A bioethics view on the latest covid vaccination policies

With the UK Government due to announce its Covid winter plan, Danielle Hamm, Director of the Nuffield Council on Bioethics, provides a bioethics perspective on recent and expected policy developments relating to covid vaccination.

What is your view on the proposed booster vaccine programme this autumn?

“This decision has to be based on the best available scientific evidence about whether an extra dose will be beneficial – but there are other factors to weigh up too.

“For example, we need to consider our responsibilities towards people in other countries. Global solidarity is important, and we should think about whether its right to offer booster vaccines to people who already have some protection before helping those who don’t have any protection at all.

“The UK has already pledged to donate 100 million doses around the world, but the timing of these doses is critical – when will people get them? And we need to support vaccine production in other countries by having patenting policies and intellectual property licensing that focus on fairness and global public good.

“There are other ways to protect people – such as mask wearing in enclosed public spaces and social distancing. We are puzzled as to why the Government has decided to stop mandating these measures, especially given they help protect those who cannot have the vaccine or who are at risk of a severe covid infection.

“We want to see more transparency in Government decisions over these important issues.”

Do you think vaccination should be mandatory for frontline healthcare workers?

“Public health interventions like this, which are highly intrusive or restrictive of people’s lives, require a strong justification. We would particularly want to see clear evidence that other, less intrusive measures – such as tackling vaccine hesitancy in areas where this is particularly high – have been tried first and are not proving enough.

“We have not seen this evidence and are not convinced it exists. Despite this, the Government is pushing ahead with mandatory vaccination for care home workers. And, crucially, the Government is allowing no time to monitor the effect of the policy before potentially expanding it to a much wider group of healthcare professionals.

“It is estimated that 7% of the care home workforce will choose to remain unvaccinated, and the costs to the care home sector of replacing those workers will be £100 million. If the policy is rolled out across the whole health sector, there could be huge staffing and cost implications.”

What do you think of the Government’s decision not to pursue vaccination passports?

“We welcome this decision.

“The idea of vaccine passports raises ethical questions concerning respect for individual rights and interests, public health responsibilities and social justice.”

We are concerned that bringing in passports in relatively uncontroversial areas (e.g. for entry to large events and clubs) could pave the way to passports being required in other areas of life.

“This, we believe, could lead to discrimination against and a loss of opportunity those who cannot provide proof of vaccine status. It could also exacerbate distrust by marginalised people and increase vaccine hesitancy, particularly if this is seen as introducing mandatory vaccination by the back door or building surveillance apparatus for communities that are already disproportionately monitored.”

Do you think all children should be offered the vaccine?

“After the JVCI advised that the vaccine only offered a marginal health benefit to 12 to 15 year olds, the four chief medical officers for the UK have recommended that children in that age group should be offered one dose of the Pfizer Covid vaccine.

“It’s obviously been a very difficult call, and the CMOs have rightly taken a broad view of children’s health and their lives when weighing up the benefits and harms, such as disruption to children’s education. It will be important to monitor and gather evidence on the effects of vaccination on these different factors.

“We need to think about what children want too, particularly in older age groups. The law on obtaining consent for medical interventions in children is well established but not always well-understood. We would hope to see clear guidance for health professionals if they are to deliver COVID vaccinations for children.”

Further reading

• Bioethics briefing note: Vaccine access and uptake
• Bioethics briefing note: Fair and equitable access to COVID-19 treatments and vaccines

• Statement: COVID-19 and the basics of democratic governance
• Consultation response: Making vaccination a condition of deployment in older adult care homes
• Report: Public health: ethical issues
• Report: The ethics of research in global health emergencies