Hello, I'm David Edmonds and this is the Pandemic Ethics Accelerator Podcast.
The UK Pandemic Ethics Accelerator was a project funded by the Arts and Humanities Research
Council in 2021 22 to examine the ethical challenges faced during the COVID pandemic,
it combined expertise from the University of Oxford, Bristol, Edinburgh University College, London and the Nuffield Council on Bioethics.
This six part podcast series covers some of the themes that emerged from the research.
The Pandemic Ethics Accelerator Program was led by a nursing and Oxford professor of Neuroscience and Society.
Here she explains what the program was, what it was designed to achieve, and whether it succeeded in a nursing welcome.
Lovely to be here. We're starting the podcast series with you because you were really the brains behind the pandemic ethics accelerator.
So perhaps you can begin by telling us what it is. Thank you.
But I should start by saying it was a very collaborative effort of nine of us.
So I was the principal investigator and there were eight co-investigators spread across UK institutions.
So the idea of the UK pandemic ethics accelerator really came about early in the pandemic when we looked at what was happening,
the speed with which really profound decisions were needing to be made,
not just at the political level but also in everyday life, was when going to go shopping, how much food were you going to buy in one go?
Were you going to go visit your grandmother in the care home?
So we thought actually all of these are really important ethical decisions that people are making
in a way that they probably haven't had to make ethical decisions on a daily basis before.
And the UK has an extraordinary resource in having among the best ethicists and philosophers
in the world to help people understand how to think about these difficult questions,
these dilemmas. And you received a grant to do this work, which was spread out among a series of participating institutions.
Yes. So we were funded by the UK, COVID 19 Research and Innovation Budget,
which was the enormous budget that was put together very quickly to fund research to help improve things during the pandemic,
everything from developing vaccines to helping to shape the social and moral dimensions of the pandemic response.
So we were a group of philosophers, ethicists and sociologists who were from Oxford, from UCL,
from Edinburgh, from Bristol, and we had the Nuffield Council on Bioethics also join us.
One of our core national resources for bioethics thinking and development.
And why did you call it specifically an ethics accelerator?
That's a great question.
What I saw looking around was that there were a number of observatories that were coming about as a consequence of the pandemic.
So we had the the National Economics Observatory, for example.
I had initially said, well, we should be the Ethics Observatory.
And then my colleagues, I think, quite rightly said, well, that's not nearly action oriented enough.
We don't want to just observe, we want to do things.
And in fact, we want to accelerate the pace at which ethics is brought to bear on the decisions that are being made.
Because we thought that that transparency was really lacking at the point when we were putting in the application.
So we thought, well, let's call it an accelerator.
And the other dimension of the acceleration was that we wanted it not to be just the nine of us sitting
around talking to each other about what kind of ethical thinking we should bring into the pandemic context.
But we really wanted to mobilise ethics communities across the UK beyond our institutions, particularly early career scholars,
to help kind of mobilise them into this space of particularly policy decision making, where ethics tends not to have a very good reach.
Scientists can disagree with one another about the spread of the virus and so on,
but there were ways of sorting out who's right and who's wrong in science, and that's just not quite so easy, is it?
With ethics, even among so-called ethical experts, you can't expect unanimity.
And where there's disagreements, it's not at all clear how they're to be resolved.
I think you're right.
I'm trained as an empirical scientist, and I converted to bioethics even before I finished my Ph.D. So this question that you're asking,
I recognise very early on as a fundamental disconnect between what empirical scientists do and what ethicists do.
So empirical scientists can disagree with each other on the basis of the evidence.
How is the evidence collected? How is the data analysed?
How is it interpreted and how is it then apply?
The question becomes about the data in ethics.
The goodness of the argument is about the argument.
How coherent is your argument? It's a fully analytical challenge.
I think a lot of people don't understand that. They don't understand the reasoning behind decision making.
So one of. Charges really want to make that available to people, to give them the tools that philosophers and ethicists have to judge arguments,
the goodness, the soundness of an argument, but also to say, look, it depends on your approach.
So if I'm a utilitarian and I want to maximise the good for the most, I'm going to think differently from somebody who's an egalitarian,
who would be much more likely to, for example, randomly allocate ventilators rather than prioritising people through a ventilator system.
So that the way we approach these questions, the kind of ethics we bring to the table,
have profound implications and consequences for what decisions we make.
So you can bring clarity both in arguments and in the concepts that we use in those arguments.
Yes. And we can also talk about reasonable disagreements.
We tend to live in a world where we think, well, we should all achieve consensus.
But of course, what ethics allows us to do is to identify both bad arguments, inconsistencies in coherence,
but also good arguments from different perspectives that lead to different actions.
And that is what we call reasonable disagreement.
Reasonable disagreement says, well, you have to put up with disagreement.
Disagreement isn't necessarily a bad outcome as long as you can trace the ways in which people have come to those disagreements.
And that's empowering. Another aspect of ethics and the way we came at it in the pandemic is that we wanted to empower
people to actually feel like they had some major and in the decision making in their own lives.
And part of that empowerment, we felt,
was to be able to have some reflection on how they themselves came to make the decisions that they made on a daily basis.
So you've had a lot of researchers in various universities researching different aspects of the pandemic and pandemic ethics.
Is it your view that ethics was a serious consideration during the pandemic?
Well, it was for us, I mean, for government and for policymakers.
But I think there was a lot more reflection on how people were making decisions in those contexts
and the huge implications that those decisions were having for publics of various kinds.
What there was not was any public debate or invitation to reflect,
to disagree or any transparency about what approaches to ethical decisions were being made.
And I think that that was a real failing of the government response, because what it meant, as you'll hear from other colleagues in this accelerator,
is that the government largely lost trust with people who were already at greater risk during the pandemic.
And I think that was a real failing. We'll get on to that in a minute. But I wonder whether we have short memories about the pandemic.
In February and March 2020, there was a real sense of panic.
We had very little data about the pandemic. Politicians had to make very quick decisions.
And in Britain, Boris Johnson has been accused of being too slow in introducing a lockdown.
There wasn't really time, was there, to reflect too deeply about the ethics.
You're right, people had to make quick decisions.
But perhaps that's one of the points here that a pandemic ethics accelerator should not have come into being a year or more into the pandemic.
It should have existed prior to the pandemic. There should have been an ethics resource infrastructure within policymaking that could have
been mobilised in the same way that vaccines development infrastructure was mobilised.
So that's something they got wrong. What else did they get wrong?
Well, one of the areas that we focussed on most was the lack of public deliberation,
the lack of fora for people who aren't used to having a voice in policymaking but were
disproportionately affected during the pandemic to actually allow for a degree of not just reflection,
but actually just educating policymakers on what their values and priorities are.
Why do we have such an extraordinary rate of non vaccine uptake among certain groups?
We could have learned a lot actually just by having those public deliberations.
But I also want to say, because one shouldn't just point the finger in one way.
One of the areas in which we as researchers are, I think,
still quite weak is that we don't have terribly good methodologies for what we call public deliberation.
We tend to just get a bunch of people together in a room to talk and we listen well and then we write it up.
That's not a method. I don't think that has much credibility.
Certainly not when you're trying to make normative decisions.
You know what we could do? Not just what do people. Think is the case.
And so we need to get better at that. And then I think we would be more persuasive in helping governments come to us to do that kind of work.
So it's a two way street and is the point that the virtues of transparency and clarity and
deliberation and consultation is the point that those virtues would lead to better decisions?
Or do they have intrinsic value? Both.
If you take someone like my father who's Indian and didn't want a vaccine for a long time until he was finally persuaded by his children,
and this was not an unusual situation for members of some minoritized groups.
For him, the question was not just about trying to understand the values and priorities that were driving the decisions to mandate a vaccine.
But he wanted to know that for him, those decisions were inherently good to do, not just of his own health, but for broader health benefits.
In the end, that's what persuaded him to do.
This was not his own health, which we were focussed on, but the fact that he was protecting others by protecting himself.
I think the intrinsic good drives the better decision making.
But if there had been more consultation with minority groups or representatives of minority groups.
That's always a contentious topic. Who is a representative of a minority group?
Had there been more of that, there would have been more trust in your father, for example, might have shown less resistance to having the vaccine.
Yes, that makes it sound very simple and that disregards an entire history that has made him sceptical of medical interventions in general.
As a person of colour. So I think we can't ignore that.
And I guess one has to come back to this question of what's the grounds on which the pandemic response was taking place?
And that ground itself is full of historic injustices and inequities, etc., and one can't solve those in the moment of the crisis.
These are the conditions in which any response to crises is going to have to contend.
You have to tackle those conditions outside the crisis in a kind of proprietary way.
We know now, of course, that the pandemic did have a disproportionate impact on certain groups,
but presumably that was something that we could have predicted as soon as the pandemic began.
While health disparities certainly didn't start with the pandemic, though, we certainly could have predicted it.
The question is, did anybody care? And an important ethical question is why do we now?
Do we care? Because of the broader impact, the cost to the NHS?
The fact that we're going to be living with the consequences of health injustices now in an amplified way for many, many years.
So is it an economic form of care? Because we've come to understand the intrinsic value of caring for people who are at risk of health injustice.
And I think that's part of the work of ethics in going forward, is to help people understand, again,
that those are two different approaches to why we should care about the disproportionate impact of the pandemic.
Accelerator program. It receives a fair amount of money.
What are the criteria for judging whether it's been money well spent?
It's a very good question. I think for us, there are a number of ways in which we thought about the success of the Endeavour.
So one was, did we make an impact? Have we affected policy thinking, if not policy making?
We don't just mean by that. Did number ten listen to us, but all the way down the chain of command of people who make decisions,
I include in that people who are making decisions about their own family members and their own behaviour.
So I think the answer there is to a large extent no, we've not been successful, but we're also coming to understand that time will tell.
The pandemic isn't over and in part this period of recovery.
What we're finding is there's more opportunity now to speak and to be heard.
People are listening because they want to know how to do better.
To that degree, we hope to be successful even beyond the end of the grant.
The other way to judge success is did we mobilise the ethics research community to bring forward their skills in this period of time?
And again, I don't think we did as well as we wanted to in mobilising the national research ethics community.
But in terms of the early career researchers in the accelerator who were just really the engine of the whole thing,
I think that we did a great job and they did a fantastic job of generating new kinds of products, learning how to do things much more quickly than.
Academic timescales would normally provide giving them opportunities to engage with policymaking.
So I think in that way we've been very successful and I hope that that will be a legacy of the project.
And then finally, the fact that we, as nine ethicists, social scientists, had this really intensive interaction over 18 months to 24 months,
has also kind of shaped a collaborative entity and a way of doing a big ethics project in a collaborative way.
We've learned a lot from that, and I think going forward there will be much more opportunities,
these kind of things that usually scientists do that build these huge collaborations and across institutions, etc.
So we really found a way to come together and also maintain independent expertise as well as working as a collective.
And I think that that we did really well. So you've given you the self a mixed report.
You've been very honest about that. I wonder if you've been too tough on yourself.
How do you know that nobody's been listening or few people have been listening?
We know because of the things we haven't been asked to do, we haven't been invited into number ten.
We haven't been invited. Again, I want to say yet two conferences that are looking at the legacy of the track and trace program,
other groups that are coming together to think about pandemic recovery.
We have been talking to the people who are leading the COVID inquiry.
One of the people leading that is an academic, which I think helps.
And he said, gosh, you know, I hadn't thought ethics would be one of the strands that we look at.
But as I learned about what the accelerator was doing, I began to see that it's actually everything.
It's in all our strands. And so we'd really like to think about it as a cross-cutting resource.
Could we potentially use your group on a kind of consultancy basis?
We'll see if that comes to fruition. But we were really excited about that because we thought, yes, exactly.
That's exactly what we want people to realise. You criticised the Government earlier for being slow to respond to the pandemic.
I wonder whether there's a case for having something like the pandemic ethics accelerator existing as a permanent body?
Yes.
So I think there certainly is a case for having the infrastructure available so that the pandemic ethics accelerator could mobilise again quickly.
And that would mean allowing us to continue on in the background of a low hum.
As you well know, nothing in academia works unless it has funding.
What I would really like to see happen in the next phase of national funding is that
there are infrastructure projects that are funded by all the research councils.
We know that science and medicine are very good at funding these large scale infrastructure projects,
but we're really less good and almost non-existent in funding them in,
for example, arts and humanities, where ethics and philosophy funding comes from.
And one of the problems, of course, is that these larger infrastructure projects have a very long lead time.
And so success indicators, which you asked about earlier, are more difficult to establish.
But I think we've shown ourselves as a group to be very productive and to a limited but growing extent impactful.
It would make a lot of sense to keep us going and to have this infrastructure.
And then I think that it also makes sense to continue having that happen in collaboration with the Nuffield Council on Bioethics,
which is itself going to be moving to more of a responsive mode, but obviously needs UK academics to support its work.
And so I think that that infrastructure funding for us would be very valuable.
And then saying thank you very much indeed. Thank you very much.
Thanks for listening to the Pandemic Ethics Accelerator podcast.
You can hear more in this six part series on University of Oxford Podcasts.
Well, that's Pandemic Ethics dot UK.