Ethical dimensions of neglected tropical disease programming

Addiss, David G.; Kienast, Yvonne; Lavery, James V.

doi:10.1093/trstmh/traa155

Cited by 4 publications

(10 citation statements)

References 30 publications

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“…In line with Addiss et al ,20 we found that only a small number of publications specifically focus on the ethics of MDA. Instead, ethical issues often come up as side points in discussions or arise in qualitative interview studies with different primary aims.…”

Section: Discussionsupporting

confidence: 89%

“…sustained commitment and vigilance are needed to detect and respond to recrudescence of infection and develop the infrastructure, such as sanitation, vector control and primary health services, needed to sustain public health gains 20…”

Section: Resultsmentioning

confidence: 99%

“…National governments ‘own’ NTD programmes within their borders, but the goals, strategies and interventions are often developed at the global level, significantly influenced by partners in the global north, and authorized through resolutions at the World Health Assembly in Geneva 20…”

Section: Resultsmentioning

confidence: 99%

“…Concerns about the ethics of such an indiscriminate measure were brought up16 and some scholars started advocating for the adoption of a biosocial lens in the evaluation of NTD control measures 19. To this day, however, very few publications fully dedicate to discussing ethical issues surrounding MDA for NTD control and elimination, and ethical guidance documents lack in policy 20…”

Section: Introductionmentioning

confidence: 99%

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Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons

Hoefle-Bénard,

Salloch

2024

BMJ Glob Health

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BackgroundNeglected tropical diseases (NTDs) are a diverse group of debilitating diseases and conditions afflicting more than one billion people in impoverished communities. Control of these diseases is crucial to achieve Sustainable Development Goal 3 and the pledge to ‘leave no one behind’. Relying on large-scale delivery of wide-spectrum drugs to individuals in at-risk communities irrespective of their health status, mass drug administration is a core strategy for tackling half of the NTDs targeted by the latest WHO roadmap (2021–2030). However, ethical challenges surround its implementation and long-term impact. This systematic review aims to give a comprehensive picture of the variety of ethical reasons for and against mass drug administration for NTD control and elimination, facilitating further debate in ethics and policy.MethodsPubMed and Web of Science Core Collection were searched for all relevant publications. Of the 486 retrieved records, 60 met the inclusion criteria for qualitative analysis. Ethical reasons discussing the topic at hand were extracted from full texts and synthesised through the Kuckartz method of qualitative content analysis.ResultsData extraction revealed 61 ethical reasons, of which 20 (32.7%) had positive, 13 (21.3%) had ambivalent and 28 (45.9%) had negative implications regarding mass drug administration for NTDs. The health benefits and cost-effectiveness of the measure were extensively highlighted. However, equity, autonomy and sustainability emerged as the domains with the most pressing ethical concerns. Many issues related to implementation are yet to be adequately addressed in policy documents.ConclusionsThis is the first systematic review of ethical reasons pertaining to mass drug administration for NTD control and elimination. Due to the diversity of included studies, no general recommendations can be made. Instead, context-specific strategies seem necessary. Alternative approaches tackling socioecological determinants of ill health are needed for long-term sustainability. Future research could benefit from contributions of non-Western philosophies and perspectives by local researchers.

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Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons

Hoefle-Bénard,

Salloch

2024

BMJ Glob Health

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“…As the results of our survey show, field epidemiologists are aware of these gaps, not only within the context of community-based implementation research, but more acutely, within public heath practice. For example, the emphasis on informed consent in the context of human subjects research does not always extend to public health practice, particularly for population-level interventions [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Ethical challenges and moral distress among field epidemiologists

et al. 2022

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Background As ‘disease detectives’ and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress. Results Among 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it “frequently” or “almost always.” Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress “frequently” or “almost always” than those in higher-income countries (33.0% vs 9.1%, P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%). Conclusions Field epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in association with these challenges. These findings indicate an unmet need among field epidemiologists for support in navigating ethical challenges, as well as for resources to address the human and professional consequences of moral distress.

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