Ethical issues associated with vector-borne diseases.

Vector-borne diseases (VBDs) are associated with heavy burdens, particularly in poor and vulnerable communities. Their transmission by vectors provides opportunities for specific public health interventions and gives rise to unique ethical issues. Despite their growing importance, ethical issues associated with VBDs have not previously been explored comprehensively.

Many VBDs are prototypical examples of "neglected diseases". This is ethically problematic because, when research and control activities are not proportional to disease burden, the consequences include avoidable harm (particularly for the poor) and failure to predict and prepare for epidemics (as was observed during the recent outbreaks of Zika virus infection and yellow fever).

More generally, the burden of VBDs is inequitably distributed among the poor, and pregnant women and children are often at highest risk. Such vulnerability in terms of the social determinants of VBDs is compounded by environmental factors. When the influence of climate change increases VBD burden among the worst-off groups of humankind, existing global injustice is exacerbated.

Appropriate policy-making often requires explicit consideration of not only scientific but also ethical matters. Yet, the ethical issues that arise in VBD control and research have not previously received the analysis necessary to further improve public health programmes, and WHO Member States lack specific guidance in this area.

On 23–24 February 2017, WHO held a scoping meeting to identify the ethical issues associated with VBDs. At the meeting, over 25 international and WHO experts discussed salient ethical issues and the main features of a future guidance document. They mapped the ethical issues associated with VBDs, highlighting in particular: environmental and social determinants of health, the ethics of vector control (including new technologies), relevant aspects of ethics in surveillance and research, and the ethics of mass public health interventions.

These main topics will form the basis of a project to identify and analyse ethical issues associated with VBDs more comprehensively, with the eventual aim of providing relevant WHO guidelines within the next two years.