0:00
in response um what i'm going to do is give a quick introduction to the nuffield council on bioethics because i
0:05
know we may not be familiar to um to many of you and make a few reflections on how various kinds of expertise and
0:12
evidence including ethics feed into the decisions or sometimes don't feed into the decisions
0:18
made by national or local decision makers i'm then going to highlight a number of i think ethically
0:23
difficult situations thrown up by covid i'm going to do that quite briefly because i want to cover a
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range and i think hopefully that will prompt some discussion in the in the chat at the end and then i'd like to finish by looking
0:35
in more detail at two particular case studies um one i want to talk about um the what
0:40
we've learned i think about some of the challenges of of the way we think about people in care homes that's been illustrated by um by the covid m19
0:48
outbreak and and and the restrictions that they've experienced and then i'm going to hand over to my colleague arson
0:54
to talk about i think the very current question of equitable access um to vaccines and vaccines and
1:00
treatments but particularly vaccines on a global level which i think is a real issue now for the world in terms of how
1:05
we think about this this pandemic and i'll try not to overrun but um it's quite a big brief um so
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nether council on on bioethics um as it says there were a small independent body i think there
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are 13 of us in total now um and our remit is to inform policy and public debate about the ethical questions raised by
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biological and medical research and were established 30 years ago now
1:30
back in 1991 by the nuffield foundation and we're co-funded by the foundation by welcome
1:37
and by the medical research council we take an inclusive approach to the way we
1:42
interpret our remits to advise and ethical issues in bioscience and health and when we identify an issue
1:49
we think is worth exploring and we bring together an expert group bringing in i think quite a wide range
1:55
of academics and practitioners and policy makers and we also it's an important part for us in any project to think about how we
2:01
get wider public input too and the aim of all that is to ensure that
2:06
your weather are scientific and medical developments that could affect our lives in some way these are brought into practice in ways
2:13
that are consistent with public interests and values a sense of it's going below the technical to think about how things actually
2:18
impact our lives our values and our interests we do that in a
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variety of ways we have really in-depth inquiries that last a couple of years i've been at the council 14 years now
2:29
and i'm on my seventh seventh inquiry we also do much shorter scale policy briefings you know because of turn
2:35
around um some concerns in two to three months and we use both these different ways of working
2:40
and to seek to influence policy both through the recommendations from our long long term projects and also just by
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drawing attention to some of the ethical challenges that arise in the shorter briefings we also
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do a variety of other things to sort of be aware of what's coming up on the horizon and to collaborate internationally
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and to give you a quick flavor of the kind of issues that we that we cover some of those are are very
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much about novel interventions so going back to gm crops or 20 years ago in the particular
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youth both in the uk um and and in in developing countries thinking about novel technologies
3:14
thinking about alternatives to meat um we're doing a current series of projects looking at genome editing
3:20
so partly it's human reproduction and then now as fiona mentioned ourselves working on a
3:25
project on genome editing and farmed animals so quite a wide range of novel new things and but we also try
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and tackle some of the sort of long-standing ethical questions that arise in medical research so i had a lovely couple of years
3:37
thinking about how you involve children ethically in clinical research and involving children in that process
3:43
and then in the right-hand corner of the slide i hope it's not hidden by by the pictures um thinking about um the
3:49
ethical aspects of public health now that was a report we published in 2007
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um and actually that's formed a lot of the basis for a lot of our thinking about covid that's one that's really sort of stayed
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stayed the term in terms of remaining valuable so how does all that activity on our
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part actually feed into um policy making along of course with um
4:12
oh dear i've just done some funny click there sorry where do we go why can't there we are and along of
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course with other people with an interest um in in in ethics i think we need to
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think about the role of ethics alongside other kinds of expertise in policymaking
4:30
and there's been a mantra for the last i think several decades of this idea of evidence-based policy making
4:35
so the idea that when policymakers at national or local level are planning to do things that affect
4:41
effect public interest spend public money but actually there should be a decent research base for that that if we do a
4:46
then b is likely to to arise not cd or e and there are parallels there with
4:52
evidence-based medicine in the very well-established role of medical research underpinning medical
4:58
care and i think you're on this core we'll all be aware of um forms of treatment that were common and were normal in our childhood that
5:04
have since changed because of the increasing um knowledge gained by medical research and sometimes it
5:09
actually undermines what we thought and was good practice in the past but i think there's a real tension when
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one starts then thinking about evidence-based policy-making because social policy questions are also inherently political questions
5:22
if we think of today's news there is not a consensus um on what the national rail system should look like or what transport policy should
5:29
look like these are political questions as are what our education system should look like what our exams for children
5:35
should be seeking to test so all these kind of social policy questions they are capable of being influenced by
5:41
evidence and evidence is an important part of of of thinking through what they should be but they are also these political
5:47
questions that also brings us therefore to ethics
5:52
brexit i think was a really interesting example of some of these tensions between research evidence between
5:57
expertise and politics and many of you may remember michael gove back in 2017
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saying i think the people of this country have had enough of experts and i have to say at the time i found
6:09
that a very dispiriting um comment and that i rather have spent my working life thinking that evidence
6:15
and logical argument actually actually matter but i think actually what this captured
6:20
was that for many people making decisions about about brexit whichever way they voted in the referendum
6:25
it wasn't actually about the evidence on um exports or imports around delays at the
6:31
border or whether you could take your your your your pet's dog to uh to to holiday in france
6:37
it was a much more visceral thing about the kind of country we wanted to be and how we wanted others to perceive us
6:43
so actually in this case evidence about financial implications about practical implications about um implications of
6:49
particular parts of the economy weren't actually a relevant factor for many people and i think this is what michael gove was trying to capture
6:55
um in that quite provocative statement if we fast forward three years to to
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spring last year to the um when the covered 19 pandemic first took hold i think we'll all remember the phrase or
7:07
very familiar with the phrase we are following the science your experts seemed very much back in
7:13
favor um and yet this hasn't been uncontroversial either
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so this is a headline from the guardian um in april last year where ministers were accused of
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abdicating political duty to a narrow field of opaque expertise on covert 19.
7:30
i think if we unpack a little that little bit it really starts bringing in this these wider questions of how
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evidence and how particular ethics fit into policymaking so this idea of
7:41
narrow field of opaque expertise i think it's it's certainly the case that there's a vast range of relevant
7:46
expertise um in terms of responding to the pandemic and that range i think has expanded
7:51
during the last 12 to 14 months so there's the technical expertise the modeling the virology the understanding
7:58
epidemiology and how diseases are spreading what public health interventions can work there are also the social and
8:05
behavioral sciences think about how we feel how we behave because the public health model
8:10
may identify certain kinds of changes if we all follow it but if in fact only 60
8:15
of us follow it or only 40 of us follow it that has real life consequences for it and then ethical expertise also plays
8:22
into this mix thinking about what values are at play whose interests are affected how we balance those and while there's a
8:30
lot of criticism early on about the nature of the the expertise that was that was going into to
8:35
government advice and particularly lack of transparency about that was in the early days i think it's important to recognize that
8:41
a very large number of scientists from a very wide range of disciplines including i know at least two ephesus
8:47
have been involved in sage the scientific advisory group on emergencies and its subcommittees spy m and spy b but of
8:54
course there's still scope for disagreement both within those those involved and perhaps even more importantly those who feel themselves
9:00
outside outside that advisory machinery and therefore you'll comment from from outside and of course this has been
9:07
a completely new disease and a completely new situation so knowledge is evolving constantly if we think in terms of the advice on masks
9:14
for example i think that's a very clear example of how how things have changed very very much in our understanding over the
9:20
last year but that second criticism that following the science is an abdication of
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political duty i think brings us back to this main focus of ethics and the role of values and
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decision-making because decisions about public policy are not merely technical
9:37
you can you can do different models for what might happen under different scenarios and what pressure they might put on the nhs but then it's a question
9:44
it's a decision based on values as to how you act on that what policy decisions um come in
9:49
response and in this case public policy decisions are based on values but often this is
9:55
implicit it's very rare that that is spelt out they also often require trade-offs
10:00
between different kinds of interests and this is very much i would suggest where ethics comes in
10:10
so what can ethics and ephesus actually do i think it's really important without
10:16
doing myself and my my colleagues down too much that ethics and emphasis can't provide ready-made answers
10:22
precisely because we're talking about i think a political consensus often or a political mandate as to what um is is the
10:29
a chosen course of action however what we can do is offer a framework of values and where
10:35
others may not always agree with those values the fact that they've been set out explicitly rather than implicitly allows
10:41
for that kind of discussion to take place it helps unpack where tensions
10:47
arise we emphasize the importance of a fair and transparent process and in the blog i've i've copied into
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the um the slides there below my director um hugh whittle made a very strong argument
11:00
um for much greater transparency early on in the first lockdown when we had no idea how we're going to come out it to
11:06
come out of it in order to to to create a greater trust in the system
11:12
and then really importantly we identify where responsibilities may lie so it's not for ethics and ethicists to
11:18
make ethical decisions what they can do is provide the tools to help those whose responsibility it is to make the decisions
11:24
to make to make those decisions and that may be at the level of national or local government it may be the national health service it
11:30
may be thinking about what our responsibilities our citizens are and i think this pandemic has really brought out all those different
11:36
levels of decision making by i think a a a rather fortuitous um um
11:44
situation as fiona mentioned i spent 2018 and 2019 working on a project that asked the question
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how can research be conducted ethically in global health emergencies now we saw that project is coming very
11:55
much out of the challenges of ebola in west africa of zika in latin america
12:00
um you know the last thing we were expecting when we when we launched it or just before we launched it was that it would be coming into the midst of a
12:05
global pandemic that would turn all our lives upside down and in fact we published it just two
12:10
days before coverage was declared to be a public health emergency of international concern by the code by
12:16
by the who and the findings and the approach in that report have been used extensively
12:21
during covet um including forming the basis of the ethical advice issued by the world health organization
12:27
to researchers working on curvid related research the reason in this talk i'll put this
12:32
slide up is to give an example of the kind of ethical framework that i'm talking about so as part of
12:38
this project we developed what we called an ethical compass to guide decision making both to researchers on the ground and to
12:44
policy makers particularly to research funders but also governments and others and that identified three core values
12:51
about helping reduce suffering being the reason why you're doing research in the first place about demonstrating respect for others as
12:58
moral equals and thinking about what that meant in terms of how research was conducted and then thinking in terms of fairness
13:04
both in terms of how people are treated who's included who's excluded who benefits who doesn't benefit
13:09
and thinking about fair process as well and i think a really important element of this is recognizing that these values
13:16
will often be in tension they'll pull in different directions but none can simply be overridden
13:21
so in thinking about a policy aim you'll be argued you have to think about how you would use suffering in ways that are fair and in ways that
13:28
are respectful and that each of these act as a kind of constraint on the other
13:34
so that was one example of a particular piece of work that we did that was rather fortuitously very timely in terms
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of the kovid 19 research response it was the council done in in in the
13:45
broader sort of um covid 19 responses in our commentary on that
13:51
we've produced a number of rapid policy briefings on immunity certification vaccine uptake and equitable access to
13:57
treatments and vaccines we've brought together experts and policy makers in meetings and webinars
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and to try and explore some of these issues and we've used them the findings to brief ministers scientific advisers chris whitty and
14:09
patrick balance um talk to parliamentary committees so the they both the house of lords and house
14:14
of common science and technology committees and the health and social care committee we published um 30 blogs which enables
14:22
us to i think bring out particular issues that we might not have worked on in particular but where we have have things to say um and i found when i
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wrote one on the ethics of challenge trials that was um taken up sufficiently for me to appear on some sky tv and channel four
14:34
which is very interesting and alarming um and through the uh the international
14:40
and connections we had through the research um in global health emergency work we've contributed to wha
14:45
advice and to the work of the kovid 19 clinical research coalition
14:50
that's of course all our side of it you know the other side of that is you know has it made a difference um has the government listened i think
14:58
that's a rather harder um question to answer particularly in the context context of a pandemic
15:03
um where things move fast where i think governments instinctively focus knuckle down and focus on on a few
15:08
decision makers i think there are areas um where we have been able to make a contribution
15:14
and in fact most recently just earlier in the week and we had a closed meeting with a number of experts and and
15:19
and officials thinking about the suggestion or the current public consultation on on mandatory vaccination
15:27
for care workers and the the ethics of that and that will then lead into a a formal
15:32
response to the consultation but by bringing people together we're able to expose um officials and others to
15:37
the wider questions around from very different perspectives we've made contributions as i've said on
15:43
on immunity certification um and we've keep we've kept and pushing questions of equitable access to
15:49
treatments and vaccines worldwide which our zoo will will come back to and in fact we had a webinar about that today
15:56
and so i think in a sense the jury is out as to how much influence we've had there but i think we've had been part of a wider
16:01
um i think wider set of voices encouraging greater transparency encouraging the government to be more
16:07
explicit about about values and interests so if we turn now to some specific
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examples of ethical dilemmas in covid as i said in my introduction i'd like to start by making some brief
16:20
reflections on a number of quite high profile ethical scenarios that i hope will then prompt discussion um in the um in the in in the
16:28
discussion in the questions and answers at the end and then move on to the the more detailed case
16:35
and studies common theme across the three dilemmas i want to talk about um is the critical importance of context
16:41
at the start of the pandemic i think the phrase was used quite a lot that we're all in this together we're all affected by this
16:47
i think 14 months on we realized that that isn't really true we're not all in this together we have been affected
16:52
very differentially i've been very aware that myself i'm able to do my job from home here in my kitchen i can have groceries
16:59
delivered i can keep myself safe very easily that is not the case for many people
17:04
so the backdrop of health inequalities we've known for years have been some important reports making a very clear
17:10
correlation between deprivation and reduced life expectancy and healthy life expectancy
17:16
we know the social care sector was particularly badly or it continues to be particularly badly um affected um by
17:23
um by covered by covert deaths and we know also there's been a really disproportionate impact
17:28
on minority ethnic groups that we understand less well why why that is and something some shocking
17:34
figures there about the impact on black men and women more than four times as likely to die as their white counterpoints
17:40
counterparts and bangladeshi pakistani men and women more than three times as
17:45
likely to die those are really quite quite shocking figures so bearing that in mind as we think about the particular
17:51
scenarios i want to bring up if we start by this question of how we balance the harms of covid itself
17:58
the threat to life um indeed the threat to health through long coverage that it represents versus the harms of lockdown more
18:04
broadly and one way of unpacking this question is asking how we should balance the interests of very
18:10
different parts of society if we think of school children and young adults the people who are least likely
18:16
to be affected um in terms of their health by covid they are some of those who have borne the greatest burden children through
18:22
their um the interruption to schooling um with both interrupting to education but also
18:28
mental and physical health harms and again very differential depending on what kind of experience of online schooling they had particularly in the
18:34
first lockdown if we think of younger adults particularly those in insecure work and what that has meant
18:41
to them for the last last year or 14 months and contrast with those who mainly older not exclusively
18:47
who are more likely to suffer serious illness and even die from covid
18:52
and you may be aware that last october a number of academics very high profile ones from harvard from stanford
18:57
from oxford came together in something called the great barrington declaration where they said as infectious disease
19:03
epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health
19:09
impacts of the prevailing kovid 19 policies and recommend an approach instead that we
19:14
call focused protection and that was basically as an extension of the government's early shielding programme so the idea that
19:21
those who are most vulnerable should effectively stay inside keep out of harm's way
19:26
get the kind of services they would need to to continue life like that and the rest of us could go out and live our lives as normal
19:33
and business could could continue now i think the great barrington
19:38
declaration did raise some really important questions about the consequential harms of the pandemic and some of the differential
19:44
impacts but i think there's some really important and difficult ethical questions that are sort of hidden underneath that and in
19:51
particular about the extent to which we see ourselves as a connected society or as atomized
19:57
individuals and first and foremost i think it assumes that those who are more
20:02
vulnerable to covid actually live quite separate lives from those who are not and to make this personal for a moment i
20:09
have a number of health conditions that makes me more vulnerable to covid i also have a 16 year old son if i were
20:14
to be the subject of focused protection i didn't quite know what that would mean would i live in one room in the house
20:20
and not see him would i move somewhere else how feasible is that and i'm going to talk about this a bit more when i talk
20:25
about older people living in care homes because i think this segregation this idea that one can compartmentalize
20:31
ourselves into those who are vulnerable and those who are not and live different lives is actually quite an alarming and
20:37
frightening um um thought i think the sort of the the
20:42
the remedy suggested by the great barrington declaration also assumes that it's okay to ask those
20:47
who are vulnerable to bear the burden of lockdown alone that by staying inside keeping themselves out of harm's way
20:53
out of risk of burdening the nhs and all the other language that was used that can allow others just to just to
20:59
deliver as they wish but i think asking all of us to accept some degree of inconvenience
21:05
in order to be able to support others is a fair thing to do so expecting us to wear masks to go
21:11
one-way systems around supermarkets if necessary to queue in shops or whatever those all seem to be fair things to ask
21:18
all of us to do so that people who are more vulnerable do feel it's safe to step outside their front door
21:24
i think once you start thinking of you know the implication of the lockdown and what that meant for people's economic livelihoods the fact the number
21:31
of jobs have been lost number of businesses have been lost that does get a much more difficult balance you can't just balance that by
21:37
by somebody's convenience and then that brings in questions of responsibility for government for mitigation
21:42
and obviously the furlough scheme i think was a very important and i think perhaps quite surprising um aspect um of of of the government
21:49
last year in in in march or april and that was introduced as a way of of trying to mitigate those those impacts there's been a lot said about
21:56
actually the need for much better sick pay for example to help mitigate the impact of asking people to um
22:01
to isolate when they might matter come into contact with cobit and by that way make it feasible and likely
22:07
that more people actually can help cut down contacts so that's the first first of my my three
22:14
scenarios the second one which i think was a very very um hot topic um last december since it's worked its
22:21
way out now is the question of who should have priority access to the vaccine in the uk and ethicists
22:27
would unpack this in a number of different ways so what do you think of it in terms of need those who are most likely to die or
22:33
become seriously ill from covid would we talk and talk about it in terms of dessert who deserves it
22:40
would we think about it in terms of reciprocity should we prioritize those who put themselves at risk for others
22:46
and obviously if we think of health care workers they potentially fit into all three of those categories
22:52
if we think about needs and just think about that for a moment that in itself is also quite complex so would we think
22:58
about age alone and which has been the main focus within the government approach um there's a very broad correlation to risk
23:04
is easy to organize should we think about age plus other factors other health conditions
23:10
that has been a factor gender we know men are much more likely to get very seriously ill
23:15
obesity another major risk factor and i've already touched on ethnicity and deprivation as being key
23:21
um key key factors in in in risk of death then should we think of
23:27
occupational exposure so we think of health and care workers who are clearly potentially exposed but
23:32
also have access on the whole to ppe but how about all these other people who've enabled people like me to
23:37
sit at home and have their grocery deliveries you know how about people who are working shop assistance how about those who are working in public transport
23:44
how about any of those whose jobs cannot be done at home they also have an occupational risk
23:49
in that sense so in making this decision going back to this idea of how the
23:54
government makes his decisions it took a decision based on advice by an expert committee called the joint committee on
24:01
vaccination and immunization that committee does not usually i think involve ethics input but in this
24:06
particular case it had input from at least one academic ethicist and here we all know what the well the
24:12
outcome was it was broadly based on age there's a category of people with other age conditions um
24:17
and then health and care workers were also prioritized and i find it very interesting that
24:23
i've heard chris whitty present this as purely a clinical decision this is simply about need but it doesn't actually pick out
24:30
some of those other aspects of need so it shows age it shows other um conditions so there's been controversial which have been in and
24:36
which have been out but it didn't think about these factors of occupational exposure other than um for for healthcare workers they
24:43
didn't think about deprivation and ethnicity and there may be very good reasons why that's the case in terms of the
24:48
practicality of the rollout i think it's interesting just to see it's a lot more complex than being as the simple clinical decision
24:54
which it was presented as and then the third of my three scenarios
25:00
how about covered status certification um otherwise known as vaccine passports um or immunity passports
25:07
and this has been debated now for well over a year but i think lots of very different stairs and hints as to what might happen from
25:14
different government ministers at different times and you're clearly being able to demonstrate that you've had
25:21
your immune from from cobra that you've had your two vaccinations and and so forth offers very clear benefits from some in
25:27
some simply inconvenience um but some really importantly in terms of being able to reopen parts of the the economy and actually
25:34
enable people to to to earn earn a living i think there are also some really important factors to
25:40
consider you know and these are the kind of issues that i hope are being considered at the moment by the government in its public consultation
25:46
so by definition it risks creating a two-tier system where those who haven't yet been able to
25:51
access vaccines or are willing to be vaccinated or exceptionally um may not be able to for health reasons
25:57
effectively may become second-class citizens and i think if it were introduced now i think it's quite interesting that most under 50s
26:04
would still not have access particularly if you're required to um to um um the the the two jobs the
26:10
full course of the vaccine um there are further risks of exclusion if for example it was only available by
26:16
a particular device i was very struck last year when the kovit 19 app came into interforce and you could
26:22
zap your way into pubs when they were when they were open and that actually a number of people
26:27
i know who don't have particularly old mobile phones found they couldn't download it because because it was the software needed a
26:34
more recent mobile phone there's been quite a lot of talk recently about people either being selfish or it serves them right if they
26:40
refuse to have vaccines and i think that really does underplay some of the very complex reasons why
26:46
people are hesitant about vaccine i think they're very good evidence that actually we need to build trust
26:52
and support people in dealing with the the fears and concerns they have about the vaccine before being penal in some way and for
26:58
not having one then there are really important questions about what the threshold will be for use
27:03
yeah are we talking about a passport to go abroad so the eu is now going to allow those of us with two vaccines
27:08
um to go to other european countries um might be used for other things how about for particular kinds of job
27:15
how about for particular kinds of of um either nightlife going to pubs even particularly kinds of shops
27:21
all these things raise different questions of proportionality and then i think there's a fear of
27:26
future mission creep um i think in the uk looking at some of the press coverage of this we've always
27:31
had an instinctive anxiety or concern about the idea of carrying papers and i think the some of the public
27:37
concerns about this plays into that kind of nervousness and if we unpack what that means i think it's a sense of do do
27:42
we trust how it be used might this might our medical data be used in other ways in future what kinds of protections and
27:49
assurances might we want to have before we went down this route and then just the other factors i put on
27:55
the slides thinking about the importance of a wide consultation which the government is currently doing but the importance of that actually
28:01
reaching out to those who are most likely to be disadvantaged you'll be the wrong side of this two-tier system and then really
28:07
importantly think about mitigating factors so are there alternatives to for example demonstrating that you've had
28:13
um both courses of the vaccine and obviously the the question of being able to show a a recent test result
28:20
is an important element of that in making this less discriminatory more open to to to everyone
28:28
so finally moving on to the two case studies i promised you and i'll hand over in a couple of minutes to asu
28:33
um and i'd like to talk about what we've learned about how we care for people in care homes you may remember that in
28:40
march last year the health secretary matt hancock talks about creating a protective ring around care homes who were back to
28:46
shielding back to protective factors again but the idea that people in care homes would be protected from a disease that
28:52
even then it was known would be likely most to affect them because of what we know about flu and other kinds of
28:57
and viral infections and so the front door as it were and to care
29:03
homes was closed to families and to those close to to to to care home residents on the basis that it was
29:08
really important to stop infection coming in and yet we know that didn't work because the back door as it were was
29:14
left open people were discharged from hospital whether or not it was known whether they were infected by covid
29:20
in some cases it was alleged that even known covert patients were sent to care homes because of the perceived need to clear hospitals
29:27
for other apparently more urgent um cases we know that care home staff inevitably
29:34
brought risks in we know that ppe was not readily available early on and that infection control practices
29:40
were maybe um were not necessarily as part of the care home practice at that point with the expertise required as as in
29:46
hospitals and then perhaps understandable reaction to that
29:51
really this is very disastrous first few months of the outbreak last year there has been quite
29:58
extraordinary restrictive guidance on care homes ever since so
30:03
visits were banned for many months when they restarted over the summer it was often only outside in very restricted
30:08
circumstances and then this picture on the slide was tweeted by someone who went to see a family member
30:14
um in in a care home and described it as being like prison visiting with the with the screen and i can really imagine
30:20
that with hearing issues or with someone with dementia quite how difficult any kind of meaningful visit
30:26
would be um in that kind of scenario while the guidance of the department of health is guidance i think care home
30:33
managers have felt they've had very very few choices um about whether or not they implemented it and in particular because of
30:39
some fear of their insurers not actually supporting them um if if they were not to follow it in
30:44
any way and they were subsequently to be an outbreak one of the issues that i've struggled with most i think is that until the
30:51
first of may so just three weeks ago residents were not allowed to leave the care home at all without having a 14-day
30:57
isolation in their rooms on return that would include for a dental appointment or even for a walk to see
31:02
the blue bells at the time in april when we were all actually rediscovering be able to go outside in the good weather and see people again
31:11
that was that was lessened on the first of may but there's still requirements for supervision by an approved family member or by a
31:16
staff member and i think that raises interesting questions over how we control people how we trust them to make
31:22
decisions for themselves and it also raises really practical questions of limits of staff time
31:28
because actually the amount we know the social care sector is not a well-resourced sector we know it's an ongoing challenge over how to provide
31:34
proper care vital to people who need um long-term care whether in their own homes or in or
31:39
or in care homes and the inevitable limits of staff time to achieve that you have led to people saying
31:45
it's all well and good the department of health saying you can have five visitors now but the care home where my husband is um
31:51
only allows a half hour a week or a half hour a fortnight um i think if some of us just think
31:56
about what that would mean for the last 12 14 months to ourselves i i find this really very very
32:01
challenging now i apologize i presented that in quite an emotional way because it's
32:07
something i do feel very strongly about i think one of the points of ethics is to unpack what's at stake in perhaps a
32:12
calm away and public health decisions do always require trade-offs between individuals
32:18
choices and wider public good you know we saw that in italy and spain for example early on the lockdown did literally
32:23
prevent anyone from leaving their homes including young children we didn't go that far we were enabled always to go out to have
32:29
exercise and i think that was a good judgment but in making those decisions we have to
32:34
ask what is proportionate you know the sledgehammer and that question are there other ways we could have achieved the same good aim
32:41
what is fair are we valuing people are we treating people the same regardless of their age their health or
32:46
disability and really importantly whose voices are being heard so we start with the
32:53
proportionality question you know was this kind of closure of homes to visits and the only way of keeping people safe
33:00
and in fact infection control specialists in the in the form of this um nursing times article that i've i've put
33:06
up there have really challenged it this is a complete inappropriate use of infection control
33:11
measures actually infectious control measures ppe appropriate cleaning and so on should be ways of actually facilitating
33:17
access to family members and friends and it's a crucial part of our lives to have that kind of contact when we're not just people who
33:24
need to be physically kept safe we also need our emotional well-being and very alarmingly in the third bullet
33:29
point there on the slide um the writers in the nursing times talk about discussion from some care homes
33:35
about how effectively to move all visits outside or online um for infection control reasons even
33:41
beyond the pandemic and i find that a very frightening way of normalizing what should not or should not be normal
33:50
but then quite beyond the proportionality question i think there's some really fundamental questions here
33:56
of fairness and thinking about how we respect and value older people i think we need to ask
34:02
ourselves do these policies really treat them as people of equal moral worth what weight has been given to their own views on
34:08
keeping themselves safe and really importantly how have others been treated i'd like to finish by
34:14
drawing comparison um with the experience of students last autumn i don't know if you'll recall
34:19
in october or so september october when students first went back to university and i
34:25
think it was matt hancock floated the idea that maybe they would not be able to come home for christmas
34:30
because of the risks of the kind of movement around the country that that would involve would be unacceptable
34:36
there was a complete furore and within i said 24 hours there i think it was the same day i think it was within 12 hours
34:42
it was announced that a way of bringing students home for christmas would be found this is something that's important to do
34:48
and we will find a way of doing it safely my feeling throughout the whole pandemic has been that's the way we should have
34:53
approached thinking about um people in care homes having proper contact with their family members how to
34:59
identify something that's a moral value and then how do you find a way of doing it rather than turning into
35:05
everything's about safety we can't do that
35:10
i'm now i think only five minutes too late i'm sorry i'm now going to hand over to my colleague azu ahmed to talk about
35:16
our second case study about equitable access globally to covet 19 treatments and vaccines
35:22
thank you all very much thanks catherine um hi everyone thanks again fiona for
35:27
the invitation today and catherine for telling us a very rich story of how ethics has interacted
35:34
with the pandemic throughout from the beginning up until now i'm going to finish off our presentation
35:40
today by briefly exploring this case study around equitable access
35:45
to vaccines and that that's mostly in the global context
35:51
and it's something that you will most likely have heard of if you're tuning into the news so next
35:57
slide please catherine thanks so we published this policy
36:04
briefing a year ago i think it was very nearly today or maybe a week later at the start of the
36:11
pandemic and it looked at an overview of barriers to equitable access to copy 19 treatments
36:18
and vaccines across the research to product pipeline and this briefing actually came out of a piece of work
36:24
that i was doing before the pandemic started on looking at equity in the development
36:30
and of an access to drugs and therapies so when the pandemic started we just
36:36
thought how can we make this piece of work relevant to what's happening now and that's where this question of
36:42
looking specifically at covert 19 vaccines came up but not just covered 19 vaccines
36:48
we also need to think more broadly about other covid19 technologies such as tests
36:54
and medical equipment that help in the response to covid and
36:59
it's very pertinent that we're talking about this today because we marked the one year on
37:04
um since the publication of the policy brief and hosted a webinar as catherine has already mentioned where we
37:11
brought back the experts that joined us this time last year um to talk about looking ahead you know
37:17
when we didn't have any vaccines um what might access look like
37:23
um and now that we're in we're in a context where we have vaccines and vaccination programs are
37:28
underway and what progress has been made and it was a very sobering occasion um and we'll talk a bit more
37:36
about that later so in my presentation today i'm going to take you through a few
37:41
different stages we'll start off with a snapshot of vaccines vaccinations and also
37:47
looking at covered 19 cases and deaths just to give you a background of what context we're working with
37:55
and then i'll move on to talk about why equitable access so why should we care about equitable
38:00
access and share some of the different cases for that i'll then look at some
38:05
challenges and barriers for ensuring equitable access and highlight where these might occur in
38:11
the research product pipeline and then end with some ethical considerations and
38:17
questions that are surfacing around this topic and if we have time at
38:23
the end i'll share some of the solutions that have been proposed throughout the past
38:28
year on how we can ensure greater access and also look at how these have fared
38:33
and whether or not they've been successful in doing what they set out to do next slide please catherine
38:41
so this is a snapshot which shows us the leading vaccine candidates and we can see at the top we've got the
38:47
fisa vaccine the moderna vaccine the oxford astrozenica one and the johnson former one and these
38:53
have all been authorized um and then we can see some of the others that are currently in phase three
38:58
trials and are likely to be authorized in the near future and it's important at this stage to bear
39:05
in mind that to bear in mind the geographies and locations of where these where the development of these vaccines
39:12
has taken place you know we're looking at the us the uk china
39:17
russia netherlands and and belgium and and this is it's important to keep
39:24
us at the back of our minds when we then consider who has access and who doesn't in that global context
39:30
next slide please so here's a map that i downloaded um a couple of days
39:36
ago and it shows the covet it shows covered 19 vaccines administered per 100
39:43
people in different countries so the dark blue regions are areas where up to 120 to 140
39:52
vaccines have been administered per 100 people um and that basically is because
39:58
people need two doses of most vaccines so you know the number will exceed 100. and
40:04
if you look at the map the uk and the us are dark blue
40:09
so that means they've had the most number of vaccines administered whilst most of africa has barely
40:16
administered between 0 to 10 vaccines per 100 people so you can already see the disparity
40:23
the geographic disparity between high and low income countries and how many vaccines they've been able to
40:29
administer africa's covert 19 vaccination coverage is the lowest at the moment for any
40:35
region in the world i think it accounts maybe for one percent of the vaccines administered worldwide
40:43
next slide please um i thought i would also extract a graph
40:49
which shows the difference in the rates so we obviously saw the difference in color
40:54
but here you can even see in the lines across the graph that the uk and the us in green are
41:01
you know they're doing really well with their vaccination programs but if you look at the bottom south
41:06
africa ethiopia egypt indonesia india these are all almost flatlining so there's very little
41:13
progress in how many vaccines they've received and have been able to give to their populations
41:20
um next slide
41:25
right sorry i hope i'm not boring you with all the data but i thought it's quite important to give you the facts and figures
41:31
um because it really should that's the best way to see the disparity in inequitable access and this is a table
41:38
which shows us the percentage of the population in different countries that has been
41:45
vaccinated for covet and if you look at the uk um
41:50
30 of the uk population has been fully vaccinated and if you were to so that means they've
41:56
had two doses but in fact if you were to look at single dose over 70 percent of the uk
42:02
population has been vaccinated um similarly with the u.s over 37
42:07
percent of the vac of the population has been fully vaccinated and if we compare this with places like
42:14
india where the pandemic is absolutely raging at the moment they're having 4 500 deaths a day
42:22
only 3 percent of the indian population has been vaccinated and in south africa only 0.8 percent
42:31
it's just shocking like you know we're looking at these figures and it really is quite shocking um and it's useful to compare the case
42:39
numbers and deaths to get a sense of covered 19's imp covert 19's impact um in those countries
42:46
india has had over 280 000 deaths with over 25 million cases
42:53
um and that's over five times the case numbers in the uk and over double the number of deaths
43:00
in brazil we've seen over 435 000 deaths and another thing it's useful to
43:06
remember is that often the the numbers we're seeing are under reported so you can easily
43:12
extract a percentage above these numbers that i'm giving you because that's the reality of the countries and
43:18
the public health systems and their ability to record um what's really happening
43:24
and the extent of it so in conclusion we can see that vaccination rates in
43:29
countries do not necessarily reflect the number of cases or deaths which countries have been faced with um
43:36
and so you know that should lead us to question well what is driving vaccination programs um in terms of the number of vaccines
43:43
being given in different countries and are there ways that this can be dealt with more equitably
43:49
so next slide please okay so the case for equitable
43:56
access there are we've heard lots of arguments throughout um throughout the pandemic on
44:04
why equitable access is important and when we're thinking about this question of access it's basically about who will get access
44:11
to the vaccines and when and if we have fair and equitable access
44:17
strategies it would ensure that vaccines are distributed fairly and speedily to those in greatest need
44:25
first if we start off with the interests argument we've heard that a threat to the virus
44:32
anywhere is a threat to the virus everywhere and the un secretary general um
44:38
quoted i'm going to quote him he says none of us are safe until all of us are safe um the ceo of seppi dr richard
44:46
hatchet is quoted to have said kovit-19 cannot be beaten one country at a time
44:52
we must be able to share life-saving vaccines globally and so in this case for in the interests
44:59
argument we're agreeing that countries are driven by self-interest and that they recognize that securing
45:06
timely vaccine access in other countries serves their own interest and so they would work for equitable access
45:13
the second argument is the economic argument we've seen the impact that the pandemic has had not only in lives but
45:20
also on livelihoods and given the interdependent nature of global trade travel
45:25
tourism again it's in all of our interests to wipe out this virus beyond our national borders
45:32
and a vaccine promises one of the best ways to open up the global economy and control the economic
45:38
impact of covert 19. under the scenario where advanced
45:44
economies are vaccinating universally within four months in 2021
45:49
but only 50 percent of the population is vaccinated in emerging markets and developing economies by early 2022
45:56
it finds that the global economic costs might be as high as 3.8 trillion dollars and up to 49
46:05
of these costs would be worn by advanced economies so again it's within our economic
46:12
interests as developed or high-income countries to vaccinate the rest of the world in a
46:18
timely fashion the third argument is that vaccinating in a fair inequal way would ensure the
46:24
quickest exit globally from the pandemic and if we took a nation-first approach where
46:30
you know we're driven by we're driven by vaccine hoarding export bans bilateral agreements where
46:38
we are purchasing our own vaccines separate to the kovacs facility or other access initiatives
46:46
what we can see is that what we can predict is that vaccine nationalism might prolong the pandemic and not
46:51
shorten it not shorten it according to to what we have heard from um leading figures across the world and
46:59
again dr ted ross the director general of who has has called for countries to work
47:04
collaboratively to end the pandemic by sharing vaccine supplies in a strategic
47:10
way where we are considering the global context if we look at the moral case um
47:17
[Music] catherine has already touched upon some of this where we know that the disproportionate impact
47:24
of covid has been on particular countries and particular communities but also the impact of covid 19 policies
47:33
and meant both of these things have not only shown a light on existing inequalities
47:40
but they've exacerbated inequalities so people who started off worse off are far worse off at the end
47:47
of the pandemic or as we're still going through the pandemic at this point in time
47:53
and if vaccines are not made available fairly to those in greatest need the consequences will be disproportionately
47:59
severe for those groups extreme poverty has risen for the first
48:04
time in more than two decades the kovind 19 pandemic has pushed over 120 million people
48:11
into extreme poverty over the last year mostly in low and middle-income countries
48:16
and this is according to the world bank that sends us back in terms of our
48:22
sustainable development goals and all the progress that has been made in the last decade on helping economies
48:29
move forward and if we look at non-coveted vaccination programs for children these have acquired a
48:35
deficit of vaccinations for around 80 million children so this has nothing to do with
48:42
covered vaccines these are other programs that would be running so you could just see
48:47
how many dimensions there are in which things are getting worse um so the moral case might be that an
48:53
approach driven by solidarity would place equity at the heart
48:58
of any solutions and that those of us who are able and privileged
49:05
have a moral responsibility which dictates that we would prioritize those in greatest need because
49:11
that would be the right thing to do but of course there are so many other arguments here you know we don't need to
49:17
necessarily rely on the moral argument there are so many arguments in our self-interest which means we would ideally support
49:24
equitable access for very practical reasons so finally what happens if there's no
49:30
equitable access you know what would what would the world look like in this scenario and a study that was carried out last
49:37
year at um the northeastern university funded by the gates foundation compared
49:42
the equitable and non-equitable scenarios and it said that when countries cooperate the number of deaths is cut
49:49
in half and the model found that 61 of deaths could be averted if the vaccine
49:54
was distributed to all countries proportional to population while only
49:59
33 of deaths would be averted if high-income countries got the vaccines first
50:05
and this is precisely the situation we have seen unfold unicef has calculated that all rich
50:12
countries could share at this point in time 20 of their available vaccines
50:17
and it would not hamper the speed of their vaccination programs and that's that's a very significant
50:22
number um and just there's like a another bit of context we know that 30
50:28
of the world's population lacks access to essential medicines um
50:33
and we saw what happened in the hiv aids pandemic many preventable
50:38
deaths occurred because there was a delay of almost a decade in treatments reaching low and middle-income countries
50:46
so next slide catherine
50:52
in the briefing and i'm actually not going to go through any of this now because we don't have
50:58
time but um when we looked at factors affecting fair and equitable access
51:03
we saw that these take shape across the entire pipeline beginning with research and development and how that's carried
51:09
out through to regulation production procurement and pricing
51:14
distribution and eventually the uptake and access of products so access is not just about
51:20
who is the who is the product given to at the end of the day or at what time it's about all of these
51:26
different stages and how it is that access um is designed into the very
51:31
um research process the regulatory process and how it is that the whole system is
51:37
set up next slide please okay again no time to go through this um but i
51:44
would have gone into a bit more detail around regulation um the production side
51:49
of it um you know just read the briefing i guess the next slide
51:58
um so on this very quickly procurement um
52:05
is is about how it how how different countries have been able to block supplies and
52:12
production for the next year or two not just for vaccines but also for other kobit 19 technologies
52:19
um so we've seen we've heard lots of stories of um countries in africa and other parts of the world who were not able to even
52:26
order the testing you know reagents required for covert tests because wealthier
52:32
countries had just blockbooked supply and so even if they had the funds they couldn't get into the queue
52:38
and they'd have to wait a year or two years for you know to have access
52:43
and we've seen that wealthy nations that represent 13 of the world's population have already
52:49
secured this was last year they had already secured more than 50 of covert vaccines that were to be
52:57
coming so this was through advanced market purchases um when it comes to pricing there's a
53:05
lack of transparency in how pricing agreements are are set and it often transpires that
53:11
countries who have better negotiating power end up with a better price
53:17
um and this you know we've now seen just in the last few weeks that uganda will be paying
53:22
seven dollars seven us dollars per dose for its 18 million doses of the
53:27
astrazeneca vaccine which is 20 percent more than what south africa will be paying
53:32
at 5.25 and it's roughly triple the price which the eu is paying for the
53:39
astrazeneca doses which is 2.16 so there's already this differential
53:45
access occurring through how it is that um pricing mechanisms work out um
53:52
next slide please catherine i thought i'd make this a little bit
53:58
more interesting um just by sharing some of the headlines that have been
54:04
captured over the past year just following the story of equitable access and we've seen
54:12
headlines around how nationalism could prolong the covet 19 pandemic
54:19
how it is that western country western countries have prevented african nations from having their own
54:24
vaccine by not sharing technology transfer and allowing the continent to manufacture its own
54:30
vaccines there's this stuff on patents and power and i didn't get to cover that
54:35
in the regulation but patents and intellectual property are a huge issue at the moment if you've been following the the trips
54:42
waiver discussion at the world trade organization where the sentiment is that vaccine doses are
54:50
charity but knowledge is justice so if we're empowering countries to be able to produce vaccines um that's far
54:57
better than just relying on donations and we've seen also how it is that countries brought up auto
55:05
supplies of drugs that would be required to treat covid um rem de severe was completely bought
55:12
out by by the us um
55:18
and we've just before i move on to the next slide the us and the uk have led the push
55:24
against the global patent poll uh pool for carbon 19 drugs which would have been an opportunity for
55:30
companies and countries to voluntarily share knowledge about covert 19 vaccines and
55:36
and and the technology transfer but instead um we've seen countries completely block
55:42
those proposals um next slide please catherine
55:47
um i think we'll probably have to end here now because it's nearly six o'clock but um ethical considerations some of the
55:54
things that come up are this balance between
55:59
profit and monopolies versus prioritizing livelihoods and lives um charitable
56:06
donations at what point do we donate um doses do we wait until
56:12
our entire populations are vaccinated before we um before we share doses with other
56:18
countries so professor andrew pollard who was involved in the development of the astrazeneca
56:24
vaccine um said this week that offering children in some richer countries a covered vaccine before some high-risk
56:32
people in poorer countries is a morally wrong is a morally wrong action and he said
56:39
that the inequity of vaccine distribution must change urgently um there's this issue around
56:45
pandemic phase and end of pandemic phase we're already seeing headlines in the uk that you know we've almost we're almost
56:52
done we're going out of the pandemic we'll be going on our summer holidays soon but pandemic phase for who and where and
56:58
how do we define what the pandemic is um i'm seeing fiona and i can't carry on
57:04
talking so i'm gonna just leave it there but um if anyone's interested you know we're happy to share our slides
57:11
and you can take a look at those there's lots more i could have shared but i think i'll end on one final quote
57:19
from one of our speakers from today who said saying something is a global public good
57:25
doesn't make it a global public good you actually have to do something about it and you need to have a legal
57:32
framework in place to make that happen so i think that's what we need more of thank you so much for listening
57:39
thank you very much to both of you that was a huge amount that we got through there and it's such a massive
57:44
topic that there's absolutely no way i don't think that you can get through the detail of everything so thanks very much
57:50
to both of you we've got questions coming in now we are going to run on a little bit everybody but let's
57:55
let's give ourselves 10 minutes and we'll go through some of the questions if that's okay with everybody okay so i shall start from the top
58:04
and i'll try and piece my way through this um okay there was there's a question from
58:09
guy richards and this was um when you were talking about um the take-up of vaccines and the the
58:16
sort of issue of vaccines within certain countries he's asking if you have any reflections on
58:22
the three percent figures for japan in terms of vaccination take up
58:29
so i don't know if either of you have any kind of thoughts or reflections around that
58:37
i would i would have to look at the um
58:43
i'm just seeing if japan's on my list it is i think would i'd have to i have not
58:49
looked uh at japan as a case study so i'd have to go back and look at um you know is that three percent
58:56
because they have limited supply or is it that out of all the vaccines they've been offered only three percent of them have
59:01
been taken up i'm i can't comment on that because i don't right okay okay that's fine
59:06
um we also had um a question from diana christian she was asking does
59:13
does india not have its own vaccine this is a really good question um and it
59:20
was in fact covered today because um the india situation is is quite different because india the
59:27
this the si the serum institute india is the main partner for the astrazeneca
59:33
vaccine and so what what has been happening so far is that
59:38
india has been producing this vaccine on behalf of astrazeneca and
59:44
distributing it back out into the world and keeping very few doses for itself
59:50
um and what has happened this week is that india has had to um
59:57
given the situation that's that's transpiring in india with the amount of covert cases they've had to stop that
1:00:04
export to try and focus on its own population but even once it stops that and it can
1:00:10
get things under control it will then still prioritize countries that
1:00:15
are in direct deals with astrazeneca so um again india is the main partner
1:00:22
for the kovacs scheme which is there to ensure access for the 91 plus countries
1:00:27
that are relying low and middle income countries that are relying on kovacs for
1:00:32
for their vaccines but they've now been told they won't be getting those vaccines until the end of the year
1:00:38
perhaps december 2021 maybe even january 2022 so it's not great news for
1:00:46
access and this is the argument for why we need to diversify supply chains and not just rely on
1:00:51
one or two key manufacturers um where the whole supply chain would be
1:00:56
disrupted if there's um a situation like we're seeing now okay thank you very much um we've got
1:01:03
another question here from kevin doyle i don't know if he will be best placed to answer this one um but i shall read it out um he's
1:01:11
asking why should we treat the ethics of access to covert 19 vaccines
1:01:16
as a special case if we were to follow a global fair distribution approach to health
1:01:22
care then we should dismantle the nhs and use the money to build healthcare services in poorer countries
1:01:28
i don't know where either of you have any thoughts around that and i'm very happy to have a go and i
1:01:36
mean interestingly we we were invited up on the back of our zoo's briefing notes to discuss with
1:01:42
treasury officials with foreign office with cabinet office and and other people within government about
1:01:47
some of these questions and recognizing this tension between a government's duties to to look after his own citizens the sense of
1:01:54
not only that people who are nearest seem more immediate to us but actually there are responsibilities to your own citizens you perhaps don't have
1:02:00
citizens of the world and then this wider question of what it is to be a good a good global citizen
1:02:05
um i mean i think i would turn that around and talk about perhaps not cutting the aid budget as opposed to
1:02:10
dismantling the nhs i think one of the striking issues or some of the current retrenchments has been actually cutting back on on
1:02:17
projects that will make make healthcare more problematic in in many countries and you know clearly it's not
1:02:22
the uk government's sole responsibility to provide health care across the world i think one of the interesting things
1:02:27
about vaccines is that what we do has a direct impact on what other people have so it's not just about donating
1:02:33
generously to some of these international initiatives and the uk has been a generous funder to what's called covax which is funding the purchase of of
1:02:41
vaccines for for other countries um but it's actually access to the vaccines themselves there are only so many of them
1:02:47
so as we now give them to 30 year olds 20 year olds potentially to children that is literally taking up the limited
1:02:54
stocks while in other countries healthcare workers those who are particularly vulnerable and are not having access um i think one
1:03:02
can get two um emergency specialists about this i think a lot of the challenges that appear very acutely in emergencies
1:03:08
actually you know we should be thinking about outside the emergency context too and thinking about what it is to have
1:03:14
access to basic health healthcare and what all countries could do to contribute and i would certainly agree
1:03:19
that you dismantling our own nhs is not a constructive way forward i think there are other ways of of thinking about how one might contribute
1:03:25
in that way okay thank you catherine um okay another question
1:03:31
from um sally half acre um surely it's not just a question of
1:03:38
supplying vaccines to other countries but also an issue of how effective their infrastructures are to facilitate coordinated
1:03:45
vaccination programs and if they do not have a good national healthcare system this must be a barrier
1:03:51
to that rollout and i don't know if there's any kind of thoughts around that that you would want
1:03:56
to share um yeah yeah no go for it catherine go
1:04:02
for it i cannot answer them yeah i mean that clearly is the case and i mean i've been picking things up from um from from twitter on
1:04:08
on some of the challenges in more rural parts of india um for example but also actually in
1:04:13
quite a few if we talk about african countries um actually sometimes the most effective part of the system is actually sort of
1:04:19
community health workers and so actually if you can actually get vaccines to particular communities and actually it
1:04:25
can be rolled out quite efficiently and a great deal was learned for example during the west africa ebola outbreak of how to actually get to
1:04:32
really quite remote places um and roll out vaccine programs and work with communities dealing
1:04:37
with some of the concerns about what is this vaccine and will will it be harmful and for me one of the
1:04:43
really interesting things over the last of 18 months really has been you know i spent two years doing work that was very much based
1:04:48
around ebola around zika and it was very much about them rather than being about us it was about
1:04:54
challenges of doing research and and expecting people to accept the the products of research in in countries
1:05:01
where perhaps the people were not very research literally not very science literate and actually everything that we heard in that report
1:05:07
is actually played out in the uk and the us in in um in developed countries in terms of how
1:05:13
people respond to fear how people respond to um shortages in shops and
1:05:19
how people um respond sometimes through misinformation and anxiety about vaccines which usually
1:05:24
isn't about anti-vac sentiment per se it's actually about genuinely shared misinformation about about the potential
1:05:31
impact of the vaccine so i think we we have a lot more in common perhaps than we would sometimes think
1:05:37
okay also i didn't i don't know whether you wanted to come in as well i don't have much more to add
1:05:42
other than just acknowledging that there are logistical concerns um to do with infrastructure to do with
1:05:48
storage to do with transport and that's why investing locally and
1:05:53
building that capacity is so important and supporting you know one of the biggest calls from the african continent at the moment
1:05:59
is for technology transfer for getting the systems in support for getting the
1:06:05
systems in place that would facilitate um
1:06:10
these programs and as catherine has said i think we sometimes underestimate local capacity
1:06:16
because it works differently to how we're used to okay thank you very much um a question
1:06:24
here from i think we've just got a couple more questions and then we'll we'll we'll stop um this is a question
1:06:31
from sue crane she firstly talks about you know the difficulties around the
1:06:36
kobe vaccines and needing to be called stored and taking time to produce but also what will happen what do we
1:06:43
think what do you think will happen to the the millions of vaccines that the government has has ordered from various
1:06:50
suppliers so i could say something about the cold storage and i'll leave it to azure to
1:06:55
say something about the the uk and i mean i think i sometimes feel a little bit protective
1:07:01
with some of the criticisms made of the astrazeneca um vaccine in that the oxford researchers who developed that vaccine
1:07:07
it was a requirement it was a key requirement for them when they were developing it was to produce something that wouldn't require excess cold
1:07:14
storage so while pfizer and madonna both require you know minus 80 or minus 70 order or
1:07:19
whatever um artisanally it can be kept in in northern refrigerators and that was the re the researchers working off the
1:07:25
university that was their sort of starting point for the research and that it will be affordable which is why also i find it very challenging the
1:07:31
fact that differential prices are being charged to uganda and south africa and so on because the researchers who actually
1:07:36
initiated that research were very much based on the idea of this has to be a vaccine for everyone in
1:07:41
affordability and in terms of of cold storage so i mean the different vaccines do have different challenges
1:07:47
but you know that's what i think the fundamental ethics of research of thinking about how the way you do research
1:07:52
actually then impacts on on the access at the end of think of our zoo's arrow how about all these different things it's not just the access point it's all
1:07:58
the earlier things you've thought about honestly do you want to say something about the the millions of spare doses
1:08:04
yeah i don't really so at the moment i'm less concerned about that simply because you know we're still we're not in a
1:08:12
position where the manufacturer is happening um in excess of what's required um and i
1:08:17
know that you know many countries so just biden the biden administration this week um talked about
1:08:23
donating 80 million doses um to kovacs which will mean that they get
1:08:29
redistributed out to different countries so i just i i don't think our manufacturing and supply is matching up
1:08:35
to need um but yeah you know once we have an excess
1:08:40
hopefully we will hand them back out to the world but i'm not sure
1:08:46
you know how much damage will have been done by then and how late it will be in the day and how many more lives will
1:08:51
have been lost so that's it's really a question of timing um and just to pick up your point i was doing
1:08:56
about the unicef figures which i hadn't heard before that um that we could actually giving 20
1:09:02
of the stocks that we have access to at the moment while still keeping our own program rolling out
