The recent outbreak of the Zika virus was deemed a Public Health Emergency of International Concern by the WHO Emergency Committee, and continues to receive heightened attention. Zika has raised many specific ethical issues, in particular regarding pregnancy. At the same time, it has highlighted ethical issues that arise in vector-borne diseases (VBDs) more generally. Attention to Zika is thus an opportunity not only to address ethical concerns in relation to an ongoing epidemic outbreak and its consequences, but to broaden our field of enquiry to VBDs as such.
What are vector-borne diseases?
These are diseases such as Malaria, Dengue, Chikungunya, Trypanosomiasis, and Leishmaniasis that depend upon a vector (usually an arthropod) for transmission. The recent emergence of these diseases – sometimes in epidemic proportions – is a cause of concern. The complex epidemiology and transmission of VBDs require distinctive responses in research and public health interventions, raising a set of particularly salient ethical issues. Although practitioners, researchers, public health decision-makers, and bioethicists have been concerned with them for decades, WHO and its Member States lack international guidance on how to adequately address ethical questions in VBDs.
Following the scoping meeting in 2017, WHO organized an international consultation on Ethics & vector-borne diseases, which was hosted by the Medical University of Vienna, 7-9 May 2018. The goal was to move forward with the development of a WHO guidance document.
Scoping meeting in 2017
In February 2017, the Global Health Ethics Unit hosted a scoping meeting which seeked to lay the groundwork for a guidance document on the ethical issues raised by the management and control of VBDs. The aim of the meeting was to map out issues that should be considered in the development of a guidance document, the principles that should guide the public health response to VBDs, and identify candidate topics for discussion in the final guidance document. The scoping meeting included in-depth discussion of the following questions:
- What are the ethical issues specific to VBDs, and which issues are familiar from epidemic diseases broadly construed?
- What are similarities and differences amongst ethical issues raised by individual VBDs?
- Which safeguards should be implemented to manage and mitigate these ethical issues?
- Which ethical principles should guide surveillance, prevention, control, and epidemic response efforts?
- Do research studies on VBDs in general raise any particular ethical concerns? For example, what are the conditions under which human challenge studies and the involvement of humans in field research on the biology and transmission of VBDs are ethically sound?
- What are the ethical concerns surrounding the eradication of vectors? Is it ever permissible to eradicate vectors?
The immediate target audience consists of Ministries of Health and relevant public health agencies, specific disease programs, public health experts, researchers, scientists, members of research ethics committees, patient organizations, NGOs active in relevant areas, and most importantly: the individuals and populations affected by VBDs.