Faculty of Arts and Science, Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada
Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
BMJ Glob Health. 2022 Mar;7(3). doi: 10.1136/bmjgh-2021-007873.
In January 2021, Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, warned that the world was 'on the brink of a catastrophic moral failure [that] will be paid with lives and livelihoods in the world's poorest countries'. We are now past the brink. Many high-income countries have vaccinated their populations (which, in some cases, includes third and even fourth doses) and are loosening public health and social measures, while low-income and middle-income countries are struggling to secure enough supply of vaccines to administer first doses. While injustices abound in the deployment and allocation of COVID-19 vaccines, therapies and diagnostics, an area that has hitherto received inadequate ethical scrutiny concerns the upstream structures and mechanisms that govern and facilitate the research and development (R&D) associated with these novel therapies, vaccines and diagnostics. Much can be learnt by looking to past experiences with the rapid deployment of R&D in the context of public health emergencies. Yet, much of the 'learning' from past epidemics and outbreaks has largely focused on technical or technological innovations and overlooked the essential role of important normative developments; namely, the importance of fostering multiple levels of trust, strong and fair governance, and broad research collaborations. In this paper, we argue that normative lessons pertaining to the conduct of R&D during the 2014-2016 Ebola epidemic in West Africa provide important insights for how R&D ought to proceed to combat the current COVID-19 pandemic and future infectious disease threats.
2021 年 1 月,世卫组织总干事谭德塞博士警告说,世界正处于“灾难性道德失败的边缘[,]这将以世界上最贫穷国家的生命和生计为代价”。我们现在已经越过了边缘。许多高收入国家已经为其民众接种了疫苗(在某些情况下,包括第三针甚至第四针),并放宽了公共卫生和社会措施,而低收入和中等收入国家则难以确保获得足够的疫苗供应来接种第一针。虽然在 COVID-19 疫苗、疗法和诊断方法的部署和分配方面存在诸多不公,但迄今为止,人们对一个关注甚少的领域进行了伦理审查,即与这些新型疗法、疫苗和诊断方法相关的研究和开发(R&D)的上游结构和机制。在公共卫生紧急情况下,回顾过去在 R&D 方面的快速部署经验,可以学到很多东西。然而,从过去的流行病和疫情中“吸取”的教训在很大程度上集中在技术或技术创新上,而忽视了重要规范发展的重要作用;即,培养多层次信任、强大和公平的治理以及广泛的研究合作的重要性。在本文中,我们认为,与 2014-2016 年西非埃博拉疫情期间的 R&D 行为相关的规范经验教训,为如何开展 R&D 以应对当前的 COVID-19 大流行和未来的传染病威胁提供了重要的见解。