title: Antimalarial mass drug administration: ethical considerations.
abstract: Falciparum malaria is a major cause of death and illness in tropical countries, particularly in childhood. In endemic countries, a significant proportion of the community is infected with malaria asymptomatically. One promising way to eliminate malaria is to give the entire population malaria treatment. This is called mass drug administration (MDA) and it raises a number of ethical issues, as possible long-term benefits are uncertain. The effectiveness of MDA is critically dependent on level of participation, so the promised benefits to the community can be annulled by non-participation of a small number of individuals. These potential benefits range a wide spectrum, from the permanent elimination of malaria (success) to a transient reduction in the prevalence of infection and the incidence of illness (failure). The drawbacks of MDA are: inconvenience, potential toxicity, loss of confidence in the elimination campaign, possible drug resistance (though highly unlikely), and the potential for a rebound of malaria illness (if immunity is lost and malaria is reintroduced later). Other ethical issues are related to balancing individual and public health interests, and potentially limiting individual autonomy by making MDA compulsory.
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok, 10400, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK The Ethox Centre, Nuffield Department of Population Health, University of Oxford, UK phaikyeong@tropmedres.ac.
authors.forename: Phaik Yeong
authors.initials: PY
authors.lastname: Cheah
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok, 10400, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D018890:Chemoprevention / Q000941:ethics*; D060740:Disease Eradication / Q000379:methods*; D004351:Drug Resistance; D019353:Endemic Diseases / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D014330:Tropical Medicine / Q000379:methods
chemical_list: D000962:Antimalarials
keywords: Elimination; Ethics; Malaria; Mass drug administration