The rapid development and roll-out of COVID-19 vaccines has been a surprising success of the pandemic and has likely saved hundreds of thousands of lives. Although most people were eager to receive a vaccine, many jurisdictions introduced mandates to ensure rapid uptake in the population, especially among key workers including healthcare workers. In some instances, individuals who can prove they have recovered from COVID-19 have been exempt from vaccine mandates, but in other cases such exemptions have not been made. Pugh (...) et al argue that such exemptions for those already immune ought to be included in COVID-19 vaccine mandates.1 They review the evidence on infection-induced and vaccine-induced immunity and show that that there is not evidence that vaccines offer better protection against severe COVID-19 or of SARS-CoV-2 infection. They argue that to treat people differently based on the source of their COVID-19 immunity is wrongful discrimination, with this discrimination bringing harms in the form of unjust restriction of liberty and negative consequences such as lost employment. I agree with Pugh et al ’s view that, given the available evidence, infection-induced immunity to SARS-CoV-2 ought to be treated as equivalent to vaccine-induced immunity for the purposes of most COVID-19 vaccine mandates. However, their article highlights the need for clarity in the rationale for mandates. This clarity is necessary to be able to identify when exemptions are appropriate. It may be the case that in some instances infection-induced immunity ought not to be grounds for exemption. Pugh et al ’s argument also suggests that collection of data on infection-induced immunity may be a requirement for ethical vaccine mandates. To be confident in such exemptions, we need evidence that infection-induced immunity is comparable to vaccine-induced immunity in the …. (shrink)

Populists are often cast as deniers of rationality, creators of a climate of “post-truth,” and valuing tribe over truth and the rigors of science. Their critics claim the authority of rationality and empirical facts. Yet the critics no less than populists enable an environment of spurious claims and defective argumentation. This is especially true in the realm of science. An important case study is the account of scientific trust offered by a leading public intellectual and historian of science, Naomi Oreskes, (...) and the misapplication of that theory during the coronavirus pandemic. (shrink)

In their thoughtful, nuanced and interesting discussion, Jonathan Pugh, Julian Savulescu, Rebecca Brown and Dom Wilkinson argued that officials should recognise proof of prior infection as a valid exemption from vaccination requirements.1 This commentary agrees with parts of their analysis, but argues that the case for the exemption is less clear than the authors suggest, and the better approach is to allow officials flexibility: an exemption for natural immunity may be appropriate or may not. In part, the disagreements may stem (...) from different experiences in different societies. The authors are in the UK, and their experience may differ from the USA in multiple ways, three very glaring. First, the UK broadly used the AstraZeneca vaccine, which has higher risks than the mRNA vaccines, so our assessment of vaccine risks differs. Second, the UK has universal health insurance, so some of the access to testing issues that I raise concerns about may not apply there. And third, the risk of fraud or misrepresentation may be less in the UK—and other countries—than in the USA, where real concerns about, for example, fake vaccine cards have led to multiple arrests.2 Another issue is that information about COVID-19 changes fast—what was known when the authors wrote may no longer fit the current picture. In their article, the authors argue that it is ethically imperative that COVID-19 mandates exempt those with natural immunity. The authors argue that those who have become immune through infection are ‘potentially equivalent’ to those who were vaccinated, and refusing them an exemption is ethically unjustified—they call this the ‘unnaturalistic fallacy’. The authors convincingly conclude that existing data suggest that previous infection leads to durable immunity for at least several months and protects against reinfection. The …. (shrink)

I have two concerns about Pugh et al ’s case that vaccine requirements without a natural immunity exception are unjustified.1 First, the scientific question they suggest must be answered to justify the policy is in my view the wrong one, or at least not the only relevant one. Second, the authors set up a standard for public health regulation that will be often unattainable, risking paralysis of public health authorities. Pugh et al suggest two legitimate bases for vaccine mandates: ‘the (...) prevention of severe outcomes from COVID-19 and the reduction of viral transmission.’ Governments and employers have a legitimate interest in protecting the health of their citizens and workers, respectively. To maximally accomplish these goals, the relevant scientific question for whether people with prior infection should be subject to a vaccine mandate is: in persons who have been previously infected, does vaccination enhances protection against severe disease and/or infection and transmission? The relevant comparison, if one is trying to maximise protection in the population, is not vaccination vs prior infection, but vs prior infection alone. I am unaware of a systematic review of this question, but the answer in two recent studies appears to be that the combination is more protective.2,3 The comparison the authors propose, in contrast, seems to be one based on an unstated conception of fairness and adequacy: if vaccination alone provides some level of protection, and prior infection can’t be shown to provide an inferior level, then prior infection should be an acceptable alternative to vaccination to satisfy mandates. No argument is given to support the greater relevance of the comparison the authors emphasise. A second and independent concern is that the authors’ proposal …. (shrink)

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. (...) Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle. (shrink)

According to G E Moore,1 we commit the naturalistic fallacy when we infer ‘x is good’ from non-evaluative premises involving x such as ‘ x is pleasant’ or ‘ x is desired’. On Moore’s view, the mistake is to think that we can reduce moral goodness to anything else or explain it in any other terms. We cannot analyse ‘good’, Moore thought, because goodness is simple, non-natural and sui generis. If Moore were alive today, and if he were to ask (...) contemporary bioethicists the right questions, he would probably find that many of them commit the naturalistic fallacy when they move from empirical premises to normative conclusions or when they articulate complex notions of the good. Pugh et al 2 might commit the naturalistic fallacy themselves when they conclude that people with natural immunity to COVID-19 should be exempt from vaccine mandates because such exemptions would achieve desired public health benefits. Moore would probably find me guilty of committing the naturalistic fallacy if I were to present my arguments against such exemptions. A reanimated Moore would find that the naturalistic fallacy pervades bioethics and public health. In contrast, as I shall argue, the un naturalistic fallacy is probably nowhere to be found. In this commentary, I explain what the so-called unnaturalistic fallacy really is and raise doubts about whether anyone really commits it. Decades after Moore published Principia Ethica, Bernard Williams observed that the naturalistic fallacy is unfortunately named since it is neither a fallacy nor an argumentative tendency unique to ethical naturalists.3 Ethical non-naturalists make the same mistake—if it is a mistake—when they move from, say, ‘x is commanded by the gods’ to ‘x is good’. Just as Moore’s ‘naturalistic fallacy’ misnames, Pugh et al ’s ‘unnaturalistic fallacy’ misleads. To be …. (shrink)