Ebola, an (Un)ethical Crisis

by Brandon Brown, MPH, PhD, Assistant Professor and Director of the Global Health Research, Education, and Translation (GHREAT) Initiative, University of California-Irvine Program in Public Health

So far, the current Ebola epidemic has resulted in more than 9,000 cases and 4,500 related deaths in affected West African countries, with additional cases now in the United States and Europe. As we learn more, the Centers for Disease Control and Prevention is updating its website with new information, and we find ourselves inundated with reports from every major news channel, on the internet, and in our favorite print publications. Ebola is an obvious priority in the US, as signaled by the recent appointment of an “Ebola czar” to guide us in our preparations and response to the epidemic.

Still, there are several outstanding ethical questions that have arisen as a result of the Ebola outbreak:

    1. Why did it take so long for the US to respond to the West African epidemic, and are we ethically obligated to provide assistance? What are our obligations to strengthen the health infrastructure in West Africa and help ensure that it’s prepared for future threats?
    2. How do we ensure that fast-tracked trials meet minimum ethical standards and that resulting vaccines are safe and effective? How do we determine who should be prioritized to receive the resulting vaccines?
    3. What do we go about the other epidemics still ravaging the affected countries? Will it be one step forward in preventing Ebola, but one step back for the big three: HIV, tuberculosis, and malaria? Should Ebola be the economic priority at this time?
    4. What happens to the 9,000 non-American, infected individuals who don’t have the luxury of being evacuated from affected countries in hopes of adequate treatment and care? 

Some of these issues were eloquently asked in a recent article in the Annals of Internal Medicine. One key in addressing these concerns and reversing the epidemic may be education about the virus. Lack of understanding about how Ebola is spread can result in fear and stigma, especially with a virus that is as virulent as Ebola, and a screening process that can take five days or more. Perhaps new rapid testing technology in development can help with this.

And what about the ethical issues in the United States? With news of the first case of transmission in the US and reports of lax guidelines for the prevention of transmission, hospital preparation and training seem to be at the top of the domestic priority list. For instance, the recent arrival of a New York doctor who treated Ebola patients in Guinea resulted in rules for automatic quarantine for doctors working with Ebola patients abroad. We are still learning, however, how to prevent Ebola transmission as time goes on, and US health care workers may be at the biggest risk of infection. We have an ethical imperative to protect them. Until recently there were no guidelines on how to use personal protective equipment in a robust and effective manner. Before the first US case, nurses in Nevada sensed this vulnerability and staged a “die in” on September 24, to gain attention and support for Ebola preparation. Another question on the radar is whether to ban flights from other Ebola affected countries to prevent a domestic outbreak.

Many of these outstanding questions will be discussed at the 2014 Advancing Ethical Research (AER) Conference during a session titled “Ethics During the Time of Ebola,” which will be held on December 6 from 11:15 AM to 12:30 PM. Nancy E. Kass, ScD, Bavon Mupenda, MPH, Aminu A. Yakubu, and I will explore the ethical concerns related to the Ebola epidemic in West Africa and the United States, including the issues faced by health care workers; concerns related to the use of vaccines and experimental drugs during the Ebola outbreak including black market treatments; the potential effect of misunderstandings and stigma about Ebola; and questions related to quarantine rules and resource allocation. I hope that you will consider joining us as we examine the ethical landscape of the current epidemic.

To learn more about the 2014 AER Conference or to register, please visit our website