Abstract
Proposals for SARS-CoV-2 virus vaccination priorities in the UK and in
many other countries are heavily influenced by epidemiological models,
which use outcome measures such as deaths or hospitalisation. Limiting
the values under consideration to those attributable to the direct
effects of infection has the advantage of simplifying the models and the
process of decision-making. However, the consequences of the pandemic
extend beyond outcomes directly attributable to SARS-CoV-2 infection.
The alternative to vaccination (in addition the threat of illness and
death) is restrictions on educational and work opportunities, access to
services, recreational activities, affiliations and relationships with
others, freedom of movement (including escaping abusive relationships),
and other determinants of human experience. Capability theory gives
emphasis to the freedoms that individuals have to express themselves (in
doings and beings). Restrictions on freedoms restrict our capabilities.
Capability theory has been used to provide a framework for the
evaluation and comparison of international development approaches and in
the evaluation of public health policy. There is a clustering of
disadvantages associated with this pandemic that adds to pre-existing
inequalities. Much of the disadvantage engendered in the SARS-CoV-2
pandemic is left out when public health policy is based on a limited
range of metrics. Acknowledging the impact of policy across the range of
human freedoms at both a national and international level has the
potential to improve policy, facilitate the mitigation of direct and
indirect adverse consequences, and improve public confidence in vaccine
deployment strategies.