The moral question about the suppression strategy has been framed as one concerning how many COVID deaths we should be willing to accept each year. We might be able to reduce COVID deaths while protecting the freedom of those who do not pose a transmission risk by introducing COVID certificates or passports, but only if we are willing to accept the inequality that such schemes involve.įinally, we can give everyone in society as much freedom as possible, but only if we are willing to accept the increased COVID deaths it will probably involve if the virus has not yet been sufficiently suppressed in other ways. We might be able to reduce COVID deaths while safeguarding equality, but only if we are willing to accept the potential need for future lockdowns, severe travel restrictions, and the costs to freedom and general health that entails. We can maximise one or two of these values, but we can’t have all three.
The societal decision we make about the acceptable level of viral suppression involves a choice about which of three competing values we should prioritise and which we must compromise.
This is the fundamental trilemma of the long-term suppression strategy. However, these targeted strategies involve forms of unequal treatment and possible discrimination. The extent of some of the costs of mitigation measures could be lessened by targeting these interventions at certain groups, such as those who have not been vaccinated, or those who have a particularly high risk of death from COVID, such as those over the age of 65. On the figures from this model, deaths from the virus itself may come to only account for about 54% of the overall death toll of the outbreak in the UK. Recent models suggest that in the long term, the mitigation of the pandemic could lead to 100,000 non-COVID deaths. Lockdowns significantly restrict civil liberties and cause a wide range of other harms, including significant non-COVID mortality and morbidity. But evidence suggests that mitigation measures, such as lockdowns and effective test, trace and isolate systems, may be effective in reducing transmission of the virus. The first year of the pandemic has taught us that, without suppression measures, coronavirus will lead to significant death and harm, including long COVID. The liberty, equality and mortality trilemma But adopting a suppression strategy for the long term will require us to make a societal decision about the harms we are and are not willing to accept.
One of the main alternatives to the elimination strategy is to treat coronavirus as endemic to the UK and to aim for long-term suppression of the virus to acceptable levels. However, the government has been reluctant to endorse an elimination strategy, given the importance of international trade to the UK economy. New Zealand successfully implemented an elimination strategy earlier in the pandemic and is now in a post-elimination stage.Īn elimination strategy in the UK would require combining the mass vaccination programme with severe restrictions on international travel to stop new cases and variants of the virus being imported. One strategy would be to aim for the elimination of the virus within the UK. While this is very welcome news, a mass vaccination programme is unlikely to be enough to eliminate the virus, so we need to turn our thoughts towards the ethics of the long-term management of COVID-19. The UK Ethics Accelerator project can be found at Īs mass vaccination continues to be rolled out, the UK is beginning to see encouraging signs that the number of COVID deaths is reducing, and that the vaccines may be reducing the transmission of coronavirus. This work was supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu
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