(protozoan)
mos quito vector
meningitis, necrotizing
Group A Streptococcus
uncertain
fasciitis (flesh-eating
(bacterium)
disease), toxic-shock
syndrome, and other
diseases
pertussis
Bordetella pertussis
refusal to vaccinate based on fears the vaccine is not
(whooping cough)
(bacterium)
safe; other possible factors: decreased vaccine efficacy
or waning immunity among vaccinated adults
polio (infant paralysis)
poliovirus
–
rabies
rabies virus
breakdown in public health measures; changes in
land use; travel
Rift Valley fever (RVF)
RVF virus
–
rubeola (measles)
measles virus
failure to vaccinate; failure to receive second dose of
vaccine
schistosomiasis
Schistosoma species
dam construction; ecological changes favoring snail
(helminth)
host
trypanosomiasis
Trypanosoma brucei
human population movements into endemic areas
(protozoan)
due to political conflict; diagnosis is very difficult,
and current treatments have severe secondary effects
tuberculosis
Mycobacterium
antibiotic-resistant pathogens; immunocompro mised
tuberculosis (bacterium)
populations (malnourished, HIV-infected, poverty-
stricken)
West Nile encephalitis
West Nile virus
complex interactions between the virus, birds and
other animals, mosquitoes, and the environment;
emergence in U.S. and other regions likely due to
global travel
yellow fever
yellow fever virus
insecticide resistance; urbanization; civil strife
Sources: Krause, R.M. 1992. The origin of plagues: Old and new. Science, 257: 1073–1078; Measles—United States, 1997. 1998, April 17.
Morbidity and Mortality Weekly Report, 47(14): 273–276; Pertussis vaccination: Use of acel ular pertussis vaccines among infants and young children. 1997, March 28. Morbidity and Mortality Weekly Report, 46(RR-7); ProMED. 1994. About ProMED. Available from
http://www.fas.org/promed/about/index.html. June 1999. Centers for Disease Control and Prevention Web site: http://www.cdc.gov/mmwr/
preview/mmwrhtml/mm6115a1.htm. July 2013.
Note about rubeola: After the initial decline of measles cases after the licensing of the vaccine in 1963, there was a resurgence of measles—to some 50,000 cases—from 1989 to 1991. Since then, the incidence of measles declined to a median of 60 cases per year between 2000 and 2010, and then increased to 222 in 2011.
34
by researchers funded by NIH and others. These
individuals, families, communities, institutions,
drugs, when used in combination with other
and society. Here, an “interest” refers to a
anti-HIV drugs, are responsible for the dramatic
participant’s share or participation in a situation.
decrease in deaths from AIDS in the United
The terms “wrong” or “bad” apply to those actions
States. One active area of research at NIH is the
and qualities that impair interests.
development of new types of vaccines based on
our new understanding of the immune system. In
Ethical considerations are complex and multifaceted,
addition, basic research on the immune system and
and they raise many questions. Often, there are
host-pathogen interactions has revealed new points
competing, well-reasoned answers to questions
at which vaccines could work to prevent diseases.
about what is right and wrong and good and
bad about an individual’s or group’s conduct or
Finally, basic research on the ecology of disease
actions. Thus, although science has developed
organisms—their reservoirs, modes of transmission,
vaccines against many diseases, and professional
and vectors, if any—reveals points at which
medical recommendations encourage their
preventive measures can be used to interrupt
widespread use, individuals are permitted (in
this cycle and prevent the spread of disease. For
most, but not all, states) to choose not to be
example, research supported by NIAID delineated
vaccinated. (Figure 7)
the mechanism of Lyme disease transmission and
how disease results: The tick vector was identified
Typically, answers to these questions all involve
and the life cycle of the causative bacterium was
an appeal to values. A value is something that
traced through deer and rodent hosts. Understanding
has significance or worth in a given situation.
this ecology has led to predictions about the
One of the exciting events to witness in any
regions where and years when the threat of Lyme
discussion in ethics in a pluralist society is
disease is greatest, as well as recommendations to
the varying ways in which the individuals
the public for avoiding infection. These examples
involved assign value to things, persons, and
and others demonstrate that investment in basic
states of affairs. Examples of values that students
research has great long-term payoffs in the battle
may appeal to in discussions of ethical issues
against infectious diseases.
Infectious Diseases and Society
Figure 7. Most states allow exemptions to
What are the implications of using science to
immunization law.
improve personal and public health in a pluralist
society? As noted earlier, one of the objectives
of this module is to convey to students the
relationship between basic biomedical research
and the improvement of personal and public
health. One way to address this question is by
attending to the ethical and public policy issues
raised by our understanding and treatment of
infectious diseases.
Ethics is the study of good and bad, right and
wrong. It has to do with the actions and character
of individuals, families, communities, institutions,
and societies. During the past two and one-half
millennia, Western philosophy has developed a
variety of powerful methods and a reliable set of
concepts and technical terms for studying and
talking about the ethical life. Generally speaking,
we apply the terms “right” and “good” to those
actions and qualities that foster the interests of
35
Understanding Emerging and Re-emerging Infectious Diseases
Emerging and Re-emerging Infectious Diseases
include autonomy, freedom, privacy, protecting
Third, because tradeoffs among interests are
another from harm, promoting another’s good,
complex, constantly changing, and sometimes
justice, fairness, economic stability, relationships,
uncertain, discussions of ethical questions often
scientific knowledge, and technological progress.
lead to very different answers to questions about
what is right and wrong and good and bad. For
Acknowledging the complex, multifaceted
example, we acknowledge that individuals have a
nature of ethical discussions is not to suggest
right to privacy regarding their infectious disease
that “anything goes.” Experts generally agree
status. Yet, some argue that AIDS patients who
on the following features of ethics. First, ethics
knowingly infect others should have their right
is a process of rational inquiry. It involves
to privacy overridden so that partners may be
posing clearly formu lated questions and seeking
notified of the risk of contracting AIDS.
well-reasoned answers to those questions. For
example, developing countries and isolated
It is our hope that completing the activities in this
rural areas suffer particularly severely from
module will help students see how understanding
many infectious diseases because conditions of
science can help individuals and society make
crowding and poor sanitation are ideal for the
reasoned decisions about issues relating to
growth and spread of pathogens. The same is
infectious diseases and health. Science provides
true for many inner-city environments. These
evidence that can be used to support ways of
places provide a constant reservoir of disease-
understanding and treating human disease, illness,
causing agents. We can ask questions about what
deformity, and dysfunction. But the relationships
constitutes an appropriate ethical standard for
between scientific information and human choices,
allocating healthcare funds for curtailing the
and between choices and behaviors, are not linear.
spread of infectious diseases. Should we expend
Human choice allows individuals to choose against
public research dollars to develop drugs whose
sound knowledge, and choice does not necessarily
cost will be out of reach for developing countries?
lead to particular actions.
Is there any legal and ethical way for the United
States to prevent over-the-counter sales of
Nevertheless, it is increasingly difficult for most
antibiotics in other countries, a practice that
of us to deny the claims of science. We are
may enhance the evolu tion of antibiotic-resistant
continually presented with great amounts of
pathogens? Well-reasoned answers to ethical
relevant scientific and medical knowledge that
questions constitute arguments. Ethical analysis
is publicly accessible. As a consequence, we can
and argument, then, result from successful
think about the relationships among knowledge,
ethical inquiry.
choice, behavior, and human welfare in the
following ways:
Second, ethics requires a solid foundation of
information and rigorous interpretation of that
knowledge (what is known and not known)
information. For example, one must have a solid
+ choice = power
understanding of infectious disease to discuss the
ethics of requiring immunizations and reporting
power + behavior = enhanced human welfare
of infectious diseases. Ethics is not strictly a
(that is, personal and public health)
theoretical discipline but is concerned in vital
ways with practical matters. This is especially
One of the goals of this module is to encourage
true in a pluralist society.
students to think in terms of these relationships,
now and as they grow older.
36
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