A new strain of COVID-19, more contagious than previous strains, is now circulating in dozens of countries. Other new strains, such as one first detected in South Africa, will almost certainly emerge. Aside from the challenges these mutations pose to public health, they will also be a test of our moral and political principles. As exhausted as we all are from making stressful judgments throughout this pandemic, we are about to face some of the most difficult trade-offs yet.

Preliminary data indicate that the new strain in the U.K. allows the virus to spread from one person to another more easily. The practical upshot is that even the strict lockdowns of early 2020, such as the one just ordered in the U.K. by Prime Minister Boris Johnson, may not be enough to reverse the spread of the virus.

It is far from obvious that politicians will be able to sell voters on strict lockdowns if they still allow the virus to spread. Furthermore, vaccine distribution has been sufficiently slow that a full lockdown would have to last for many months, and that probably isn’t feasible or desirable. Yet not having lockdowns would lead to a much more rapid spread of the virus, overloading hospitals and public health facilities.

It’s hard to come up with the moral language to compare those outcomes when all of them are unacceptably bad. Trust in elites is already weak in the U.S., and it is likely to wane further. Whatever one might think is the correct course of action, how exactly would or should a President Joe Biden present and defend it to the public?

A further set of moral dilemmas comes from the interaction of viral spread and the vaccine process. If the virus is spreading more quickly, then so should vaccinations. The U.K. will be vaccinating a greater number of people with a single dose, and giving them the second dose somewhat later, rather than reserving second doses for a rapid follow-up within two to three weeks. The Brits also might experiment with giving a first dose of one vaccine, and a second dose of a different vaccine, to stretch the available supply. That might work, but it is also untested and thus it involves some risk.

Whatever you think of those approaches, the public health establishment is not well-geared to evaluate and present them to the public. The common mentality and message in public health is “safety first.” Yet none of the available approaches increases the level of safety or avoids major additional risks.

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One option would be for public health experts to speak explicitly in terms of “expected value” and medical triage, and to be upfront about how many lives are being sacrificed and according to which standards. An alternative would be to retreat into a defense of status-quo vaccine allocation procedures, insisting that major changes would involve risks, and maximizing blame avoidance rather than seeking the best outcome.

Either way, the public health bureaucracy doesn’t appear to have much ability to negotiate such treacherous shoals. Perhaps more condescension is what should be expected.

The biggest moral dilemmas might come in those countries that to date have been fairly successful at containing the spread of the virus. Apart from restrictions on foreign travel, life in Taiwan has been normal for some time now, and COVID-related casualties have been minuscule. Other successful examples of virus containment can be found throughout Asia and the Pacific.

But how will those countries deal with the new strain? It has already appeared in both Taiwan and China. So far it has not taken over, but the previous tactics of quarantine and tracing may no longer suffice, should the new strain become more active. It is already spreading in Denmark, which did a good job against COVID-19 early on.

Imagine being a leader of a country that has successfully contained COVID, and now realizing that a single mistake could undo almost a year of very hard work. You also know that, precisely because your country has been so effective at fighting the virus, it is not on the verge of vaccinating your entire population. What if you let a single returning citizen pass through customs taking one COVID test rather than three? What if you then cannot control the subsequent spread of the strain that person is carrying?

When was the last time that stakes for such apparently minor decisions were so high? How will leaders deal with the extreme moral anxiety that their decisions will likely induce?

It is like we are living in a horror movie, and just when we think it’s over, the monster comes back, stronger than ever.