Pandemic Ethics and Status Quo Risk (forthcoming in PHE)

My latest paper, 'Pandemic Ethics and Status Quo Risk', has just been accepted for publication in Public Health Ethics. Here's the abstract:

Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by “caution”. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias—exaggerating the moral significance of the risks inherent in medical interventions, while systematically neglecting the (objectively greater) risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes

The central idea is that heuristics of ambiguity-aversion and favouring inaction over (potentially risky) action can be expected to backfire terribly in circumstances -- such as a pandemic -- in which "business as usual" is leading us towards disaster.  Instead, I suggest that our policy and institutional responses to such emergency circumstances need to be rebalanced towards (i) liberalizing access to experimental treatments and vaccines, and (ii) requiring an explicit cost-benefit analysis to justify any sort of vaccine obstructionism (e.g. failure to immediately grant Emergency Use Authorization to any credible candidate vaccine early in the pandemic, and of course any post-authorization suspensions).

Other key points of the paper:

(1) "Governments and their agencies are not generally entitled to describe vaccine suspensions as reflecting “an abundance of caution”, unless they can show that the policy actually reduces overall risk. If it instead increases overall risk, it would seem more objectively accurate to describe such suspensions as “reckless”—as they would then reveal a reckless disregard of the objectively greater threat posed by the unchecked spread of the virus."

(2) Non-consequentialists should be even more appalled by vaccine obstructionism, as it constitutes harmful coercion resulting in death (which is to say: killing) by the government -- no less than if the FDA sent out agents to steal a cure from the hands of those who will die without it.

(3) Vaccine challenge trials were a no-brainer, and opposing them on ethical grounds constitutes anti-beneficent paternalism -- a kind of moral insanity.  The basic argument also carries over to "any research that has a feasible chance of reducing the population-wide toll of the pandemic," including research into variolation, and challenge trials for candidate preventative measures (such as antiseptic nasal sprays). 

(4) Early targeted immunity via variolation (ideally preceded with experimental vaccination) could have done a lot of good, slowing the spread of the virus and freeing many healthy young people from unnecessary lockdowns.

(5) Fear of "vaccine hesitancy" provides but weak reasons to oppose liberalization.  I offer several reasons for this in the paper, but I think the strongest is that however much you'd like to reduce vaccine hesitancy, it isn't ethical to pursue this goal via killing innocent people, but (as per #2 above) that's precisely what obstructionism amounts to.

(6) If you're on board with my conclusion that pandemic policy was rife with status quo bias, the next step is to design institutional reforms to change the incentives that lead to this result.  Right now, "policy-makers are more likely to be blamed if an intervention goes wrong (resulting in highly salient identifiable victims), whereas they tend to escape blame for inaction that results in grave preventable harms (many of which may be less salient, or only linkable to the policy decision on a statistical basis—we cannot identify which particular deaths would have been prevented by earlier access to vaccines, for example)."  My paper doesn't address this problem, but perhaps it could help to shift EUA-granting authority to a new institution that's authorized to make such decisions on the basis of explicit cost-benefit analysis, and very explicitly does not recommend that anyone take the experimental treatments that it authorizes (i.e. makes legally available) for personal use.