In recent years, however, there has been an open tendency to distrust experts and their knowledge (notable case studies involve climate change and Brexit), not only among laypeople but also among political circles (the former American President Donald Trump, the British Prime Minister Boris Johnson and the Brazilian President Jair Bolsonaro are probably the most paradigmatic examples of such a distrust).
Yet, during the COVID-19 crisis, biomedical experts have been called upon to manage the emergency, even in countries in which they previously had been harshly contested, like the United Kingdom (Clarke and Newman 2017). This likely happened because both policymakers and citizens experienced first-hand the dangerousness of the virus and the costs of an ineffective response.
However, there was no general agreement among biomedical experts. This is a common situation in science, albeit often overlooked (Coady 2006). Many experts suggested technical recommendations for the containment of the infection, including a variety of non-pharmacological interventions, such as the lockdown. Others advised against the implementation of such measures for epistemic, constitutional, and economic reasons, and, for example, suggested to pursue herd immunity, as in United Kingdom or Sweden (Lavazza and Farina 2020, 2021a, 2021b; Farina and Lavazza 2021a, b).
In the United Kingdom, a few experts, including the U.K.’s chief scientist adviser, provided scientific arguments to support the government’s initial scepticism about the possibility of the contagion taking place on a large scale. Top advisers initially endorsed a prudent strategy to fight the spreading of the coronavirus, based on the Contain-Delay-Mitigate-Research: as a result, those who had symptoms were not tested, contrary to WHO’s recommendations, and the state did not enforce either quarantine or isolation within the general population.
It was only after the release of a report predicting 500,000 deaths in the United Kingdom if the pandemic was not properly tackled (Ferguson et al. 2020), that the government decided to change its strategy and announced more drastic measures—including school closures throughout the country and restrictions on the people’s freedom of movement and assembly—to prevent the contagion from spreading further. The official justification for this change in policy was that scientific data had changed. However, the justification provided was quickly refuted as scientifically unsound by leading scholars (such as Horton 2020).
As it emerged in the following months, achieving herd immunity in the case of a virus like the Sars-CoV-2 is essentially impossible. This because, as Brett and Rohany (2020, 25897) demonstrated:
1. social distancing must initially reduce the transmission rate to within a narrow range; [and] 2. to compensate for susceptible depletion, the extent of social distancing must be adaptive over time in a precise yet unfeasible way; and 3. social distancing must be maintained for an extended period to ensure that the healthcare system is not overwhelmed.
For these reasons, it is reasonable to assume that a wider panel of experts, more attentive to the social and psychological consequences of the embraced strategy, could have led to the adoption of decisions, such as an earlier lockdown, that could have considerably lowered the death toll (an instructive comparison can be drawn with Ireland, see Colfer 2020).
In the anticipation of the arrival of vaccines, herd immunity may have seemed a reasonable strategy, mostly based—according to the U.K. government—on the risk of a “behavioural fatigue,” which could have possibly undermined “the effectiveness of the lockdown, as people would start violating the recommendation to stay home” (Sibony 2020, 354). However, most behavioural scientists immediately dismissed such a claim as scientifically ungrounded (Sibony 2020).
With respect to vaccines, it should be noted that, at the time of writing, it remains yet to be determined to what extent they prevent the transmission of the virus, as it appears that vaccinated individuals may still carry the virus and infect vaccinated and unvaccinated subjects (even though at a lower rate). In addition, vaccine roll-out is dramatically uneven (Farina and Lavazza 2021a); the emergence of new variants is likely to modify any predictions about herd immunity; furthermore, immunity may not last forever; and, no less important, vaccination may induce an unjustified sense of safety and lead people to adopt more relaxed behaviours, abandoning those preventive measures that should still be maintained until the virus has been completely eradicated (Aschwanden 2021).
Another example of disagreement among biomedical experts concerns the adoption of criteria for accessing life-saving ventilators in some U.S. states, when the available devices became fewer than the patients needing them. These criteria incorporated specific priorities (e.g., the exclusion of mentally disabled individuals or people with specific pathologies), which were deemed by some experts to be the most effective or the most suitable for the emergency situations (Baker and Fink 2020).
Specifically, in March 2020, Alabama issued a state policy according to which people with “severe or profound mental retardation” and “moderate to severe dementia” were “unlikely candidates” for receiving a life-saving medical device. After complaints from organizations of disabled people, the state withdrew the policy and introduced new and more generic guidelines, which did not discriminate on the basis of cognitive status.
On a similar vein, the state of Washington recommended that patients with “loss of reserves in energy, physical ability, cognition and general health” be reserved for palliative care. These guidelines aroused the protests of several organizations for the defence of disabled people, which appealed to the federal Government to impose on local authorities and hospitals the principle that disabled people ought to be entitled to the same treatment as all the other COVID-19 patients, on the grounds that the above-mentioned exclusion criteria were utterly unfair and discriminatory (Disability Rights Education & Defense Fund 202).
In response, the Office for Civil Rights at the U.S. Department of Health and Human Services stated that, based on Section 1557 of the Affordable Care Act and Section 504 of the Rehabilitation Act, “persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities or age” (OCR 2020, 1).
A systematic literature review conducted in the United States at the beginning of 2020 revealed that twenty-six states had publicly available ventilator guidelines (Piscitello et al. 2020), eleven of which recommended certain exclusion criteria in adults. Specifically, eight states envisaged exclusion criteria for “irreversible severe neurologic injury or disease” and three states had such criteria applied for “severe dementia.” The protests that the formulation of these guidelines triggered, both among politicians and intellectuals, mostly regarded the bioethical aspects related to their adoption (Bledsoe et al. 2020; Andrews et al. 2020; McGuire et al. 2020; Chen and McNamara 2020; cf. Lavazza and Farina 2020). Overall, this widespread reaction indicates that the decision of adding exclusion criteria for mental disabilities likely was made following mere biomedical priorities in the absence of ethical experts and/or representatives from disadvantaged and disenfranchised groups.
It is worth noting that roughly in the same period, other experts proposed different frameworks to allocate ventilators in cases of shortages. In particular, White and Lo (2020, E1) argued that those criteria of exclusion (namely, severe cognitive impairments) “are not explicitly justified and they are ethically flawed” because they “are selectively applied to only some types of patients.” In addition, “such exclusions violate a fundamental principle of public health ethics: use the means that are the least restrictive to individual liberty to accomplish the public health goal.”