Developing an ethical framework for asymptomatic COVID-19 testing programmes in higher education institutions

Background: Mass asymptomatic COVID-19 testing programmes are being introduced in a range of settings, including in higher education institutions (HEIs). We aimed to produce an ethical framework to identify the range of ethical considerations relevant to HEI testing programmes and to support organisational decision-making. Methods: We conducted a mixed-method consultation (survey and semi-structured interviews) with students and staff at a case study university that was running a student testing programme. Survey data were analysed descriptively; data analysis for interviews was based on the Framework method. The findings of the consultation were combined with literature review, legal/ethical analysis and expert views to produce an ethical framework. Results: A total of 239 people took part in the consultation: 213 completed surveys (189 students, 24 staff) and 26 (16 students, 7 staff) participated in interviews. The survey identified clear support (99% of survey respondents) for the testing programme. Around two-thirds (62%) supported non-mandatory participation. Over half (54%) felt that the programme would need to be at least moderately effective to be acceptable. Over three-quarters (76%) felt the university had some responsibility to run a testing programme. Synthesis of consultation findings and further analysis identified nine areas of ethical consideration for HEIs looking to implement mass asymptomatic testing programmes: design and operation; goals; properties of the test; enabling isolation; choices about participation; benefits, harms and opportunity costs; responsibilities between students and institutions; privacy, confidentiality and data-sharing; and communication. The ethical framework includes recommendations in each of these areas, with illustrative examples of how they might be put into practice. Conclusions: By identifying ethical considerations relevant to university student testing programmes using analysis and consultation, the framework we developed has potential to facilitate deliberation about ethical aspects of such programmes, as well as informing decision-making about their introduction, design and delivery.