Please read the following case and answer the questions outlined below. It is hi
Please read the following case and answer the questions outlined below. It is highly advisable to prepare your answers using Word and then paste your answer once it is complete to avoid losing your work if the internet goes out. Although this is an open book exam, do not simply cut and paste from the lecture slides. You need to demonstrate that you understand the concepts and principles being employed and so it is best to put things in your own words. 100 points Total
The United States is seeing rising infection rates for COVID-19. Fortunately, on 11/9/2020, Pfizer announced that an interim analysis of phase 3 trial results show that its experimental COVID-19 vaccine is 90% effective in preventing infection. Pfizer is expected to request an Emergency Use Authorization from the Food and Drug Administration (FDA) in a few weeks, and if this Authorization is granted, the U.S. government may have enough doses to vaccinate 15-20 million people by the end of 2020.
The North Carolina government faces a number of policy challenges regarding the pandemic and is deliberating about the following courses of action.
North Carolina currently has a mask mandate in place, requiring people to wear a face covering when in public places where physical distancing is not possible. While there is strong evidence that masks are effective in preventing people from transmitting the virus to others, many object to the mask mandate on the grounds that it infringes people’s liberty. North Carolina must decide whether to keep the mask mandate in place or repeal it.
Some public health experts have argued that governments should employ randomized controlled trials to evaluate the effectiveness of non-pharmaceutical interventions to stem the rise in infections. Such interventions include, occupancy regulations for restaurants, re-opening regulations for gyms, and different modes of K-12 schooling. Currently, policymakers in North Carolina face the challenge of whether to re-open schools and what such re-opening should look like. Unfortunately, there isn’t great evidence regarding whether schools increase community transmission of the virus. The North Carolina government is currently considering conducting a randomized controlled trial in which different counties will be randomly assigned to three different modes of K-12 schooling to determine which mode of re-opening does not substantially increase community spread. Parents will not be asked to give consent to their children’s participation in this study, though they have the option to home-school their children or place them in a private school. Investigators are primarily interested in seeing whether these different modes of re-opening lead to differences in COVID-19 infection rates at the county level. The three different modes are:
2 day in-person, 2 day remote, with Wednesday for cleaning (i.e. students will be split into 2 groups, with one attending school in-person Monday and Tuesday and other attending school in-person Thursday and Friday.
5 day in-person with safety measures within schools – e.g. masks and physical distancing.
North Carolina will be initially allocated a small number of doses of any vaccine that is authorized for emergency use by the FDA (perhaps enough to vaccinate a few hundred thousand people in early 2021). It has proposed the below plan for allocating vaccines. The plan prioritizes people at greater risk of infection and who are more likely to transmit the virus. One of the chief objections to this plan is that it does not directly prioritize Black and Latino North Carolinians who have been disproportionately harmed by the pandemic. One alternative proposal (see article by Harald Schmidt covered in Lecture 7) is to first allocate vaccines to front-line healthcare workers, and then allocate vaccines to members of these communities, for example, by giving priority to people in neighborhoods that score lowest on a social deprivation or vulnerability index. North Carolina faces the choice of whether to revise their allocation proposal along these lines.
NC’s COVID-19 Prioritization Framework – Four Phase Plan:
Stabilize healthcare delivery and protect those at highest risk of mortality
Frontline healthcare workers and medical first responders – 140,000-161,00 people.
Residents of long-term care settings; people with two or more chronic conditions; people over 65 in congregate settings (prisons/migrant farm camps/homeless shelters) – 727,000-951,000 people.
Reduce transmission – prioritize those at highest risk of exposure and transmission (people in congregate living situations, frontline workers, other healthcare workers, adults with one chronic condition, and people over 65) – 1.18-1.57 million people.
Remaining frontline workers, workers in industries critical to societal functioning, K-12 and college students – 574,000-767,000 people.
Remaining population – 3.6-4 million people.
Some North Carolinians object to the mask mandate on the grounds that it interferes with people’s liberty. What is the harm principle? Is North Carolina’s mask mandate defensible from the standpoint of the harm principle? Should North Carolina keep the mask mandate in place for the duration of the pandemic? Why or why not? (25 Points)
State officials plan to evaluate the three modes of school reopening using a randomized controlled trial (RCT). What is the principle of policy equipoise? What is the justification for it? What would have to be the case for the planned RCT to satisfy the principle of policy equipoise? (25 Points)
In the context of the planned RCT, parents will not be asked to give informed consent for their children’s participation in the study. What is informed consent? According to MacKay and Chakrabarti, under what conditions is it not necessary to secure informed consent in the context of a government policy experiment? In your view, does the fact that the planned RCT does not secure people’s informed consent mean that it is unethical? Why or why not? (25 Points)
With respect to the allocation of a COVID-19 vaccine, what is an argument in support of directly prioritizing Black and Latino North Carolinians who have been disproportionately harmed by the pandemic? Should North Carolina’s plan be revised to do so? Why or why not? (25 Points)