Infectious Diseases

The novel COVID-19 pandemic has placed medical triage decision-making in the spotlight. As life-saving ventilators become scarce, clinicians are being forced to allocate scarce resources in even the wealthiest countries. The pervasiveness of air travel and high rate of transmission has caused this pandemic to spread swiftly throughout the world. Ethical triage decisions are commonly based on the utilitarian approach of maximising total benefits and life expectancy. We present triage guidelines from Italy, USA and the UK as well as the (...) Jewish ethical prospective on medical triage. The Jewish tradition also recognises the utilitarian approach but there is disagreement between the rabbis whether human discretion has any role in the allocation of scarce resources and triage decision-making. (shrink)

Developing World Bioethics, Accepted Article.

Developing World Bioethics, Accepted Article.

We investigate a stochastic SIRS model with transfer from infectious to susceptible and nonlinear incidence rate. First, using stochastic stability theory, we discuss stochastic asymptotic stability of disease-free equilibrium of this model. Moreover, if the transfer rate from infectious to susceptible is sufficiently large, disease goes extinct. Then, we obtain almost surely exponential stability of disease-free equilibrium, which implies that noises can lead to extinction of disease. By the Lyapunov method, we give conditions to ensure that the solution of this (...) model fluctuates around endemic equilibrium of the corresponding deterministic model in average time. Furthermore, numerical simulations show that the fluctuation increases with increase in noise intensity. Finally, these theoretical results are verified by numerical simulations. Hence, noises play a vital role in epidemic transmission. Our results improve and extend previous related results. (shrink)

After initially emerging in China, the coronavirus outbreak has advanced rapidly. The World Health Organization has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and (...) this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians. (shrink)

Pox parties are a controversial alternative to vaccination for diseases such as chickenpox. Such parties involve parents infecting non-immune children by exposing them to a contagious child. If successful, infection will usually lead to immunity, thus preventing infection later in life, which, for several vaccine-preventable diseases, is more severe than childhood infection. Some may consider pox parties more morally objectionable than opting out of vaccination through non-medical exemptions. In this paper, I argue that this is not the case. Pox parties (...) involve immediate risk of harm for children and reduce future harms, whereas opting out of vaccination places children at long-term risk of harms that increase with time, at least for some pathogens. Regarding harm to others through onward transmission of infection, this can be easily prevented in the case of pox parties—given the relatively controlled timing of infection—by quarantining attendees after the party, whereas opting out of vaccination involves risks to others that are more difficult to control. I defend three criteria for an ethical pox party: that the disease is sufficiently low risk, that parents consent to their child’s attendance and that children exposed to infection are quarantined and isolated appropriately. I argue that, if these criteria are met, pox parties are morally preferable to non-vaccination; such parties involve less risk to non-consenting others and, for some pathogens in some cases, even involve less risk for the children who participate. Thus, policies that permit non-medical exemption to vaccination should also permit ethical pox parties. Alternatively, if pox parties are not permitted, then vaccination should be mandated for those without medical contraindication. (shrink)

The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The experience (...) of Northern Italy—a couple of weeks ahead of the UK, suggests that it will simply not be possible to provide mechanical ventilation to every patient who might need it. When the crunch comes, the unpalatable question facing clinicians is which patient to save. There are some obvious strategies to avoid or reduce the problem—through measures to increase intensive care capacity, and via society-level interventions to reduce the spread of the virus. These are vitally important, but unfortunately they are unlikely to prevent the problem of demand outstripping supply from occurring. What, then, should clinicians do? How should they allocate the scarce resource of intensive care—particularly over the coming weeks as the crisis escalates? There are different values at stake in triage decisions, but at a basic level the key values are those of benefit and …. (shrink)

BackgroundOutbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy.MethodFour community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, (...) Australia to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health researchusing this information in concert with data linkage and machine learning to enhance communicable disease surveillance systemsFifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts.ResultsAlmost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems.ConclusionsParticipants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected. (shrink)

The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

The COVID-19 virus is a new pathogen that is highly contagious, can spread quickly, and considered capable of causing enormous health, economic and societal impacts in any setting. According to WHO report, about (78%-85%) human-to-human transmission of the COVID-19 virus is the household transmission have occurred in families. The main purpose of this article is to assess the potential of women in crises management. These findings suggest that, women leadership has a potential advantage in crises management mainly because, women are (...) on average more likely than men to adopt a relational approach to leadership. So that Ethiopia, will benefit more, hence the country‟s more than half of the population and 50% of toplevel leaders are women as a golden opportunity for Ethiopia to easily overcome this pandemic crisis by engaging a full potential of women at all levels. I recommend for Ethiopian government to use this acknowledged golden opportunity of having more women leaders especially at top-level and having women more than half of the population by mobilizing this women force up to family level to overcome this pandemic disease better than any countries in the world. (shrink)

This viewpoint provides an explanation from the public health policies of Vietnamese government to contain the contagious disease with regard to COVID-19 pandemic. A combination of an early lockdown, increase in “virality” of the health information, encouragement in health declaration, regulation for wearing mask in the public, and country’s unity have been the effective ways to cope with this deadly virus in Vietnam, a developing country, which became the first country to halt the SARS spread successfully in 2003.

In order to study the transmission of rabies epidemics in vampire bats, we propose a mathematical model for vampire bat rabies virus. A threshold R0 is identified which determines the outcome of the disease. If R0 1, the endemic equilibrium is globally asymptotically stable with certain conditions. Through the numerical simulation, the correctness of the theoretical results is verified. We carry out the sensitivity analysis of the parameters which provide a theoretical basis for preventing and controlling the transmission of bat (...) rabies. (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

Vietnam, with a geographical proximity and a high volume of trade with China, was the first country to record an outbreak of the new Coronavirus disease (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-CoV-2. While the country was expected to have a high risk of transmission, as of April 4, 2020—in comparison to attempts to contain the disease around the world—responses from Vietnam are being seen as prompt and effective in protecting the interests of its citizens, (...) with 239 confirmed cases and no fatalities. This study analyzes the situation in terms of Vietnam’s policy response, social media and science journalism. A self-made web crawl engine was used to scan and collect official media news related to COVID-19 between the beginning of January and April 4, yielding a comprehensive dataset of 14,952 news items. The findings shed light on how Vietnam—despite being under-resourced—has demonstrated political readiness to combat the emerging pandemic since the earliest days. Timely communication on any developments of the outbreak from the government and the media, combined with up-to-date research on the new virus by the Vietnamese science community, have altogether provided reliable sources of information. By emphasizing the need for immediate and genuine cooperation between government, civil society and private individuals, the case study offers valuable lessons for other nations concerning not only the concurrent fight against the COVID-19 pandemic but also the overall responses to a public health crisis. (shrink)

This work is focused on the rise of institutionalized information control exercised by governments in times of the Covid-19 crisis and the systematic removal or demonetization of content that contradicts or challenges the defined official narrative on influencial platforms like YouTube. With national authorities fragmenting reality into contradicitng national narratives of confinement/no confinement, masks/no masks, ibuprofen/no ibuprofen, chloroquin/no chloroquin etc. the illusion of objective reality in the perpection of the world and even in the context of scientific discourse become more (...) and more evident. Do viruses and medical drugs differentiate between the nationalities of their hosting organisms? The systematic suppression of information that contradicts the respective national narrative as defined by institutionalized authorities lead to a situation in which influencial platforms like YouTube silence everybody that challenges these narratives. (shrink)

Discrimination against women and other vulnerable groups prevailed throughout the twentieth century; it persists today. This historical case study analyzes the life and times of “Typhoid Mary,” an unmarried, Irish Catholic, immigrant woman who was persecuted as an intransigent carrier of a deadly infectious disease. Being a Mexican immigrant, Muslim, or unattractive woman could condemn someone for similar mistreatment today. The failure to overcome prejudice impedes the effectiveness of public health to protect infected patients and susceptible persons from harm and (...) to interrupt disease transmission in communities; it jeopardizes the realization of social quality. Social justice, solidarity, equal valuation, and human dignity will be achieved through resistance to the human rights violations of the Trump administration and the resilience of strong women like Mary Mallon. (shrink)

A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary approaches (...) to EID decision-making—which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice. (shrink)

The Marchuk model of infectious diseases is considered. Distributed control to make convergence to stationary point faster is proposed. Medically, this means that treatment time can be essentially reduced. Decreasing the concentration of antigen, this control facilitates the patient’s condition and gives a certain new idea of treating the disease. Our approach involves the analysis of integro-differential equations. The idea of reducing the system of integro-differential equations to a system of ordinary differential equations is used. The final results are given (...) in the form of simple inequalities on the parameters. The results of numerical calculations of simulation models and data comparison in the case of using distributive control and in its absence are given. (shrink)

Immunization plays a crucial role in global health security, preventing public health emergencies of international concern and protecting individuals from infectious disease outbreaks, yet these critical public health benefits are dependent on immunization law. Where public health law has become central to preventing, detecting, and responding to infectious disease, public health law reform is seen as necessary to implement the Global Health Security Agenda. This article examines national immunization laws as a basis to implement the GHSA and promote the public's (...) health, analyzing the scope and content of these laws to prevent infectious disease across Sub-Saharan Africa. Undertaking policy surveillance of national immunization laws in 20 Sub-Saharan African countries, this study: developed a legal framework to map the legal attributes relevant to immunization; created an assessment tool to determine the presence of these attributes under national immunization law; and applied this assessment tool to code national legal landscapes. An analysis of these coded laws highlights legal attributes that govern vaccine requirements, supply chains, vaccine administration standards, and medicines quality and manufacturer liability. Based upon this international policy surveillance, it will be crucial to undertake legal epidemiology research across countries, examining the influence of immunization law on vaccination rates and disease outbreaks. (shrink)

Thanks to how Girolamo Fracastoro defines the different types of contagion in his book De contagione, et contagiosis morbis et eorum curatione, libri tres (1546), and his defense of the “seeds of contagion” (seedbed) as the cause of contagious diseases, he is considered today one parent of the modern epidemiology and microbiology. One of the crucial problems in this book is to explain the remote transmission of the contagious diseases refuting the etiologic use of the occult qualities. The aim of (...) this study is to investigate the philosophical background of the problem and draw the conclusions that his solution had for medicine and for science in general. (shrink)

Public health emergencies, including infectious disease outbreaks and natural disasters, are issues faced by every community. To address these threats, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness, as well as improve coordination and collaboration across jurisdictions. As sovereign entities, Tribal governments have the authority to create their own laws and take the necessary steps to prepare for, respond to, and recover from disasters and emergencies. Legal preparedness is a key (...) component of public health preparedness. This article first explains legal preparedness and Tribal sovereignty and then describes the relationship between Tribal Nations, the US government, and states. Specific Tribal concerns with respect to emergency preparedness and the importance of coordination and collaboration across jurisdictions for emergency preparedness are discussed. Examples of collaborative efforts between Tribal and other governments to enhance legal preparedness are described. (shrink)

Emerging genomic technologies promise more efficient infectious disease control. Whole genome sequencing is increasingly being used in tuberculosis diagnosis, surveillance, and epidemiology. However, while the use of WGS by public health agencies may raise ethical, legal, and socio-political concerns, these challenges are poorly understood. Between November 2017 and April 2018, we conducted semi-structured interviews with 22 key stakeholders across the fields of governance and policy, public health, and laboratory sciences representing the major jurisdictions currently using WGS in national TB programs. (...) Thematic analysis of the interviews was conducted using NVivo 11. Respondents identified several ethical and practical challenges associated with WGS in TB care and surveillance, all related to issues of trust, including: 1) the power of public health; 2) data sharing and profits derived from surveillance efforts; and 3) concerns regarding who has access to, and can benefit from, the technology. Additional challenges included: the potential utility that WGS adds to a public health program, the risks associated with linking necessary epidemiological metadata to the genomic data, and challenges associated with jurisdictional capacity to implement the technology. Successful implementation of WGS is dependent on fostering relationships of trust between those working with genomics technology and those directly impacted by it, including clinicians. Building trust between the public and the public health agencies and within public health agencies themselves is critical due to the inherent complexity of WGS and its implementation for communicable disease control purposes. (shrink)

There is a wide range of works that have proposed mathematical models to describe the spread of infectious diseases within human populations. Based on such models, researchers can evaluate the effect of applying different strategies for the treatment of diseases. In this article, we generalize previous models by studying an SIR epidemic model with a nonlinear incidence rate, saturated Holling type II treatment rate, and logistic growth. We compute the basic reproduction number and determine conditions for the local stability of (...) equilibria and the existence of backward bifurcation and Hopf bifurcation. We also show that, when the disease transmission rate and treatment parameter are varied, our model undergoes a Bogdanov-Takens bifurcation of codimension 2 or 3. Simulations of the solutions and numerical continuation of equilibria are carried out to generate 2D and 3D bifurcation diagrams, as well as several related phase portraits that illustrate our results. Our work shows that incorporating these factors into epidemic models can lead to very complex dynamics. (shrink)

In some jurisdictions, the institutions of criminal justice may subject individuals who have committed crimes to preventive detention. By this, I mean detention of criminal offenders (i) who have already been punished to (or beyond) the point that no further punishment can be justified on general deterrent, retributive, restitutory, communicative or other backwardlooking grounds, (ii) for preventive purposes—that is, for the purposes of preventing the detained individual from engaging in further criminal or otherwise socially costly conduct. Preventive detention, thus understood, (...) shares many features with the quarantine measures sometimes employed in the context of infectious disease control. Both interventions involve imposing (usually severe) constraints on freedom of movement and association. Both interventions are standardly undeserved: in quarantine, the detained individual deserves no detention (or so I will, for the moment, assume), and in preventive detention, the individual has already endured any detention that can be justified by reference to desert. Both interventions are, in contrast to civil commitment under mental health legislation, normally imposed on more-or-less fully autonomous individuals. And both interventions are intended to reduce the risk that the constrained individual poses to the public. Yet despite these similarities, preventive detention and quarantine have received rather different moral report cards. (shrink)

The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our policies (...) regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

Ensuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, researchers and other concerned stakeholders also have to carefully balance time and resources allocated to immediate treatment and control activities, with an approach that integrates research as part of the outbreak response. Under such circumstances, research (...) “ethics preparedness” constitutes an important foundation for an effective response to infectious disease outbreaks and other health emergencies. A two-day workshop was convened in March 2018 by the World Health Organisation Global Health Ethics Team and the African coaLition for Epidemic Research, Response and Training, with representatives of National Ethics Committees, to identify practical processes and procedures related to ethics review preparedness. The workshop considered five areas where work might be undertaken to facilitate rapid and sound ethics review: preparing national ethics committees for outbreak response; pre-review of protocols; multi-country review; coordination between national ethics committees and other key stakeholders; data and benefit sharing; and export of samples to third countries. In this paper, we present the recommendations that resulted from the workshop. In particular, the participants recommended that Ethics Committees would develop a formal national standard operating procedure for emergency response ethical review; that there is a need to clarify the terminology and expectations of pre-review of generic protocols and agree upon specific terminology; that there is a need to explore mechanisms for multi-country emergency ethical consultation, and to establish procedures for communication between national ethics committees and other oversight bodies and public health authorities. In addition, it was suggested that ethics committees should request from researchers, at a minimum, a preliminary data sharing and sample sharing plan that outlines the benefit to the population from which data and samples are to be drawn. This should be followed in due time by a full plan. It is hoped that the national ethics committees, supported by the WHO, relevant collaborative research consortia and external funding agencies, will work towards bringing these recommendations into practice, for supporting the conduct of effective research during outbreaks. (shrink)

The exponential accumulation, processing and accrual of big data in healthcare are only possible through an equally rapidly evolving field of big data analytics. The latter offers the capacity to rationalize, understand and use big data to serve many different purposes, from improved services modelling to prediction of treatment outcomes, to greater patient and disease stratification. In the area of infectious diseases, the application of big data analytics has introduced a number of changes in the information accumulation models. These are (...) discussed by comparing the traditional and new models of data accumulation. Big data analytics is fast becoming a crucial component for the modelling of transmission—aiding infection control measures and policies—emergency response analyses required during local or international outbreaks. However, the application of big data analytics in infectious diseases is coupled with a number of ethical impacts. Four key areas are discussed in this paper: automation and algorithmic reliance impacting freedom of choice, big data analytics complexity impacting informed consent, reliance on profiling impacting individual and group identities and justice/fair access and increased surveillance and population intervention capabilities impacting behavioural norms and practices. Furthermore, the extension of big data analytics to include information derived from personal devices, such as mobile phones and wearables as part of infectious disease frameworks in the near future and their potential ethical impacts are discussed. Considered together, the need for a constructive and transparent inclusion of ethical questioning in this rapidly evolving field becomes an increasing necessity in order to provide a moral foundation for the societal acceptance and responsible development of the technological advancement. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

Healthcare workers carry a substantial risk of harm from infectious disease, particularly, but not exclusively, during outbreaks. More can be done by healthcare institutions to identify risks, quantify the current burden of preventable infectious disease amongst HCWs and identify opportunities for prevention. We suggest that institutional obligations should be clarified with respect to the mitigation of infectious disease risks to staff, and question the duty of HCWs to care while healthcare institutions persist with a reactive rather than proactive attitude to (...) infectious disease threats. (shrink)

In teasing out the diverse origins of our “modern, ecological understanding of epidemic disease” Greater than the parts: holism in biomedicine, 1920–1950, Oxford University Press, Oxford, 1998), historians have downplayed the importance of parasitology in the development of a natural history perspective on disease. The present article reassesses the significance of parasitology for the “invention” of medical ecology in post-war France. Focussing on the works of microbiologist Charles Nicolle and on that of physician and zoologist Hervé Harant, I argue that (...) French “medical ecology” was not professionally insulated from some major trends in parasitology, especially in Tunis where disciplinary borders in the medical sciences collapsed. This argument supports the claim that ecological perspectives of disease developed in colonial context but I show that parasitologists such as Harant built on the works of medical geographers who had called attention to the dynamic and complex biological relations between health and environment in fashioning the field of medical ecology in the mid-1950s. As the network of scientists who contributed to the global emergence of “disease ecology” is widening, both medical geography and parasitology stand out as relevant sites of inquiries for a broader historical understanding of the multiple “ecological visions” in twentieth-century biomedical sciences. (shrink)

Contemporary infectious disease surveillance systems aim to employ the speed and scope of big data in an attempt to provide global health security. Both shifts - the perception of health problems through the framework of global health security and the corresponding technological approaches – imply epistemological changes, methodological ambivalences as well as manifold societal effects. Bringing current findings from social sciences and public health praxis into a dialogue, this conversation style contribution points out several broader implications of changing disease surveillance. (...) The conversation covers epidemiological issues such as the shift from expert knowledge to algorithmic knowledge, the securitization of global health, and the construction of new kinds of threats. Those developments are detailed and discussed in their impacts for health provision in a broader sense. (shrink)

Many countries have implemented infection control measures directed at carriers of multidrug-resistant organisms. To explore the ethical implications of these measures, we analyzed 227 consultations about multidrug resistance and compared them with the literature on communicable disease in general. We found that control measures aimed at carriers have a range of negative implications. Although moral dilemmas seem similar to those encountered while implementing control measures for other infectious diseases, 4 distinct features stand out for carriage of multidrug-resistant organisms: carriage presents (...) itself as a state of being; carriage has limited relevance for the health of the carrier; carriage has little relevance outside healthcare settings; and antimicrobial resistance is a slowly evolving threat on which individual carriers have limited effect. These features are of ethical relevance because they influence the way we traditionally think about infectious disease control and urge us to pay more attention to the personal experience of the individual carrier. (shrink)

Conservation medicine examines the interactions between pathogens and disease and their linkages with the interactions that occur between species and ecosystems. Thus, it focuses on the study of the ecological context of health and the remediation of ecological health problems. In response to the growing health implications of environmental degradation, conservation medicine includes examining the linkages among change in climate, habitat quality, and contaminants; and maintenance of biodiversity and ecosystem functions as they sustain land use; emergence and re-emergence of infectious (...) agents, parasites, and the environmental health of plant and animal communities, including humans. A conservation Medicine approach involving many parties including human and animal health professionals, ecologists, modelers and others would help provide comprehensive, coordinated, and cohesive strategies in addressing this immense threat. (shrink)

The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...) the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics. (shrink)

Inequalities persist when it comes to the attention, resource allocation and political prioritization, and provision of appropriate, adequate, and timely health interventions to populations in need. Set against a complex socio-political backdrop, the pressure on public health science is significant: institutions and scientists are accountable for helping to find the origins of disease, and to prevent and respond effectively more rapidly than ever. In the field of infectious disease epidemiology, new digital methods are contributing to a new ‘digital epidemiology’ and (...) are seen as a promising way to increase effectivity and speed of response to infectious disease and public health events. New types of health data and access to personal information that are available through diverse channels will continue to have wide implications for epidemiology and public health practice. The purpose of this short paper is to introduce the emerging backdrop of practical and ethical challenges for those involved within the practice of public health as they face increasing collaborations with those from fields that have not traditionally applied their methods to epidemiology. (shrink)

Digital epidemiology, also referred to as digital disease detection, successfully provided methods and strategies for using information technology to support infectious disease monitoring and surveillance or understand attitudes and concerns about infectious diseases. However, Internet-based research and social media usage in epidemiology and healthcare pose new technical, functional and formal challenges. The focus of this paper is on the ethical issues to be considered when integrating digital epidemiology with existing practices. Taking existing ethical guidelines and the results from the EU (...) project M-Eco and SORMAS as starting point, we develop an ethical assessment model aiming at providing support in identifying relevant ethical concerns in future DDD projects. The assessment model has four dimensions: user, application area, data source and methodology. The model supports in becoming aware, identifying and describing the ethical dimensions of DDD technology or use case and in identifying the ethical issues on the technology use from different perspectives. It can be applied in an interdisciplinary meeting to collect different viewpoints on a DDD system even before the implementation starts and aims at triggering discussions and finding solutions for risks that might not be acceptable even in the development phase. From the answers, ethical issues concerning confidence, privacy, data and patient security or justice may be judged and weighted. (shrink)

We address the question “does digital epidemiology represent an epistemic shift in infectious disease epidemiology” from a statistician’s viewpoint. Our main argument is that infectious disease epidemiology has not changed fundamentally as it always has been data-driven. However, as the data aspect has become more prominent, we discuss the statistical toolbox of the modern epidemiologist and argue that problem solving in the digital age, more than ever requires an interdisciplinary quantitative approach.

Leprosy has taken on many names throughout human history. But none of its nomenclature has adequately captured the essence of what it has historically meant to live with the disease like the Hawaiian term ma`i ho`oka`awale, or “the separating sickness.” The appropriateness of this term is twofold: on the one hand, it accurately reflects the physical isolation imposed on leprosy patients as a result of stigmatization and quarantine policies; on the other, it seems fitting to use the language of the (...) culture and race that leprosy so disproportionately affected in nineteenth and twentieth century Hawai`i. This essay offers an ethical analysis of the treatment of leprosy patients in Hawai`i to identify mistakes made in the sphere of public health to better guide the management of infectious diseases today. It provides an historical overview of leprosy in order to contextualize its journey to the Hawaiian Islands, with a particular focus on the horrific century-long isolation of leprosy patients to the remote Kalaupapa settlement. It then presents two contrasting normative claims about the banishment and isolation practices by using two different theories of justice: utilitarianism and Rawls’ justice as fairness. In doing so, this essay illustrates the ways in which stigmatization and racism could likely affect the abhorrent treatment of leprosy patients by disproportionately appealing to the “greater good.” However, I contend that this dichotomization of justice brings us to a moral impasse in the context of public health. Rather, considering infectious diseases with a “patient as victim and vector” approach may prove more beneficial, especially in tandem with a schema of justice that promotes self-respect as a primary good to combat the deleterious effects of stigma. This historical reflection may thus allow medical professionals and policy makers alike to draw upon valuable ethical lessons for contemporary initiatives in public health. (shrink)

Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation, with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics (...) guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic. (shrink)

Resident microbiota do not just shape host immunity, they can also contribute to host protection against pathogens and infectious diseases. Previous reviews of the protective roles of the microbiota have focused exclusively on colonization resistance localized within a microenvironment. This review shows that the protection against pathogens also involves the mitigation of pathogenic impact without eliminating the pathogens (i.e., “disease tolerance”) and the containment of microorganisms to prevent pathogenic spread. Protective microorganisms can have an impact beyond their niche, interfering with (...) the entry, establishment, growth, and spread of pathogenic microorganisms. More fundamentally, we propose a series of conceptual clarifications in support of the idea of a “co-immunity,” where an organism is protected by both its own immune system and components of its microbiota. -/- . (shrink)