LAUSR

That they are ‘following the science’ has become the watchword of many politicians during the present pandemic, especially when imposing or prolonging lockdowns or other libertyrestricting regulations. The scientists who advise politicians however are usually careful to add that the decision what to restrict and when is ultimately a political one. In science, as in medical practice, there is a delicate balance to be maintained between confidence in the best available information, and the necessary caveat that the assumptions and calculations on which that information is based are subject to further scientific enquiry. For politicians and the public, moreover, as for patients, whether those informing them are judged to be trustworthy is a necessary consideration, a judgement determined by a variety of personal and political contingencies and circumstances. Ethics, by contrast, unable to appeal to scientific consensus (however revisable) or political authority (however reversible), let alone a confidenceinspiring bedside manner, must rest the case for its essentially contestable assumptions and arguments being judged trustworthy, on its willingness to admit all reasoned voices (including occasionally those that question reason itself) to a conversation that is potentially unending, but in the process often highly enlightening. That conversation is contributed to in this issue of the Journal by several reasoned voices, mostly on ethical aspects of the COVID-19 pandemic. Relevant to issues on which politicians claim to be ‘following the science’, but also raising fundamental ethical questions, is this month’s feature article. In Ethics of Selective Restriction of Liberty in a Pandemic, Cameron and colleagues consider ‘if and when it may be ethically acceptable to impose selective libertyrestricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups [for example, the elderly in COVID-19] of the community from contracting the disease’ [and thereby, for example, increasing the disease burden]. ‘Preventing harm to others when this is least restrictive option’, they argue, ‘fails to adequately accommodate the complexity of the issue or the difficult choices that must be made’. Instead, they propose ‘a dualist consequentialist approach, weighing utility at both a population and individual level’, thereby taking account of ‘two relevant values to be promoted or maximised: wellbeing and liberty’, as well as the value of equality, ‘protected through the application of an additional proportionality test’. The authors then propose an algorithm to take account of the different values and variables which need to be weighed up. They conclude: ‘Selective restriction of liberty is justified when the problem is grave, the expected utility of the liberty restriction is high and significantly greater than the alternatives and the costs of the liberty restrictions are relatively small both at a population and individual level... Discrimination can be justified under these conditions when it is proportionate and limited to a very specific public health challenge’. The arguments and conclusions of the feature article are discussed in the two Commentaries . In COVID-19 controlled human infection studies: worries about local community impact and demands for local engagement, Eyal and Lee review recent arguments which express ‘concern about undue usage of local residents’ direly needed scarce resources at a time of great need and even about their unintended infection’ – and hence a requirement for ‘either avoiding controlled infection trials (CHIs) or engaging local communities before conducting CHIs’. They then examine and compare the evidence of such adverse (and some potentially positive) effects of CHIs with those of conventional field trials and argue that ‘both small and large negative effects on struggling communities are likelier in field trials than in CHIs’. ‘Whether or not local community engagement is necessary for urgent vaccine studies in a pandemic’, they conclude, ‘the case for its engagement is stronger prior to field trials than prior to controlled human infection studies’. In Payment of COVID-19 challenge trials: underpayment is a bigger worry than overpayment, Blumenthal Barby and Ubel consider the impact not on communities but on individuals, and specifically on ‘how much people should be paid for their participation in COVID-19 challenge trials’. Noting recent worries about ‘incentivising people with large amounts of money’, they argue that ‘higher payment that accounts for participant time, and for pains, burdens and willingness to take risks’ constitutes neither ‘undue inducement’ (for which the remedy is strengthening informed consent processes and minimising risks) nor ‘unjust inducement’ of individuals from ‘already disadvantaged groups’: evidence of recruitment to challenge trials worldwide suggests, on the contrary, that participants ‘come from all walks of life’. Nor are these authors convinced that ‘offering substantial payment waters down the altruistic motives of those involved’: ‘altruism and payment’ they argue, ‘frequently coexist. Teachers, physicians, public defenders – they all dedicate their lives to helping people. But few do without compensation.’ In Money is not everything: experimental evidence that payments do not increase willingness to be vaccinated against COVID-19, Sprengholz and colleagues report on an ‘experiment investigating the impact of payments and the communication of individual and prosocial benefits of high vaccination rates on vaccination intentions.’ In November 2020 over 1,000 ‘individuals from a German nonprobabilistic sample’ were asked about their intentions. The ‘results revealed that none of these interventions or their combinations increased willingness to be vaccinated shortly after a vaccine becomes available.’ Given that this experiment was conducted before vaccines became available and only in Germany, the authors suggest that these results ‘should be generalised with caution’, but that ‘decision makers’ also ‘should be cautious about introducing monetary incentives and instead focus on interventions that increase confidence in vaccine safety first’. In Voluntary COVID-19 vaccination of children: a social responsibility, Brusa and Barilan observe a pandemic paradox: ‘while we rely on low quality evidence when harming children by school deprivation and social distancing, we insist on a remarkably high level of safety data to benefit them with vaccination’. The consequent exclusion of children from vaccination, they argue, is unjust and not in ‘the best interest of the child as a holistic value encompassing physical, psychological, social and spiritual wellbeing’, something which ‘there is no scientific method for evaluating’. Society, rather, ‘has the Concise argument