Professor Ilina Singh is the Principal Investigator of the UK Pandemic Ethics Accelerator. She is a Professor of Neuroscience & Society in the Department of Psychiatry and has been Co-Director of the Wellcome Centre for Ethics & Humanities at the University of Oxford since 2017. Her research focuses on the social and ethical dimensions of research and innovation in biomedicine, neuroscience and psychiatry. In this blog she offers reflections on the work of the UK Pandemic Ethics Accelerator.
Building the Ethics Accelerator
The UK is a global ethics powerhouse. Across a range of disciplines we have world-leading experts bringing ethical thinking and techniques to bear on the critical questions that impact our lives. When the Covid-19 pandemic hit, we were determined to make this expertise available to decision makers at a time of national crisis.
Within a few months we had brought together a team across the Universities of Oxford, Edinburgh and Bristol, University College London and within the Nuffield Council on Bioethics and applied to UKRI for funding. Unfortunately – in what became an echo of the challenges we faced as the pandemic continued – it took six months for funding to be confirmed. Making the case for ethical input to be heard alongside scientific advice, economic analysis, and so on, was challenging.
Over the months of our work we explored a wide range of critical issues, offering rapid ethics reviews, developing frameworks and contributing to debates. Some members of the team played formal advisory roles, others offered comment in the media, or shared papers and developed their research and analysis.
Ethics at the heart of pandemic decision-making
As we reflect on what we have learnt and think about what is needed for the future we are convinced that ethics has a vital contribution to make to pandemic response, and beyond, as we build a more resilient future.
Our experience showed us that decision-making during a pandemic is essentially ethical. Individuals, communities and governments were forced to make multiple complex ethical judgements at speed. Necessarily we looked to government to make critical judgements on our behalf. From the decision to curtail liberties and order lockdown in the name of protecting health, to considerations around prioritising groups for treatment and vaccination, to the dilemmas of introducing tracking apps – EVERY one of these political decisions had an ethical dimension.
The fact that that policy makers failed to grapple with ethics transparently – and sheltered behind the glib refrain of “following the science” – does not negate the existence of these ethical questions. Indeed by failing to acknowledge ethical complexity we missed opportunities to:
- Name, debate and define together the key ethical concepts and ideas that were engaged by the decisions we faced – to explore what we mean by rights, duties etc
- Respectfully explore the underlying biases and values that inform people’s sense of the right thing to do, and how these differ
- Draw on existing expertise in navigating different understandings and perspectives
- Use frameworks and processes that could support debate and decision-making and help to balance different arguments
- Identify groups and communities who would be particularly affected by decisions and ensure their voices are included
- Use tried and tested ways of engaging the public in considering ethical questions, of deliberating transparently and of building trust in decision making processes
As a result, not only were decision making processes within Government weaker, but so too were the decisions themselves. In turn, these failures also reduced the efficacy of policies, by undermining public trust – an issue that is clearly seen in relation to the low take up of vaccines among certain ethnic minority communities.
Building a better future
As we move into pandemic recovery, it is the right time to reflect on what happened and to think about how we can build our resilience for the future.
Our work shows that this will require two things
- Work to build an infrastructure to support ethical input to policy making – encompassing mechanisms for engaging ethical expertise, the use of ethical frameworks to support decision making, and ongoing work to engage the public in ethical deliberation
- An ethically-informed approach to the long-term challenges which weakened our capacity to respond in this pandemic and which matter for the future – for example in addressing health inequalities, tackling the ongoing impacts of the pandemic on young people, and widening our understanding of the action needed to protect health, to take a more global and cross-disciplinary approach
Ultimately, we believe considerations of ethics and equity should be at the heart of decision-making about the key issues that affect our health. We want to see a proactive approach to ethical considerations in which we acknowledge, actively navigate, and engage the public in ethical questions using established processes and frameworks.
Critically we believe this approach must be taken in plain sight and with a firm commitment to ensuring that processes are inclusive of the full diversity of expertise and perspective from across sectors and all sections of the public, in particular those who are seldom heard.
Reflections on challenges
Of course no project is without its struggles. We wanted to bring the wider ethics together and had funding to commission research, but we weren’t able to draw others as we hoped. Perhaps the pressures on time that we all faced personally and professionally meant collaboration fell down the list of priorities. Having said that, within our own collaboration we learnt a lot about how to create space for differences of approach and assessment, while sharing the best of what ethical approaches have to offer – those frameworks for thinking through complexity and balancing different understandings and values in a respectful way.
Similarly we didn’t always achieve the cut-through we hoped into the decision-making processes and with hindsight we could have worked harder to build links right up and down the decision-making structures. Along the way, we have learnt a lot. Our experience makes us more convinced than ever that we need to start now to build a better, more ethically-informed system for the future.