Dr Abha Saxena Coordinator Global Health Ethics Epidemic Preparedness Planning Priority setting Rationing Triage Stockpiling and creating reserves of treatment schedules Putting in place protective measures isolation and social distancing ID: 736949
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Ethical guidance for the public health response to epidemics
Dr. Abha SaxenaCoordinator, Global Health EthicsSlide2
Epidemic Preparedness Planning
Priority settingRationingTriageStockpiling and creating reserves of treatment schedulesPutting in place protective measures, isolation, and social distancing
Identifying research priorities, and conducting relevant research Slide3
Why EthicsHigh uncontrolled morbidity and /or mortality Scarcity of resources in many areas (manpower, logistics, financial, drugs and vaccines etc. )
Need to take immediate decisions on the basis of incomplete information of uncertain validity.Policy makers and those who make decisions at various levels need a moral compass to make those decisions.Slide4
Ebola epidemic
Ebola epidemic saw the development of ethics guidance in several areas as the need arose ….
Clinical trial design, convalescent plasma therapy, inclusion of pregnant women in research etc.
- Ebola ethics working group Slide5
Issues related to research
An epidemic outbreak may be the only opportunity to conduct studies capable of answering scientific questions important to future outbreak response efforts. Challenges to conducting such studies include the danger of interfering with efforts to control the immediate crisis; the time needed to undertake clinical trials; infrastructure needs; ethical issues and cultural challenges; legal, policy, and financial challenges of public-private partnerships; regulatory compliance issues; and cost.
And most of all the issue of Trust - Are societies willing to accept the burdens associated with placebo control designs?Slide6
Problem Statement
Despite the existence of important ethics guidance in related to specific diseases (including pandemic influenza, TB, and HIV), comprehensive international/global public health ethics
guidance related to epidemic outbreaks is lacking. Slide7
Meeting in Dublin
Do we need more guidance documents or rather a better integration and translation of ethical considerations into policy and practice? How do we ensure that ethical considerations get valued in same manner as technical considerations? Slide8
Process
Synthesis of 24 existing guidance documents on ethical issues in epidemic responsesWHO documents, English-language guidance from official governmental bodies, and selected guidance or position papers from professional associations, advisory commissions, and academics.
3 - general issues,
8 - Ebola,
12 - pandemic influenza, and
1 - tuberculosis.Slide9
Meeting in Dublin
Thirteen thematic issues
Issues addressed at a high level of generality
No clear guidance on how to implement in concrete situations
When are mandatory restrictions the “least restrictive alternative”?
When is it appropriate to collect biological specimens without obtaining informed consent?
When is it appropriate – or not appropriate – to direct scarce resources to vulnerable populations when doing so will result in the faster depletion of those resources?
Lack of consensus on few specific issues
Guidance in some areas is lackingSlide10
Translation of guidance
Public health practitioners and policy makers find it difficult to translate normative guidance into action, and that further efforts are needed to help bridge this gap
We need to learn from the translation of clinical guidelines Slide11
Moving forwards……
Rather than producing another statement of general principles, develop an implementation guide with concrete case examples of how the principles were applied in specific situationsSimilar to how the “common law” is developed by the continual application of broad principles to specific situationsSlide12
Relevant streams
Governance International - global health treaty?National – effective mechanisms for coordinationTrust
Community Engagement – for
implemetnation
of
programmes
and for priority setting etc.
Lack of capacities
Link
to IHR?Slide13
Typology of epidemicsSlide14
Ongoing work….
Review of guidance documentsReview of literature – identify gaps…
.
Develop new guidance
Liaise with IHR
Identify case studies, develop checklist
Normative and operational guidanceSlide15
Next Steps
Prato, Italy - 22 – 24 November, 2015 - Ethicists, public health experts, policy makers, epidemiologists, country response team members, social scientists.
Draft guidance document and operational component
Wide peer review
Finalize document