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Ethical framework for asymptomatic COVID-19 testing programmes for students in higher education institutions

This project was to develop a framework based on a consultation, ethical and legal analysis, and expert discussion.

The consultation was conducted through Thiscovery, THIS Institute’s online research platform, to gather the views of students and staff relating to an asymptomatic COVID-19 testing programme at the University of Cambridge.

The framework helps to support higher education institutions in their decision-making about asymptomatic COVID-19 testing programmes for students.


The University of Cambridge introduced a weekly asymptomatic screening programme for students in College accommodation in October 2020 as part of its efforts to reduce the spread of COVID-19.

The programme, based on laboratory PCR tests using facilities managed as part of the national lighthouse laboratory network, involves pooling swabs from students in their households. If the pool tests positive, individual tests are performed for each participating student to investigate further.


This project featured a consultation with students and staff through THIS Institute’s online research platform, Thiscovery. Individuals were invited to take part through an online questionnaire or interview. Over 200 participants provided their views, enabling students and staff to say what was important to them on a range of issues relating to the asymptomatic testing programme.

The findings of the consultation were integrated with ethical and legal analysis and expert discussion to produce an ethical framework, with the aim of supporting higher education institutions in making decisions about asymptomatic testing programmes.


During the project, 239 students and staff took part either via online questionnaire or interview. Most people who took part in the study supported asymptomatic testing in higher education in principle, but some concerns were raised about whether public health interventions should be allowed to interfere with individual freedoms. Just under two-thirds (62%) of survey respondents felt that asymptomatic testing should be voluntary. There was resistance to any sense of coercion about testing – for example, two-thirds (64%) opposed the introduction of penalties for those who did not participate in testing.

Around three-quarters indicated some support for use of small incentives such as a coffee for testing, but large and/or financial incentives were not seen as helpful.

Our study suggests that an effective, ethically sound asymptomatic student testing programme should put choice and personal responsibility at the centre. This, combined with education and communication, is likely to be the optimal strategy for such programmes in pandemic conditions. A paper looking at asymptomatic COVID-19 testing programmes for staff in workplaces has also been published.

The framework has been made available to help support higher education institutions in their decision-making.

Funding and ethics

This study is funded by Mary Dixon-Woods’ NIHR Senior Investigator award, and by The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK. Caitriona Cox, Academic Clinical Fellow, lead researcher, is funded by the National Institute for Health Research (NIHR) for this research project, which was also part-funded by Mary Dixon-Woods’ NIHR Senior Investigator award (NF-SI-0617-10026). The project is supported by the Wellcome Trust.

The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care or the Wellcome Trust. The survey and interview consultation received approval from the University of Cambridge Psychology Research Ethics Committee.

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