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Hello, I'm David Edmonds and this is the Pandemic Ethics Accelerator Podcast.

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The UK Pandemic Ethics Accelerator was a project funded by the Arts and Humanities Research

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Council in 2021 22 to examine the ethical challenges faced during the COVID pandemic,

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it combined expertise from the University of Oxford, Bristol, Edinburgh University College, London and the Nuffield Council on Bioethics.

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This six part podcast series covers some of the themes that emerged from the research.

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The Pandemic Ethics Accelerator Program was led by a nursing and Oxford professor of Neuroscience and Society.

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Here she explains what the program was, what it was designed to achieve, and whether it succeeded in a nursing welcome.

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Lovely to be here. We're starting the podcast series with you because you were really the brains behind the pandemic ethics accelerator.

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So perhaps you can begin by telling us what it is. Thank you.

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But I should start by saying it was a very collaborative effort of nine of us.

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So I was the principal investigator and there were eight co-investigators spread across UK institutions.

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So the idea of the UK pandemic ethics accelerator really came about early in the pandemic when we looked at what was happening,

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the speed with which really profound decisions were needing to be made,

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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?

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Were you going to go visit your grandmother in the care home?

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So we thought actually all of these are really important ethical decisions that people are making

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in a way that they probably haven't had to make ethical decisions on a daily basis before.

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And the UK has an extraordinary resource in having among the best ethicists and philosophers

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in the world to help people understand how to think about these difficult questions,

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these dilemmas. And you received a grant to do this work, which was spread out among a series of participating institutions.

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Yes. So we were funded by the UK, COVID 19 Research and Innovation Budget,

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which was the enormous budget that was put together very quickly to fund research to help improve things during the pandemic,

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everything from developing vaccines to helping to shape the social and moral dimensions of the pandemic response.

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So we were a group of philosophers, ethicists and sociologists who were from Oxford, from UCL,

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from Edinburgh, from Bristol, and we had the Nuffield Council on Bioethics also join us.

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One of our core national resources for bioethics thinking and development.

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And why did you call it specifically an ethics accelerator?

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That's a great question.

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What I saw looking around was that there were a number of observatories that were coming about as a consequence of the pandemic.

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So we had the the National Economics Observatory, for example.

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I had initially said, well, we should be the Ethics Observatory.

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And then my colleagues, I think, quite rightly said, well, that's not nearly action oriented enough.

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We don't want to just observe, we want to do things.

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And in fact, we want to accelerate the pace at which ethics is brought to bear on the decisions that are being made.

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Because we thought that that transparency was really lacking at the point when we were putting in the application.

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So we thought, well, let's call it an accelerator.

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And the other dimension of the acceleration was that we wanted it not to be just the nine of us sitting

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around talking to each other about what kind of ethical thinking we should bring into the pandemic context.

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But we really wanted to mobilise ethics communities across the UK beyond our institutions, particularly early career scholars,

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to help kind of mobilise them into this space of particularly policy decision making, where ethics tends not to have a very good reach.

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Scientists can disagree with one another about the spread of the virus and so on,

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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?

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With ethics, even among so-called ethical experts, you can't expect unanimity.

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And where there's disagreements, it's not at all clear how they're to be resolved.

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I think you're right.

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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,

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I recognise very early on as a fundamental disconnect between what empirical scientists do and what ethicists do.

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So empirical scientists can disagree with each other on the basis of the evidence.

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How is the evidence collected? How is the data analysed?

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How is it interpreted and how is it then apply?

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The question becomes about the data in ethics.

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The goodness of the argument is about the argument.

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How coherent is your argument? It's a fully analytical challenge.

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I think a lot of people don't understand that. They don't understand the reasoning behind decision making.

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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,

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the goodness, the soundness of an argument, but also to say, look, it depends on your approach.

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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,

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who would be much more likely to, for example, randomly allocate ventilators rather than prioritising people through a ventilator system.

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So that the way we approach these questions, the kind of ethics we bring to the table,

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have profound implications and consequences for what decisions we make.

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So you can bring clarity both in arguments and in the concepts that we use in those arguments.

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Yes. And we can also talk about reasonable disagreements.

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We tend to live in a world where we think, well, we should all achieve consensus.

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But of course, what ethics allows us to do is to identify both bad arguments, inconsistencies in coherence,

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but also good arguments from different perspectives that lead to different actions.

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And that is what we call reasonable disagreement.

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Reasonable disagreement says, well, you have to put up with disagreement.

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Disagreement isn't necessarily a bad outcome as long as you can trace the ways in which people have come to those disagreements.

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And that's empowering. Another aspect of ethics and the way we came at it in the pandemic is that we wanted to empower

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people to actually feel like they had some major and in the decision making in their own lives.

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And part of that empowerment, we felt,

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was to be able to have some reflection on how they themselves came to make the decisions that they made on a daily basis.

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So you've had a lot of researchers in various universities researching different aspects of the pandemic and pandemic ethics.

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Is it your view that ethics was a serious consideration during the pandemic?

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Well, it was for us, I mean, for government and for policymakers.

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But I think there was a lot more reflection on how people were making decisions in those contexts

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and the huge implications that those decisions were having for publics of various kinds.

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What there was not was any public debate or invitation to reflect,

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to disagree or any transparency about what approaches to ethical decisions were being made.

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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,

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is that the government largely lost trust with people who were already at greater risk during the pandemic.

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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.

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In February and March 2020, there was a real sense of panic.

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We had very little data about the pandemic. Politicians had to make very quick decisions.

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And in Britain, Boris Johnson has been accused of being too slow in introducing a lockdown.

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There wasn't really time, was there, to reflect too deeply about the ethics.

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You're right, people had to make quick decisions.

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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.

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It should have existed prior to the pandemic. There should have been an ethics resource infrastructure within policymaking that could have

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been mobilised in the same way that vaccines development infrastructure was mobilised.

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So that's something they got wrong. What else did they get wrong?

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Well, one of the areas that we focussed on most was the lack of public deliberation,

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the lack of fora for people who aren't used to having a voice in policymaking but were

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disproportionately affected during the pandemic to actually allow for a degree of not just reflection,

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but actually just educating policymakers on what their values and priorities are.

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Why do we have such an extraordinary rate of non vaccine uptake among certain groups?

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We could have learned a lot actually just by having those public deliberations.

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But I also want to say, because one shouldn't just point the finger in one way.

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One of the areas in which we as researchers are, I think,

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still quite weak is that we don't have terribly good methodologies for what we call public deliberation.

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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.

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That's not a method. I don't think that has much credibility.

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Certainly not when you're trying to make normative decisions.

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You know what we could do? Not just what do people. Think is the case.

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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.

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So it's a two way street and is the point that the virtues of transparency and clarity and

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deliberation and consultation is the point that those virtues would lead to better decisions?

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Or do they have intrinsic value? Both.

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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,

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and this was not an unusual situation for members of some minoritized groups.

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For him, the question was not just about trying to understand the values and priorities that were driving the decisions to mandate a vaccine.

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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.

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In the end, that's what persuaded him to do.

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This was not his own health, which we were focussed on, but the fact that he was protecting others by protecting himself.

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I think the intrinsic good drives the better decision making.

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But if there had been more consultation with minority groups or representatives of minority groups.

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That's always a contentious topic. Who is a representative of a minority group?

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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.

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Yes, that makes it sound very simple and that disregards an entire history that has made him sceptical of medical interventions in general.

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As a person of colour. So I think we can't ignore that.

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And I guess one has to come back to this question of what's the grounds on which the pandemic response was taking place?

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And that ground itself is full of historic injustices and inequities, etc., and one can't solve those in the moment of the crisis.

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These are the conditions in which any response to crises is going to have to contend.

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You have to tackle those conditions outside the crisis in a kind of proprietary way.

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We know now, of course, that the pandemic did have a disproportionate impact on certain groups,

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but presumably that was something that we could have predicted as soon as the pandemic began.

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While health disparities certainly didn't start with the pandemic, though, we certainly could have predicted it.

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The question is, did anybody care? And an important ethical question is why do we now?

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Do we care? Because of the broader impact, the cost to the NHS?

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The fact that we're going to be living with the consequences of health injustices now in an amplified way for many, many years.

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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.

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And I think that's part of the work of ethics in going forward, is to help people understand, again,

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that those are two different approaches to why we should care about the disproportionate impact of the pandemic.

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Accelerator program. It receives a fair amount of money.

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What are the criteria for judging whether it's been money well spent?

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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.

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So one was, did we make an impact? Have we affected policy thinking, if not policy making?

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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,

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I include in that people who are making decisions about their own family members and their own behaviour.

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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.

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The pandemic isn't over and in part this period of recovery.

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What we're finding is there's more opportunity now to speak and to be heard.

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People are listening because they want to know how to do better.

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To that degree, we hope to be successful even beyond the end of the grant.

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The other way to judge success is did we mobilise the ethics research community to bring forward their skills in this period of time?

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And again, I don't think we did as well as we wanted to in mobilising the national research ethics community.

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But in terms of the early career researchers in the accelerator who were just really the engine of the whole thing,

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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.

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Academic timescales would normally provide giving them opportunities to engage with policymaking.

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So I think in that way we've been very successful and I hope that that will be a legacy of the project.

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And then finally, the fact that we, as nine ethicists, social scientists, had this really intensive interaction over 18 months to 24 months,

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has also kind of shaped a collaborative entity and a way of doing a big ethics project in a collaborative way.

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We've learned a lot from that, and I think going forward there will be much more opportunities,

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these kind of things that usually scientists do that build these huge collaborations and across institutions, etc.

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So we really found a way to come together and also maintain independent expertise as well as working as a collective.

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And I think that that we did really well. So you've given you the self a mixed report.

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You've been very honest about that. I wonder if you've been too tough on yourself.

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How do you know that nobody's been listening or few people have been listening?

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We know because of the things we haven't been asked to do, we haven't been invited into number ten.

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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,

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other groups that are coming together to think about pandemic recovery.

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We have been talking to the people who are leading the COVID inquiry.

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One of the people leading that is an academic, which I think helps.

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And he said, gosh, you know, I hadn't thought ethics would be one of the strands that we look at.

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But as I learned about what the accelerator was doing, I began to see that it's actually everything.

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It's in all our strands. And so we'd really like to think about it as a cross-cutting resource.

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Could we potentially use your group on a kind of consultancy basis?

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We'll see if that comes to fruition. But we were really excited about that because we thought, yes, exactly.

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That's exactly what we want people to realise. You criticised the Government earlier for being slow to respond to the pandemic.

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I wonder whether there's a case for having something like the pandemic ethics accelerator existing as a permanent body?

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Yes.

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So I think there certainly is a case for having the infrastructure available so that the pandemic ethics accelerator could mobilise again quickly.

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And that would mean allowing us to continue on in the background of a low hum.

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As you well know, nothing in academia works unless it has funding.

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What I would really like to see happen in the next phase of national funding is that

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there are infrastructure projects that are funded by all the research councils.

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We know that science and medicine are very good at funding these large scale infrastructure projects,

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but we're really less good and almost non-existent in funding them in,

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for example, arts and humanities, where ethics and philosophy funding comes from.

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And one of the problems, of course, is that these larger infrastructure projects have a very long lead time.

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And so success indicators, which you asked about earlier, are more difficult to establish.

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But I think we've shown ourselves as a group to be very productive and to a limited but growing extent impactful.

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It would make a lot of sense to keep us going and to have this infrastructure.

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And then I think that it also makes sense to continue having that happen in collaboration with the Nuffield Council on Bioethics,

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which is itself going to be moving to more of a responsive mode, but obviously needs UK academics to support its work.

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And so I think that that infrastructure funding for us would be very valuable.

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And then saying thank you very much indeed. Thank you very much.

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Thanks for listening to the Pandemic Ethics Accelerator podcast.

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You can hear more in this six part series on University of Oxford Podcasts.

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Well, that's Pandemic Ethics dot UK.