Global health ethics

Ethical questions related to health, health care, and public health cover topics as diverse as moral issues around reproduction, state obligations in the provision of health care services, and appropriate measures to control infectious disease. Scholars and health care professionals have debated ethical questions related to health and health care since the earliest days of medicine. Recent formal efforts to articulate international standards of ethics applicable to health and health care can be traced to the Nuremberg trials of 1947, during which the horrors of Nazi medical experiments came to light.

The principles that emerged from those trials, known as the Nuremberg Code, are broadly applicable to many types of health-related research involving human participants, including clinical trials. The growing breadth and complexity of contemporary health challenges have produced a range of difficult questions that cannot always be adequately addressed by relying exclusively on existing policies, guidelines or codes of conduct. Debates over access to new and expensive pharmaceuticals and medical technologies, as well as increasing awareness of the gross health disparities that exist both within and between countries, have called attention to the need for an ethics of health policy and practice.

Research ethics govern the standards of conduct for scientific researchers. It is important to adhere to ethical principles in order to protect the dignity, rights and welfare of research participants.

The WHO Manual (Section XV.2) defines research with human subjects as 'any social science, biomedical, behavioural, or epidemiological activity that entails systematic collection or analysis of data with the intent to generate new knowledge, in which human beings:

• are exposed to manipulation, intervention, observation, or other interaction with investigators either directly or through alteration of their environment; or
• become individually identifiable through investigator's collection, preparation, or use of biological material or medical or other records.

• Immunization raises a host of challenging ethical questions that researchers, governments, funders, pharmaceutical companies, and communities must confront.
• TB: Ethical issues include questions about the equitable distribution of resources, protection of vulnerable groups, respect for patient choice of treatment options and solidarity between communities during outbreaks.
• Zika has raised many specific ethical issues, in particular regarding pregnancy. At the same time, it has highlighted ethical issues that arise in vector-borne diseases more generally.
• The HIV epidemic has raised many ethical challenges for public health officials, researchers and clinicians, reaching from macro-level policy to micro-level clinical decisions.