Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation (PAHO), with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic.
- public health ethics
- interests of woman/fetus/father
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Contributors EJ and MS conceived the paper together. EJ wrote the first draft and both authors were involved in editing/revising the manuscript.
Funding This research is supported by an Australian Government Research Training Program Scholarship.
Disclaimer The views expressed are the authors' own, and do not necessarily represent the decisions or the stated policy of the World Health Organization.
Competing interests MJS participated in the PAHO Zika Ethics Consultation: Ethics Guidance on Key Issues Raised by the Outbreak (Apr 2016). Both authors participated in the WHO Scoping Meeting on Ethical Issues Associated with Vector-borne Diseases (Feb 2017).
Provenance and peer review Not commissioned; externally peer reviewed.