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

Abstract

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.

Trends and ethical issues in nursing during disasters: A systematic review

“…The majority (73.3%) were published from 2020 to 2022 24–34 The study designs were cross-sectional (4/25, 26.6%), 24,30,35,36 qualitative (9/15, 60.0%), 26–29,31,33,34,37,38 and mixed methods (2/15, 13.3%). 25,32 Eight studies were conducted in-hospital and out-of-hospital (53.3%).…”

“…26–28,32,33,35 The second sub-theme reveals strategies for involving nurses in policymaking, 24–27,32,35 then engaging them in the training and education 24,26,29,30,32,33,35–38 related to disasters ethics, and creating clear guidelines for nurses regarding ethical practice in disaster situations. 29,31,35…”

“…This review also revealed the impact of ethical practices in disaster that identified two sub-themes: impact on quality of care 25–27,29–34,36 and impact on HCWs. 25,26,28,29,31–35,37 Several studies reported that ethical practice by nurses could improve the quality and safety of patient care 25,27,29–32,36 and provide adequate care during disasters. 26,32,34 However, it also causes physical and psychological impacts on nurses and HCWs, such as fatigue, frustration, anxiety, stress, and burnout when dealing with ethical issues in disasters.…”

Wonder of wonders, miracle of miracles: the unprecedented speed of COVID-19 science

“…Establishment of immune correlates of protection with influenza, Varicella-zoster virus (shingles), and human papillomavirus vaccines provided a foundation for assessment of new candidate COVID-19 vaccines in animal models. The urgent need to develop an effective Ebola vaccine during the 2015 outbreak in West Africa sparked the use of the adaptive clinical trial design, which was employed during the development of the COVID-19 vaccines ( 58 ). This accelerated vaccine development tremendously, saved months to years of time.…”

Ethics in Research: Relevance for Nephrology

“…The mortality experienced in the recent Ebola epidemics and coronavirus disease 2019 pandemic have highlighted the need for research on potential new therapies and vaccines to control disease spread in real time. 46,47 This has led to the compassionate use of experimental therapeutic agents, 48,49 which may notbe acceptable under normal circumstances. REC responses therefore must balance the duty of protecting individual participants and the special public needs derived from the disease control.…”