A vaccine/pandemic reading list

A few years back, I spent a week of my ethics of public policy (PAIR6040) module on vaccines. I'd originally planned to focus on compulsory vaccination, but wasn't able to find much written on that at the time, so I ended up covering how to allocate vaccines in case a pandemic led to scarcity. I've since dropped the topic from the module entirely, but it might be worth reintroducing it next year.

In any case, here's a copy of the reading list:

Marcel Verweij (2009) ‘Moral Principles for Allocating Scarce Medical Resources in an Influenza Pandemic’ Journal of Bioethical Inquiry 6: 159—169.

Ezekial J. Emanuel and Alan Wertheimer (2006) ‘Who Should Get Influenza Vaccine When Not All Can?’ Science 312: 854—855.

Hugh V. McLachlan (2012) ‘A Proposed Non-consequentialist Policy for the Ethical Distribution of Scarce Vaccination in the face of an Influenza Pandemic’ Journal of Medical Ethics 38: 317—318.

Alasdair Wardrope (2012) ‘Scarce Vaccine Supplies in an Influenza Pandemic should Not be Distributed Randomly: Reply to McLachlan’ Journal of Medical Ethics 38(12): 765—767.

Kristy Buccieri and Stephen Gaetz (2013) ‘Ethical Vaccine Distribution Planning for Pandemic Influenza: Prioritizing Homeless and Hard-to-Reach Populations’ Public Health Ethics 6(2): 185—196.

Martin Peterson (2008) ‘The Moral Importance of Selecting People Randomly’ Bioethics 22(6): 321-327.

Matthew K. Wynia (2006) ‘Ethics and Public Health Emergencies: Rationing Vaccines’ American Journal of Bioethics 6(6): 4-7.

Jeroen Luyten, Antoon Vendevelde, Pierre Van Damme, and Philippe Beutels (2011) ‘Vaccination Policy and Ethical Challenges Posed by Herd Immunity, Suboptimal Uptake and Subgroup Targeting’ Public Health Ethics 4(3): 280—291.

Unfortunately, most if not all of this will be 'quarantined' behind journal paywalls, unless any of them are being particularly good at opening this research to the public (as some journals are doing with Covid19 work).

UPDATE:
There's a crowd-sourced, interdisciplinary reading list here.

New look

Amazingly, this blog is approaching 15 years old. I don't update as actively as I used to, but I still plan to keep it, if only as a repository of useful links for my own benefit. Anyway, I thought the layout and design was starting to show its age - and often rather cluttered.

I've selected a new theme, which to my mind looks a lot cleaner. It seems to have come at the loss of my 'blogroll' but many of those links were dead anyway. If there are actually any readers out there, then any comments on the new look at welcome. Especially any relating to navigation on other devices. (I assume the standard templates should be fine, but I haven't been able to test this myself.)

Review: The Case for Community Wealth Building

I'm cross-posting a review that I originally wrote on Amazon:




The Enlightenment philosopher David Hume famously remarked that his Treatise on Human Nature “fell dead-born from the [printing] press”. I’m afraid that, given recent political developments, this short book may suffer the similar fate of being dead on arrival.

The back cover carries endorsements from Jeremy Corbyn and John McDonnell. Hardly surprising, given that much of the book is devoted to outlining and defending Corbyn’s economic model. However, whatever one thinks of this vision, it seems that its time has already passed.

The book carries a copyright date of 2020, but I could see no clear indication of when the text was actually written. Nonetheless, when the authors write (on p. 107) of the opportunity “in the unknown amount of time between now and the next UK general election” I assume this must have been before the 2019 election was called. Thus, the election referred to has already happened. With Labour losing that election (heavily), and Corbyn soon to be replaced as leader, it is hard to avoid concluding that whatever opportunity there was for this radical new economic model – at least on a national level – has gone.

Much, if not all, of this book is written as a call from those on the left of the political spectrum to others on the left, encouraging them to seize the opportunity created by recent crises to implement a new economic settlement. Pitched in such a manner, it’s probably unlikely to find much favour outside of Corbynistic circles. That’s probably a shame though, since – at least if the authors are right – the idea of community wealth building has much to recommend it across the political spectrum. However, the chances of anyone taking up these ideas now seem slim.

The book consists of three main chapters, which in turn address the history, justification, and potential of community wealth building. I have to say that it assumes a certain familiarity with politics and economics, for instance what is meant by Keynesianism or the neoliberal economic paradigm. Even though I consider myself more than averagely informed, I was still a little unclear on what exactly community wealth building means after the first chapter. There’s a list of principles, on p. 84, that might have been more useful in the first chapter. (Incidentally, the text introduces “eight principles” of the Democracy Collaborative, but the list that follows includes only seven.)

The second chapter was probably the most interesting, at least in my view. Here, the authors seek to defend community wealth building arguing that, even if it is less economically efficient than unregulated markets (a point that they dispute), it is a means for ordinary citizens to ‘take back control’ over their lives. Existing democratic structures seem relatively powerless in the face of global economic forces. Democratising the economy, however, offers ordinary workers the chance to have a say over decisions that affect their lives. Again, I would expect much of this to appeal not only to the radical left but also to at least some in the centre and even on the right, at least to the extent that a remodelled economy of the sort proposed here should then involve less state interference.

Unfortunately, as I remarked at the outset, the chapter on the prospects for community wealth building seems to hang its hopes on the opportunity for a Corbyn-led Labour government. While it does note that some progress can be made at local levels, without a change of national government (p. 112), even this seems to assume that Labour will be the party of change. Thus, while this book was intended as an optimistic manifesto for radical change, it now reads like an account of what might have been. An opportunity missed, perhaps – we may never know.


While this review is not entirely positive, if you still want to buy the book then you can do so from Amazon (affiliate link).

Disclaimer: I do know one of the authors.

CoE position on sex and marriage

The Church of England holds the view that sex is only for married heterosexuals. Even opposite-sex civil partnerships don't qualify in the eyes of God it seems. This will be relevant when teaching both sex and marriage in future years.

Taking Back Control

Labour leadership contender (possibly) Clive Lewis has called for a referendum on the future of the monarchy, abolition of the House of Lords, and the introduction of proportional representation.

I'll be teaching democratic theory again next semester (starting in a few weeks), so this is topical...

Electoral disenfranchisement

There are reports that significant numbers of students were turned away from polling stations due to administrative errors.

In fact, one of my colleagues - someone with a PhD in Politics - was also denied the vote, due to an apparent mix up over registration. Not good.

Publication: Upsetting the Balance on Sex Selection

This piece has been online since July, but I'm pleased to see it made it into print in the November issue of Bioethics, as it's actually my first research publication of 2019...

Abstract:
It is widely assumed that the strongest case for permitting non‐medical sex selection is where parents aim at family balance. This piece criticizes one representative attempt to justify sex selection for family balance. Kluge (2007) assumes that some couples may seek sex selection because they hold discriminatory values, but this need not impugn those who merely have preferences, without evaluative commitments, for a particular sex. This is disputed by those who see any sex selection as inherently sexist because it upholds stereotypes about the sexes. This article takes an alternative approach. I argue that, even if we accept that preference‐based selection is unobjectionable, a policy permitting selection for family balancing does a poor job of distinguishing between value‐based and preference‐based selection. If we wish to permit only preference‐based sex selection we should seek to identify parents’ motives. If we wish to justify a family balancing policy, other arguments are needed.

How NOT to present stats...

I don't teach stats, but this Youtube video provides a good example of how NOT to present survey results...

Liveblogging Brexit #4: Not Dead

PM Johnson's Brexit legislation passed through the second reading stage, only for MPs to vote against his proposed timetable. Apparently it is now not dead but inert. I wonder whether it is also pining for the fjords, for I couldn't help being reminded of the dead parrot sketch.

Liveblogging Brexit #3: Federal union?

I'm not sure whether this link will work - it's intended to go to comment 300 on this story. In case it doesn't, or ceases to in future, here is the relevant comment:



The relevant part, corrected for better English, is:

"How can the Brexit referendum result be to leave, if three countries voted against leaving and only one voted to leave? It's really not democracy, if three countries are held to ransom by one."

First, this is factually inaccurate, as Leave won in Wales and England so, on a country by country basis, it's actually two apiece, not three-to-one.

Suppose, however, the facts were as 'gerry' suggested and only England had voted to leave. Would this be democratic?

The referendum was a UK-wide one. There were over 28m votes cast in England (plus Gibraltar), compared to around 5m from Scotland, Wales, and Northern Ireland. Or, in terms of potential electorates, 39m to 7.5m. Thus, a large enough majority in England would be able to outvote the other countries on a 'one person, one vote' basis. That's how most people normally understand democracy.

There are some countries where major constitutional decisions would have to be ratified by a majority of constituent federal units or similar. I'm sympathetic to the idea that a major constitutional decision should not be left to a simple majority process. However, I'm not sure whether treating the UK as a four-country federal system is the answer.

Suppose it had been specified, in advance of the referendum, that Brexit would only happen if at least two of the four countries voted to leave the EU. In that case, just 4m people (majorities in Wales, Scotland, and N.I.) would have been able to block Brexit, even if over 40m others (the whole population of England plus the minority in each of those three countries) had voted to leave. Surely, that would be undemocratic...

Liveblogging Brexit #2

Update from the BBC:

Boris Johnson says Jeremy Corbyn "has become the first leader of the opposition in the democratic history of our country to refuse the invitation of an election".

My comment:

Prior to the Fixed-term Parliaments Act, the PM could call an election whenever (s)he wanted, so there was no need to invite the opposition to vote for one. It's therefore not so surprising that the 'democratic history of our country' has never previously need the leader of the opposition refuse such an invitation, because I doubt there's ever really been one...

If the Fixed-term Parliaments Act continues, then such refusals may be more common than one might expect, given that the point of the Act was to prevent PMs from calling elections at opportune moments.

Liveblogging Brexit #1

 I'm going to start a series of small blog entries that I'll call 'Liveblogging Brexit'. Obviously, I don't actually plan to live blog the whole Brexit process, but the current political crisis is throwing up many snippets that may be useful for classroom discussion, so I want to preserve some of them for posterity... Here's the first.

From the BBC:

Conservative MP Nigel Evans says, "the British people have voted to leave the European Union [in the 2016 referendum]. If this Parliament decides we are not going to leave the European Union, then the British people ought to have an opportunity to change their Parliament."

My comment:

This argument may have been all very well in late 2016 or early 2017, but the current parliament was elected more recently than the referendum - that is, voters have already had one chance to change their parliament.

If the outcome of the 2017 election seems to conflict with that of the 2016 referendum, then perhaps the more recent should take precedence. At the very least, there's as much case for re-running the 2016 referendum as there is for re-running the 2017 general election.

Diet and Nutrition

There was a sad story in the news today about a teenager who went blind due to living on a diet of junkfood - chips, crisps, bread, and no fruit or vegetables.

Even the BBC article, linked to in the previous sentence, takes this opportunity to 'lecture' on how vegans can get vitamin B12, although the problem in this case was clearly nothing to do with a vegan diet (it mentions that he had occasional ham or sauage).

This piece at The Conversation goes even further, with the gratuitous statement that "Without nutrient supplements or fortified foods, strict veganism can lead to irreversible blindness." This is true, but the case supposedly under discussion shows that a non-vegan diet can also lead to irreversible blindness, if lacking essential nutrients.

The case in question involves a 'picky eater' who may even qualify as having an eating disorder, but the more important general lessons are probably those about nutritional education and the dangers of food poverty.

An end to smoking?

The big news of the day was the announcement of Boris Johnson as the new Conservative Party leader and Prime Minister. In light of this, much may change regarding future priorities. However, what caught my eye was the announcement that the (current) government intends to end smoking in England by 2030.

That's a rather bold move. It's probably misleading for the BBC to describe this as a 'pledge' though, given that it's only a green paper for consultation. The end of the article says this consultation runs until 14th October, with a government response due in spring (2020). I can't help thinking they might have other priorities, perhaps even including an early election...

Universal Credit and Prostitution

I've been reading some stuff on prostitution lately, for my Ethics of Public Policy module. Predictably, much of it focuses on whether prostitutes have any free choice over engaging in sex work or whether they are coerced, for instance by poverty and a lack of acceptable alternatives.

This piece on the BBC is therefore timely. It reports that a number of women, particularly single mothers, are forced into 'survival sex' as a result of changes to universal credit. Unfortunately the deadline for submitting evidence has now passed, but this was a concern of the DWP.

Vegan-Friendly Cities?

I've seen a couple of people sharing this ranking of vegan-friendly cities, which has also been picked up by some news sources, such as The Metro.

You wouldn't know the methodology from the news reports but, if you go to the original source, it seems to be based entirely on total population divided by the number of vegan/veggie-only restaurants. It takes no account of things like quality of restaurants or how accommodating other restaurants are for vegans (which I'd say is pretty important in branding a city 'vegan-friendly').

 Indeed, despite labelling the table 'most vegan friendly cities' it doesn't even seem to distinguish vegan from vegetarian. Theoretically, somewhere could top this list based on having a lot of vegetarian restaurants without any vegan dishes.

I'm also curious as to how this ranking would compare with one of total restaurants per person. While I'd expect some places to have a higher proportion of vegan/vegetarian restaurants than others, it seems this methodology will simply favour places with more restaurants per head (assuming some will be vegetarian/vegan).

It's a pretty meaningless ranking I'd say.

I wonder if she smiles - the danger of gender expectations

This is a quite moving piece. I may use it when teaching about sex selection in future.

Plain packaging for sugar

We already tax sugary drink. Now, this BBC column suggests going further, adopting 'plain packaging' requirements that have been used for regulating cigarettes. The idea apparently comes from this IPPR report (press release), which is mentioned but seemingly not linked to by the BBC.

I'll be running an undergraduate version of my ethics of public policy module in the autumn, so topical discussions like this are useful - expect to see more links posted here as I stumble across them.

David Davis on Referendums

Back in 2002:

"Referendums should be held when the electorate are in the best possible position to make a judgment. They should be held when people can view all the arguments for and against and when those arguments have been rigorously tested. In short, referendums should be held when people know exactly what they are getting. So legislation should be debated by Members of Parliament on the Floor of the House, and then put to the electorate for the voters to judge.
We should not ask people to vote on a blank sheet of paper and tell them to trust us to fill in the details afterwards. For referendums to be fair and compatible with our parliamentary process, we need the electors to be as well informed as possible and to know exactly what they are voting for. Referendums need to be treated as an addition to the parliamentary process, not as a substitute for it."

Source.

Which 'constituency' should MPs be responsive to?

According to Edmund Burke, MPs should exercise their own judgement, rather than being beholden to what 'the people' want. Many disagree. But even if we accept that MPs should do what 'the people' tell them, it is still an open question which people they should listen to.

I'm getting to Burke in my lectures in a couple of weeks, but this is such a good example that I may have to save it for then...

Gerard McMullan says: "The DUP are representing their constituents, their constituents told them, 'We want to Remain.' The DUP don't represent the UK, they represent Northern Ireland. And Northern Ireland say they want to stay."

 

Adam Petticrew says: "People voted to leave so we have to leave.... I think it's a joke that the DUP get to decide [what's going to happen] because the people decided already what's to happen. The DUP should be doing what the people said - they want to leave. Northern Ireland is part of the UK and on the whole the UK wanted to leave."

 

This touches on another point, namely whether MPs should pursue the national interest or the interests of their constituents. Burke thought that MPs should pursue what they think is in the national interest, but one might disagree on both points or only on one of them. This gives at least four options:

 

A. MPs should make their own independent judgement of the national interest.

B. MPs should make their own independent judgement of their constituents' interests.

C. MPs should accept the people's view of the national interest.

D. MPs should accept their constituents' view of their local interests.

 

(Obviously, this could be further complicated. I assume that if MPs are to promote the national interest, but not exercise their own judgement, then they should respond to the national vote. But, in principle, they could do what their constituents think is in the national interest.)

The Difficulty of Targetting Junk Food (Advertising)

It's often suggested that the state should ban the advertising of junk food, particularly to children. Saqiq Khan's (long proposed) ban on such advertising on London public transplant recently came into force. (This, of course, comes on top of the recent sugar tax.)

This Spectator article neatly summarises one problem with these proposals though. There is no agreed definition of junk food. What's actually banned is the advertising of food high in fat, sugar, or salt, but this includes (amongst other things) many tinned fruits, cereals, and jams. (Another blow for our post-Brexit economy, based on jam and biscuits.)

A lot of foods people might think of as 'healthy' could fall foul of these restrictions on supposedly 'unhealthy' food. For instance, fruit smoothies are high in sugar.

Liam Fox channels Edmund Burke

I'll be teaching the trustee-delegate debate as part of my democratic theory module next semester, so here's a convenient example: Liam Fox saying "We are not elected to do what we want to do, but to do what is in the national interest".

Of course, no one defends the view that representatives should do whatever they want. The crucial question is whether they should exercise their own judgement as to what's in the national interest or accept the people's verdict.

Fox seems to agree with Burke, in suggesting that they focus on the national interest (rather than particular interests, such as their constituency), but perhaps to disagree on whether they ought to exercise independent judgement. Burke famously argued that MPs should make their own minds up about what is in the national interest.

Publication: Altruism and Organ Donation

My latest paper just appeared in print here (subscription required). Here's a word cloud illustrating the content:

And, for those interested, here is the abstract:

It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good – either excessive or deficient – is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives – that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations.

Cats and Dogs

I commented recently on proposals to ban the consumption of dog meat in the UK. I don't know whether this is really going anyway - I suspect our political class have greater concerns right now. However, it seems that the US House has just passed a bill penalizing consumption of dogs or cats (with exemptions for native religious customs).

Again, the logic seems to be that these animals ought not to be slaughtered because of how beloved they are by people. It doesn't seem to be based on anything like intelligence, since pigs seem to be as smart as dogs (see here and here).

According to what moral system does an animal's right not to be slaughtered depend on its popularity?

Food Choices and Voluntariness

While making some updates and changes to my Ethics of Public Policy module, I decided to change one of the core readings on the food topic. I use a piece by Sarah Conly arguing for paternalistic interventions, but wanted to pair it with something defending a more traditional liberal approach.

I found this piece by Alex Rajczi, which outlines some fairly standard liberal positions, for instance denying that voluntary self-harm is a reason for government interference. There are, however, two arguments that he does give some credence to, both suggesting that people's unhealthy choices are not substantially voluntary.

First, he suggests that people may lack the necessary information to make good choices (by their own lights). For instance, calorie information is not always easy to find or may be difficult to interpret. Rajczi argues that this is not itself reason to ban unhealthy food, since there are less intrusive measures available, such as better food labelling.

This is topical, since it seems there's currently disagreement between the Department for Health and the Treasury over proposals to require restaurants to provide calorie information. (See BBC report here.) The main argument against this proposal seems to be economic - the cost to small businesses in particular - though the article also raises the interesting point that calorie labelling can exacerbate eating disorders. I'd like to see the evidence mentioned, but not specifically referenced, in the article. It does raise an interesting health vs. health conflict though.

The second argument that Rajczi gives some credence to says that people's food choices are non-voluntary because they cannot afford to eat more healthily. As it happens, this is also in the news at the moment. According to this story, 3.7 million children live in homes struggling to afford a decent, healthy diet.

Rajczi considers that some of us may live in an unjust nutritional environment. This is not immediately obvious, since it depends on what theory of justice one subscribes to. On some, such as libertarianism or luck egalitarianism, the inability to afford healthy food is not itself sufficient to establish injustice. However, one need only accept some kind of sufficientarian minimal safety net - and not full-blown egalitarianism - in order to think that this is unjust.

Again, Rajczi argues that the appropriate response to this problem is not to ban unhealthy foods, or even to tax them (which, by increasing the cost, exacerbates problems for the poor), but rather addresses the affordability of healthy food. Rajczi proposes either income/wealth redistribution or subsidies for healthy foods.*

*There's an unfortunate typo in the last sentence before the concluding section, which actually says subsidies for unhealthy foods. In context, this is obviously a mistake, though I took the trouble to confirm that with him.

For the Dogs

It seems that there's sufficient concern around dog meat that some people want the UK to ban its consumption.

I'm unclear what could justify singling out dogs in particular. If the UK really is a nation of animal lovers, then I'd have thought more people would be vegetarian - but, even then, I'm not sure it would be legitimate for the state to ban the consumption of meat.

But to argue for a ban on dog meat, while happily eating pigs, cows, etc, seems hypocritical.

J. S. Mill argued that, if Muslims were a majority, they would have no right to ban the eating of pork, simply because they find it abhorrent. The same seems to apply, mutatis mutandis, to dog meat.

Edit: see also this later post on US measures.

Marching for Scottish Freedom

I don't know their exact route, but these marchers probably passed within a proverbial stone's throw of my old house up in Stirling.

According to the BBC coverage, and their website, All Under One Banner aim to "march at regular intervals until Scotland is free".

I think I'll use this to discuss the connection between freedom and independence when lecturing this autumn.

Pigeon Politics?

Are pigeons political animals? The subtitle of this Conversation article would suggest so, though the term 'politics' does not seem to appear in the original research that it reports.

The research is concerned with hierarchies, but it's plausible that not all politics involves hierarchy - a society of equals could still be political. But what of the reverse? Can there be hierarchies that are not political?

Publication: Altruism and Organ Donation

I have a new paper, forthcoming in the Journal of Medical Ethics.

I made a word cloud, to illustrate the main ideas:

You can also view this word cloud here. If you prefer the more traditional abstract, here it is:

"It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good—either excessive or deficient—is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives—that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations."

Those with access to the journal can access the full paper, ahead of its print publication.

Fines and School Holidays

I saw this article about truancy fines for term-time holidays on the BBC website. I don't know about the content of the review being reported on, but the first two sentences of the article seem clearly contradictory:

"Fining parents for taking children out of school in term time in Wales has had no effect on overall absence rates, a review has found.

It shows the number of unauthorised family holidays actually increased after fixed penalty notices were introduced in 2013."

If there was an increase, then there was an effect on absence rates, though perhaps not the one expected. (It might perhaps be that the increase was attributable to something else, and the fine judged to have no effect either way, but there's no indication in the article that anything else was responsible for this increase.)

This isn't so surprising if you're familiar with the literature in the area. One of the most referred to studies is this one, concerning the introduction of fines for late collection of children from day care centres. Again, the study found that more parents were late to collect their children after the introduction of fines.

The usual interpretation is that the extrinsic motivation provided by the fine 'crowds out' intrinsic motivation provided by a sense of duty. Without the fine, people feel a moral obligation to collect their children on time. When there is a fine, they feel that they are paying for being late, so the feeling of moral obligation not to be late recedes. It seems there may be a similar effect in the case of term-time holidays.