Editors:Elham Reshid and Hailemariam Shimelis : Click for the PDF version
Ebola has been known to be one of the deadly diseases and so far, only supportive therapies were used constantly to treat the patient. More importantly, the preventive measures, namely case management, surveillance and contact tracing, and social mobilization took the stand to lessen the spread of the disease. However, it is against this background that critics and humanitarians have raised ethical concerns and argued that outbreak response activities conflict with the constitutionally protected rights of individuals with suspected and probable Ebola cases.
Social isolation has never been an attribute of human behavior and isolation measures during outbreak responses to Ebola have had both positive and negative influence on the social well-fare of man. Of course, due to isolation and restriction measures, it was possible to control the spread of Ebola but the social impact during and after these outbreak responses is pessimistic.
The isolated individuals often feel neglected and abandoned for the disease to take its natural course. This social detachment is devastating and has raised ethical concern. Psychologically, outbreak response activities such as isolation, restriction of movement lead to a state of anxiety, sense of hopelessness, helplessness and can often progress to depression among the confirmed, suspected and probable cases. Furthermore, it creates panic within the entire community.
Moreover, the preventive (vaccine) and treatment strategies have also raised plenty of ethical dilemmas. It was being heard about experimental drugs and vaccines for the past few weeks, some being tried in humans and others, yielding results from animal trials. But so far, they haven’t reached the places in West Africa where they are most needed.
The issue of whether medicine untested on humans should be used on people—and if so, who should get it—is just one of many ethical questions stirred by the Ebola crisis. Even if the World Health Organization (WHO) has recommended jumping straight into what amount to phase III efficacy tests in Liberia, Guinea, and Sierra Leone, difficult questions are now emerging about how to design clinical trials, who should be the first to get the shots under scarce supply, and when to begin mass production. Whether the trial should be a randomized control trial or not is also part of the dilemma.
And, same goes with the vaccine along with the possibility that, if the vaccine doesn’t provide the promised protection, people may behave as if it does, perhaps touching and taking care of loved ones with the disease, believing they are protected when they aren’t.
Though this is the case, WHO recommended that ongoing evaluation should guide interventions, and the panel identified areas that need more detailed analysis and discussion, such as:
- ethical ways to gather data while striving to provide optimal care under the prevailing circumstances
- ethical criteria to prioritize the use of unregistered experimental therapies and vaccines
- ethical criteria for achieving fair distribution in communities and among countries, in the face of a growing number of possible new interventions, none of which is likely to meet demand in the short term.