Ebola, ethics, and the question of culture

Ebola, quarantine, and the need for a new ethical framework

Quarantine is a broad public health strategy used to control infectious diseases outbreaks. An arguably most aggressive public health intervention, quarantine limits the asymptomatic individuals’ liberty and can result in significant harm. Quarantine was used in an attempt to control several Ebola outbreaks during the Ebola epidemic in West Africa in 2014. The most concerning quarantine intervention occurred at West Point, a slum of 75,000 people in the capital Liberian capital, Monrovia. This work critically reviews present ethical frameworks in public health for the examination of outbreaks in West Africa. This work utilizes the nine public health ethical principles described by Kerridge, Lowe and Stewart to argue that the quarantine at West Point was not ethically justified; and, it concludes that a new ethical framework for quarantine is required to address future outbreaks in the West African context.

The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak

The 2013-2016 West Africa Ebola virus disease pandemic was the largest, longest, deadliest, and most geographically expansive outbreak in the 40-year interval since Ebola was first identified. Fear-related behaviors played an important role in shaping the outbreak. Fear-related behaviors are defined as "individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. FRBs modify the future risk of harm." This review examines how fear-related behaviors were implicated in (1) accelerating the spread of Ebola, (2) impeding the utilization of life-saving Ebola treatment, (3) curtailing the availability of medical services for treatable conditions, (4) increasing the risks for new-onset psychological distress and psychiatric disorders, and (5) amplifying the downstream cascades of social problems. Fear-related behaviors are identified for each of these outcomes. Particularly notable are behaviors such as treating Ebola patients in home or private clinic settings, the "laying of hands" on Ebola-infected individuals to perform faith-based healing, observing hands-on funeral and burial customs, foregoing available life-saving treatment, and stigmatizing Ebola survivors and health professionals. Future directions include modeling the onset, operation, and perpetuation of fear-related behaviors and devising strategies to redirect behavioral responses to mass threats in a manner that reduces risks and promotes resilience.

Bioethics meets Ebola: exploring the moral landscape

INTRODUCTION

The Ebola Virus Disease (EVD) outbreak in West Africa raised ethical issues about structural disadvantage; the duty to care of healthcare workers; the use and study of unregistered agents; the use of restrictive measures like mass quarantine and the importance of public trust.

SOURCES OF DATA

WHO reports, literature on EVD and ethics.

AREAS OF AGREEMENT

The use of restrictive measures and the testing of unregistered agents is ethical if support for individuals or communities is provided.

AREAS OF CONTROVERSY

Controversy exists over ethical trial design for the study of unregistered agents and over the limits of the duty to care.

GROWING POINTS

The role of the WHO in outbreak control and research oversight needs rethinking and further support. Solidarity in global health needs fostering.

AREAS TIMELY FOR DEVELOPING RESEARCH

Research is needed on how to restore and enhance health systems and public trust in EVD-affected countries.

The Ebola Outbreak of 2014-2015: From Coordinated Multilateral Action to Effective Disease Containment, Vaccine Development, and Beyond

The Ebola outbreak of 2014-2015 exacted a terrible toll on major countries of West Africa. Latest estimates from the World Health Organization indicate that over 11,000 lives were lost to the deadly virus since the first documented case was officially recorded. However, significant progress in the fight against Ebola was made thanks to a combination of globally-supported containment efforts, dissemination of key information to the public, the use of modern information technology resources to better track the spread of the outbreak, as well as more effective use of active surveillance, targeted travel restrictions, and quarantine procedures. This article will outline the progress made by the global public health community toward containing and eventually extinguishing this latest outbreak of Ebola. Economic consequences of the outbreak will be discussed. The authors will emphasize policies and procedures thought to be effective in containing the outbreak. In addition, we will outline selected episodes that threatened inter-continental spread of the disease. The emerging topic of post-Ebola syndrome will also be presented. Finally, we will touch on some of the diagnostic (e.g., point-of-care [POC] testing) and therapeutic (e.g., new vaccines and pharmaceuticals) developments in the fight against Ebola, and how these developments may help the global public health community fight future epidemics.