Epidemic outbreaks such as Ebola, dengue, Zika, measles, and influenza have all made international headlines within the last few years. Data suggest that epidemics are increasing in frequency largely as a result of global interconnectedness, which allows viruses to travel from one region to another in just a few hours.1 Because epidemics are extremely complex, they require coordinated responses across many disciplines. Not only biology and medicine but also anthropology and sectors such as international relations and defense are needed to understand and treat these diseases. It is no surprise that, no matter where one lives, epidemics matter or at least should be of concern. In 2014, an Ebola outbreak in West Africa quickly crossed into the United States and Europe,2 and global spread of influenza occurs annually. Navigating ethical dilemmas raised during epidemics is central to good decision making and managing responses effectively, so this issue of the AMA Journal of Ethics considers them from a variety of disciplinary perspectives.
There are several sets of ethical questions. Since a goal of epidemic response is to contain disease while minimizing harm, one set of ethical questions explored in this theme issue considers whether and when violating individual freedoms is ethically justifiable to motivate safety for a majority. Another set of questions considers the nature and scope of response teams’ obligations to ensure that iatrogenic consequences of response strategies are addressed. Roles of political borders in epidemic responses are also interrogated in this issue. For example, whether, when, and how international experts should cross borders can be informed by colonial legacies, influence locals’ trust in public health efforts, and undermine containment efforts in some regions. As a global governing body and a leader in pandemic responses, the World Health Organization and its policies, practices, and publications can guide day-to-day operations during epidemics, including in the ongoing (from 2018) Ebola outbreak in the Democratic Republic of the Congo (DRC). Decisions about which criteria should be used to consider when it is just to use experimental vaccines and how to prioritize limited resource expenditures are also critical. Questions related to communication and how information is transmitted when members of a community are at risk are also considered in this issue, as are roles of international journalists when offering the world accurate stories of what happens and when.
Leading experts in global health, anthropology, international security, infectious disease, journalism, and law contribute to this collection of articles exploring the complex intersections of ethics and epidemic response strategy. In doing so, these authors pursue a better understanding of what constitutes good micro-level and macro-level decision making during global health crises.
Madhav N, Oppenheim B, Gallivan M, Mulembakani P, Rubin E, Wolfe N. Pandemics: risks, impacts, and mitigation. In: Jamison DT, Gelband H, Horton S, et al, eds. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. Washington, DC: International Bank for Reconstruction and Development; World Bank; 2017:315-346.
- Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016;374(7):636-646.