Saturday, February 24, 2007
Tuesday, February 20, 2007
The Lancet, global justice and bird flu vaccine
This seems to hold for potential emergencies too, like the possibility of an avian flu epidemic. Back in 2004, the WHO already sensed that the developing world would only have belated, if any, access to effective vaccines in the event of an avian flu pandemic. This only makes sense, given the spotty developing world access to anti-retroviral treatment for AIDS, years after its invention. Of course, not everyone will have equal access to vaccines in industrialized countries either: the CDC has developed its own way of rationing bird flu vaccine. But the global picture is pretty clear: the poorest countries, those with the worst health systems, will basically act as 'natural history studies' of what happens with human populations when exposed to avian flu virus without real defences. It will not be pretty.
An editorial this week in the Lancet finds this prospect morally indefensible, and calls for global solidarity in regard to avian flu vaccine access. It recognizes that developing world countries do not have the sophisticated means of production of vaccines in their own hands, and, if the future is anything like the past and the present, access will be dependent on the prices that powerful pharmaceutical companies sets on vaccines. The editorial calls on the WHO to "seek an international agreement that would ensure that developing countries have equal access to a pandemic vaccine" motivated by concerns of justice. Whether WHO has the clout to forge such an agreement is debatable, and the word 'access' hides a hornet's nest of problems concerning the delivery of vaccines in resource-poor settings, starting with scarcity of health care workers. But the heart of the editorial is at least in the right place.
Monday, February 12, 2007
The ethics of disaster research
Stakeholders in the developing world seem to take a more sophisticated view than the knee-jerk accusation of exploitation. For one thing -- as an article by Sri Lankan researchers in the Lancet pointed out a couple of years ago -- some disaster research has revealed that some well-intentioned psychological counseling offered to disaster victims disasters is useless or even harmful. Disaster research is like emergency research: the predicament of the participants may open the door for exploitation, but such research is also useful and could be ethically conducted if appropriate protections are proposed and enforced.
Sri Lanka seems in fact to be taking the lead in the ethics of disaster research. The Institute for Research and Development last month organized an international conference with the title, 'Disaster Related Research Ethics: Developing world Perspective'. For a welcome change, 'international' here meant participants from south-east Asian countries affected by the recent tsunami were invited, rather than the usual suspects from the Eastern United States and Geneva. Members of the conference have formed a working group that aims to craft guidelines of the ethics of disaster research. Standard ethics guideline manufacturers -- such as the WHO or UNESCO -- should take note.