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Some ethical questions

I was recently surprised to discover that Canada (my country of birth) had approved the Pfizer vaccine for use in children aged 12 and older. More significantly, Canada intends to start administering it to that age group soon. This is contrary to the WHO’s plea to donate vaccine doses to the COVAX scheme first, as many frontline workers in poorer countries have still not been able to be vaccinated. Not only is this the WHO’s recommendation, but they have noted that research into the safety of these vaccines for children is still incomplete. Of course, ALL of the research on COVID-19 vaccines is incomplete as the clinical trials that have led to their approval and widespread administration will continue to monitor trial participants for two full years (the Pfizer phase 3 trial will be my point of reference everywhere in this post).

Normally, vaccines would be tested first in adult populations to ensure safety before including children. Considering that children are the least likely to suffer seriously from COVID-19 would seem to support this standard protocol.

From my perspective, the number of ethical questions is growing at a rapid pace.

How does a child give informed consent to participate in a clinical trial?

  • In short, a child does not, a parent or guardian does.

Where were children ‘volunteers’ found to participate in the first clinical trial?

  • They definitely were NOT found in the EU, as p. 40 of Pfizer’s clinical trial protocol can confirm. I have not found data to confirm specifically where children participants were recruited, but I suppose they are in the trial’s non-EU countries: Argentina, Brazil, Turkey, South Africa, and the United States. I would be very curious to know how many children were ‘volunteered’ in wealthier nations.

How were parents/guardians encouraged to ‘volunteer’ their children?

  • Many of the nations where the trials took place are poorer than the majority of nations currently offering large-scale vaccination campaigns. Considering that up to $2,000 was offered to trial participants (and I would speculate that this ‘up to’ amount was not the normal offer to participants in poorer countries) we cannot rule out that some people’s decisions may have been financially motivated. I see no major ethical problems with this for consenting adults, although other ethical questions arise as a result (for example Pfizer highlighting the trial’s ‘Participant Diversity’ – 42% in total, 30% in the US – as if this should be celebrated like more diversity in positions of leadership and power, rather than potentially representative of persisting economic inequality). However, I think it poses significant ethical issues related to children.

How much money would you accept to ‘volunteer’ your child in a clinical trial that has not yet been proven safe (in adults)?

  • I guess, if you participated in the first trial, up to $2,000 – piecing together information from various sources noted above.
  • But moving forward, we can say that parents are willing to ‘volunteer’ their children for $0. At least, that will be the case in Canada once children start receiving the vaccine along with the wider public and further data can be collected.
  • It is important for parents to know that the Pfizer trial only included 3,013 participants under 18 years of age (of 46,331 in total). That means that only 1,507 people under 18 years of age actually received the vaccine (as the other half were given a placebo). I believe the WHO’s recommendation that children not be vaccinated at this time is far more ethically than politically motivated.

Is it ethical to vaccinate a low-risk population in a rich country when the high-risk population in a poorer country is still waiting?

and more specifically …

Is it ethical to vaccinate a low-risk population in a rich country (that was not involved in the clinical trials) when the high-risk population in a poorer country (that WAS involved in the clinical trials) is still waiting?

  • I think these are two questions that every parent might ask themselves before signing their children up for their first shot.

Perhaps there are things I have failed to consider in this post, and it would be unethical NOT to vaccinate your child at the first opportunity. Perhaps you feel it IS unethical but still choose to go ahead anyway. If that is the case, then at least own that decision rather than making ridiculous, unsubstantiated justifications to yourselves and others.

As of 18 May 2021 – the percentage (rounded off) of people in countries that participated in the Pfizer phase 3 clinical trial (+ Canada) who have received their first dose of a COVID-19 vaccine.

  • 47% – Canada
  • 47% – United States of America
  • 38% – Germany
  • 18% – Turkey
  • 18% – Argentina
  • 17% – Brazil
  • 1% – South Africa

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I’m mad as hell

For many musicians, the anniversary of this pandemic’s first lockdown coincides with an added pain of our second lost ‘Passion season’. I have learned to deal with the disappointment of cancellations over the past year, but was recently shocked to experience the cruelty that can still be inflicted on freelance artists. What kind of industry do we want to work in? After a year of forced reflection on our precarity, are we still content to put up with those leaders and organizations that treat us like shit? Do we want to be part of an industry that assumes we are easily disposable and replaceable? If we want to come out of this pandemic with greater security and agency in our lives, it is high time for us to stop hiding behind our fears of pissing off our next possible employer. 

In truth, I had already mourned the loss of this Passion period last July when my scheduled tour was preemptively cancelled. The decision was based on the continued uncertainty about how the pandemic would evolve and how governments would react. I commend many of my employers for making tough decisions to postpone and cancel rather than stringing me along with false hopes (I will give some notable shoutouts in the comments below). This past year has clearly taught us that ‘hoping for the best’ is naïve amidst the knee-jerk, illogical, and inequitable decisions of most governments (there is NO logic that permits the crowded, confined spaces of public transport but forbids socially distanced performances outdoors or in large halls and churches). Quite simply, artists are not seen as important enough, or at least not influential enough. But, we partly have ourselves to blame. We have accepted so much crap and lived in so much fear throughout our careers, it is not really a surprise that we have literally been silenced now.

On 16 March 2021 (almost exactly a year after the first lockdown started), I received an invitation to sing the Evangelist part in a Johannes-Passion performance on 28 March at the Monastère Saint-André de Clerlande (https://www.clerlande.com/). The director who contacted me had only been approached the day before and was making initial inquiries to check availabilities while awaiting confirmation from the organizer. As it was very short notice, and my involvement would require added complications of international travel (possible quarantines, COVID-19 tests, reduced travel possibilities, etc.), I was reluctant to agree. But the next day the project received a ‘definite go’ from the organizer. I booked my travel and began practicing my role while the director assembled and confirmed an incredible cast of early music specialists. Fast forward 6 more days, and we receive a message that the concert has been cancelled.

I am mad as hell.

How is this possible? How does someone invite someone else to organize a major performance in less than two weeks, confirm that it will take place (if not with public, then internet streamed), and then turn around and cancel one week later? 

It is beyond cruel. 

This pre-Easter period is normally one of the busiest and most lucrative of the year for professional singers and players. Literally hundreds of performances take place of J.S. Bach’s famous oratorios. The extreme sadness and disappointment of last year’s loss was coupled with the horrible realization of how precarious our lives as freelance professional artists are. Some of us were fortunate then to receive compensation for cancelled projects. Some countries were generous to extend their emergency support to artists. In retrospect, the beginning of the pandemic could have been much worse. However, the softening of the initial blow does little to change the fact that this past year has been a prolonged period of stress and uncertainty for many of us, if not outright depression and anxiety.
But we have not only lost income. We have lost our way of life. We have lost our communities of fellow artists. This single Johannes-Passion for me was not about the money. It was a beacon of hope, a needed opportunity to reconnect with several colleagues whom I love and respect, and once again experience the challenge and beauty that performing Bach’s music always offers. To offer this hope, and then rip it away is inexcusable. It is thoughtless, reckless, and cruel beyond measure. But we can only expect situations like this to continue if we do not ‘out’ those individuals and organizations who treat us and our fellow artists so inhumanely.

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