Ethics for pandemics beyond influenza: Ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response.
The unprecedented outbreak of Ebola virus disease (EVD) in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: (1) different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, (2) clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and (3) current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics.
Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, 155 College Street, Suite 549, Toronto, ON, M5T 3M7, Canada. max.smith@utoronto.ca.
Maxwell J
MJ
Smith
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Bulsson Hall, Room 11008, Burnaby, BC, V5A 1S6, Canada. dsilva@sfu.ca.
Diego S
DS
Silva
D002959:Civil Defense / Q000941:ethics* / Q000639:trends*; D003140:Communicable Disease Control / Q000458:organization & administration; D029043:Ebolavirus; D004992:Ethics, Medical; D005544:Forecasting; D019983:Guideline Adherence / Q000941:ethics / Q000639:trends; D006284:Health Plan Implementation / Q000941:ethics / Q000458:organization & administration; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007391:International Cooperation; D058873:Pandemics / Q000941:ethics* / Q000517:prevention & control*; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control* / Q000635:transmission*; D014944:World Health Organization
All-hazards planning; Ebola; Ethics; Pandemic planning; Pandemic preparedness; Public health emergency preparedness and response; Tuberculosis