Ethical challenges of containing Ebola: the Nigerian experience

Abstract

Responding effectively to an outbreak of disease often requires routine processes to be set aside in favour of unconventional approaches. Consequently, an emergency response situation usually generates ethical dilemmas. The emergence of the Ebola virus in the densely populated cities of Lagos and Port Harcourt in Nigeria brought bleak warnings of a rapidly expanding epidemic. However, these fears never materialised largely due to the swift reaction of emergency response and incident management organisations, and the WHO has now declared Nigeria free of Ebola. However, numerous ethical issues arose in relation to the response to the outbreak. This paper discusses some of these ethical challenges and the vital lessons learned. Ethical challenges relating to confidentiality, the dignity of persons, non-maleficence, stigma and the ethical obligations of health workers are examined. Interventions implemented to ensure that confidentiality and the dignity of persons improved and stigma was reduced, included community meetings, knowledge communication and the training of media personnel in the ethical reporting of Ebola issues. In addition, training in infection prevention and control helped to allay the fears of health workers. A potential disaster was also averted when the use of an experimental medicine was reconsidered. Other countries currently battling the epidemic can learn a lot from the Nigerian experience.

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

“…Community engagement has also figured prominently in discussions about an ethics framework to guide public health practice, in general (Lee, 2012;Marckmann et al, 2015;Spike, 2018), and during health emergencies (Gainotti, 2008;Kenny et al, 2010;O'Neill, 2004;Swain et al, 2008). Severe acute respiratory syndrome (SARS), Ebola, Middle East respiratory syndrome (MERS), and pandemic flu each prompted assessment of outbreak ethics (Kim, 2016;Maduka et al, 2015;Singer, 2003). Against this backdrop, our study examined assumptions that local opinion leaders in 4 US localities at high risk of Zika transmission held about community involvement in public health policymaking for outbreak response.…”

Digital Technology and Mobile Applications Impact on Zika and Ebola Epidemics Data Sharing and Emergency Response

“…Important public health messages may become lost or overlooked with all the other information available. For example, in 2014, a rumour spread via Twitter that drinking copious amounts of salt water cures Ebola lead to two deaths in Nigeria [8,11].…”

“…However, digital innovations during and post-Zika and Ebola outbreak continue to be developed; unforeseen consequences should be tackled promptly [5,6]. Ethical, legal and medical issues associated Zika complications and use of compassionated serum treatment during Ebola or deployment of military forces in vector breeding sites ablation, care delivery and human protection have been reported and patient/survivors rights considerations that emerge from international Zika and Ebola response have also been documented in affected areas in West Africa Ebola, or Zika epidemics in Brazil, Cuba, The America and Colombia [2,3,6,8]. Nevertheless, limited attention has been given to ethical ICT access and use considerations during and post Zika and Ebola epidemics particularly leveraging on digital applications implications on future epidemics while rapid development and growth [6,8].…”

“…Building local early social media, digital maps, and network diagrams are key technologies that have been used to achieve early warning during the Ebola epidemic mapping works to impede public health emergencies and allows individuals to prepare for an outbreak [8,26,27,46,47]. Ethics and security in ICT access and use during and post-epidemic public health emergency surveillance and monitoring of formal and informal sources of social media channels such as blog posts and tweets need to be strengthened in most epidemics prone countries [28,35,36].…”

“…Such interactive and real time social mobilization, information via social media; SMS and internet-based information sharing enables individuals, patient groups or survivors and communities to understand epidemics and transmission dynamics, safety and precautionary measures to exposure, pathology and actions in control [2,[8][9][10]13,14]. Proactive prevention and recovery approaches on from mobile applications information regarding these emerging outbreaks from humanitarian organizations, NGOs, healthcare workers, health professionals and communities are needed.…”