ETHICAL PROBLEMS IN CONDUCTING RESEARCH IN ACUTE EPIDEMICS:THE PFIZER MENINGITIS STUDY IN NIGERIA AS AN ILLUSTRATION

摘要

The ethics of conducting research in epidemic situations have yet to account fully for differences in the proportion and acuteness of epidemics,among other factors. While epidemics most often arise from infectious diseases, not all infectious diseases are of epidemic proportions, and not allepidemics occur acutely. These and other variations constrain the gener-alization of ethical decision-making and impose ethical demands on theindividual researcher in a way not previously highlighted. This paper dis-cusses a number of such constraints and impositions. It applies the ethicalprinciples enunciated by Emmanuel et al.' to the controversial Pfizer studyin Nigeria in order to highlight the particular ethical concerns of acuteepidemic research, and suggest ways of meeting such challenges. The paper recommends that research during epidemics should be partlyevaluated on its own merits in order to determine its ethical appropriatenessto the specific situation. Snap decisions to conduct research during acuteepidemics should be resisted. Community engagement, public notificationand good information management are needed to promote the ethics ofconducting research during acute epidemics. Individual consent is most atrisk of being compromised, and every effort should be made to ensure thatit is maintained and valid. Use of data safety management boards should beroutine. Acute epidemics also present opportunities to enhance the socialvalue of research and maximize its benefits to communities. Ethical research is possible in acute epidemics, if the potential chal-lenges are thought of ahead of time and appropriate precautions taken.