Bioethics of a pandemic!

Hello all,

Namaste! I want to let my blog readers know about my new website-swaroopa.net. Very simple id, not the complicated blog id address. Now to the post.

As per the discussion, we had last week, we explored how bioethics started as a separate field in the last hundred years. It is a field that many times deals with the highest of the moral and societal issues. Many times the answers that come in this field are not clear cut black and white, but grey and shades of grey. As a society if there is no morality and ethics, the human group itself would fall into anarchy and lawlessness. So, ethics and morals are important.

In the last 300 years, Science and research that too bio-research has exploded. This makes it imperative to have a field that looks into the ethical issues that can be hidden underneath or come up. At these current times, such a post deserves even more importance, as we are in the middle of a pandemic. As we explored last week, humans are not always very ethical to start with. So, Science as a tool in someone's hand without ethics, can become dangerous. So, ethical standards and concepts need to be maintained.

Tree of Life by Ernst Haeckel
Image credits - Ernst Haeckel / Public domain

Science is an area where a whole lot of money is involved. So, if the Science becomes a tool in an unethical person's hands, it can be twisted to serve their ends. It does not matter whether it is a male or female. Both can be very unethical. Let us look at two episodes that brought two companies down due to the unethical behavior of their founders.

Unethical behaviors: The biotech company Turing Pharmaceuticals, makes the drug Daraprim, which treats newborn babies who are infected from their mothers as well as immune compromised AIDS patients from a severe disease called Toxoplasmosis. The founder and CEO of the company Martin Shkreli increased the price of the drug from $13.50 to $750 overnight. Patients who were dependent on the drug for their life were not able to afford the drug. Here, the business mindset of profit overtook the person than the  patients the company was serving. Ethics went out of the window. Shkreli had to step down and later went to prison for another unrelated crime, he had committed a few years earlier.

In another case, Elizebeth Holmes founder of a start up, Theranos, was selling blood testing solutions on a technology that was faulty and error prone. The gaps in the technology was covered up by Ms. Holmes through deliberate falsification of facts and data. The company, which had an estimated value of $9 billion, came crashing down, later the labs and the company itself closed. Today, Ms.Holmes is facing fraud charges in the US courts.

This is to show that money, fame, influence and power, many times becomes the driving force behind people starting biotech companies rather than helping the people. Why is this important in a pandemic blog post you may ask? As of now the world is reeling under a pandemic and people are stressed out and hurting. We are not sure how this is going to evolve, how long it would take it to end and would there be a second or a third wave? Time becomes of essence to develop a vaccine that can stop the spread of the disease.

At this time, I would like to bring the focus to another time and effort. During the 20th century and before, the world was reeling under another disease, small pox. Any time a person got small pox, the society shunned them. There was no cure. Most of the time, the person died. As the virus was very contagious, people were very fearful. I have read stories where they used to burn the patient alive along with their house to get rid of the person as well as the disease. That is how much the disease brought terror into people. Now, is that behavior ethical? Burning a person alive because they have a very contagious disease? Humans can be very cruel many times.

It was the physician Edward Jenner who was variolated himself at eight years, where the child is deliberately exposed to the virus so that the kid gets the virus and later recovers, found the vaccine for small pox. Even though the methods he used were many times unethical, the small pox vaccine finally brought the disease to a complete end in the 1980s. Dr. Jonas Salks found the vaccine for Polio in 1955. He decided not to patent the vaccine at that time as people especially children needed that vaccine to have strong, polio free legs. When asked why he didn't patent the vaccine, his counter question was, "Well, the people I would say. There is no patent. Could you patent the sun?"

Dr.Jonas Salk with his virus culture bottles
Image credits - The Owl. / Public domain

So, in the field of Science and bio-research, bioethics becomes very important. We are dealing with people, their health and wellness. It becomes a question, how much and how far can you go within the ethical standards. The question always comes back to-"Would you sell your Soul, and if so for what and how much"? This question can be asked in each and every field. This we see played out many times in political, social, party and religious affairs. This is an attempt to elaborate the bio-ethical issues specific to pandemic and to Covid-19.

Issues of concern: All of us know, the world is over-taken by the pandemic. It started first in China, in the city of Wuhan in December 2019. Wuhan Municipal Health Commission, China first reported it on Dec 31, 2019. In the last six months, it has spread over the world. As of now, humans know very little about the virus itself. It has been known to arise from the bats.We don't know whether, it can mutate, how the mutated version  be, whether it would cause second or third wave of infections? How long would humanity have to stay at home, not out and about.

There are many issues that come up in a pandemic. How can we control it? How can we make the effect least impactful? How to make sure the people who really need treatment are getting it? Who should be tested? Who should be watched? How can we protect the front line workers and first responders? Is it enough to just provide them with personal protective equipment (PPE) or masks? What more can be done?

Humans have not dealt with a pandemic of such proportions. So, there are many questions that come up, that needs to be answered. The fist thing  to be considered is vaccines. Small pox and Polio were erased due to concerted and collaborative efforts by nations where leaders, doctors, health workers and other medical personnel came together to vaccinate the world. A major issue that comes against this is, people still believe Covid-19, the disease and pandemic itself is a hoax. Even though the mainstream media and true journalism draws the picture of a terrifying, fear evoking pandemic, people still think it is a hoax.

This is because many times the leaders themselves are not ready to accept the reality and take charge of the situation. When leaders are not making mask wearing and social distancing mandatory, people take it as a 'no big deal' issue. Just yesterday I read a city council in the state of Alabama said 'No mandatory masks' even after the doctors from the neighborhood hospitals testified for the requirement of masks. If the leaders who are supposed to set examples are not strict enough, how would people follow the rules? Many times people are thinking the pandemic is a hoax and are not taking strict steps to keep themselves safe.

Another issue we as humans are going to face is that there is a big group of people who think vaccination works against them and is dangerous. There are very vocal advocates against vaccination. Connected with this, read some time back, that there are polio cases in the state of Uttar Pradesh and other places after almost erasing it from the face of the Earth. Because these kids were not vaccinated, they developed polio. If you know, in India the zero dose is given as soon as the baby is born. There is a movement against anti-vaccination that is happening in many places. Science is just a tool that can help. But if people don't take advantage of that tool, science cannot help. Also, people voicing against vaccination helps fear about vaccines to develop in the minds of the people. The great efforts put towards human health by the scientific community is thwarted and made pointless by these anti-vax campaigns. These campaigns are done by people who may not even have basic scientific knowledge. Yes, vaccines do cause harm sometimes. But the benefits far outweighs the harm is my opinion, So, vaccinate your children!!

The process of vaccination
Image credits - BruceBlaus / CC BY-SA

Yes, there are individual cases where vaccines can be harmful and cause reaction. But the overall benefits of vaccines are much more compared to its disadvantages. For example, Polio can make a being handicapped for the rest of their days. Small pox can kill or make a person permanently scarred. At present, we are dealing with Covid-19 and people who don't agree to vaccination, and when there is a big group of them, the disease is not going anywhere. This is because the non-vaccinated babies would grow up, spread the disease and may die from it. Above this, a loud voice against a genuine effort  can delay the process.

Bioethics of Covid-19: Now, let us look specifically at Covid-19. The pandemic has been there for last six months. Scientists are in a race to find vaccine for Covid-19. As of now the world death numbers stands at 450,800+ at the time of writing this. So, it is not a hoax, as it is coming out of respected organizations like Johns Hopkins University and WHO. One way to help humanity is to find vaccines. But it is not that easy.

In normal times a vaccine development takes a minimum of 5-6 or even 15 years, because there are a lot of process (The poster in the link gives a nice over-view) involved with it. The first step is to find the correct strain of the virus to work with. This is called pre-clinical evaluation, where scientists test strains and how it can be used as a vaccine and whether it is too malignant for human use. Remember, vaccines are attenuated or weakened viruses that  are injected into humans to develop antibody. If the virus is not well tested, the vaccine itself can cause reactions. So, the pre-clinical stage is very important.

Once the strain of virus is selected then comes the stage of animal testing. Here as of now, in the case of Covid-19 we are in a rush to develop a vaccine. But now the question comes is it worthwhile to skip the animal trials because the world needs a vaccine 'Now'. Mice are the closest animals we can test to see whether they develop any unwanted symptoms. Because after the animal testing stage, the human trials would start. So, any complications has to be removed in the animal testing stage. But if there is no animal testing, then how do we truly know whether there is any danger to the humans? Then, is it enough to test one species of animals? (There is the ethical issue of animal testing. That is a whole another blog post. There are animal advocacy groups against it.)

After this comes three stages of clinical testing- Phase1, Phase 2 and Phase 3. The first stage is always a small group of very different individuals of 25-100, second stage is several hundreds and third is several thousands. So, as you can see, vaccine development is a very intense, elaborate and difficult process. After the Phase 3 clinical stage, the company or the lab has to go through rigorous regulatory approval process with Food and Drug Administration (FDA). Getting an approval from FDA is very intense, verbose, policy and rule driven process. Many times it takes 1-3 years to get an approval, may be more.

That is how intense a drug or vaccine development is. In this scenario think of a Covid pandemic where we need to develop a vaccine as soon as possible. A whole range of bio-ethical questions come into focus. Which all stages can we bypass? Is it ethical to bypass any stage? How much time should we give for vaccine development when people are dying of the disease. So, in such a case a fast vaccine development becomes very necessary.

Time is ticking to find a vaccine
Image credits - Pixabay.com

But every step of the vaccine development needs the efficiency, efficacy and sensitiveness of intense quality control. Otherwise a vaccine that is not efficient would be developed. That won't reduce the incidence of the disease and protect the vaccinated human. Above this there is another scenario that can evolve. The person in the thought they are vaccinated, can move about and come into contact with virus and develop the disease. Even more, they can become an asymptomatic carrier- person without any symptoms and spread the disease all around.

Another ethical issue that comes about is, the severe allergic reactions many people can have with vaccines. So, to reduce this number, very rigorous testing becomes necessary. Otherwise instead of saving the person from Corona virus, it would take the person to ICU due to anaphylactic shock and immune cascade. Instead of the patient dying from the disease, they can die from the vaccine, if it is not of the highest and purest quality.

A different problem that can arise is that so many groups of scientists and countries are rushing to make vaccines. How much are they stringent in their regulatory and testing process? We don't want people to get sick because they were subjected to inferior vaccines. I am skipping a point called herd immunity. You can read upon it. This blog post would become too long, if I take up that as well here.

So, these all are the bio-ethical concerns with the pandemic as well as the vaccine. Let us finish with a thought. As of now the world has seven billion people and increasing. Think about the magnitude of vaccinating everybody. What a huge task it is. Wonder about the logistics, organization and structural concerns that needs to be taken care of. It may take at least 2021 to start that process. Until then our best bet to protect ourselves and our loved ones is to be at home, stay safe, reduce contact with others, limit the amount of going outside, don't go to huge gatherings, stay healthy and wash hands often. Above this, don't fear and have courage, because a stressful body reduces immunity and at this present moment, we need our innate immunity very much.

I wish you a good and safe weekend, and I'll see you next Friday!😉
  
Next week: My entrepreneurship!
Image Credits:  Wikimedia Commons