AstraZeneca & the moral imperative

Why changing tracks is so hard

The baffled British reaction to the German decision to suspend use of the AstraZeneca vaccine this week reminded me of a lecture I once watched by the Harvard philosopher Michael Sandel. 

In it, Sandel proposed the hypothetical of a train flying at full speed with no functioning brakes. Up ahead, three people were tied to the track and faced certain death. But there was a way out. A fork in the track allowed the driver to turn the train to the left. The bad news: one person was lying on that track too and would be killed instead.

What to do? There are two moral solutions, Sandel explained.

The solution proposed by British philosopher Jeremey Bentham is to take action that maximises the good, even if that causes pain to the few. According to Bentham’s utilitarian theory of ethics, the right decision is to steer the train onto a new course, although that inevitably entails killing one helpless victim.

That is a conclusion rejected by German philosopher Emmanuel Kant. For Kant a person must always act according to a strict moral code. That even means telling the truth in a situation where it could put you in danger. In Kant’s world, changing the train’s trajectory is an intervention that leads to a known harmful outcome and is therefore forbidden.

So it’s no surprise that the utilitarians in the British media have been scratching their heads this week at the German decision to suspend the use of a vaccine that has been shown to drastically reduce hospitalizations. One British newspaper was frantically trying to work out how many people would die every day as a result. Even the pro-European Guardian was so puzzled that it concluded that the motives couldn’t be scientific.

According to the logic underlying British thinking, the greater good has to trump the remote chance that a vaccine leads to death. Indeed, the British press has refused to even acknowledge the evidence for a causal link with the deaths for the “Oxford vaccine”.

So before we go on, a myth needs to be dispensed with.

Germany did not suspend use of the vaccine simply because it was swept along in the panicking European herd.

The Paul Ehrlich Institute (PEI), the government agency that assesses vaccine safety, last week declined to follow the Scandinavian countries in suspending use of the AstraZeneca remedy, stating that there was no evidence to suggest a greater prevalence of blood clots than in the general population.

But seven cases the PEI received at the end of last week led them to change their minds. Six of them involved women aged between 20 and 50. All of them had the extremely rare sinus venous thrombosis. Three died as a result. Reacting to the news, SPD health spokesman Karl Lauterbach - himself a vocal advocate of the AstraZeneca vaccine - said that it was “very likely” that a causal link existed. 

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While at this stage we don’t have more detail on who these women were, it seems like a safe bet to say that they would most probably not have died as a result of an infection with the coronavirus. 

Thus, to return to Sandel’s thought experiment, continuing to administer the vaccine to healthy young women is the equivalent of steering that careening train onto another track. Yes, lives will be saved, but it is an active moral choice in which one knowingly causes harm.

In the Kantian world of moral imperatives that is highly problematic. In the German ethical landscape there is no room for ifs and buts. A philosophy like utilitarianism is too fuzzy, too open to interpretation, too open to abuse.

This notion of doing the least harm has guided German action from the beginning of the pandemic. It meant that Germany had no qualms about quickly going into a lockdown in the spring. As long as the state could prevent death without causing harm - it was an easy calculation.

At the same time, this rigidness has led to a snail-paced vaccine roll out, as Germany has insisted on waiting for full approval by the European Medicines Agency. It also meant that AstraZeneca wasn’t released for use among pensioners as long as there was a lack of data on its efficacy. Everything has to be done by the book.

The flipside is the more proactive British approach of ‘doing the maximum good’. The British lockdown came late - the government had to be convinced that this unknown new virus really trumped the higher good of civil liberties. But once defeating the virus became the objective, everything made way for it. Vaccines were given emergency approval; liability was waived for the pharma firms; AstraZeneca was given to the elderly despite holes in the data.

So, which philosopher would you rather have in a pandemic, Bentham or Kant?

Well, Germany with its focus on individual moral probity didn’t even have excess deaths last year, while the UK hasn’t buried as many people since the Second World War.

But Britain will also come out of the crisis significantly quicker. And Germany felt safe approving AstraZeneca for the over 65s… based on data that was gathered during Britain’s gung-ho rollout.


Who we are:

Jörg Luyken: Journalist based in Berlin since 2014. His work has been published by German and English outlets including der Spiegel, die Welt, the Daily Telegraph. Formerly in the Middle East. Classicist; Masters in International Politics & Arabic from St Andrews.

Axel Bard Bringéus: Started his career as a journalist for the leading Swedish daily Svenska Dagbladet and has spent the last decade in senior roles at Spotify and as a venture capital investor. In Berlin since 2011.