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Ebola: what it teaches us about medical ethics. A response to Angus Dawson
  1. Bridget G Haire1,
  2. Morenike O Folayan2,3
  1. 1Kirby Institute for Infection and Immunity in Society, University of NSW Australia, Sydney, New South Wales, Australia
  2. 2Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
  3. 3New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria
  1. Correspondence to Dr Bridget G Haire, Kirby Institute for Infection and Immunity in Society, University of NSW Australia, Sydney, NSW 2052, Australia; b.haire{at}unsw.edu.au

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In his recent Viewpoint, Angus Dawson has argued that ‘good medical ethics’ needs to pay more attention to societal, population and community values and perspectives,1 and that the recent international response to the Ebola outbreak in West Africa has been characterised by an unhelpful emphasis on individualistic values. While we agree with Dawson that the Ebola crisis in West Africa is indeed a symptom of a collective moral failure to address global injustice, we refute his claim that ‘individual values’—as exemplified by access to treatment, whether proven or experimental—can or should be separated from public health ethics. We contend that community support for and compliance with public health containment measures requires some measure of reciprocity in the form of decent standards of care for those infected with Ebola.

While the current outbreak is now in decline, initially the health systems in the affected countries were overwhelmed and were unable to contain the epidemic more than 12 months after the first case. This reflects the inadequacy of the public health infrastructure in these countries, including the low capacity for surveillance, security and quarantine of those who may have been exposed and isolation of those infected, as Dawson rightly notes.1 What the WHO Advisory Panel achieved with its statement regarding ethical consideration for the use of unregistered interventions for Ebola virus disease (EVD)2 was to open up the possibility of compassionate use of experimental therapies within West Africa for countries such as Sierra Leone and Liberia that did not have legislation regarding use of unregistered medicines. The WHO statement provided international normative guidance that could be used to defend the use of such medicines, should they be used in these settings. Accordingly, we argue that the WHO report is a step towards integrating treatment access issues into a public health …

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