Over a hundred years ago, the American judge Louise Brandeis wrote that “sunlight is said to be the best of disinfectants“. Publicity, he argued, was “a remedy for social and industrial diseases”, that it helped to cure and reduce corruption. This remains true today: When public decisions are made in full view of the public, the decisions are better. Not only do the decision-makers behave better, but further, public scrutiny allows members of the public to contribute to the decision-making process. After all, only the most fundamentalist neo-socialists would seriously argue that Government officials know everything – there is some knowledge in our community that resides outside centralised Government bunkers. Arrogance that only Government employees have information is truly the fatal conceit: it is possible that some medical experts who are not Government-employees may have information and expertise to contribute.
In coming months, various vaccines are likely to be developed and become candidates for widespread deployment. Given the physical limitations of manufacturing and distribution, it is obvious that not every person who wants to have a vaccine against coronavirus will be able to obtain it on the same day. Indeed, yesterday, the Isle of Man’s Health Minister, David Ashford, said, “We’re not going to get all the vaccines at once, the vaccines will be released in batches into the Island.”
Minister Ashford also revealed that the Government already has a “priority list” for vaccine distribution. According to Minister Ashford, the priority list consists of “front line key workers, such as doctors, nurses… and those in the vulnerable category.” Unfortunately, the Government has so-far apparently refused to publish its priority list, with a search of the IOM Government’s Coronavirus website revealing no such publication.
This is in sharp contrast to the United Kingdom Government, which published back in September a provisional listing of priority groups for COVID-19 vaccination. While the Isle of Man has apparently chosen to keep its priority listings a secret, the UK has shared their prioritisation with the public.
Publication has obvious benefits – it allows different people to contribute to the public debate on the issue. This is important because it is not just a medical question – but it is also a moral question, and even if a Government knew everything about the medical issues (obviously, it doesn’t[1]), it certainly cannot know everything about the moral dimension. This is fundamentally a real-world implementation of the trolley problem: We have a real-life choice about ranking which lives to save. Yes, that is certainly partly a medical problem (who is most likely to die without the vaccine?) but it is also a moral problem (who should we save first?).
Indeed, Bruce Gellin, the former director of the U.S. government’s National Vaccine Program, said back in June that it is difficult to balance protection of the individual and protection of society. “These are tough decisions, because everybody can make a case for why somebody should be ahead of somebody else in line,” he said. Gellin is right: there’s no cut and dried mathematical answer here.
Because the question is in-part a moral question, there no universally “right” answer here – and the question for the Isle of Man is significantly different to other nations. The ranking list for the United Kingdom was created in the context of the disease circulating in that community. Here in the Isle of Man, the disease is not (currently, to the best of our knowledge) in circulation in the community, and therefore, our risks are different. For example, someone who travels off the island (such as a Manx-resident, UK key worker) is at a significantly higher risk of contracting the disease currently than someone who is in a relatively safe aged care facility on the Isle of Man. Thus, we need to have a local debate to take into account our local conditions: we can’t just import a British priority list. We need a Manx solution for a Manx problem.
The Isle of Man Government should immediately publish its proposed priority list in full, so that the public can see the proposed rankings. It is possible that opening the ranking to transparency and sunlight might reveal an opportunity for improvement: so the Government can then benefit from that information and improve its decision. And if the Government’s priority list is already perfect, then great! If it is perfect, then we can restart the effort to rebuild greater confidence in a public health bureaucracy that has destroyed so much of its credibility this year.
[1] After all the IOM Government experts were wrong in March that the risk to the Manx community was “moderate to low” from the pandemic, the experts were wrong in April that wearing a mask increased the spread of the disease, and the experts were wrong in May that the disease could be eradicated from the Manx community.
