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

• Main Authors: Antierens, A. (Author), Nichol, A.A (Author)
• Format: Article
• Language: English
• Published: Public Library of Science 2021
• Subjects: adaptive clinical trial (topic); Adaptive Clinical Trials as Topic; adult; Adult; Africa; Africa, Western; Article; awareness; communicable disease; Communicable Diseases, Emerging; controlled study; decision making; disease burden; disease duration; Disease Outbreaks; Ebola hemorrhagic fever; epidemic; epidemiology; ethics; experimental therapy; female; Female; grounded theory; health care access; health care organization; health care personnel; Health Care Rationing; health disparity; Health Personnel; Hemorrhagic Fever, Ebola; human; humanitarian aid; Humans; interview; Interviews as Topic; male; Male; medical ethics; middle aged; Middle Aged; resource allocation; social acceptance; social participation; Therapies, Investigational
• Online Access: View Fulltext in Publisher

 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. © 2021 Nichol, Antierens. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.