 --> 00:10:42,970 allocation can be translated straightforwardly to a prioritisation strategy in a pandemic context. 110 00:10:43,330 --> 00:10:47,650 Certainly, I think the guiding principle for a lot of the decision making the. 111 00:10:47,730 --> 00:10:53,250 Prioritisation in the pandemic was based on this fundamental notion that all lives matter equally. 112 00:10:53,340 --> 00:10:57,899 And that's something that the broadly utilitarian approach takes into account. 113 00:10:57,900 --> 00:11:02,850 The length and quality of lives being saved, if you like, fails to adequately accommodate. 114 00:11:03,090 --> 00:11:10,740 Okay, so we talked a bit about the direct benefits which are lives saved and perhaps we include in that years saved. 115 00:11:11,100 --> 00:11:18,540 Are there other benefits? Presumably a more indirect benefit is if I don't get ill from COVID, I can carry on being economically active, for example. 116 00:11:18,660 --> 00:11:25,440 That's absolutely true. And in fact, some other countries accommodated that insight into their own prioritisation strategies. 117 00:11:25,440 --> 00:11:34,049 So a number of countries around the world included key workers in their first phase of vaccine prioritisation, most notably China. 118 00:11:34,050 --> 00:11:40,890 But also, Germany prioritised some key occupations in their initial vaccine prioritisation strategy. 119 00:11:41,250 --> 00:11:45,540 The idea there being that as well as affording protection to vulnerable individuals, 120 00:11:45,870 --> 00:11:51,420 it can be really important to safeguard certain social goods in your pandemic response. 121 00:11:51,960 --> 00:12:02,610 So is that the only rationale for giving some kind of priority to NHS workers and other key workers in, say, the police or in key retail sectors? 122 00:12:02,940 --> 00:12:06,780 Is it purely about these people being essential for the flourishing of society? 123 00:12:07,260 --> 00:12:10,800 I think that's a significant justification, but it's not the only one. 124 00:12:11,040 --> 00:12:12,629 So throughout the pandemic, 125 00:12:12,630 --> 00:12:19,590 a lot of people working in these key occupations were asked to take on significant risk in delivering these key social goods. 126 00:12:19,710 --> 00:12:28,470 Before we had the protection afforded by vaccination, there is an argument that once the vaccines were available, we had reasons of reciprocity. 127 00:12:28,470 --> 00:12:33,420 If you like, to prioritise these professionals for vaccination, 128 00:12:33,420 --> 00:12:38,730 an idea they perhaps deserved priority given what they had sacrificed in the pandemic already. 129 00:12:39,210 --> 00:12:44,340 It's also worth noting that health care workers and care home workers were placed at 130 00:12:44,340 --> 00:12:48,750 perhaps the highest degree of priority across a wide range of prioritisation strategies. 131 00:12:49,200 --> 00:12:53,140 They are a particularly key occupation in the pandemic for obvious reasons. 132 00:12:53,160 --> 00:13:01,050 If you are interested in saving the most lives with your prioritisation strategy, the first thing you need to do is to protect your healthcare system. 133 00:13:01,410 --> 00:13:09,390 So healthcare workers and care home workers were placed at the highest priority of any profession for a wide range of reasons. 134 00:13:10,020 --> 00:13:18,450 But even in phase two, the UK strategy was not to give priority beyond NHS workers to other professionals. 135 00:13:18,960 --> 00:13:22,770 Yes, that's true. We continued to prioritise solely in accordance with age. 136 00:13:23,100 --> 00:13:30,840 I think one rationale for that was that it was simply the most practicable approach that could be carried out very quickly. 137 00:13:31,260 --> 00:13:39,360 We wouldn't have to obtain proof of which individuals were serving, in which professions and other important factors to take into account. 138 00:13:39,390 --> 00:13:42,300 So it was really a decision made out of practicality. 139 00:13:42,540 --> 00:13:49,950 There was at the time a great deal of public discussion about whether certain professions, particularly teachers, should be prioritised. 140 00:13:50,160 --> 00:13:56,730 Again, drawing on these arguments to do with reciprocity, but also the need to ensure that schools could reopen. 141 00:13:56,820 --> 00:14:03,180 For example, there were other safety risk factors, of course, that could have been taken into account at that second phase stage. 142 00:14:03,180 --> 00:14:09,120 So even if we assume that in phase two, we should be seeking to save as many lives as possible, 143 00:14:09,480 --> 00:14:13,160 we could perhaps have brought about the risk factors we took into account. 144 00:14:13,170 --> 00:14:21,510 So occupational exposure to the virus was one important factor, but we also had a fair amount of data for that point to show that ethnicity, 145 00:14:21,510 --> 00:14:27,810 obesity and social deprivation to take a few examples were also important risk factors for COVID mortality. 146 00:14:29,010 --> 00:14:33,030 So Johnny, you're an applied ethicist and you've been focusing a lot of time looking at this. 147 00:14:33,030 --> 00:14:42,059 Do you think we got it right? Not focusing, as other countries did, on those other risk factors and on issues of reciprocity, 148 00:14:42,060 --> 00:14:50,610 pointing out that some people in some professions are more exposed to the pandemic and so are more deserving of a vaccine. 149 00:14:51,630 --> 00:14:59,910 Yes, that's a very difficult question to answer in hindsight, because in many ways the UK appeared to do extremely well with its vaccine rollout. 150 00:15:00,270 --> 00:15:04,250 I think the first thing to say is that I think we absolutely got phase one right. 151 00:15:04,260 --> 00:15:09,480 I think prioritising 99% of mortality was an extremely important goal to achieve. 152 00:15:09,900 --> 00:15:11,700 I think when we reached Phase two, 153 00:15:11,790 --> 00:15:19,049 there were certainly more reasons to consider protecting certain key professions for the reasons of reciprocity and achieving social goods, 154 00:15:19,050 --> 00:15:27,570 I've pointed out. But it's difficult to look at in hindsight because, as I said, the age based prioritisation had the virtue of practicality. 155 00:15:27,570 --> 00:15:33,389 It could be carried out extremely quickly. It's not at all clear how quickly we could have rolled out the second phase of 156 00:15:33,390 --> 00:15:37,800 vaccination if it had focussed solely on prioritising certain occupations. 157 00:15:38,250 --> 00:15:43,889 So from a moral perspective, I think there were very strong reasons we would need to speak to those at the centre 158 00:15:43,890 --> 00:15:47,310 of policymaking to find out just how practicable they would have been in the UK. 159 00:15:47,390 --> 00:15:53,719 Context. Bringing in the international perspective raises another question. 160 00:15:53,720 --> 00:15:57,830 Of course, we've assumed that the states priority is to help its citizens. 161 00:15:58,370 --> 00:16:01,730 Is that an entirely contentious assumption? 162 00:16:02,060 --> 00:16:03,920 Well, the short answer to that question is no. 163 00:16:04,380 --> 00:16:12,440 So there's been a great deal of debate about the extent to which nations should prioritise their own citizens for vaccination. 164 00:16:12,620 --> 00:16:19,219 Typically, when they've reached a stage where large numbers in their own countries have already received two doses before, 165 00:16:19,220 --> 00:16:23,420 individuals living in less developed nations have been able to access a single dose. 166 00:16:23,720 --> 00:16:30,320 In fact, the director of the World Health Organisation previously called for a moratorium on booster programs 167 00:16:30,530 --> 00:16:36,680 until a larger number of vulnerable individuals in less developed nations had received vaccine doses. 168 00:16:37,220 --> 00:16:45,920 Now this is a hugely complex issue. One complexity arises from whether vaccine scarcity alone was responsible for the 169 00:16:45,920 --> 00:16:50,930 considerable inequity between vaccine uptake in developed and less developed nations. 170 00:16:51,380 --> 00:16:59,060 There's also a question about whether it was in developed countries best interests to prioritise their own citizens. 171 00:16:59,090 --> 00:17:04,070 Certainly there was an argument that if more doses had been delivered to less developed nations, 172 00:17:04,340 --> 00:17:13,460 perhaps we might have had a better chance of reducing the likelihood of dangerous mutations such as the variant that we saw arise. 173 00:17:14,210 --> 00:17:23,600 So there are those empirical complexities, but once we assume that scarcity was partly responsible for the vast inequity we saw in vaccine allocation, 174 00:17:23,840 --> 00:17:33,500 then really settling the question is going to require us to form a view about how we should set up the debate between cosmopolitanism and nationalism. 175 00:17:33,770 --> 00:17:39,920 And that, of course, is a debate that has a huge history and philosophy, and we probably can't settle it here. 176 00:17:40,610 --> 00:17:48,380 I think one thing we can say is that it would perhaps be appropriate to set a threshold of protection in developed nations, 177 00:17:48,770 --> 00:17:57,530 such that once that level of protection has been achieved, it can no longer be justifiable to prioritise your nations own citizens if other 178 00:17:57,530 --> 00:18:01,580 countries have a level of protection that falls far below that threshold. 179 00:18:01,730 --> 00:18:06,530 Now, of course, the devil is going to be in the detail. Where should we set that particular threshold? 180 00:18:06,950 --> 00:18:13,070 One suggestion from Owen Schaefer and colleagues has been that we should set it at an influenza standard. 181 00:18:13,250 --> 00:18:21,470 So once we have reduced the threat of COVID in our community to the level of background public health risks, 182 00:18:21,770 --> 00:18:26,329 then it can no longer be justifiable to prioritise our own citizens for vaccination 183 00:18:26,330 --> 00:18:30,800 over those in less developed nations still require much better protection. 184 00:18:30,890 --> 00:18:32,310 There is a lot of complexity here. 185 00:18:32,330 --> 00:18:38,210 I think it's certainly something going forward for future pandemics that it would be useful to get a much clearer view of them. 186 00:18:38,990 --> 00:18:42,830 So I was going to end with that and the lessons for the future. 187 00:18:43,070 --> 00:18:47,150 There's something very particular about the pandemic we've just been through, 188 00:18:47,360 --> 00:18:51,170 still going through, which is the older you are, the more at risk you are. 189 00:18:51,200 --> 00:18:58,520 That won't necessarily be the case with future pandemics, but what lessons are there from the last few years? 190 00:18:59,240 --> 00:19:03,049 This is a really important question. Turning to your example, that you're absolutely right. 191 00:19:03,050 --> 00:19:07,880 We don't know what the mortality risk profile of the next pandemic will be. 192 00:19:08,240 --> 00:19:16,310 In some ways, though, from a moral perspective, this pandemic was particularly challenging for the reason that risk arose in accordance with age, 193 00:19:16,580 --> 00:19:23,820 because it forced us to confront what matters morally. Is it saving lives per say, or is it maximising expected life years? 194 00:19:24,200 --> 00:19:28,430 So that was a really deep conflict that we faced, not just in vaccine prioritisation, 195 00:19:28,670 --> 00:19:32,900 but also thinking about ICU admission, intensive care unit admission. 196 00:19:33,830 --> 00:19:39,380 So I think we saw a pandemic where say, 18 to 30 year olds had the highest mortality risk, 197 00:19:39,680 --> 00:19:42,649 then I think there would be very little doubt they should be prioritised for 198 00:19:42,650 --> 00:19:47,060 vaccination because that would be supported by a wide range of moral principles. 199 00:19:47,540 --> 00:19:52,820 But I think there are much broader lessons we can draw from how we dealt with the COVID 19 pandemic. 200 00:19:53,150 --> 00:19:56,330 I think the first important point is one of transparency. 201 00:19:56,370 --> 00:20:02,659 Now, there are good reasons why there wasn't a widespread public debate about the appropriate vaccination 202 00:20:02,660 --> 00:20:08,590 prioritisation strategy in different countries simply due to the urgency of the situation. 203 00:20:08,600 --> 00:20:16,160 And I think that the decision making bodies did a very good job of delivering a practicable strategy in the very short time frame they had. 204 00:20:17,060 --> 00:20:21,980 I think when we reached phase two, there perhaps could have been a little bit more public discussion, 205 00:20:21,980 --> 00:20:26,210 particularly on the question of prioritising key occupations, 206 00:20:26,480 --> 00:20:31,640 given the reasons of reciprocity and social value that we've considered in our discussion. 207 00:20:32,150 --> 00:20:33,620 And more broadly going forward, 208 00:20:33,620 --> 00:20:39,859 I think there are lessons that we can draw about where we struck the balance between benefit and fairness in this pandemic and whether 209 00:20:39,860 --> 00:20:47,210 that balance should be the same across different phases of a prioritisation strategy that we might need to adopt given a future pandemic. 210 00:20:47,650 --> 00:20:55,210 So I think a really important lesson to draw here is that although we did a lot of things really well in our pandemic response, 211 00:20:55,480 --> 00:21:01,540 we shouldn't be complacent. There are still a lot of important lessons to draw from our experience of the COVID 19 212 00:21:01,540 --> 00:21:06,790 pandemic that we really ought to take forward for future public health emergencies. 213 00:21:07,000 --> 00:21:12,180 What is the role of the professional ethicist in all this? 214 00:21:12,190 --> 00:21:23,320 You've been writing and talking about the pandemic, but how central a role should philosophers have in future pandemics? 215 00:21:24,690 --> 00:21:31,290 So I think philosophers can play a really important role because a lot of the crucial policy 216 00:21:31,290 --> 00:21:36,720 decisions that we were facing in the pandemic ultimately relied on moral judgements. 217 00:21:36,780 --> 00:21:39,840 Vaccine prioritisation is a really great example of this. 218 00:21:40,290 --> 00:21:45,509 So what I think the philosopher can do is lay out the relevant arguments and identify 219 00:21:45,510 --> 00:21:49,680 the kinds of ethical trade-offs that we have to make in crucial policy decisions. 220 00:21:49,830 --> 00:21:57,990 There was a bit of a mantra in the U.K. policy decision making circles that the U.K. government was following the science at all times. 221 00:21:58,170 --> 00:22:04,260 That may have been wrong to some extent, but what it fails to accommodate is the point that in following the science, 222 00:22:04,260 --> 00:22:09,940 you are implicitly making a really important moral judgement. Science can only tell you what to do. 223 00:22:09,960 --> 00:22:14,670 It can only give you direction to follow if you're already making some implicit moral judgements. 224 00:22:14,830 --> 00:22:22,530 The key role of philosophy, I think, is to tease out where those judgements are being made and identify where there can be conflicts. 225 00:22:23,040 --> 00:22:26,310 John Compute, Thank you very much indeed. Thanks for having me. 226 00:22:30,760 --> 00:22:33,940 Thanks for listening to the Pandemic Ethics Accelerator podcast. 227 00:22:34,540 --> 00:22:38,650 You can hear more in this six part series on University of Oxford Podcasts. 228 00:22:38,890 --> 00:22:41,650 Well, that's Pandemic Ethics dot UK.