23 Sep 2009
The anticipated onset of a second wave of the H1N1 influenza pandemic could present a host of thorny medical ethics issues best considered well in advance, according to the University of Toronto Joint Centre for Bioethics, which today released nine papers for public discussion.
Topics include duty of health care workers to work during a serious flu pandemic; government restrictions on individual freedoms and privacy and their responsibilities administering vaccination programs; how to allocate limited medical resources; and the obligation of rich countries to share such resources with those less fortunate.
“While we hope there will not be a major second wave of the H1N1 flu, there is limited cause for optimism and we could well see the pandemic’s full onset late this year or early next when the traditional flu season begins,” says JCB Director Ross Upshur.
“Now is the time to think through the serious ethical challenges societies may confront, not in the midst of crisis with line-ups at hospital doors. These issues and concerns, though drawn largely from a Canadian point of view, have relevance to countries everywhere.”
JCB’s Canadian Program of Research on Ethics in a Pandemic (CanPREP) prepared the papers with the benefit of both academic and public opinion research, obtaining the views of 500 Canadians through a national telephone survey and nearly 100 more via a series of town hall meetings nationwide.
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22-Jan-2007
Public health trumps individual human rights, medical ethics experts say
Medical ethics and other experts say tough isolation measures, involuntary if need be, are justified to contain a very deadly, highly-contagious and drug-resistant mutant strain of tuberculosis and to prevent “a potentially explosive international health crisis” brewing most dangerously in South Africa.
They warn that new variations of the disease now defeat many of the world’s existing drugs and “the forced isolation and confinement of XDR-TB (extensively drug resistant tuberculosis) and MDR-TB (multiple drug resistant tuberculosis) infected individuals may be a proportionate response in defined situations given the extreme risk posed.”
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Experts rank top 10 ways of improving health in poor countries from emerging stem cell and related technologies
Eliminating the need for costly insulin injections for diabetics, regenerating heart muscle after it fails, and improving resistance to disease by engineering immune cells top a list of 10 potential breakthroughs for health in developing countries seen emerging from the new world of regenerative medicine, according to a study published today in the prestigious journal Public Library of Science (PLoS) Medicine.
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]]>University of Toronto Joint Centre for Bioethics
Coping effectively with a predicted influenza pandemic that threatens to affect the health of millions worldwide, hobble economies and overwhelm health care systems will require more than new drugs and good infection control.
An international medical ethics think-tank says that all-important public cooperation and the coordination of public officials at all levels requires open and ethical decision making.
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Full text: www.eurekalert.org/pub_releases/2005-11/uotj-eia112105.php
]]>27 Nov 2005
Ethicists offer guide to decision-making in predicted flu pandemic; quarantine, duty to care, resource allocations among key issues
Coping effectively with a predicted influenza pandemic that threatens to affect the health of millions worldwide, hobble economies and overwhelm health care systems will require more than new drugs and good infection control.
An international medical ethics think-tank says that all-important public cooperation and the coordination of public officials at all levels requires open and ethical decision making.
The Influenza Pandemic Working Group at the University of Toronto Joint Centre for Bioethics today recommended a 15-point ethical guide for pandemic planning, based in part on experiences and study of the Severe Acute Respiratory Syndrome (SARS) crisis of 2003.
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]]>University of Toronto Joint Centre for Bioethics
The biggest issue in medical ethics today is the growing occurrence of conflict between health care providers, their patients and patients’ families over treatment options, according to Canadian medical ethicists in a survey published today.
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In a new study by researchers at the University of Toronto Joint Centre for Bioethics (JCB), published in PLoS Medicine, the open access global health journal, an international panel of 63 experts were asked to rank the nanotechnology applications they think are most likely to benefit developing countries in the areas of water, agriculture, nutrition, health, energy and the environment in the next 10 years. The study is the first ever ranking of nanotechnology applications relative to their impact on development.
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]]>6 January, 2005
Report urges end to monopoly of economists as development policy advisors
Science and technology is so critically important to improving conditions in poor countries that scientific advisors should join economists at the center of government policy-making on development issues, an eminent group of 27 international experts says in a landmark report to the United Nations.
“Economic advice will always be important in guiding policy makers on development matters. But in a knowledge-based economy, leaders and governments increasingly need science advisors to make effective use of emerging technologies,” says the report co-author, Calestous Juma of Harvard University. “In a world marked by rapid technological change and the enormous, emerging opportunities presented by biotechnologies and nanotechnologies, science advisors will soon be a necessary part of every presidential and executive office, including the Office of the UN Secretary-General.”
The report, “Innovation: Applying Knowledge in Development,” was prepared by the Task Force on Science, Technology and Innovation of the UN Millennium Project, commissioned by the UN Secretary General to advise on implementing the Millennium Development Goals (MDGs). Agreed by world leaders in 2000, the MDGs are clear, quantifiable targets to be achieved by 2015. The full Millennium Project will report later in January on strategies to reach all MDGs, including reducing poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women.
Three years in preparation, the report of the Task Force (a 19-member group, with an additional eight-member working group on genomics and nanotechnology based at the University of Toronto), says science, technology and innovation have helped to largely eliminate poverty and hunger and driven remarkable economic growth in much of Southeast Asia and the Asian Pacific.
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]]>6 December, 2004
Cuba, South Korea, and India make and export their own biotech vaccines, Egypt manufactures recombinant insulin, and South Africa is developing a novel vaccine for HIV/AIDS.
Health biotechnology is no longer the sole preserve of high-level research institutions of North America and Europe, according to a ground-breaking three-year study by 15 researchers of health biotechnology innovation systems in seven countries: Brazil, China, Cuba, Egypt, India, South Africa and South Korea.
“Nowhere is the need for science and technology as a tool for development more relevant than in addressing the health needs of the world’s poor,” says co-author Peter Singer, MD, Director of the University of Toronto Joint Centre for Bioethics, a world-leading think tank on medical ethics.
“Vaccines, diagnostic tools and other products of biotechnology which can be produced relatively easily and cheaply by developing countries have the potential to save millions of people who die every year from diseases. This study helps to reveal and understand the recipe used by developing countries to create thriving health biotech industries.”
Results of the study, funded by Genome Canada and others and published Dec. 6 in a supplement to Nature Biotechnology, documents the development of successful health biotechnology sectors in detailed case studies of seven countries. It identifies factors that led to their success and the challenges that remain.
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]]>University of Toronto Joint Centre for Bioethics
New medical tools that quickly and accurately diagnose diseases like AIDS and malaria top a list of 10 biotech breakthroughs deemed most important for improving health in developing countries within the decade, science that will dramatically move the world towards its Millennium Development Goals for 2015, according to scientists and ethicists in a major new report to the United Nations.
Newly emerged diagnostic tools detect illness at a molecular level in blood or tissues — thus improving a patient’s chance of survival, conserving scarce resources in poor countries now wasted on inappropriate treatments, and better containing disease outbreaks, according to Genomics and Global Health, being launched Oct. 7 at the 4th World Conference of Science Journalists in Montreal.
Prepared for the Science, Technology and Innovation Task Force of the UN Millennium Project, the report calls for a global institute to share and promote the health and environmental benefits being created through genomic sciences – and thereby save tens of millions of lives per year in developing countries.
“Imagine a world in which a doctor in the poorest country can instantly diagnose tuberculosis or malaria, or provide women a way they can prevent HIV-AIDS; where bad water is made safe again. This report is about the pathways to get there,” says report co-author Peter Singer, MD, Director of the University of Toronto Joint Centre for Bioethics.
The list of top 10 of biotechnologies for improving health in developing countries represents a consensus of 28 eminent scientists canvassed separately in developing and developed countries.
The report details dozens of specific health-improvement applications the 10 new technologies have today and are expected to produce in future.
Examples include sequencing the genomes of parasites responsible for most of the world’s human malaria, as well as the mosquito that carries it. Knowledge of these genomes, paired with the knowledge of the human genome, can be used to develop new drugs and vaccines.
As well, the report forecasts the creation of microbicides for female-controlled protection against sexually transmitted disease like HIV, both with and without contraceptive effect.
The report maps the top 10 new biotechnologies against the UN Millennium Development Goals, established by world leaders in 2000 for achievement by 2015. It then predicts the extent to which the new science will drive progress towards five of the eight globally agreed objectives:
- Promote gender equality and empower women;
- Reduce child mortality;
- Improve maternal health;
- Combat HIV, malaria and other diseases; and
- Ensure environmental sustainability.If not properly harnessed, the experts warn, the breakthroughs being produced through genomics will dramatically widen rather than narrow the gap between developed and developing countries.
“Millions of people in developing countries die each year from diseases that could be prevented or treated cheaply and easily through the development and use of a handful of biotechnologies,” says Dr. Singer. “This report is about reaching the UN’s Millennium Development Goals (MDGs), mobilizing the developed countries of the world to share its wealth of information and know-how, and supporting the innovation of developing countries.”
10 Promising New Technologies Can Help World Achieve Its MDGs
Funded by Genome Canada’s GE3LS program and others , the report details the potential contribution of genomics and related biotechnologies in achieving five of the eight MDGs.
It notes genomics-related technologies, including DNA sequencing and bioinformatics, once so costly only wealthy nations could afford them, are now becoming available to many in developing countries. Some applications are now so simple and cheap they can start replacing older, cumbersome, time-consuming and expensive health care technologies in poorer countries.
The 10 most promising cutting-edge technologies for health in developing countries:
- Easy-to-use molecular diagnostic tests for TB, hepatitis C, HIV-AIDS, malaria and other diseases, which detect the presence or absence of pathogen-associated molecules, such as DNA or protein, in a patient’s blood or tissues;
- Recombinant vaccines against infectious diseases, produced through genetic engineering, which promise to be safer, cheaper and possibly easier to store and transport than traditional vaccines;
- Reducing pollution and making water safe to drink through bioremediation – the potential exploitation of micro-organisms with remarkable biochemical properties;
- Creating microbicides for female-controlled protection against sexually transmitted disease like HIV, both with and without contraceptive effect;
- Better drug and vaccine delivery methods that avoid the use of needles and reduce cross contamination;
- Bioinformatics to identify drug targets and to examine pathogen-host interactions;
- Nutrition-enriched crops to counter specific deficiencies, such as vitamin A-rich “Golden Rice” to improve health for millions without a balanced diet;
- Sequencing pathogen genomes to understand their biology and identify new antimicrobials;
- Recombinant technology to make therapeutic products (e.g. insulin, interferons) more affordable to help fight such diseases as diabetes, now emerging as a major public health problem throughout the world;
- Combinatorial chemistry for drug discovery.”In the long run such emerging technologies tend to help people in developing countries more than in developed countries,” says co-author Abdallah S. Daar, MD, co-director of the Canadian Program on Genomics and Global Health at the JCB.
“A good example is vaccines, which have always depended on biotechnology and were initially expensive, but in the end helped save millions of lives in the developing world where the majority of humanity lives. With a commitment to international cooperation and a relatively modest financial investment, we can make substantial gains in the battle against a suite of the world’s deadliest diseases.”
Global Genomics Initiative
“Every year 11 million children die before reaching their 5th birthday,” says co-author Elizabeth Dowdeswell, former UN Under Secretary-General and Executive Director of the UN Environment Programme. “Recent rapid advances in genomics and related biotechnologies offer radically improved tools to help remedy such global tragedies. But either they’re not being used or they’re not accessible.
“We need a governance mechanism that fosters a balance between the global public goods characteristics of genomics knowledge and the private goods nature of its application.”
The report calls for creation of a Global Genomics Initiative (GGI), promoting genomics as a “global public good” and enlisting governments, private companies and other organizations from developed and developing countries alike to support genomics research and learning worldwide.
The GGI would give developing countries access to knowledge essential to their reaping the benefits of genomics for development. It would promote actions needed at a global level, strengthen capacity in biotechnology worldwide by increasing the international exchange of know-how, and encourage partnerships between countries.
Key Actors: Developing Countries Themselves
“Countries such as India, China, Cuba and Brazil that already have genomics and health biotech capacity set the example for others are best positioned to take advantage of the genomics revolution,” says co-author Halla Thorsteinsdottir.
Cuba, for example, has invested heavily since the 1980’s in research infrastructure and manufacturing in biotechnology. The country has produced several successful products, including the world’s only Meningitis B vaccine. It also holds at least 400 patents in the biotechnology field. The biotechnology sector has already contributed towards improved health in the country and is poised to become a major export industry in Cuba.
The report says education is key to creating National Systems of Innovation (NSIs) in biotechnology in developing countries and active research and commercialisation of research are needed to promote sustainable development in this field. These countries need to:
- Re-energize academic institutions and public sector research to strengthen their science base;
- Train people to use, adapt and innovate biotechnologies;
- Encourage regional and international cooperation to exchange knowledge;
- Improve the policy environment (including intellectual property laws and regulation);
- Foster private sector growth, encouraging it to address local health needs, and strengthening linkages between public and private sectors to create new biotechnology goods and services.Says co-author Tara Acharya: “With this report we try to illustrate the importance of investing in new tools for health and development in order to complement existing technologies and energize the field of global health.”
The report says most governments in developing countries and the international donor community have seriously underestimated the value of investing in health. The Commission on Macroeconomics and Health estimates that approximately 330 million disability-adjusted life years (one disability-adjusted life-year is defined as the loss of one year of healthy life to disease) could be saved for every 8 million deaths prevented, generating economic benefit of US$186 billion per year as of 2015. This would require additional annual health outlays, for all low-income countries and selected middle-income countries, of US $57 billion by 2007 and US $94 billion by 2015.”
Harvard University professor Calestous Juma, Co-ordinator of the Task Force on Science, Technology and Innovation of the UN Millennium Project commissioned by Secretary-General Kofi Annan, called the contribution “a pioneering report that will shape the way leaders around the world think about the role of new technologies in solving old problems. Its clarity is only matched by its practical approach.”
###Appendix 1
Genomics and related biotechnologies can support the MDGs
Millennium Development Goal Statistics/Facts
Goal 3: Promote gender equality and empower women.
In 2001 55% of HIV cases in sub-Saharan Africa were women. Average HIV infection rates in teenage girls are five times higher than those in teenage boys.
Biotechnology to address MDG
- Female control over sexually transmitted diseases (STD) protection.
- Vaccine and drug delivery.Goal 4: Reduce child mortality. About 11 million children die before reaching their fifth birthday.
Biotechnology to address MDG
- Molecular Diagnostics.
- Vaccine and drug delivery.
- Recombinant vaccines.
- Female control over STD transmission protection.
- Nutritionally enriched genetically modified (GM) crops.
- Combinatorial chemistry.Goal 5: Improve maternal health. Over 500,000 maternal deaths per year.
Biotechnology to address MDG
- Molecular Diagnostics.
- Vaccine and drug delivery.
- Recombinant vaccines.
- Female control over STD transmission protection.
- Nutritionally enriched GM crops.
- Combinatorial chemistry.Goal 6: Combat HIV, malaria and other diseases. HIV/AIDS, malaria and TB responsible for about 40% (5 million) of all deaths in developing world. In 2002, 3.1 million people died of AIDS, 2 million of TB, over 1 million of malaria.
Biotechnology to address MDG
- Molecular Diagnostics.
- Vaccine and drug delivery.
- Recombinant vaccines.
- Female control over STD transmission protection.
- Bioremediation.
- Sequencing pathogen genomes.
- Bioinformatics.
- Enriched GM crops.
- Combinatorial chemistry.Goal 7: Ensure environmental sustainability. 5 million deaths per year attributed to waterborne diseases.
Biotechnology to address MDG
- Bioremediation.University of Toronto Joint Centre for Bioethics
Innovative. Interdisciplinary. International.
Improving health care through bioethics.The JCB is a partnership among the University of Toronto and nine hospitals. It provides leadership in bioethics research, education, and clinical activities. Its vision is to be a model of interdisciplinary collaboration in order to create new knowledge and improve practices with respect to bioethics. The JCB does not advocate positions on specific issues, although its individual members may do so.
The goals of the JCB are:
- To foster interdisciplinary research and scholarship, link education to research, and disseminate research findings to improve policies and practices.
- To support undergraduate, graduate and postgraduate educational programs in bioethics.
- To support clinical ethics activities including continuing education for health care providers, ethics committees, ethics consultation, and projects to address specific issues arising in JCB hospitals.
- To foster collegial discussion of bioethics issues throughout the JCB participating institutions, and to serve as a resource for the media, policymakers, and community groups.For more information: http://www.
utoronto. ca/ jcb/
Full text: www.eurekalert.org/pub_releases/2004-10/uotj-rh1100504.php
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