Ethics, health policy, and Zika: From emergency to global epidemic?

Abstract

Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation (PAHO), with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic.

On the front line: Health professionals and system preparedness for Zika virus in Peru

“…The characteristics of Zika virus infection present new challenges for the public health response and long‐term prevention. A large number of asymptomatic cases, the persistence of the virus in semen, and the preference of the mosquito for living inside homes mean a higher risk of infection in low‐income urban communities and especially among vulnerable women and children . Engaging health professionals effectively in a coordinated response is key to managing Zika virus in its new endemic form.…”

Vector control in Zika-affected communities: Local views on community engagement and public health ethics during outbreaks

“…As a result, public health professionals faced many ethics concerns: Was comprehensive reproductive healthcare available for women (Lancet Global Health, 2016;PAHO, 2016;Saenz, 2016)? What outbreak controls were appropriate when most contagious individuals were asymptomatic (Jamrozik et al, 2018)? Which prevention and treatment studies were morally defensible (Marston et al, 2016;Shah et al, 2017)?…”

“…Analyses of the public health ethics of Zika virus vector control demonstrated that community engagement is vital (Jamrozik et al, 2018;Nuffield Council on Bioethics, 2016;Tambo et al, 2017;WHO, 2017). Interventions seen as out-of-sync with local values could foster community resistance.…”

“…Accessing private property to identify mosquito habitats, too, could upset residents who cherish their independence, chafe at government interference, and value their property rights. By explaining control alternatives, eliciting community input on acceptable interventions, and sharing the rationale for specific choices, public health professionals have a greater chance of earning the public's confidence and cooperation (Jamrozik et al, 2018;Nuffield Council on Bioethics, 2016;Tambo et al, 2017). Moreover, involving local residents in a coordinated campaign to reduce mosquito habitats at the community level -such as enlisting whole neighborhoods to empty/cover containers with standing water -can raise the likelihood of successful vector control (Jamrozik et al, 2018;WHO, 2017).…”

“…By explaining control alternatives, eliciting community input on acceptable interventions, and sharing the rationale for specific choices, public health professionals have a greater chance of earning the public's confidence and cooperation (Jamrozik et al, 2018;Nuffield Council on Bioethics, 2016;Tambo et al, 2017). Moreover, involving local residents in a coordinated campaign to reduce mosquito habitats at the community level -such as enlisting whole neighborhoods to empty/cover containers with standing water -can raise the likelihood of successful vector control (Jamrozik et al, 2018;WHO, 2017). Control of other mosquito-borne diseases (e.g., Dengue, Chikungunya), has increasingly enlisted community members in decentralized campaigns (Alvarado-Castro et al, 2017;Andersson et al, 2015;Elsinga et al, 2017;Lucena et al, 2018).…”