While this is very welcome news, there is a mass vaccination program in place probably not enough To eliminate the virus, we must turn our minds to the ethics of long-term management of COVID-19.
One strategy would be to get rid of the virus in the UK. New Zealand successfully implemented an elimination strategy formerly in the pandemic and is now at a post-elimination stage.
An elimination strategy in the UK would require the combination of the mass vaccination program strict restrictions on international travel to prevent new cases and variants of the virus from being imported. The Government was reluctant to support an elimination strategy given the importance of international trade to the UK economy.
One of the main alternatives The elimination strategy includes treating coronavirus as endemic to the UK and to seek long-term suppression of the virus to acceptable levels. However, in order to adopt a strategy of repression in the long term, we have to make a social decision about the damage that we accept and that we do not want to accept.
The trilemma of freedom, equality and mortality
The first year of the pandemic taught us that without suppression, the coronavirus will cause significant death and damage, including long COVID. But the facts suggest that mitigation measures such as blocking and effective test, trace and isolate systems can effectively reduce the transmission of the virus.
These measures have their own costs. Bans severely restrict civil liberties and cause a wide range of other damages, including significant non-COVID mortality and morbidity. Recently Models suggest that mitigating the pandemic could lead to 100,000 deaths without COVID in the long run. According to the numbers in this model, deaths from the virus itself can only be roughly responsible 54% of the total death toll of the UK outbreak.
The scale of some mitigation costs could be reduced by targeting these measures to specific groups, e.g. B. to those who have not been vaccinated or to those who are at a particularly high risk of dying from COVID, e.g. B. over the age of 65. However, these targeted strategies include forms of inequality and possible discrimination.
This is the basic trilemma of long-term oppression strategy. The societal decision we make about the acceptable level of virus suppression involves choosing which of the three competing values to prioritize and which to compromise. We can maximize one or two of these values, but we cannot have all three.
We may be able to reduce COVID deaths while ensuring equality, but only if we are willing to accept the potential need for future lockdowns, severe travel restrictions, and the associated costs to freedom and general health. We might be able to reduce COVID deaths while protecting the freedom of those who are not at risk of transmission by introducing COVID certificates or passports, but only if we are willing to accept the inequality that such Bring systems with them.
After all, we can give everyone in society as much freedom as possible, but only if we are willing to accept the increased COVID deaths will this likely happen if the virus has not been adequately suppressed in other ways.
The moral question about the suppression strategy was asked as a question of how many COVID deaths we should accept each year. This leads to comparisons between COVID and annual deaths from other infectious diseases such as influenza, which in European countries have caused fewer than two deaths per 100,000 people per year since 2000and those we have lived with in the past, like tuberculosis, which causes around 100 deaths per 100,000 people per year in England and Wales in the beginning of the 20th century.
These comparisons are instructive as they provide a basis for the number of infectious disease deaths that we have found acceptable in the past. If we accept a bad flu year with over 22,000 Deaths in England without imposing significant societal restrictions then we may accept the same number of deaths from COVID.
However, these comparisons are only relevant to one of the most important ethical values. In the context of COVID, we may have to risk a higher number of COVID deaths if there are no significant societal constraints or inequalities.
To decide what is acceptable for the suppression strategy, we must face the fundamental conflict between values in the COVID trilemma.
Jonathan Pugh, Research Associate in Applied Moral Philosophy, Oxford University;; Dominic Wilkinson, Consulting Neonatologist and Professor of Ethics, Oxford University, and Julian Savulescu, Visiting Professor of Biomedical Ethics, Murdoch Children’s Research Institute; Excellent Visiting Professor of Law at the University of Melbourne; Uehiro Chair for Practical Ethics, Oxford University