By Julian Savulescu.
Imagine you are about to board a plane. Authorities have reason to believe you are carrying a loaded gun. They are entitled to detain you. But they are obliged to investigate whether you have a gun. And if you are not carrying a gun, they are obliged to free you and allow you to board your plane. To continue to detain you without just cause would be false imprisonment.
Having COVID is like carrying a loaded gun that can accidentally go off at any time. The main ground for restricting people’s liberty is if they risk harming other people. This is the justification for quarantine, isolation, lockdown and other coercive measures in the pandemic. But if they are not a risk to other people, they should be free.
The ‘loaded gun’ analogy fails to acknowledge that most who are infected are significantly less harmed than gunshot victims: most recover swiftly and fully. However, in a pandemic, there is a second reason to restrict liberty: to decrease the number who fall ill and “save the NHS”. A person becoming ill not only threatens to harm others who become infected, but also increases the strain on the NHS itself.
While research on immunity and transmission is ongoing, typically, immunity (natural or via a vaccine) both protects the individual from getting ill and reduces transmission to others. The Federal Drug Administration in the US has admitted as much. A recent study by Public Health England showed natural infection confers similar immunity vaccination (the SIREN study). There are also reasons to believe natural immunity might reduce transmission (by specific antibodies in the airways, called IgA).
An immunity passport would record a past infection (or presence of antibodies) or vaccination. It could be a bracelet, an app on the phone, or a certificate. An immunity passport would constitute evidence that a person was no longer a threat to herself or others. Because people have a human right of freedom of movement, they should be released from current lockdown if they are known not to be threats. There is no ethical basis to imprison people who are not a threat.
Opponents of immunity passports point out (correctly) that we do not know for certain the degree to which natural infection or vaccination reduces risk of transmission. However, it is a grave moral issue – verging on wilful ignorance – that we do not know this. Nearly a year ago I argued for challenge studies to be conducted to understand these basic features of the virus and the disease. These would involve deliberately infecting volunteers with COVID19. More than 30 000 young people (1DaySooner) have volunteered worldwide and agitated to be allowed to help in this way.
Why, after nearly a year, have such studies not been conducted? They were planned for this January but apparently have not occurred. It is either too hot a political potato or there are misplaced ethical concerns. The risks to people aged 20-30 are equivalent to other permitted activities (like donating a kidney or driving a car for a year) and they are capable of consenting.
It is most likely that natural or vaccination immunity reduces but does not eliminate chance of reinfection or transmission. A reasonable objection to immunity passports is that the situation is so grave in the NHS, we can’t tolerate any increased chance of transmission.
This is the case for now. But at some point, we will have to make decisions about what level of risk is low enough. Road fatalities would be reduced by drastically reducing speed limits. Yet we balance lives lost on the roads (and carbon emissions) with transport efficiency, pleasure and liberty. The same will eventually happen as we learn to live with COVID. We have missed the chance for elimination.
As lockdown begins to be relaxed, one obvious and safe candidate for release are those who are immune. It is not just about being able to go to the pub: it is about people feeling confident to get medical care for other reasons, for mental health, return to education, to enable safer care of the vulnerable, and to get society moving again.
Some object that this sends the wrong signal, and that we should be in this together. We should not discriminate against one group in society.
Firstly, this should be temporary, as a way of getting people out of lockdown safely. Just as earlier in the pandemic some were asked to shield while others were released. Hopefully, as more vaccine becomes available, everyone will have the opportunity to be vaccinated. And as numbers approach herd immunity, and the health system regains some capacity, immunity passports will no longer be needed.
Secondly, there is a good reason to treat people with immunity differently – if they are not a risk to others. To treat them the same is “levelling down” equality.
Thirdly, people don’t obey laws they believe to be unjust. Neil Ferguson, whose model motivated lockdown, resigned from his role as UK government adviser after breaking lockdown guidelines, and confessed, “I acted in the belief that I was immune”.
I haven’t said anything about the justifiability of limiting the liberty of the non-immune. That ultimately depends on how we weigh different values. And as I have said, it is likely we will have to live with COVID, as we live with influenza. Vaccines are unlikely to be a magic bullet.
Lockdown is best at saving COVID lives in the short term, and early in the pandemic several countries achieved national elimination with them. To this point it has arguably been necessary. But it is a sledgehammer, and now an unnecessary one. It may not be the best strategy in the longer term and is certainly not the best strategy now for people with other health conditions. Immunity passports are way of respecting people’s rights and getting society moving again.
Authors: Julian Savulescu
Affiliations: Oxford Uehiro Centre for Practical Ethics, University of Oxford
Competing interests: None declared.
Social media accounts of authors: @juliansavulescu