08:30 am
Solidarity as a Regulatory Principle for Digital Technologies Used in the Pandemic Response
Prof. Junhewk Kim | Yonsei University College of Dentistry | Korea, Republic of
Show details
Author:
Prof. Junhewk Kim | Yonsei University College of Dentistry | Korea, Republic of
In addition to existing epidemiological methods, the on-going COVID-19 pandemic requires effective approaches for controlling the disease spread. The use of digital technologies has been discussed in this context, and digital contact tracing technology (DCTT) and vaccine passport are representative examples of such technologies. Ethical discussions on the application of these technologies have noted privacy breach and undermining social trust as concerns, arguing that these two aspects should be balanced with the public benefits of technology application. The discussion on digital technologies, including DCTT, as a pandemic response, have called for a new perspective on existing public health ethics. We proposes that applying solidarity as a regulatory principle to digital technologies can offer ways to pursue privacy-public interests complementarily instead of as competitive values. Existing studies and discussions on digital technologies in the COVID-19 context were explored, particularly focusing on the utilization and ethical aspects of DCTT. The development of solidarity in biomedical ethics and the direction applied to public health ethics were also considered. Our discussion led to the conclusion that the acceptability of DCTT can increase when privacy is secured, which results in increased overall effectiveness of the technology. This can be achieved by applying solidarity as a regulatory principle that requires individuals to participate, while empowering the privacy and social trust of the participating individuals at the national level. Thus, we presents an ethical approach based on the principle of solidarity that reciprocates the interests of individuals and the collective instead of making them compete.
08:45 am
Public Health Equipoise and Placebo-Controlled COVID-19 Vaccine Trials
Dr. Liza Dawson | Walter Reed Army Institute of Research | United States
Show details
Author:
Dr. Liza Dawson | Walter Reed Army Institute of Research | United States
Introduction: Currently, COVID -19 vaccine candidates continue to be tested in placebo-controlled trials, even while authorized vaccines are widely rolled out in some regions. The use of placebos when effective interventions are available can be ethically problematic.
Methods: Normative analysis
Outcome: Existing ethics guidance proscribes the use of placebos in clinical trials when there are known effective interventions except when risks are limited. However, recent WHO guidance has suggested special provisions for use of placebos in COVID vaccine research in light of the public health crisis and urgent need to address the pandemic.
The concept of clinical equipoise is relevant to placebo use. Equipoise involves uncertainty in the expert community about the relative merits of study arms (which can include placebo), as long as no arms are inferior to current standard of care. However clinical equipoise does not address population level decision-making. For this purpose, I introduce a variation on clinical equipoise, called public health equipoise (PH equipoise). PH equipoise differs in that it benchmarks the standard of care to the health system standard of care (not best individual care). I use PH equipoise to analyze the ethics of placebo use, and further, to address the international landscape of COVID vaccine trials.
Conclusion: Public health equipoise provides a framework for analysis of the ethics of clinical trials addressing public health needs. Under this framework, research stakeholders have responsibilities not only to design trials appropriately, but also to consider background conditions and additional obligations to address global health disparities.
09:00 am
On duties to strangers. The obligation to vaccinate refugees, undocumented migrants and asylum seekers and COVID 19: A question of justice.
Prof. Deborah Zion | Victoria University | Australia
Show details
Authors:
Prof. Deborah Zion | Victoria University | Australia
Dr. Bridget Haire | University of New South Wales | Australia
Introduction: Refugees, asylum seekers and irregular migrants are particularly vulnerable to COVID 19. This vulnerability is based upon unstable housing, inability to isolate, poverty, and existing poor health. By mid 2020 it was estimated that 80 million people were living under such circumstances.
COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator seeks to purchase vaccines and distribute these globally to address issues of inequity that precludes vaccine provision in low and middle income countries. Five percent of such vaccines have been reserved for humanitarian purposes. Many displaced populations in countries that access COVAX vaccines, however, remain unvaccinated.
Method: We examined publicly available documents of the four countries that take the highest numbers of refugees globally: Turkey, Colombia, Germany and Pakistan.
Outcomes: While in some cases refuges were technically eligible for vaccines, we found significant barriers to access including language, lack of education and information about vaccines and poor access to health systems.
Conclusions: In public health terms there is an imperative to vaccinate all persons to eliminate the epidemic. However, we also make another claim in support of vaccination based upon redressing the creation of vulnerability. The actions of wealthy nations create vulnerabilities that lead to irregular migration, and the conditions in which such persons live, which in term leads to a higher risk of exposure and death in these populations. We contend that the creation of these vulnerabilities also leads to a claim based upon justice for vaccination regardless of citizenship status.
09:15 am
Are Vaccine Boosters Ethical in a World of Unequal Access?
Dr. Kyle Ferguson | NYU Grossman School of Medicine | United States
Show details
Author:
Dr. Kyle Ferguson | NYU Grossman School of Medicine | United States
Although nearly half of the global population has received at least one dose of a Covid-19 vaccine, global access is starkly unequal. In many high-income countries (HICs), more than two-thirds of their populations are fully vaccinated. In low- and middle-income countries (LMICs), reliant on the Covax initiative, vaccination coverage remains astonishingly low: in Africa, less than 7% of the population has received a dose; in many African countries, less than 2%. Against this backdrop of inequality, several HICs began administering boosters. HIC-based booster campaigns will increase in number, and their eligible populations will only expand. Meanwhile, the Covax initiative fell far short of its goals and routinely lowers its projections. Dramatically unequal access to Covid-19 vaccines will persist.
In this presentation, I consider whether it is ethical for HICs to implement booster programs in a world of unequal access. I argue that errors plague the usual way of posing this question, which involves framing the issue as the following ethical dilemma: Should we administer boosters at home or should we vaccinate the world? The flawed framing stems from misunderstanding global manufacturing capacity, mobility of available doses, and the very nature of so-called “boosters.” It also stems from ignoring or discounting special obligations of community membership or misunderstanding how those obligations relate to cosmopolitan responsibilities and solidarity-based commitments. I conclude that administering vaccine boosters under conditions of inequality can be ethically justified and that the apparent dilemma involves a false dichotomy. HICs can and should administer boosters while improving global access.
09:30 am
Can Bioethics be a mechanism of solidarity? The COVID 19 and Human Challenge Vaccine Trials debate.
Prof. Deborah Zion | Victoria University | Australia
Show details
Authors:
Prof. Deborah Zion | Victoria University | Australia
Dr. Bridget Haire | University of New South Wales | Australia
ABSTRACT
Introduction: There has been much discussion about Human Challenge Trails for COVID 19. These trials presented serious ethical challenges. Much of the bioethics literature argued in favour of such trials by focusing on questions of individual autonomy, the right to take risks, parity with other established procedures like kidney donation and high social value. Foundational to this kind of analysis were ideas autonomy liberty and necessity
Method: In contrast, we argue that such trials were ethically problematic given the risks posed by COVID 19 were unknown, there were no effective treatments, the scientific merit was hard to quantify, and the necessity was questionable given the swift development of effective vaccines without such trials. In addition, the issue of payment opened the way to exploitation of vulnerable persons. Further, we examine a different way of thinking about a politicised bioethics, drawing upon the example of HIV/AIDS which lead to changes in research ethics, community engagement and drug access. The focus of this kind of bioethics does not exclude the importance of autonomy, but is nonetheless centred on questions of justice.