Responsibility versus choice | Special report

I tested positive for Covid-19 almost 10 days ago. The only symptom I had was a runny nose. No high fever, no shortness of breath, no aches and above all, no fear.

Things were very different a year ago. People were dying or spending weeks in hospital only to have the “long Covid” haunt them months later. So what has changed? Well, a few things – we have better diagnostics that allow for rapid identification and isolation of cases, we know how to prevent the spread, we have a better understanding of how the virus causes disease, and as a result we have developed better treatments. and we have vaccines. Oh, and the virus has also changed.

As soon as I got my result, I immediately informed everyone I had been in contact with so they could check for symptoms and get tested. I then shut down for 10 days. I am always masked at work and when I go to the market. I always avoid large indoor gatherings. I am fully vaccinated and also had a booster. I am extremely aware of the fact that I have to protect my family, my colleagues and my community. However, not everyone took this position.

Vaccines work

My decision to get vaccinated was mainly based on the need to protect myself. I felt it was safe and would do the job well. I based my choice on the data I looked at in ongoing clinical trials, whether they were done at lightning speed or accelerated, that was something. I trust science; I did for decades. Despite reports of adverse effects from one of the vaccines, when you think of the millions of doses administered, that’s a drop in the ocean. Even Panadol carries a safety warning of adverse effects.

Currently, the highly transmissible variant of Omicron is causing a sharp increase in Covid-19 cases, mainly among unvaccinated people – and this latest variant is also infecting some vaccinated people. But the good news is that vaccines have been shown to be effective against serious illnesses, hospitalizations and deaths.

Recently published data show that it is the level of antibodies that is essential to protect against symptomatic infections. Scientists measured how effectively each vaccine induces the production of protective immunity in the form of antibodies against an Omicron pseudovirus (a synthetic version), as well as Delta and wild-type viruses. The results were startling. Neutralization of the Omicron variant pseudovirus was low when they used samples taken from people recently vaccinated with two doses of an mRNA vaccine or one dose of Johnson & Johnson. But individuals who received three doses of an mRNA vaccine had very strong neutralization against the Omicron variant.

This explains the rapid deployment of booster doses and the government’s home vaccination campaign last week. The government has done the remarkable job of providing free vaccines to over 75 million Pakistanis. The vaccine has been made mandatory for public officials and many private institutions also have policies requiring employees to be vaccinated. We have seen the government start with a small nudge to get people to get vaccinated.

Balancing responsibility and rights for the collective good

Some of the most important ethical questions that have arisen in the context of the coronavirus pandemic concern moral responsibility. The primary responsibility of governments is to create a balance between individual values ​​and rights, on the one hand, and the health of the population, on the other. We can consider individual responsibility as a virtue; it develops from crucial character traits and habits. The responsibility of governments is linked to individual responsibility through the values ​​of trust and solidarity.

However, a society as a whole must decide how to respond to scientific findings, instead of delegating political decisions to scientists and other “public servants”. The central ethical issue requires taking the right measures to “sustainably preserve an efficient and quality health system while avoiding or mitigating the serious harmful consequences of these measures for individuals and society”.

Individual rights are tied to the value of autonomy, and autonomy is seen to be closely tied to freedom of choice. In her article, Jessica Fahlquist takes the example of wearing a seat belt. She argues that “the obligation to wear seat belts and stop signs would be considered as infringements of autonomy if it were simply understood as the freedom to act (i.e. a “superficial autonomy” ). In contrast, the value of “deep autonomy” could be conceptualized as the value of making one’s own important life choices, evaluated over a longer period of time, involving “reflecting on the values ​​by which one’s life will be structured” . It implies respect for the choices of the individual, but also for his capacity for conscious reflection on these values. From this perspective, seat-belt laws are not invasions of autonomy because individuals can choose not to obey the law.”

Reducing the spread of the pandemic also requires individuals to take personal responsibility. Like the individuals who contribute to climate change and antibiotic resistance, they are unlikely to be solved or managed unless states and individuals take action. State action is crucial, but unless there are also behavioral changes among the individuals who make up the population as a whole, long-term change is unlikely to occur. This is crucial for the current pandemic, but it will be even more important to prevent similar challenges in the future.

However, the expectation that individuals will take responsibility for collective problems must be linked to individual contexts. Social, cultural and religious factors also play a role and determine the ease or difficulty with which individuals assume responsibility. For people to be willing to take responsibility for developing the habits needed to manage a pandemic, they must trust their governments. Trust is relational and requires the relying party to be trustworthy. Trust in public health officials has declined in recent years. This has led parents to refuse to have their children vaccinated.

Vaccination can be seen as taking responsibility to protect others as well as oneself. Forcing people to protect others is unlikely to encourage virtuous behavior. Like Dawson et al put it, “You can force action, but not trust”. Loyalty to those given responsibility requires action, and if authorities are open and honest with their information, trust is more likely to be maintained.

To overcome the pandemic, governments and individuals must take responsibility: will the two meet one day?

The social pact, far from destroying natural equality, on the contrary substitutes a moral and legal equality for the physical inequality which nature would have imposed on men; so that, though unequal in strength and intelligence, men become equal by alliance and by right.”

Jean-Jacques Rousseau, The social contract


The author is a consultant in molecular biology at the regional laboratory of the Aga Khan University Hospital in Lahore. The institution may not necessarily subscribe to the views expressed by the author

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