Carnival is Over

Henk ten Have, author of Global Bioethics: An Introduction tackles a tough question regarding what to do about infectious diseases.

In the 1967, the U.S. Surgeon General declared that it is time to close the book on infectious diseases. Children can be vaccinated against deadly infections. We need no longer be afraid of bacteria and viruses now that effective medication such as antibiotics is available. Let us worry about chronic illnesses, organ transplantations, and intensive care. These medical interventions raise many ethical questions about benefit and harm. Are they really for the good of patients, or do we better decide not to intervene?

Today, infectious diseases are on top of the public agenda. Following the Ebola scare of last year, we now face a growing Zika panic. This tropical virus, transmitted by mosquitos, is rapidly spreading through the Americas and starting to spread in Europe. It is not a new virus. Named after the Zika forest in Uganda where it was first identified in 1947, it turned up in Indonesia in 1978, caused a small epidemic in French Polynesia in 2013, than hit Latin America since May 2015, and in particular Brazil. Millions of people are now infected. Perhaps the World Cup in Summer 2014 helped to spread it.

For most people the disease is like a simple flu. However, the virus is obscure. There is not much knowledge. Vaccines, treatment and diagnostic tests fo not exist. But it is associated with usually rare conditions that now have become more frequent, such as shrunken brains of newborns. It is evident that the disease will have wide impact. People are advised not to travel to a growing number of countries. It seems that there is no way to stop the disease, not even with the military. The main question is what can we do and should we do?

This is not a technical question but an ethical one. We are confronted with a similar story over the past two years in connection to the Ebola epidemic in West Africa, highlighting mismanagement and lack of solidarity. Few people were interested until there was a global threat to developed countries. Zika as well as Ebola illustrate that debates and policies should be global with pertinent ethical challenges. Why are there no vaccines and treatments? This is not accidental. There simply has been no interest to address ‘tropical’ diseases. They are commercially not attractive. There are no incentives to produce vaccines since poor people are generally affected and strong governments lacking. An adequate public health infrastructure is absent; it has been dismantled through decades of neoliberal policies and privatization of healthcare, especially in developing countries. Past global policies have weakened health systems across the world.

Now that ‘tropical’ diseases have become global diseases, it is also clear that stronger global coordination is needed. No country alone can influence this pandemic. Even conglomerates of expertise such as the Centers for Disease Control (CDC) in the U.S. cannot coordinate a world response. The World Health Organization (WHO) is the only global body being able to do that. But as the Ebola epidemic illustrated, countries are keen to criticize and disable WHO, cutting down its budget and laying off experts. They care more to protect their vulnerability than showing global solidarity. WHO has now convened an emergency meeting of experts to develop a global response.

But even if effective global governance will be applied this time, there is no magic solution. What should concern us is not only the disease itself but the people who are ill. Health is negatively related to poverty and ecological degradation. Social, economic, and political conditions make people vulnerable. Tom Frieden, Director of CDC, recently called it a shame that tuberculosis is the number 1 killer in the world. It kills 1,5 million people each year while it is almost completely curable. Zika therefore is not a reason for panic. It is a serious motive to rethink how global health can be improved. That will require new and broader approaches to health and health ethics, creating a new alliance between health, economic, environmental and social policies. Most of all, an ethical framework is needed that values common interests more than private or national ones. This is the main purpose of my new book Global Bioethics: An Introduction.

Going to the Carnival in Rio next week?

  • Global Bioethics

    An introduction

    By Henk ten Have

    The panorama of bioethical problems is different today. Patients travel to Thailand for fast surgery; commercial surrogate mothers in India deliver babies to parents in rich countries; organs, body parts and tissues are trafficked from East to Western Europe; physicians and nurses migrating from…

    Paperback – 2016-02-09