Infectious Diseases, Misc

The Covid-19 pandemic raises the need for an ethical framework addressing unique questions of airborne infectious disease. In particular, are you ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein derives answers from ethical norms. Always covering coughs and sneezes just in case you might be infectious is an ethical norm. But if you are infectious with an airborne illness, you are probably spreading germs even with every breath and vocalization. Therefore, (...) given that respiratory covering should be done to prevent spreading germs, you should wear a mask if you believe you are infectious because it also provides covering while breathing and vocalizing. REF is grounded in the non-harm principle. Why should we avoid spreading infections to others? Because they can cause bodily physical harm and we should act to prevent causing such harm to others without justifiable reason. Under REF, the magnitude of your obligation to mask is proportional to the magnitude of risk you pose to others by way of airborne germs. This functional relationship is logically modeled and visually mapped with a decision matrix in this essay. (shrink)

COVID-19 vaccination of children has begun in various high-income countries with regulatory approval and general public support, but largely without careful ethical consideration. This trend is expected to extend to other COVID-19 vaccines and lower ages as clinical trials progress. This paper provides an ethical analysis of COVID-19 vaccination of healthy children. Specifically, we argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination (...) provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate healthy children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments. (shrink)

Despite extensive stigma mitigation efforts, infectious disease stigma remains common. So far, little attention has been paid to the moral psychology of stigmatizing practices (i.e. beliefs, attitudes, actions) rather than the experience of being stigmatized. Addressing the moral psychology behind stigmatizing practices seems necessary to explain the persistence of infectious disease stigma and to develop effective mitigation strategies. Our article proposes building on Jonathan Haidt’s moral foundations theory, which states that moral judgements follow from intuitions rather than conscious reasoning. Conceptual (...) analysis was conducted to show how Haidt’s five moral foundations can be connected to (i) moral judgements about stigmatizing practices and (ii) stigmatizing practices themselves. We found that care/harm, fairness/cheating, loyalty/betrayal and sanctity/degradation intuitions can inform moral judgements about stigmatizing practices. Loyalty/betrayal and sanctity/degradation intuitions can sometimes also feed stigmatizing practices. Authority/subversion intuitions can inform moral judgements and stigmatizing practices towards people who disrespect authoritative rules meant to protect public health. Moral dumbfounding and posthoc reasoning might explain the persistence of stigmatizing practices. In conclusion, this study demonstrates the relevance of Haidt’s approach to infectious disease stigma research and mitigation strategies. We hope that this study motivates researchers to further test and assess this approach. (shrink)

Seán O’Casey’s play _The Plough and the Stars_ presents audiences with a view of life in Dublin’s poverty-stricken tenements during the 1916 Easter Rising. Critical consensus holds that it is a play primarily concerned with the Easter Rising set against a backdrop of tenement life. This paper argues instead that this is a play about tuberculosis in Ireland set against the backdrop of the 1916 Easter Rising. The characters in the play place far more importance on tuberculosis and their impoverished (...) state than on politics or even the violence erupting in the streets. The fears and concerns regarding this infectious disease and its impact on poor communities appear in contrast to the characters’ annoyance and dismissal of the political events leading up to and including the Rising. (shrink)

The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory hygiene efforts—such (...) as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent poses a risk of harmful infection to others. REF includes illustrated decision models that instantiate a framework of proportionality between levels of risk, ethical duty and mitigation that shapes risk mitigation across domains. (shrink)

Abstractabstract:Public health emergencies are fraught by epistemic uncertainty, which raises policy issues of how to handle that uncertainty and devise sustainable public health responses. Among such responses, a herd immunity policy might be an option. Particularly before the development of vaccines, the current COVID-19 pandemic has highlighted the polarized nature of the political debate concerning the ethical feasibility of herd immunity strategies. This article provides a conceptual framework tailored to uncover the ethical rationale behind such strategies. Clarity on this issue (...) is important in order to facilitate the terms of the political debate when tackling future health emergencies. (shrink)

Each year, over 200 million people are infected with the malaria parasite, nearly half a million of whom succumb to the disease. Emerging genetic technologies could, in theory, eliminate the burden of malaria throughout the world by intentionally eradicating the mosquitoes that transmit the disease. In this paper, we offer an ethical examination of the intentional eradication of Anopheles gambiae, the main malaria vector of sub-Saharan Africa. In our evaluation, we focus on two main considerations: the benefit of alleviating the (...) malaria burden, and the loss of value that would accompany the eradication of the species. We outline a typology of the different ways in which species are valued or could be valuable, then use that typology to appraise the value of the species in question. We argue that Anopheles gambiae has minor instrumental value, little final subjective value and no objective final value. (shrink)

Through a rhetorical analysis of fragments of language used by United States public health experts, victims, and advocates during the early periods of polio, HIV and COVID-19, this project shows how constitutive rhetoric within infectious disease discourse articulates the subject position of potential victim for different publics. The author finds that the analyzed discourse simultaneously calls forth a negative identity that asks people to not become something and also asks for actions to prevent disease spread – and, in doing so, (...) the awakening of potential victim reveals hegemonic assumptions about whose bodies are valued and whose are not. (shrink)

Moulages are contact media – images made by contagion in the most literal sense: their production relies on a process in which the object to be reproduced is touched by the reproducing material. In the case of dermatological moulages, the plaster touches the infected skin of the sick and, once dried, serves as the negative form for the waxen image of a disease. Focussing on the collection of the Hôpital Saint-Louis in Paris, the article situates the production of dermatological moulages (...) within the visual culture of 19th-century medicine and raises the question how an ancient technique of image production could become such a prevalent tool for the documentation of skin diseases during a period usually associated with the rise of scientific medicine and a reconsideration of theories of contagion in medical aetiology. (shrink)

On May 16, 2020, the Center for Academic Research and Training in Anthropogeny organized the symposium “Impact of Infectious Disease on Humans and Our Origins”. The symposium aimed to gather experts on infectious diseases in one place and discuss the interrelationship between different pathogens and humans in an evolutionary context. The talks discussed topics including SARS-CoV-2, dengue and Zika, the notion of human-specific diseases, streptococci, microbiome in the human reproductive tract, Salmonella enterica, malaria, and human immunological memory.

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. (...) Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle. (shrink)

Bioethics, Volume 36, Issue 6, Page 687-698, July 2022.

Disease transmission is a fruitful domain in which to examine how scientific and folk theories interrelate, given laypeople’s access to multiple sources of information to explain events of personal significance. The current paper reports an in-depth survey of U.S. adults’ causal reasoning about two viral illnesses: a novel, deadly disease that has massively disrupted everyone’s lives, and a familiar, innocuous disease that has essentially no serious consequences. Participants received a series of closed-ended and open-ended questions probing their reasoning about disease (...) transmission, with a focus on causal mechanisms underlying disease contraction, transmission, treatment, and prevention; non-visible biological processes; and ontological frameworks regarding what kinds of entities viruses are. We also assessed participants’ attitudes, such as their trust in scientific experts and willingness to be vaccinated. Results indicated complexity in people’s reasoning, consistent with the co-existence of multiple explanatory frameworks. An understanding of viral transmission and viral replication existed alongside folk theories, placeholder beliefs, and lack of differentiation between viral and non-viral disease. For example, roughly 40% of participants who explained illness in terms of the transmission of viruses also endorsed a non-viral folk theory, such as exposure to cold weather or special foods as curative. Additionally, participants made use of competing modes of construal when explaining how viruses operate, such as framing the immune system response as cells trying to fight off the virus. Indeed, participants who displayed greater knowledge about viral transmission were significantly more likely to anthropomorphize bodily processes. Although comparisons of COVID-19 and the common cold revealed relatively few differences, the latter, more familiar disease elicited consistently lower levels of accuracy and greater reliance on folk theories. Moreover, for COVID-19 in particular, accuracy positively correlated with attitudes, self-protective behaviors, and willingness to be vaccinated. For both diseases, self-assessed knowledge about the disease negatively predicted accuracy. The results are discussed in relation to challenges for formal models of explanatory reasoning. (shrink)

This Article examines whether policies—sometimes termed “vaccine mandates” or “vaccine requirements”— that consider vaccination status as a condition of employment, receipt of goods and services, or educational or other activity for participation are legally permitted, and whether such policies may even sometimes be legally required. It does so with particular reference to COVID-19 vaccines. -/- Part I explains the legality of private actors, such as employers or private universities, considering vaccination status, and concludes that such consideration is almost always legally (...) permissible unless foreclosed by specific state legislation. Part II examines the consideration of vaccination status by state or federal policy. It concludes that such consideration is similarly allowed at the state level unless expressly foreclosed, and is allowed at the federal level if appropriately supported by federal regulatory authority. Part III examines what may be a future front in these debates: whether policies considering vaccination status may be required rather than merely permitted, just as some courts have found that mask requirements may be federally required in certain circumstances. (shrink)

This paper presents a critical interpretive synthesis of research on the efficacy of comics in educating consumers on communicable diseases. Using this review methodology, the authors drew from empirical as well as non-empirical literature to develop a theoretical framework exploring the implications of comics’ combination of images and text to communicate this health promoting information. The authors examined selected works’ alignment with the four motivational components of Keller’s ARCS Model to evaluate research within the context of learner motivation. Findings of (...) this research indicate comics offer a useful method for providing consumer health education, particularly regarding topics that individuals may have difficulty in discussing openly. (shrink)

Recent scholarship on the social history of health and medicine in colonial India has moved beyond enclavist or hegemonic aspects of imperial medicine and has rather focused on the role of Indian intermediaries and the fractured nature of colonial hegemony. Drawing inspiration from this scholarship, the article highlights the significance of the Indian subordinates in the lock hospital system in the nineteenth century Madras Presidency. This study focuses on a class of Indian subordinates called the “gomastah”, who were employed to (...) detect clandestine prostitution in Madras to control the spread of venereal disease. It also underlines the role of other native and non-native subordinates such as Dhais, Chowdranies and Matrons, the ways in which they became indispensable for the smoother operation of the Contagious Diseases Act and the lock hospitals on a day-to-day basis. By emphasising how Indian subordinates were able to bring in caste biases within colonial governmentality, adding another layer to the colonial prejudices and xenophobia against the native population, it underlines the fact that there was not a one-way appropriation or facilitation of the coloniser’s knowledge or biases by the colonised intermediaries. Rather, it argues for an interaction between them, and highlights the complexities of caste hierarchies and prejudice within the everyday colonial governmentality. Moreover, the article focuses on the consequent chaos and inherent power struggle between different factions of colonial staff. (shrink)

Recent scholarship on the social history of health and medicine in colonial India has moved beyond enclavist or hegemonic aspects of imperial medicine and has rather focused on the role of Indian intermediaries and the fractured nature of colonial hegemony. Drawing inspiration from this scholarship, the article highlights the significance of the Indian subordinates in the lock hospital system in the nineteenth century Madras Presidency. This study focuses on a class of Indian subordinates called the “gomastah”, who were employed to (...) detect clandestine prostitution in Madras to control the spread of venereal disease. It also underlines the role of other native and non-native subordinates such as Dhais, Chowdranies and Matrons, the ways in which they became indispensable for the smoother operation of the Contagious Diseases Act and the lock hospitals on a day-to-day basis. By emphasising how Indian subordinates were able to bring in caste biases within colonial governmentality, adding another layer to the colonial prejudices and xenophobia against the native population, it underlines the fact that there was not a one-way appropriation or facilitation of the coloniser’s knowledge or biases by the colonised intermediaries. Rather, it argues for an interaction between them, and highlights the complexities of caste hierarchies and prejudice within the everyday colonial governmentality. Moreover, the article focuses on the consequent chaos and inherent power struggle between different factions of colonial staff.ZusammenfassungDie jüngere Forschung zur Sozialgeschichte der Gesundheit und Medizin im kolonialen Indien hat sich jenseits spezifischer hegemonialer Aspekte der imperialen Medizin mittlerweile verstärkt der Bedeutung ihrer indischen Vermittler und der gebrochenen Natur kolonialer Herrschaft zugewandt. Davon inspiriert beleuchtet der Beitrag die Rolle indischer Subalterner im System der Krankenhäuser für Geschlechtskrankheiten der Provinz Madras im 19. Jahrhundert. Er fokussiert auf die so genannten „Gomastah“, eine Klasse von indischen Untergebenen, die zur Aufdeckung der illegalen Prostitution in Madras eingesetzt wurden, um so die Ausbreitung von Geschlechtskrankheiten zu verhindern. Untersucht wird auch die Rolle anderer einheimischer und nicht einheimischer Untergebener wie der Dhais, Chowdranies und Matrons, die für die reibungslose Umsetzung des Contagious Diseases Act und das alltägliche Funktionieren dieser Krankenhäuser unverzichtbar waren. Indem herausgearbeitet wird, wie indisches Kastendenken in die koloniale Gouvernementalität einfließen konnte und so koloniale Vorurteile und Xenophobie stärkte, unterstreicht der Artikel die Tatsache, dass es keine einseitige Aneignung oder Vermittlung kolonialen Wissens und kolonialer Vorannahmen durch die kolonisierten Vermittler gab. Argumentiert wird vielmehr für deren Interaktion, betont wird die komplexe Bedeutung des Kastensystems und seiner Vorurteile für das alltägliche koloniale Regierungshandeln. Zudem befasst sich der Beitrag mit dem daraus resultierenden Chaos und den inhärenten Machtkämpfen zwischen verschiedenen Gruppierungen des kolonialen Personals. (shrink)

In the years around 1900 one of the most significant practical consequences of new styles of bacteriological thought and practice was the development of preventive vaccines and therapeutic sera. Historical scholarship has highlighted how approaches rooted in the laboratory methods of Robert Koch, Louis Pasteur and their collaborators were transformed in local contexts and applied in diverse ways to enable more effective disease identification, prevention and treatment. Amongst these, the anti-anthrax serum developed by the Italian physician Achille Sclavo (1861–1930) has (...) received little to no attention from historians. This article positions Sclavo's serum as a neglected but significant presence in British microbiology, which achieved widespread uptake amidst a wave of optimism, despite prolonged uncertainty about its mechanism of action and dosage. After being introduced to Britain in 1904 by the enterprising first medical inspector of factories Thomas Morison Legge, within a matter of months the serum became regarded by medical practitioners as an effective treatment of cutaneous anthrax, though access to ‘fresh’ serum and the necessary speedy diagnosis remained problematic. Like the disease anthrax itself, discussion of ‘Sclavo's serum’ was out of all proportion to the relatively low number of cases, reflecting a deep-seated fascination with the wider possibilities afforded by effective serum therapy. (shrink)

Ethnicity and im/migrant classification systems and their constituent categories have a long history in the construction of public health knowledge on tuberculosis in the United Kingdom. This article critically examines the categories employed and the epidemiological discourses on TB, im/migrants, and ethnic minorities in health reporting between 1965 and 2015. We employ a Sociology of Knowledge Approach to Discourse Analysis to trace the continuities and changes in the categories used and in the discursive construction of im/migrants, ethnic minorities, and TB. (...) These continuities and disjunctures are analysed within their socio-historical context to demonstrate the historical contingency of epidemiological knowledge production. We outline two historical phases in knowledge construction. The first coincides with the period of decolonisation, which witnessed a change in discursive identity ascriptions from ‘immigrants’ to ‘ethnic groups’ in health reporting as the ‘other’. The second commenced after 1991, when the adoption of the census ethnicity categories as a standard in the collection of population statistics entrenched ethnicity categories in health reporting. We argue the health reporting discourse reveals that the ‘new’ public health exhibits continuities with the ‘old’ by targeting the immigrant ‘other’ through biosecuritisation practices. We contend that these categories originated within a postcolonial paradigm and that increasing immigration and new forms of mobility are creating the preconditions for new discourses on identity construction that have implications for the current collaborative TB strategy. (shrink)

AimWe aim to explore the impact of occupational stress on the quality of life of nurses in infectious disease departments and to explore the mediating role of psychological resilience on this impact.BackgroundSudden public health events and the prevalence of infectious diseases give nurses in infectious disease departments a heavy task load and high occupational stress, which can affect their quality of life, and which is closely related to the quality of clinical care they provide. There are few existing studies on (...) occupational stress, psychological resilience, and the quality of life of nurses in infectious disease departments.MethodsWe collected data from infectious-disease-specialized hospitals or infectious disease departments of general hospitals in China. In total 1,536 nurses completed questionnaires: the Effort-Reward Imbalance Questionnaire, the Connor-Davidson Resilience Scale, and the World Health Organization Quality of Life Brief Scale. We use a structural equation model to test the mediating role of the psychological resilience in the relationship between occupational stress and quality of life.ResultsAmong 1,536 participants, 88.2% experienced an effort-reward imbalance. The average scores for psychological resilience and quality of life were 56.06 and 51.80, respectively. Our results show that occupational stress is negatively correlated with psychological resilience and quality of life. In addition, we find that psychological resilience is positively correlated with quality of life and that the indirect effect of occupational stress on quality of life through psychological resilience is significant, indicating at least a partial mediating role of psychological resilience.ConclusionA high proportion of nurses in infectious disease departments felt that their jobs’ effort-reward imbalance was high. These nurses’ scores for psychological resilience were in the middle level among Chinese people generally, but their quality of life was lower than the Chinese norm. We conclude that occupational stress has an important impact on their quality of life, and psychological resilience plays a partial mediating role on this impact.Implications for Nursing ManagementHospital managers can benefit from paying attention to the occupational stress of nurses and helping to improve the quality of life of nurses by alleviating this occupational stress and improving psychological resilience. (shrink)

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument (...) in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption. (shrink)

Rare disease are those pathologies that affect a reduced proportion of the population. For this reason, the research on their causes and mechanisms, which is essential to find a way to treat or prevent them, is insufficient. This causes that the patients report a lack of coverage by the health system and the social discrimination that suffering one of these pathologies entails. Among rare diseases, we find the so-called prion diseases or transmissible spongiform encephalopathies. Although they are relatively well-known due (...) to the health crisis provoked by the “mad cow disease” at the end of the last century, there are still many uncertainties about these disorders that affect both animals and humans. This monograph aims at bringing to light the fascinating history and the diversity of prion diseases, which shook the foundations of the biology known before the 1980s by bringing out a new and puzzling type of infectious agent: prions. (shrink)

This article challenges the common tendency in modern research to treat impurity as a religious phenomenon divorced from mundane concerns. Employing the cross-cultural psychological notion of “contagion,” this investigation examines the usage of terms for pollution and purity in Hittite and Akkadian as they relate to distinct domains of human experience, specifically uncleanness, infection, and transgression. Special attention is given to the use of these terms in reference to infectious disease. This analysis demonstrates the real-world experiential basis for notions of (...) impurity and also provides a new perspective to shed light on the peculiarities of each culture. The article concludes with a detailed excursus on the etymology of Akkadian musukku and its relation to Sumerian uzug. (shrink)

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In this article, we (...) analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

The COVID-19 pandemic once again confirmed that zoonotic diseases are a serious threat to humanity. These infectious diseases, transmitted from animals to humans, have the power to cause a global health crisis. Over time the risk on these outbreaks has increased. Some of the main drivers are global population growth, urbanization, worldwide transport, increased demand for animal protein, unsustainable agriculture, and climate change. This development has fueled a renewed interest in the relation between human, animal and environmental health. This was (...) framed in the concept of One Health: the integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment. At present, One Health is the worldwide standard to combat zoonotic diseases. In an ideal world such a strategy should lead to a better health for humans, animals and our environment. However, in practice it is not self-evident that a One Health approach in zoonotic disease control is actually in the interest of animals or the environment. From a holistic One Health perspective it can be difficult to accept the culling of healthy animals to protect public health. The same goes for long term confinement of free-range poultry, whose housing systems are often not suitable for this purpose, to prevent avian influenza outbreaks. Or antimicrobial reduction policies that lead to higher disease incidence and mortality in animals. These ethical considerations formed the start of this thesis. The aim of my research is to clarify the ethical assumptions of a One Health approach in zoonotic disease control, to explore how these can be coherently understood and justified and to indicate what this implies for policymaking. The outcome of my research contributes to the development of an ethic of One Health and will hopefully lead to a more socially acceptable zoonotic disease control. This project is related to the interdisciplinary Wageningen UR strategic research theme ‘Global One Health’. From my conceptual analysis, it follows that there is no universal interpretation of the One Health concept nor of a One Health approach in zoonotic disease control. Nevertheless, One Health has produced several successes in zoonotic disease control, surveillance and research. Due to its ambiguity, the One Health concept functions as a boundary object: by leaving room for interpretation to fit different purposes it facilitates cooperation. In many cases this results in the promotion of health of humans, animals and the environment. However, there are also situations in which this mutual benefit of a One Health approach is not that evident. For instance, when healthy animals are culled to protect public health. To address these moral dilemmas, it is important to develop an ethical framework. Such an ethic of One Health starts with acknowledging the moral status of animals and the indirect moral obligations we have towards ecosystems. Furthermore, it is necessary that we find an appropriate definition of health, which encompasses all three components of One Health. In chapter 3, I present the results of an empirical study on normative presuppositions of health professionals involved in zoonotic disease control policies in the Netherlands. This study reveals that in theory these professionals adhere to a holistic view of the One Health concept. However, in practice an anthropocentric approach was dominant. The study identified public health as a trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. Furthermore, a lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle. In chapter 4, I discuss that within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. It must at least be clear that there is a harm and some scientific evidence for a cause and effect relation. Furthermore, precautionary measures should be effective, consistent, proportional and not counterproductive. An assessment of their effect should be integrated in the standard decision-models of public health authorities. Moreover, to ensure societal support these considerations should be transparent and open for dialogue. I present two possible conceptions of the precautionary principle. First, it is noticeable that because of the unpredictable nature of zoonotic diseases, public health authorities focus on the idea of ‘precaution as preparedness’. This reactive response leads to difficult trade-offs between human and animal health. I therefore argue that this policy should always be accompanied by a second policy: ‘precaution as prevention’. Addressing the underlying drivers of zoonotic diseases is a necessary condition to justify disease control measures that harm animals and ecosystems on the basis of the precautionary principle. In chapter 5, I elaborate the responsibilities of veterinarians within the One Health framework. Veterinarians are professionally responsible for the health and welfare of the animals under their care. Moreover, society expects veterinarians to safeguard food safety and public health. These societal expectations are sometimes overdemanding. A holistic perspective on One Health offers veterinarians a way out of the dichotomy between public and animal health, that is at the basis of many moral dilemmas in zoonotic disease control. This is explained with the ‘encapsulated health’ argument: the best way to safeguard human health is to promote the health of animals and the environment. In chapter 6, I conclude that before we decide to implement certain disease control measures, an ethic of One Health requires that we choose those interventions that have the least impact on the health of animals and ecosystems, while still effective enough to stop the disease. My research indicates that the contemporary conception of One Health is necessary but insufficient to address moral dilemmas related to emerging zoonotic diseases. A holistic interpretation of the One Health concept confronts us with underlying value conflicts but will ultimately promote human health more than the current anthropocentric conception. (shrink)

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth, have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their experience of (...) developing PTG.Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.Results: We found resilience to have a significant impact on PTG. Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development. (shrink)

Over 60% of all epidemics have a zoonotic origin, that is, they result from the transmission of infectious diseases from animals to humans. The spill-over of diseases often happens because humans exploit and use animals. In this article, I outline the four most common interfaces that favour the emergence and spread of zoonotic infectious diseases: wildlife hunting, small-scale farming, industrialised farming practices and live animal markets. I analyse which practices serve human food security – and thus have a non-trivial purpose (...) – and which predominantly have an economic purpose or serve as a symbol of wealth. I conclude that many practices that increase the risk for zoonotic infectious disease outbreaks actually do not contribute to the survival and food security of humans. I make two arguments in turn. First, I argue that in cases where the consumption and use of animal products does not contribute to the food security of a population, then this population has a duty to abstain from them, since they impose a grave and avoidable risk to themselves as well as to innocent third-parties. However, some communities must sometimes rely on practices that increase the risk of emergence and transmission of zoonotic infectious diseases, because they have no healthy alternatives. That is, the food security of the local population depends on the consumption and use of risky animal products. The second argument I advance is that, in such scenarios, the international community has a duty to provide the communities concerned with alternative food options, as well as economic and educational opportunities and technologies, in order to reduce the spill-over risk of infectious diseases. Given that abstention from such practices contributes signifcantly to the public good and benefits the international community, the latter has a corresponding duty to provide local communities which abandon such practices with alternatives. (shrink)

This paper explores differences in national responses to foodborne disease outbreaks, addressing both the sources of policy divergence and their implications for public health and coordinated emergency response. It presents findings from a comparative study of two multi-state E. coli outbreaks, one in the United States and one in Germany, demonstrating important differences in how risk managers understood and responded to each nation’s first major outbreak associated with fresh produce. Drawing on a qualitative analysis of 36 semi-structured interviews with key (...) stakeholders and hundreds of archival documents, this paper traces how social constructions of the E. coli risk interacted with organizational dynamics among state and industry actors to produce divergent policy outcomes: the U.S. outbreak was understood primarily as an agricultural problem that led to an industry-led agricultural solution, whereas the German outbreak was understood as a human disease problem that did not result in a substantial policy response once the acute health crisis passed. The paper concludes by discussing how these policy processes generate partial solutions to foodborne contamination that expose modern societies to systemic vulnerabilities. (shrink)

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In this article, we (...) analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

This article considers what can be learned regarding the ethical acceptability of intrusive interventions intended to halt the spread of infectious disease (‘Infection Control’ measures) from existing ethical discussion of intrusive interventions used to prevent criminal conduct (‘Crime Control’ measures). The main body of the article identifies and briefly describes six objections that have been advanced against Crime Control, and considers how these might apply to Infection Control. The final section then draws out some more general lessons from the foregoing (...) analysis for the ethical acceptability of different kinds of Infection Control. (shrink)

This paper aims to trace, through historical and medical sources, the syphilis epidemic that broke out in Naples in the late 15th century. When the disease overspread, the chronicles attributed the plague to the conquest of Naples by the king of France Charles VIII. Because of this, the disease was named morbus gallicus by the Italians and mal napolitain by the French. To dispel the fear, scape-goats were found in prostitutes, copious in Naples, and in the Jews, who had taken (...) refuge in the city after their expulsion from Spain. In conclusion, the success of the "Columbian theory" gave the ideal solution to absolve Europeans from any responsibility. Nevertheless, in the 16th century some physicians, like Falloppio, Fioravanti and Cesalpino, made singular conjectures about the Neapolitan origin of siphylis. (shrink)

Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service of USDA and the National Notifiable Disease Surveillance System of the U.S. Centers for Disease Control (...) and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats. (shrink)

This is an introduction to the topical collection Microbes, Networks, Knowledge: Disease Ecology in the twentieth Century, based on a workshop held at Queen Mary, University London on July 6–7 2016. More than twenty years ago, historian of science and medicine Andrew Mendelsohn asked, “Where did the modern, ecological understanding of epidemic disease come from?” Moving beyond Mendelsohn’s answer, this collection of new essays considers the global history of disease ecology in the past century and shows how epidemics and pandemics (...) have made “microbes complex”. (shrink)

This paper explains how discrimination and COVID-19 related stigmas are intertwined. When people stigmatize COVID-19 victims, they act in ways for which the victims suffer status loss and discrimination. As a result, they do not enjoy participatory parity in various aspects of their life making COVID-19 related stigmatization a deplorable instance of discrimination. But a society already fraught with discrimination is a breeding ground of stigmatization often because of people’s fear and anxiety about their life once they become a patient (...) of a disease like COVID-19. (shrink)

Controlled human infection (CHI) studies involve the deliberate exposure of healthy research participants to infectious agents to study early disease processes and evaluate interventions under controlled conditions with high efficiency. Although CHI studies expose participants to the risk of infection, they are designed to offer investigators unique advantages for studying the pathogenesis of infectious diseases and testing potential vaccines or treatments in humans. One of the central challenges facing investigators involves the fair selection of research subjects to participate in CHI (...) studies. While there is widespread agreement that investigators have a duty to select research participants fairly, this principle also yields conflicting ethical imperatives, for example requiring investigators to both exclude potential participants with co‐morbidities since they face increased risks, but also to include them in order to ensure generalizability. In this paper we defend an account of fair subject selection that is tailored to the context of CHI studies. We identify the considerations of fairness that bear directly on selecting participants for CHI studies and provide investigators and members of IRBs and RECs with a principled way to navigate the conflicting imperatives to which these considerations give rise. (shrink)

In this review study, I reflect on Richard Horton’s book and his thesis that Western countries failed in their response to the current epidemic in the first half of 2020, with a few exceptions. In the five sections of the paper, after an initial modification of Horton’s thesis (A), I discuss briefly: the suppression approach in China (B), the mitigation approach in the West (C), the SARS epidemic as the key global public health event (D), the causes of Western failure (...) (epistemic, political, ethical, cultural, etc.) (E), and final envoi (F). (shrink)

Fear, anger and hopelessness were the most frequent traumatic emotional responses in the general public during the first stage of outbreak of the COVID-19 epidemic in the Czech Republic (N = 1,000). The four most frequent categories of fear were determined: (a) fear of the negative impact on household finances, (b) fear of the negative impact on the household finances of significant others, (c) fear of the unavailability of health care, and (d) fear of an insufficient food supply. The pessimistic (...) communications used by the Czech mass media contributed to intensifying traumatic feelings, fears and psychological distress in the general public during the outbreak of the COVID-19 epidemic. The anxious emotional tone of the messages and the presentation of selectively chosen “bad ending stories” contributed to the psychological traumatization of the Czech population. This form of communication was motivated by an effort to reach the broadest audience possible. Older adults were the most affected part of the population because of their isolation and their very limited opportunity to share their worries and emotions with others. The communication used by the Czech mass media during the outbreak of the COVID-19 epidemic is a representative example of a traumatizing form of media communication during an epidemic. (shrink)

Diphtheria is an acute toxin-mediated superficial infection of the respiratory tract or skin caused by the aerobic gram-positive bacillus Corynebacterium diphtheriae. The epidemiology of infection and clinical manifestations of the disease vary in different parts of the world. Historical accounts of diphtheria epidemics have been described in many parts of the world since antiquity. Developed in the late 19th century, the diphtheria antitoxin played a pivotal role in the history of public health and vaccinology prior to the advent of the (...) diphtheria-tetanus toxoids and acellular pertussis vaccine. One of the most significant demonstrations of the importance of DAT was its use in the 1925 diphtheria epidemic of Nome, Alaska. Coordinated emergency delivery of this life-saving antitoxin by dog-sled relay in the harshest of conditions has left a profound legacy in the annals of vaccinology and public health. Lead dogs Balto and Togo, and the dog-led antitoxin run of 1925 represent a dynamic illustration of the contribution made by non-human species towards mass immunization in the history of vaccinology. This unique example of cooperative interspecies fellowship and collaboration highlights the importance of the human-animal bond in the one-health initiative. (shrink)

Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética Tuberculose na América Latina e no Caribe: reflexões da bioética The objective of this article is to analyze the conditions of access to health services by people with tuberculosis in Latin America and the Caribbean, reflecting on the public health aspects involved from a bioethical perspective. A literature review of the context of tuberculosis in LAC based on epidemiological data was performed. The results were analyzed from its relationship with (...) the social determinants of health and the ethical principles that guide medical practice. Tuberculosis is a pressing public health problem in the region because of its family, social, economic and health impact. It mainly affects vulnerable individuals and populations. Health services violate ethical principles. Tuberculosis is a serious ethics and public health problem in the region that causes death, disability and increased poverty. It is imperative to ensure the right to health services and to understand the individual and public health consequences of non-adherence to treatment. It is important that national tuberculosis control strategies include principles of dignity and non-discrimination of the sick, changes in the social determinants of the disease, and respect for the ethnicity, language culture and identity of patients. Para citar este artículo / To reference this article / Para citar este artigo Muñoz del Carpio-Toia A, Sánchez-Pérez HJ, Verges de López C, López-Dávila LM, Sotomayor-Saavedra MA, Sorokin P. Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética. pers. bioét. 2018; 22: 331-357. DOI: 10.5294/pebi.2018.22.2.10. (shrink)

This article addresses an important, overlooked regulatory challenge during global health emergencies. It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively capturing (...) these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines—which draw upon practical examples of guidelines ‘in action’—that assist in determining how to act in a particular situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples—which incorporate important lessons learned—illustrate how such guidelines can be interpreted at a practical level. (shrink)

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in (...) the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)