Contemporary Understanding of Ebola and Zika Virus in Pregnancy

Scarcity of research on breastfeeding and Ebola diseases is placing the lives of women and infants at risk: a call to specific action

Ebola virus outbreaks causing viral haemorrhagic fever occur predominantly in regions with high fertility, where breastfeeding is the only safe infant feeding option. Yet, there is a dearth of evidence to inform recommendations and decision making for breastfeeding mothers. Specific gaps in knowledge include whether or for how long replicable virus is present in breastmilk, whether mother-to-infant viral transmission can occur through breastmilk, and whether the interruption of breastfeeding would be beneficial if both mother and infant are infected. Furthermore, despite vaccine availability, there is no evidence regarding safety in mother-infant pairs. This inadequacy of evidence is long recognised, but a pathway to necessary knowledge has not previously been outlined. This Health Policy summarises existing data and delineates research priorities and methods to provide a research roadmap to protect breastfeeding women and their infants through research, rather than systematically excluding them, with the desire to protect them from theoretical risks of research in the context of Ebola.

Twice neglected? Neglected diseases in neglected populations

It is unfortunately true that clinicians lack the necessary evidence to know how to use medications properly in large sections of the population and do not have optimal treatments to use for many neglected tropical diseases (NTDs). NTDs often disproportionately affect neglected populations that are left out of research efforts, such as children and pregnant women. As reliable access to safe, effective preventives and treatments can break the cycle of poverty, illness, and ensuing debility that further perpetuates poverty, it is of paramount importance to investigate and develop new medicines for neglected populations suffering from NTDs. Furthermore, there is not only a need to develop and evaluate novel therapies, but also to ensure that these are affordable, available, and adapted to the communities who need them. The NIH has proposed a "4 C's" framework which is relevant for neglected diseases and populations and should be leveraged for the study of the Twice Neglected: Consider inclusion; Collect data from neglected populations with neglected conditions; Characterize differences through meaningful analysis; Communicate findings pertaining to neglected diseases and populations. With this editorial, the British Journal of Clinical Pharmacology hereby launches a call for high-quality articles focusing on NTDs in special populations, to facilitate and encourage the reversal of this dual neglect.

Ethical issues in therapeutic use and research in pregnant and breastfeeding women

Pregnant or potentially pregnant women have historically been excluded from clinical trials of new medications. However, it is increasingly recognised that it is imperative to generate evidence from the population in whom the drugs are likely to be used to inform safe, evidence-based shared clinical decision making. Reluctance by researchers and regulators to perform such studies often relates to concerns about risk, particularly to the foetus. However, this must be offset against the risk of untreated disease or using a drug in pregnancy where safety, efficacy and dosing information are not known. This review summarises the historical perspective, and the ethical and legal frameworks that inform the conduct of such research, then highlights examples of innovative practice that have enabled high quality, ethical research to proceed to inform the evidence-based use of medication in pregnancy.