Learning Objective 6.4 - Global Health Training Centre
Download
Report
Transcript Learning Objective 6.4 - Global Health Training Centre
WHO Training Manual
Ethics in epidemics, emergencies and disasters:
Research, surveillance and patient care
Learning Objective 6.4
Identify issues of equity of access to
unproven treatments during research in
the course of emergency response
Outline
1. Introduction
2. Case study – filovirus hemorrhagic fever
3. Debate
4. Conclusion
L.O. 6.4
Time
(minutes)
0-15
(15 min)
16-30
(15 min)
31-45
(15 min)
46-60
(15 min)
Activity
Introduction
Reading
Debate
Summary
and
conclusion
What Resources Might Be Limited in a Public Health Emergency?
Vaccines
Medications to treat infected persons
Life-sustaining medical technologies, such as ventilators
Hospital beds, particularly in intensive care
Laboratory capacity for diagnostic tests
Access to medical specialists
Infection control equipment
L.O. 6.4
Novel treatments in emergencies
May develop novel treatments/vaccines in public
health emergencies, especially where epidemic is
sporadic
Benefit sharing normally requires that portion of
benefit derived from collected data be returned to
those whose data were used
But in emergencies, benefits may not be so
straightforward to distribute
L.O. 6.4
Situations of limited access to novel agents
Physicians using professional privilege and acting as
gatekeepers
Some patients unable/unwilling to enrol in research in
spite of feeling they have a legitimate claim to the
novel agent under investigation
Physical bottlenecks e.g. limited manufacturing
capacity
Novel treatments not yet broadly accessible but at
least relatively efficacious
L.O. 6.4
Avenues to increase accessibility
Decrease regulatory restrictions
Use alternative research designs
Multiple the ‘treatments’ under investigation
Appeal to compassionate use
Eliminate physical bottlenecks
Determine minimal dose
Appeal to the Rule of Rescue
L.O. 6.4
Equity considerations
Access limited to enrolled participants
Risk bearing
Conflicts of interest
L.O. 6.4
Case study
Outbreaks of filovirus hemorrhagic fevers in central
and west Africa
Tuffs A. (2009). Trial vaccine may have saved
Hamburg scientist from Ebola fever. British Medical
Journal, 388, b1223
L.O. 6.4
Case study small group discussions
On what moral grounds was the Hamburg scientist offered
investigative treatment? Is this a case of compassionate use?
Could ‘humanitarian’ reasons be put forward to justify the efforts of
shipping the post-exposure vaccine from Canada? If yes, could
reciprocity be one moral criterion (“The scientist made the sacrifice to
risk her life by choosing to research on a highly lethal agent. In return,
the community should make all effort to save her life in case of
accidental exposure”)
When local health workers are exposed to needle stick injuries in the
course of an Ebola outbreak in Africa, should they be given the same
opportunities of a potentially life-saving treatment? Do the same moral
grounds apply (e.g., “Are they any less or more worthy of
reciprocity?”)?
L.O. 6.4
Case study small group discussions
If the investigative treatment is made available during and
outbreak, should its use be restricted to the boundaries of
a defined clinical trial? Or on compassionate grounds, like
in the case of the Hamburg scientist?
If a trial is the only acceptable solution, what should be the
design of the trial? For example: consecutive series with
historical comparisons, placebo controlled trial?
Ultimately, who are the main or intended beneficiaries of
research on treatment for filovirus infection?
L.O. 6.4
Summary
Alternative research designs may offer ways to deal
with equity of access to novel drugs in epidemics and
disasters
May be technical or moral concerns with these
alternative designs e.g. informed consent where have
lack of knowledge regarding risks of novel agent
Must consider who will be the intended beneficiaries
of research
L.O. 6.4
Sources
Tuffs A. (2009). Trial vaccine may have saved
Hamburg scientist from Ebola fever. British Medical
Journal, 388, b1223
L.O. 6.4
Acknowledgements
Chapter authors
Calain, Philippe, Médecins Sans Frontières, Geneva,
Switzerland
Boulanger, Renaud F., Faculty of Medicine, McGill
University, Montréal, Québec, Canada
L.O. 6.4