by Michael Bloom, GBI Intern
Edited by Christina Valeros, GBI Intern
Since November 2018, the Democratic Republic of Congo’s (DRC) Institut National de Recherche Biomédicale (INRB) has overseen a clinical trial of experimental vaccines to protect against the Ebola Virus Disease (EVD), coordinated by the World Health Organization (WHO). Dr. Janet Diaz, the leader of WHO’s clinical management for emerging infectious diseases, is quoted as saying, “This is the first multi-drug trial for Ebola treatments, and the rigorous collection and analysis of data is expected to deliver clarity about which drug works best.” Until last week, however, pregnant women and babies less than 1 year of age were excluded from receiving vaccinations. In a bold move, an advisory board to the WHO has reversed that opinion and is now recommending vaccinating pregnant women and infants.
A pregnant mother may transmit Ebola to their unborn child, as an August 2018 WHO guidance report suggests. EVD has been detected in breast milk for more than two months after symptom onset. Women have made important contributions in the fight against the disease as caregivers during this current EVD outbreak. The push to vaccinate pregnant mothers highlights not just a vital concern of the public health authorities but also brings to the foreground an important acknowledgment of women’s health in the battle to rid the DRC of EVD.
The fundamental question, however, is whether or not it is ethical to expose a fetus to experimental vaccines during a clinical trial, in a violence stricken and impoverished community. Unborn children are a vulnerable population, and we need to look at other ethical analyses of medical interventions on pregnant women. Christopher Kapposy and Lorraine Laferty, the authors of Overcoming Liability Concerns in Vaccine Trials Involving Pregnant Women, concluded that the health benefits of vaccination outweigh the risks in such cases. It was this ethical rationale that was implemented in the vaccination of pregnant women during the Zika virus outbreak a few years ago. Nevertheless, one can always point to the devastating results from the use of thalidomide as a counter-argument about the harmful consequences from pharmacological intervention in utero.
Fetal exposure to experimental vaccines has grave implications for public trust. Any natural birth defects may be seen as a consequence of the experimental vaccines, which could reduce the level of voluntary participation by an already suspicious local population. Conspiracy theories about vaccinations have already incited violence against health care workers. But suspicion about vaccines is not a new phenomenon. In America, misplaced fears about vaccines causing autism prompted a disturbing uptick in measles cases. Even the most developed countries can harbor mistrust toward the medical community and initiatives to bolster public health.
That pregnant women were once excluded from receiving the vaccine has been described as indefensible. Concerns about child autonomy, experimental vaccine use and the erosion of public trust must be weighed with the personal and public health implications of choosing not to vaccinate– the endangerment of the lives of both the mother and child, as well as the community at large.