Coronavirus, utlitarianism and Emmanuel Kant

 The dispute between the UK and the European Union over vaccination against coronavirus is more than just a squabble about contracts: it shows profound differences between countries in how they make policy and the priority they give to the rights of individual citizens. This is shown by the history of the Oxford Astra Zeneca (OAZ) vaccination and the bans on its use in several EU countries. The first of these involved suspending the vaccine for the older age-groups on the grounds that insufficient numbers of the elderly had been included in the Phase 3 clinical trials. Only two months later, the same countries allowed the vaccine to be administered to the elderly but now banned its use for people under the age of 50 years because a very small number of younger people had developed abnormal blood-clots after injection. Denmark has now even banned the OAZ vaccine for people of all ages, even though the risk of blood clots is many times less than that found among women taking contraceptive medication (which of course has not been banned).

There were few such doubts in the UK, which initially placed no limitation on the use of the OAZ vaccine. However, on 7th April 2021, the UK’s Joint Committee on Vaccinations and Immunisation (JCVI) reported that it:
    “has weighed the relative balance of benefits and risks and advise that the benefits of prompt vaccination with the AstraZeneca COVID-19 vaccine far outweigh the risk of adverse events for individuals 30 years of age and over and those who have underlying health conditions which put them at higher risk of severe COVID-19 disease. JCVI currently advises that it is preferable for adults aged <30 years without underlying health conditions that put them at higher risk of severe COVID-19 disease, to be offered an alternative COVID-19 vaccine, if available. People may make an informed choice to receive the AstraZeneca COVID-19 vaccine to receive earlier protection”.

In other words, UK policy was to balance the risks from adverse reactions with the number of lives potentially saved by vaccination, but to ultimately leave the decision to the informed choice of the recipient. This approach shows the influence of two themes in British philosophy, as translated into government policy. The first is classical liberalism, in which individual citizens are regarded as ultimately responsible for their own lives, to make their own ‘informed choice’. The second theme is utilitarianism, which proposes that public policy should be based on the balance for the community as a whole between benefits (the number of lives saved) and losses (the number of people dying because of adverse reactions). It is easy to see why utilitarianism should have appealed to one of the first nations in the world to have a capitalist economy, and British governments have continued to apply the same ruthless principles in determining public policy. In the case of coronavirus, this involved spending vast sums on buying very large stocks of vaccines before their approval by the regulators, indemnifying their producers and funding drug companies to build the factories which produce the vaccines. Priority was given to delivering vaccines to those most at risk of death, and administration of the vaccine on a large scale began immediately after regulatory approval.

Neither classical liberalism nor utilitarianism has commanded much support in continental Europe, where thinkers from Emmanuel Kant onwards emphasised the valuation of each individual human life rather than regarding human lives as a means to an end (or a balance between benefits and losses). Kant lived in the German Kingdom of Prussia at a time when this was ruled by an absolutist king. Kant saw no contradiction between a respect for human rights and the lack of political rights for individual citizens. Instead, he believed that the best state of affairs was one in which the king should rule according to laws which protected the individual rights of the citizens. By this means, Kant could argue that authoritarian government is compatible with the protection of human rights, and thereby deny the principles of both classical liberalism and utilitarianism.  

Most EU governments followed Kantian principles in denying their citizens the right to choose the OAZ vaccine and in proposing that the vaccine be banned because of its possible (albeit very rare) negative impact on the health of individual recipients. In other words, the rights of each such individual were more important than the balance of benefits and losses that would result from the widespread use of the vaccine. Other, less enlightened, factors may also have played a part in their decision-making. These include a desire for revenge against Astra Zeneca because of the company’s failure to meet the agreed rate of deliveries of vaccines to the EU (and revenge against the UK for leaving the EU). Another factor may have been the desire by President Macron of France to undermine trust in a competitor to the much-delayed French Sanofi vaccine.

This all had the effect in the EU of undermining public trust in the OAZ vaccine, which has produced a widespread ‘nocebo effect’. This is the opposite of the placebo effect, in which patients claim they have benefited from a pill or treatment which has no clinical content. The nocebo effect occurs when a truly beneficial treatment is regarded with suspicion by its recipients, who then report a range of ailments they ascribe to the treatment. This has certainly been the case with the OAZ vaccine, which has been accused of causing a range of ailments in addition to the small number of blood clots with which it genuinely seem to be associated. Many of these reports can be explained by the post hoc ergo propter hoc fallacy. This Latin phrase translates as ‘after this, therefore because of this’, which in this case means that any ailment which occurs after receiving a vaccination is blamed on the vaccination. Priority for vaccination is usually given to the elderly and those with major health problems - groups prone to experience symptoms in a given period of time whether or not they have been vaccinated.

Suspending vaccination, the nocebo effect and delays in beginning the vaccination programme caused by the desire of the European Commission to prioritise price-bargaining over the quick delivery of vaccine has greatly reduced the rate of administration in EU countries compared with the UK. The result has been deadly. At the time of writing, the UK has 30 deaths/day from coronavirus, compared with 300 deaths/day in France, 380 deaths/day in Italy and about 250 deaths/day in Germany. It appears that there is some point in utilitarianism when applied to public health. After all, what human rights do you have when you are dead?

PS. There is a fascinating example of British policy ruthlessness in the slaughter of 750,000 pets at the start of the Second World War, as a way of reducing the demand for imported food. See British Pet Massacre on Wikipedia.