Ethics of emerging infectious disease outbreak responses: Using Ebola virus disease as a case study of limited resource allocation

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013–2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013–2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers’ access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants’ insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.

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Pandemics at Work: Convergence of Epidemiology and Ethics

Business Ethics Quarterly ◽

10.1017/beq.2021.32 ◽

2021 ◽

pp. 1-34

Author(s):

Michele Thornton ◽

William “Marty” Martin

Keyword(s):

Public Health ◽

Infectious Disease ◽

Disease Outbreaks ◽

Control Measures ◽

Ethical Framework ◽

Workplace Intervention ◽

Ethical Challenges ◽

Infectious Disease Outbreaks ◽

Disease Causation ◽

Workplace Setting

Like COVID-19, new infectious disease outbreaks emerge almost annually, and studies predict that this trend will continue due to a variety of factors, including an aging population, ease of travel, and globalization of the economy. In response to episodic public health crises, governments and organizations develop, implement, and enforce policies, procedures, protocols, and programs. The epidemiological triad is both a model of disease causation and fundamentally used to design and deploy such control measures. Here we adapt this model to the workplace setting and use the epidemiological triad to characterize the related ethical challenges in implementing the control measures employers face as a guide for a workplace intervention framework. Through this approach, our aim is to show how an integrated ethical framework, grounded in epidemiological principles, has important implications for how we categorize, understand, and resolve the difficult decisions that emerge in the workplace under pandemic conditions.

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Core Minimal Datasets to Advance Clinical Research for Priority Epidemic Diseases

Clinical Infectious Diseases ◽

10.1093/cid/ciz760 ◽

2019 ◽

Author(s):

Amanda M Rojek ◽

James Moran ◽

Peter W Horby

Keyword(s):

Infectious Disease ◽

Clinical Research ◽

Ebola Virus ◽

Virus Disease ◽

Disease Outbreaks ◽

Disease Outbreak ◽

Significant Progress ◽

Infectious Disease Outbreaks ◽

Vaccine Trials ◽

Epidemic Diseases

Abstract The Ebola virus disease outbreak in west Africa has prompted significant progress in responding to the clinical needs of patients affected by emerging infectious disease outbreaks. Among the noteworthy successes of vaccine trials, and the commendable efforts to implement clinical treatment trials during Ebola outbreaks, we should also focus on strengthening the collection and curation of epidemiological and observational data that can improve the conception and design of clinical research.

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Addressing Disease-Related Stigma During Infectious Disease Outbreaks

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.157 ◽

2019 ◽

Vol 13 (5-6) ◽

pp. 989-994 ◽

Cited By ~ 14

Author(s):

Leah S. Fischer ◽

Gordon Mansergh ◽

Jonathan Lynch ◽

Scott Santibanez

Keyword(s):

Infectious Disease ◽

Zika Virus ◽

Ebola Virus ◽

Virus Disease ◽

Disease Outbreaks ◽

Ebola Virus Disease ◽

Effective Control ◽

Infectious Disease Outbreaks ◽

Influenza A H1n1 ◽

Related Stigma

ABSTRACTOutbreaks of emerging infectious disease are a constant threat. In the last 10 years, there have been outbreaks of 2009 influenza A (H1N1), Ebola virus disease, and Zika virus. Stigma associated with infectious disease can be a barrier to adopting healthy behaviors, leading to more severe health problems, ongoing disease transmission, and difficulty controlling infectious disease outbreaks. Much has been learned about infectious disease and stigma in the context of nearly 4 decades of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome pandemic. In this paper, we define stigma, discuss its relevance to infectious disease outbreaks, including how individuals and communities can be affected. Adapting lessons learned from the rich literature on HIV-related stigma, we propose a strategy for reducing stigma during infectious disease outbreaks such as Ebola virus disease and Zika virus. The implementation of brief, practical strategies such as the ones proposed here might help reduce stigma and facilitate more effective control of emerging infectious diseases.

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Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic

Singapore Medical Journal ◽

10.11622/smedj.2020046 ◽

2020 ◽

Vol 61 (7) ◽

pp. 350-356 ◽

Cited By ~ 46

Author(s):

QH Chew ◽

KC Wei ◽

S, Vasoo ◽

HC Chua ◽

K Sim

Keyword(s):

Infectious Disease ◽

General Population ◽

Disease Outbreaks ◽

Emerging Infectious Disease ◽

Narrative Synthesis ◽

Coping Responses ◽

Infectious Disease Outbreaks ◽

And Coping

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COVID-19 Outbreak in Africa: Lessons and Insights from the West African Ebola Virus Disease Epidemics

International Journal of Travel Medicine and Global Health ◽

10.34172/ijtmgh.2020.17 ◽

2020 ◽

Vol 8 (3) ◽

pp. 96-99

Author(s):

Oluwafolajimi Adetoye Adesanya

Keyword(s):

Ebola Virus ◽

Democratic Republic Of Congo ◽

Virus Disease ◽

Disease Outbreaks ◽

Ebola Virus Disease ◽

African Continent ◽

Outbreak Response ◽

African Countries ◽

Response Strategies ◽

Past Experiences

Over the years, the African continent has had to battle several outbreaks of infectious diseases in different countries. Some of the most deadly were the Ebola virus disease (EVD) outbreaks that occurred in West Africa between 2014 and 2016 affecting Guinea, Liberia, and Sierra Leone and, more recently, from 2018 to 2020 in the Democratic Republic of Congo (DRC). In the era of the COVID-19 pandemic, it is important that as a continent, we draw lessons and insights from our past experiences to guide outbreak response strategies being deployed to curb the latest onslaught. The Ebola outbreaks have shown that disease outbreaks should not be seen only as medical emergencies, but as full blown humanitarian crises, because oftentimes, their socio-economic impacts are more devastating than the more obvious cost to life. In this mini-review, we explore the possible humanitarian costs of the COVID-19 pandemic on the African continent by looking through the lens of our past experiences with the EVD outbreaks, highlighting how the current pandemic could significantly affect the African economy, food security, and vulnerable demographics, like children and the sexual and reproductive health and rights of women and girls. We then proffer recommendations that could be instrumental in preventing a double tragedy involving the devastating health consequences of the virus itself and the deadly fallout from its multi-sectoral knock-on effects in African countries. Keywords: COVID-19, SARS-CoV-2, Ebola Virus Disease, Coronavirus.

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Outbreak analytics: a developing data science for informing the response to emerging pathogens

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2018.0276 ◽

2019 ◽

Vol 374 (1776) ◽

pp. 20180276 ◽

Cited By ~ 38

Author(s):

Jonathan A. Polonsky ◽

Amrish Baidjoe ◽

Zhian N. Kamvar ◽

Anne Cori ◽

Kara Durski ◽

...

Keyword(s):

Infectious Disease ◽

Data Science ◽

Disease Outbreaks ◽

Health Concern ◽

Emerging Pathogens ◽

Outbreak Response ◽

Theme Issue ◽

Effective Response ◽

Infectious Disease Outbreaks ◽

Challenges And Opportunities

Despite continued efforts to improve health systems worldwide, emerging pathogen epidemics remain a major public health concern. Effective response to such outbreaks relies on timely intervention, ideally informed by all available sources of data. The collection, visualization and analysis of outbreak data are becoming increasingly complex, owing to the diversity in types of data, questions and available methods to address them. Recent advances have led to the rise of outbreak analytics , an emerging data science focused on the technological and methodological aspects of the outbreak data pipeline, from collection to analysis, modelling and reporting to inform outbreak response. In this article, we assess the current state of the field. After laying out the context of outbreak response, we critically review the most common analytics components, their inter-dependencies, data requirements and the type of information they can provide to inform operations in real time. We discuss some challenges and opportunities and conclude on the potential role of outbreak analytics for improving our understanding of, and response to outbreaks of emerging pathogens. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control‘. This theme issue is linked with the earlier issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.

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