“Guidance for managing ethical issues in infectious disease outbreaks” [OMS, 2016]

World Health Organization 2016
“Infectious disease outbreaks are periods of great uncertainty. Events unfold, resources and capacities that are often limited are stretched yet further, and decisions for a public health response must be made quickly, even though the evidence for decision-making may be scant. In such a situation, public health officials, policy-makers, funders, researchers, field epidemiologists, first responders, national ethics boards, health-care workers, and public health practitioners need a moral compass to guide them in their decision-making. Bioethics puts people at the heart of the problem, emphasizes the principles that should guide health systems, and provides the moral rationale for making choices, particularly in a crisis.”
“This guidance grew out of concern at the World Health Organization (WHO) about ethical issues raised by the Ebola outbreak in West Africa in 2014–2016. The WHO Global Health Ethics Unit’s response to Ebola began in August 2014, immediately after it was declared a “public health emergency of international concern” pursuant to the International Health Regulations (2005). That declaration led to the formation of an Ethics Panel, and later an Ethics Working Group, which was charged with developing ethics guidance on issues and concerns as they arose in the course of the epidemic. It became increasingly apparent that the ethical issues raised by Ebola mirrored concerns that had arisen in other global infectious disease outbreaks, including severe acute respiratory syndrome (SARS), pandemic influenza, and multidrug-resistant tuberculosis. However, while WHO has issued ethical guidance on some of these outbreaks, prior guidance has only focused on the specific pathogen in isolation. The purpose of this document is to look beyond issues specific to particular epidemic pathogens and instead focus on the cross-cutting ethical

issues that apply to infectious disease outbreaks generally. In addition to setting forth general principles, it examines how these principles can be adapted to different epidemiological and social circumstances.”
Relevant ethical principles
Ethics involves judgements about “the way we ought to live our lives, including our actions, intentions, and our habitual behaviour.” The process of ethical analysis involves identifying relevant principles, applying them to a particular situation, and making judgements about how to weigh competing principles when it is not possible to satisfy them all. This guidance document draws on a variety of ethical principles, which are grouped below into seven general categories. These categories are presented merely for the convenience of the reader; other ways of grouping them are equally legitimate.”

Respect for persons

Table of Contents

1. Obligations of governments and the international community

2. Involving the local community

3. Situations of particular vulnerability
4. Allocating scarce resources

5. Public health surveillance

6. Restrictions on freedom of movement

7. Obligations related to medical interventions for the diagnosis, treatment, and prevention of infectious disease

8. Research during infectious disease outbreaks

9. Emergency use of unproven interventions outside of research

10. Rapid data sharing
11. Long-term storage of biological specimens collected during infectious disease outbreaks

12. Addressing sex- and gender-based differences

13. Frontline response workers’ rights and obligations

14. Ethical issues in deploying foreign humanitarian aid workers