The UK Pandemic Ethics Accelerator brought together ethics experts from across the UK during the Covid-19 pandemic to consider key ethical questions and to offer support to policy makers. In this blog, Jamie Webb (University of Edinburgh), Kiran Manku (University of Oxford), Sarah Cunningham-Burley (University of Edinburgh) and Catherine Joynson (Nuffield Council on Bioethics), who were part of the public values, transparency and governance workstream reflect on its work.
The Covid-19 pandemic drove the UK government to make a series of complex, ethically sensitive judgements in a very short space of time.
Policy decisions are always underpinned by a set of values. The values held by the public – such as autonomy, fairness and justice – contribute to, and may guide, the decisions of policy makers, and how people behave in response. In pandemics it is more important than ever for decision makers to engage with, understand and respond to public values and to consider explicitly the ethical dimensions of the difficult decisions they need to make. This is because in pandemics both guidance, and adherence to guidance, are critical.
In the UK, the Government initially held off a decision to lockdown, partly because it believed the British public would not accept stringent measures for any significant length of time – a belief that was shown to be unfounded. Following this, steps were taken to involve the public in the pandemic response. At national Government level, surveys and opinion polls were used to extract knowledge from publics around their attitudes towards being asked to self-isolate, their willingness to get vaccinated, and their support for vaccination certification.
However, this engagement was largely one way – a combination of providing information to and extracting opinions from the public, with limited opportunity for dialogue and learning. This engagement fell low down the rungs of what has been characterised as “ladder of citizen participation”. Our work within the Ethics Accelerator, analysing pandemic public engagement, and tracking it throughout the pandemic, revealed a wide variety of approaches across academia and civil society to substantively engage citizens in more participatory ways. This more meaningful engagement can help policy makers understand people’s hopes and fears, the boundaries of what they would be willing to do, and how they would like those in decision making roles to act. Deliberative approaches will be particularly valuable as we work out how to manage Covid into the future as well as other pandemics.
Our own experience of engaging the public in dialogue through the pandemic has demonstrated that it is both a feasible and insightful endeavour. In summer 2021, we brought together people from across the UK to identify and deliberate their ethical concerns relating to Covid recovery and future pandemics. This work informed an understanding of people’s priorities and showed that people are willing and interested to engage in issues of ethical complexity, and in the process of balancing different perspectives and priorities.
The priority areas for action which emerged from the deliberations included:
- Re-balancing inequalities that Covid-19 has exposed and exacerbated: Addressing disparities in health and healthcare, particularly for racialised minorities, and combat poverty which has worsened alongside intolerable inequality.
- Building trust and transparency into government policies and actions: For example, through greater collaboration across the home nations to provide consistent and clear messaging and communications for citizens across the UK.
- Involving the public policy making: To create a society which is resilient in the face of future pandemics, the public want to be involved in shaping future policies.
The participants of a follow-up public dialogue (to be published soon) that we held a year later in summer 2022 had similar priorities – a desire for re-building trust, greater unity across the UK, and a focus on the common good. They highlighted that the anxieties and tensions around managing Covid and its long-term impacts have not gone away. They highlighted concerns around mental health, children and young people and inequalities. The participants identified gaps in research, including around recovery from the pandemic, communication and leadership, and suggested practical solutions that could help us prepare for future pandemics, such as preparing populations and providing trusted sources of information.
Our discussions with policy makers and advisors suggests that we need more joined-up processes to enable transparent and robust deliberation around issues of ethical complexity, including with the public. Trust is vital in a public health emergency, but when we fail to engage widely and openly, and to communicate transparently, we undermine trust – and this can have serious consequences. For example, we have seen the importance of community engagement in understanding and addressing vaccine hesitancy.
Our work has also identified a need to demonstrate the value of involving ethics expertise in public health policy making, and to ensure there are clear and visible routes into the UK’s rich ecosystem of ethics expertise. As well as supporting the participation of ethics experts in key committees, we need to embed ethics thinking in policy processes – for example, by providing accessible ethics tools for decision making. Ethically interrogating the arguments of politicians is also essential in evaluating value laden pandemic policy decisions.
Looking to the future, we hope that our work can inform a more co-ordinated approach to incorporating ethics expertise and public values into the policy making process. Building structures to enable this over the long-term will be a key to strengthening the voice of ethics in policy and public debate and to improving our resilience to future public health emergencies.
As a group of organisations and people immersed in ethics, we recognise our own role in achieving this. Although the UK Pandemic Ethics Accelerator initiative is drawing to a close, the collaborations and connections it has involved form the foundations of greater connectivity across ethics networks and a wider understanding of the relevance of ethics to public life, on which we intend to build.