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Although Nipah virus gets increasing attention in epidemic preparedness, there has been almost no bioethical work on the epidemiology, prevention, and treatment. Further work on public health ethics should address communication about the modes of transmission, surveillance, measures during epidemics, and social or religious norms, as well as potential vaccine trials and the different local contexts where trials may occur, and the use of unproven therapeutics during outbreaks. Further bioethics work may help to ensure that research and public health interventions for Nipah virus disease are ethically acceptable and more likely to be effective.

A new study led by researchers from the Ethox Centre at Oxford Population Health has highlighted important ethical considerations in Nipah virus outbreak control, its treatment, and research into vaccines. Read the study published in the Journal of Medical Ethics.

Nipah virus is transmitted to humans by infected animals and, in severe cases, can cause encephalitis (swelling of the brain) which can be fatal. It can also be transmitted from person to person and through contaminated food. Nipah virus is identified as a priority pathogen by the World Health Organization, meaning that it has the potential to cause outbreaks of disease or a pandemic. The virus is receiving increasing attention among scientists and in work on epidemic preparedness. Despite this trend, there has been almost no bioethical work examining ethical considerations surrounding the disease prevention, treatment, or vaccine research efforts that have already begun. 

The authors argue that Nipah virus disease has distinctive characteristics that raise important ethical questions, many of which are not present for other priority pathogens. For example, the virus has a high number of deaths in people who do become infected but has a low transmission rate, meaning that not many people are becoming infected and that measures used in response to other viruses many not be effective or ethical, or in some cases may be unnecessary despite the potential for the virus to be a major threat. These characteristics outline potential issues in public health ethics with public health messaging, potential stigmatisation and health justice concerns, and the politicisation of prevention efforts. They also discuss ethical and feasibility questions surrounding vaccine development and recruitment for clinical trials. For a disease where the health burden may increase significantly in the future, it is crucial that these questions are raised and addressed. 

Dr Euzebiusz Jamrozik, Postdoctoral Research Fellow at Oxford Population Health, said ‘The paper highlights the case of the 2023 Nipah virus outbreak in Kerala (India), when public health authorities used lockdown for the virus for the first time. Responses to past outbreaks had focused on contact tracing and more traditional infection control measures, and we discuss whether lockdowns, mask mandates, and border closures are ethically justifiable for Nipah virus. We also argue that the design of future vaccine trials should also be informed by ethical considerations, including the results of local community engagement activities.’ 

The researchers note that a key feature of work going forwards must be a collaboration with local bioethicists, biomedical scientists, and communities likely to be experiencing Nipah virus outbreaks, to ensure that the development of interventions considers all ethically relevant factors. The threats that Nipah virus poses to global health and health equity, as well as the need to develop ethically appropriate research and public health responses, are significant reasons for more work, including in bioethics, to address this previously neglected disease.

The work was jointly carried out by researchers from The Ethox Centre (Oxford Population Health), Pandemic Sciences Institute (Nuffield Department of Medicine), Centre for Tropical Medicine and Global Health (Nuffield Department of Medicine), Mahidol-Oxford Tropical Medicine Research Unit (Mahidol University/ Centre for Tropical Medicine and Global Health), and Royal Melbourne Hospital Department of Medicine (University of Melbourne).