Anjana Ahuja: Anticipating, identifying, and responding to ethical controversy and uncertainty

The following is an edited version of Anjana Ahuja’s remarks at a UK Pandemic Ethics Accelerator event on 23rd May 2022, discussing the place of values in public policy during a pandemic

Dr Anjana Ahuja is the Financial Times’ award-winning science columnist. She covers science, technology and global health for a worldwide audience, and is particularly interested in the social, political and ethical implications of developments in these areas. She was one of the first journalists, in early January 2020, to cover the emergence of a novel pneumonia in Wuhan. She subsequently co-authored a widely acclaimed book, Spike: The Virus versus The People, with Wellcome Trust Director Sir Jeremy Farrar. Spike was shortlisted for the 2022 Orwell Prize for Political Writing. 

I need to be clear that I have no formal grounding in moral philosophy or ethical reasoning, so I offer reflections as a journalist. My role as science columnist and commentator, is to communicate on scientific issues of interest and concern to Financial Times (FT) readers, to highlight uncertainty and offer clarity, to hold those in positions of power accountable for their decisions, to point out inconsistencies in policy, or where things just don’t seem to make sense, to highlight and sometimes advocate different policy positions. Essentially, during the pandemic, my role was to help FT readers think their way through the pandemic. 

In terms of ethics, one of the things I wrote about early on was how ventilators might be rationed, as was happening in Italy at that time. However I expected mostly to be writing about the science of the virus, the development of vaccines and so on. But I found I became increasingly confused by the Government’s broad ethical objectives during the pandemic and who was formulating them. 

Confusions and frustrations

My confusions were: Was government policy aimed at saving lives or preventing infection? When the Government said it wanted to “save the NHS” who were we saving it for? And where did the precautionary principle come in?

In preparing my reflections, I went back to the Coronavirus Action Plan from March 2020. I remember thinking at the time that there did not seem to be an urgent objective to prevent infection. Yet that seemed to me to be the immediate thing you needed to do to keep people safe, in view of what was happening in other countries. Much of the government’s action seemed to me to presuppose that it was acceptable for people to be infected with a new virus to which none of us had immunity; and that there was such a thing as acceptable deaths and collateral damage, particularly when it came to a perceived herd immunity strategy. That seemed to me ethically problematic. It wasn’t what other countries were doing, like Korea and Singapore, and they’d already had experience of SARS1.

It was not clear to me how UK decisions had been arrived at, or what values and thinking had underpinned them. It was not clear to me who had access to power, and Ministers, and who could therefore influence decisions. I was confused about why there was no cross-party committee. I didn’t know who was ultimately accountable for the decisions – was it the Scientific Advisory Group for Emergencies (SAGE), was it Ministers? The decision-making process seemed very opaque. I wasn’t clear what outside scrutiny any decisions had received. I wasn’t clear how short-term health consequences were being weighed against long-term health consequences, and whose voices were being listened to – for example businesses, healthcare workers, immunocompromised patients etc.

It was confusing to me, in a public health crisis, who we should be listening to when there is conflicting information – should we listen to national governments who have a democratic mandate, or to global health institutions, such as the World Health Organization (WHO), which has experience with dealing with infectious disease outbreaks?

Unequal outcomes 

Another ethical issue that came up that bothered me was the fact that early in 2020 it was becoming very clear that marginalised groups, particularly ethnic minorities, were more likely to become infected and, once infected, were at higher risk of bad outcomes. It seemed to me that government policies were, essentially, permitting racist health outcomes. Others have highlighted the other inequalities that arose. In one column I phrased this as the pandemic splitting us into the “shielded rich and the exposed poor.”

There seemed to be no explicit discussion about the rights and wrongs of exposing frontline health workers to an unknown virus. 

A lack of transparency and consistency

Many decisions during the pandemic seemed to be underpinned by unclear objectives and opaque criteria – a lack of transparency and consistency. For example, it was very unclear to me what was driving the policies on masking, and dropping masking – was it infection numbers, vaccination rates, or was it political pressure?

Consistency was an issue. I was confused about the message on child vaccination – why was the Joint Committee on Vaccination and Immunisation (JCVI) reluctant to vaccinate children against COVID given that we had a safe and effective vaccine, when we have a vaccine programme for flu? Why were we allowing parents to decline measles vaccines, but not allowing them to give their kids an approved vaccine?

A responsibility to challenge

I was interested in those under-the-radar ethical issues. They became an important focus for my FT columns through the pandemic, because they bothered me. I couldn’t understand the decisions, and I had to explain them to readers, or challenge them. They made me think about fundamental things: What is the purpose of government in a health crisis? What are a government’s duties and responsibilities to citizens? How are ethical considerations weighed and included in policy-making? Where is the transparency so they can be debated and challenged outside Whitehall? 

I covered those issues because I felt I should, as an outside observer who had some influence. I like the distinction Jonathan Montgomery drew between being inside and outside the room. I felt as a non-expert, but informed person, I should be outside the room, asking those basic questions about the strategic objectives of the government’s pandemic policy and how they were being formulated.

My last reflection is that when I was writing Spike with Jeremy Farrar I spoke to many people, both inside and outside government, including modelers and people at WHO and the whole experience reassured me that I had not gone completely mad in what I had been writing. It confirmed to me that real experts and ethicists, and those modelling the pandemic, were also unsure of the government’s objectives, reasoning and values. 

It genuinely was as chaotic and disorganised on the inside, certainly in the beginning, as it appeared on the outside.