COVID-19: The ethical Exit Strategy: the path from relaxing measures to vaccination

The focus around the Covid19 outbreak is at the moment mostly on the lockdown measures. However, the lockdown implies a societal, economic, and psychological cost that is not sustainable for too long. Shifting the focus onto the 'exit strategy' will be an urgent matter within a few months, if not weeks. From the way talk about exit strategy is currently framed, it might appear that it will be a matter of technical decisions or, as the Government put it, a matter 'of taking the right steps at the right time, informed by the best science'. But this is only partly true. Policy makers will need to show commitment to ethical principles and be able to justify decisions to sacrifice certain values and principles for the sake of others, which will be unavoidable. The exit strategy cannot be designed and implemented unless certain ethical decisions about trade-offs between different values are made. For example, decisions will need to be made about if and when to increase risk of illness or even death for certain individuals for the sake the psychological or financial interest of those who are being most heavily affected by the lockdown. Or to sacrifice to a certain degree privacy for the sake of public health in the use of contact-tracing technologies. Or again to use some level of coercion to enforce vaccination policies, when a vaccine becomes available. These decisions ar not merely about "the best science". These are ethical decisions. It will not be possible to make these decisions without having a plausible story about which values will at some point have to be prioritized, and why. This is not only because policy decisions need to be ethically acceptable (which is always a requirement, even in 'normal' times), but also because without appealing to certain ethical values, that go beyond merely technical considerations, it will be difficult to gain people's trust. This research will result in a set of recommendations, in the form of policy papers addressed to the relevant Government departments as well as academic papers, about how to make these necessary trade-offs between values in a way that can inform both public health policy and public health communication strategy. This project addresses, in chronological order, three core steps of the exit strategies that require close ethical scrutiny: 1) at what point, and through which steps, will it be acceptable to start the path back to some form of normality? 2) what kind of contact-tracing technologies (e.g mobile apps) can be used during the transition, and how? 3) when we have a vaccine, which vaccination policy should be adopted? There is also more general question about the level of coercion a Government may ethically enforce. This is an ethics project intended to inform policy making. As such, the methodological approach will be the standard one adopted in applied ethics projects, which include strategy to ensure the outcomes have practical relevance and provide feasible and easily implementable advice. I will test ethical intuitions against ethical theories and vice versa, in search for maximal coherence ("reflective equilibrium"), so that the conclusions will be as much as possible in line with shared values; use thought experiments - i.e. fictitious examples - to test future scenarios against hypothetical ones, in order to ensure the advice provided is consistent with people intuitions across various scenarios; survey different ethical points of view to identify strengths and weaknesses of each, to ensure ethical advice is informed by a pluralistic perspective.