7 Bioethics during an outbreak
Ethical considerations are vital during an outbreak in order to preserve the trust of the community. The World Health Organization has published a consensus statment on guidelines for establishing respectful partnerships with local communities and leaders while implementing evidence-based containment strategies.
7.1 Summarized WHO guidelines
1. Obligations of Governments and the International Community: Governments have a duty to prevent and respond to infectious disease outbreaks through improved health systems and public health activities and contribute to global surveillance and preparedness. These obligations extend beyond national borders, as infectious diseases can spread globally, and wealthier countries are have ethical obligations to assist poorer nations in enhancing their health capacities.
2. Involving the Local Community: Community engagement is crucial for building trust and social order during an outbreak. A community-centered approach involves inclusiveness, openness, transparency, and accountability, and ensures diverse perspectives are considered, with the media playing a key role in providing accurate, timely information.
3. Situations of Particular Vulnerability: Vulnerable individuals or groups face heightened risks during outbreaks, including difficulties accessing services, communication barriers, and the threat of stigmatization. Efforts should focus on addressing these challenges through targeted support, ensuring equitable access, and preventing discrimination or violence.
4. Allocating Scarce Resources: During outbreaks, resource allocation decisions must balance utility (maximizing benefits) and equity (fair distribution), with special attention to vulnerable populations.
5. Public Health Surveillance: Surveillance is critical for managing and preventing outbreaks, but it must be ethically managed to protect personal information and ensure transparency in its use. Ethical oversight should balance public health goals with individual rights and vulnerabilities.
6. Restrictions on Freedom of Movement: Restrictions like quarantine or travel bans should only be imposed when scientifically justified, using the least restrictive methods possible, and with humane conditions and support for those affected. They must be applied equitably, with opportunities for due process and transparency.
7. Obligations Related to Medical Interventions: Medical interventions during outbreaks must meet high standards, and individuals should have the right to refuse them, unless refusal poses significant public health risks. Any overridden refusals must be carefully justified, with due process and attention to individual and community impacts.
8. Research during Infectious Disease Outbreaks: Research during outbreaks is essential to inform public health responses and evaluate interventions, but it must be ethically conducted, respecting participants’ rights and integrating with the broader outbreak response efforts. Ethical oversight, informed consent, local capacity-building, and transparent data sharing are critical to ensuring that research supports both immediate and long-term public health goals.
9. Emergency Use of Unproven Interventions Outside of Research: Offering unproven interventions outside of clinical trials is ethically acceptable during emergencies when no proven treatments are available, but it requires ethical oversight, informed consent, and transparent data sharing. Such interventions should be administered cautiously, with careful consideration of risks, benefits, and resource allocation.
10. Rapid Data Sharing: During infectious disease outbreaks, rapid data sharing is critical for understanding the disease, predicting its spread, and guiding public health responses. Ethical issues related to this include ensuring privacy, data confidentiality, and resolving disputes over data ownership, while supporting international cooperation for timely sharing.
11. Long-Term Storage of Biological Specimens: The long-term storage of biological specimens offers valuable research opportunities but raises ethical concerns about confidentiality, informed consent, and community trust. Engaging local communities, ensuring proper governance, and implementing material transfer agreements are crucial for ethically managing the storage and sharing of biospecimens.
12. Addressing Sex- and Gender-Based Differences: Sex and gender influence the course and outcome of infectious disease outbreaks, affecting susceptibility, health care access, and interventions. Public health responses should include sex- and gender-sensitive surveillance, reproductive health services, inclusive research strategies, and tailored communication to address differential risks and needs.
13. Frontline Response Workers’ Rights and Obligations: Frontline workers during infectious disease outbreaks have the right to protection, fair remuneration, and access to healthcare for themselves and their families. In return, society has an obligation to minimize risks, ensure adequate support, and help workers reintegrate post-outbreak, while considering the equity of risk distribution and potential consequences for non-participation.
14. Ethical Issues in Deploying Foreign Humanitarian Aid Workers: Foreign humanitarian aid organizations must coordinate with local officials, ensure that workers are adequately trained and informed, and provide necessary resources for safe and effective deployment. Aid workers also have ethical obligations to adhere to their roles, maintain infection control practices, and ensure the wellbeing of affected communities while considering the ethical challenges of working in crises.