Jonathan Wolff argues that the moral character of our leaders will be revealed in how they address the long-term effects of the pandemic.
Just as the COVID-19 pandemic has manifested itself in the form of several waves – experienced in different countries at different times and to different degrees of intensity – our moral response also falls into waves, albeit waves that don’t directly match the waves of the pandemic. Although there are many ways in which the issues could be divided, I want to suggest that it is useful to regard the moral concerns raised by the pandemic as falling into three waves, which we could call emergency response, crisis management, and moral legacy. The basic idea is that when the pandemic breaks we need to respond to it first of all as an emergency requiring immediate action. At the same time, and then over a longer period we need to work out how we will manage the situation for as long as we are in crisis, but also work out how to bring the crisis to an end. Both of these periods – the emergency and crisis management – are time limited. But there is also a third type of response needed which extends into the indefinite future; how to repair the damage done, and in particular pay attention to those groups that are both most vulnerable and most likely to have suffered harm.
Each of these waves sets a whole host of issues, which need medical, legal, and institutional responses. But none of the responses is straightforward and typically requires choices and complex chains of actions. Such choices and actions need to be informed by reflection on values, and the purpose of this article is to bring out the some of the different moral questions we face and how we might address them.
The pandemic, as we’ll recall, affected different countries at somewhat different times. In the UK we were aware, initially, of reports of a type of pneumonia in Wuhan, and then serious levels of infection and death in Northern Italy. It seemed almost inevitable that the UK would also be affected as those taking vacations in Italian ski resorts returned home. The situation had become so serious in Italy that ventilators were running short, and there were reports that hospitals were having to make agonising choices about who should be offered treatment, such as limiting access to those below the age of 60. This, then, was one of the first ethical questions that had to be faced: who gets priority in access to scarce health resources? This, of course, is a perennial topic in bioethics but goes back much further than contemporary academic discussion. It is, for example, the central plot line of G.B. Shaw’s 1906 play The Doctor’s Dilemma. While there is no settled consensus there are areas where this type of emergency priority setting is a matter of routine, such as the forms of triage used in battlefield medicine as well as in Accident and Emergency medicine. There are tragic choices to be made in the short-term, even if, over a longer period supply constraints can be overcome, other forms of treatment devised and so on, and the immediate emergency passes. But for as long as scarcity continues, it is acutely troubling, in that life and death decisions need to be made with little time for deep reflection.
But the allocation of scarce medical resources is only one part of the emergency. Another is the restriction of individual freedoms to travel and associate. Decisions needed to be made about isolation and lock-down. These clearly need to be informed by medical science, and economic factors cannot be ignored. But they are also moral questions about what can be justified in the circumstances, especially under conditions of great uncertainty. Of course infectious disease is not new, and there are established protocols for dealing with outbreaks. But we were not morally or emotionally prepared for the extent of the pandemic and again decisions needed to be made at great speed. Decisions also needed to be taken about how decisions were to be taken, and whether normally parliamentary procedures could be suspended during the emergency. In most cases such suspensions were made, albeit with time limitation clauses attached.
This emergency period has a number of key features. Decisions needed to be made at great speed, with limited time for consultation or any formal process, as the urgency of the situation required bold action even under conditions of grave uncertainty. Normal forms of accountability were also put to one side. The overwhelming moral reaction seems to have been one of what we can call negative consequentialism; what do we need to put in place to minimise the most serious harms and to give us the breathing space to put in place more considered measures?
Whether or not there is an ordinary language distinction between an emergency and a crisis it is a useful frame to think about how the first wave of response turns into a second wave. If an emergency requires an instant, almost instinctive, protective response, a crisis, in the sense I intend, is something more protracted and extended over time. It stills requires exceptional, and, we hope, time limited action, but there is a little more time for consideration of options and some consultation, and a greater awareness of the wide array of options that are possible.
The types of issues that arise during this period include working out how to strike the right balance between limiting freedom and protecting health, to consider the likely economic consequences of different possible policies, and to protect people’s lives and living standards at least to a tolerable degree. Great consideration needs to be given to education, to the continuation of work under new conditions, and the availability and provision of adequate food supplies for all. Here we saw some remarkable social innovations, such as the furlough schemes in the UK, which allowed those who could not work to receive a significant portion of their normal salaries (up to a cap) for an extended period. These policies also have a strong consequentialist element in terms of how can we give as many people as possible something close to a normal life even in the face of a very significant health threat and great restrictions on movement. But like many consequentialist policies, they were aimed at the majority, and those in unusual roles could not benefit in the same way. For example, those regarded as “essential workers”, in the frontline of health care, social care, delivery, shop work, transports and other fields, were not offered the opportunity of sheltering at home with furlough payments. Consequently they faced higher risks than others. Those who were self-employed or working in the informal economy, or had not worked long enough to qualify, also were overlooked, at least at first. This is, perhaps, inevitable. Decisions in a crisis also are made under time pressure, as well as limitations of other resources, and it is no surprise that decisions are made to favour the majority. Those who are hard to reach or do not fall into conventional categories will be missed. Over time, however, more and more will be included as attention shifts.
Also in this period of crisis management there is the critically important set of issues around vaccines: most visibly who should get access, but behind the scenes questions about research ethics, intellectual property, and commercial business. These issues are for a short time, the subject of frantic and urgent discussion, though attention fades, and ultimately the outcomes of such deliberations may well become part of the moral legacy if COVID vaccinations continue to be required perhaps on an annual basis. But many of the other measures around priority setting will work themselves out over time and disappear, just as, when the crisis passes, crisis measures are lifted or expire.
One of the earliest phrases to emerge from the pandemic was “build back better”. The optimistic idea was that contemporary societies are, to some degree at least, broken or dysfunctional, and the gross shock of the pandemic provides the opportunity to rebuild in a more effective manner. The contrasting, pessimistic, view is that when the dusts finally settles it will be rather like it was before, only worse. The optimistic view derives from the thought, just as some narratives of WW2 in the UK suggest that it was a period when people of different classes and backgrounds learned how much they depended on each other, and had a duty to care for each other in the future (hence the significant development of the welfare state) the trauma of the pandemic will do the same for our generation. Generous furlough schemes, which come close to basic income proposals, are held out as an example. But the pessimistic view suggests that just as the furlough schemes are financially unsustainable for more than a few months, mutual goodwill is just as fragile. This alternative narrative can be generated by a simple line of thought. First, following Thomas Piketty and many others, the capitalist economy has a natural tendency within it towards inequality. Second, in normal circumstances, governments attempt action to address or mitigate inequality. Third, that action is difficult, slow, and takes time, resources and energy. And finally, in a pandemic, government time, resources and energy will be focused on the first two waves – emergency and crisis management – and therefore those who are vulnerable and marginalised will find themselves ever further left behind.
Although the pandemic lingers on, we hope very much that the greatest disruption is behind us and governments now have to face up to the question of how we go on from here. There are several factors to take into account. The first, in accordance with the general analysis of this article, is to try to identify those who have particularly lost out over the last two years. The most obvious is those who have had their education disrupted. Although nothing can be done to give back two years of lost contact with friends, attention can be given, first, to try to repair the educational gaps, and second, to consider how to compensate in terms of qualification so that those educated during the pandemic do not become less competitive in the workplace. Others who have lost out will include small business owners who took large losses to keep going, or even closed down completely, those who got into mortgage debt as incomes dropped, and others who fell through the cracks of government support. Now we have time to take more considered action we have the opportunity to bring everyone into the fold.
These new measures will have a financial cost, on top of acquired debts and there will be other substantial calls for government support, such as the as yet unknown cost of dealing with “long COVID” and perhaps the improvements in health services and other aspects of infrastructure to prepare better for future shocks, as well as to build back better if indeed that is the goal. Who is going to pay? Currently it appears that the UK government intends to spread the cost through society as a whole, by increasing National Insurance payments, and, no doubt, finding other ways of generally increasing revenues without changing headline tax rates. But if they do this, and little else, then inequality will grow. Indirect taxes fall disproportionately on the poor, at least as a percentage of income, and the wealthy are often able to take advantage of schemes to reduce their tax burden.
A fairer solution, certainly in terms of addressing increasing inequality and poverty, will be to protect or enhance the disposable income of those towards the bottom of the distribution, and seek extra contributions from those first, who benefited financially from the pandemic, and second, those who have wealth and high incomes independently of the pandemic. Walter Scheidel has argued that, historically, it is rare for the trend towards rising inequality to be halted, but it has happened after cataclysmic events such as wars and plagues. Part of the reason, at least after war, is that very high taxes are needed in order to rebuild, but they can only be levied on those who have the resources. Hence after WW2 marginal tax rates were applied in the UK and US that are scarcely believable now. It was possible, for example, to pay 98% on “unearned” income in the UK (83% in the highest band and a 15% “supercharge” on earnings from such things as share dividends). For myself I have no idea what tax rates are needed or possible. The shocks from Brexit, the current energy crisis, and the war in Ukraine and possible isolation of Russia from the world economy will compound the economic crisis leaving many countries around the world struggling for stability, let alone prosperity. One thing that the pandemic has taught me personally is that I know much less about how the economy functions than I thought I did. But the current trends are discouraging. The pandemic has given us the opportunity to rethink how to run the economy, but those in office at least in the UK seem to believe it was running well enough before and we simply need to make sure it’s put back on the same tracks. Sadly the moral legacy currently looks like it will be that we missed an opportunity to create a fairer society.
I have suggested that we should divide the moral analysis of the pandemic into three distinct, but partially overlapping, waves. The first is the emergency wave, in which governments have to move very quickly, with little direct accountability. The second is crisis management, which takes place over a longer period, but is time limited and, to a degree, disordered. The third, which we are moving into now, is the moral legacy, where we have to address the long-term effects of the pandemic, and who has won and who had lost. One possibility is spread the costs throughout society as a whole. But if we do this it will simply increase inequality and poverty. Another is to develop redistributive policies to ensure that those who lost out do not fall further behind, but rather begin to make up some of the lost ground. The moral character of our leaders will be revealed in the choices they now make.
Jonathan Wolff is the Alfred Landecker Professor of Values and Public Policy and Governing Body Fellow at Wolfson College, Oxford.