The ethical dilemmas of preventing the next pandemic

Would protecting one group of people from disease and exposing another to it be the best way to prevent as many deaths as possible and reduce the impact of a future pandemic? A study by some La Trobe academics says yes, but the ethical dilemmas it raises may not be worth it.

Disease modelers have found an effective way to reduce the impact of infectious diseases like COVID-19, but the results will likely pose an ethical dilemma for policymakers and decision-makers.

The study, led by Dr Joel Miller, associate professor of mathematics and statistics at La Trobe University, found that confining the most at-risk group of people for a significant period of time, while simultaneously promoting infection in other groups in order to reach the herd. immunity, could be the best way to protect high-risk groups.

However, increasing a group’s exposure to a disease would create an ethical dilemma and result in the most disadvantaged groups in the community – typically those with the least political power – becoming the most infected group.

“With COVID-19, older people were at high risk, so if we were to isolate them for a period of time during which we adopted policies that would cause younger age groups to interact more (not less), “So the disease probably wouldn’t have spread well once the isolations were lifted and interactions returned to normal,” Dr. Miller said.

“If we leave aside the question of whether such a strategy is logistically feasible, it is in a sense an optimal intervention. However, this poses major ethical challenges: the intervention makes the situation worse for younger age groups from an infection perspective.

“Our goal in this article is not to argue for such a policy, but rather to highlight some ethical dilemmas that emerge from intervention strategies. It is important that policymakers recognize the tradeoffs that a “optimal” strategy might require.”

The article titled “An ethical dilemma arises from optimizing outbreak interventions in heterogeneous populations” was published in the journal Journal of the Royal Society Interface and includes co-authors from La Trobe University, the University of Melbourne and Northeastern University in London.

Researchers used “SIR and SIR-like models” that assume individuals in the population are susceptible, infected, or recovered (with immunity) to study the optimal intervention, such as containment and isolation, required in a community to reduce and delay the peak. of an epidemic and ensure that there is no longer a risk of a future epidemic or a second wave of infections. They explored what would happen if different groups within the population, such as different age groups, had different risk factors for serious infection.

Using data from a Dutch survey that determined how often people in different age groups came into contact with each other, the researchers simulated different scenarios to determine the best outcome for an entire population, assuming that a contact-modifying intervention would be in place for some time. limited time.

It was found that if the intervention did not reduce contact sufficiently, a large outbreak would occur. However, if the intervention reduced contacts too much, there would be a modest outbreak and, once the intervention was lifted, many people would still be susceptible, and a second wave would occur.

Optimal intervention occurs when contacts are reduced so that the initial outbreak is as small as possible while still infecting enough people to avoid a second wave.

If there are multiple groups at varying risk, the same general principles apply, but sometimes the optimal intervention has increased the number of infections in lower risk groups to reduce the risk of a second wave once the intervention completed.

“This calls for a discussion about the ethics of subjecting certain groups to a higher incidence rate of disease and the feasibility of this policy,” the study says.

Dr Miller said this was the first study to consider the ethical implications of increasing infections as a strategy for optimal outcomes, without the use of vaccines.

However, Dr Miller says choosing which groups to confine and which to actively promote infection was an ethical dilemma for governments and the community.

“Mathematical models of epidemics can inform possible policy choices and can even help us choose those that lead to optimal outcomes. But the decisions made by policymakers are closely linked to political will, popularity and attitudes social”, indicates the study. .

“These ultimately determine whether a particular intervention is favored by a decision-making body.”

“Disadvantaged groups everywhere do not exercise sufficient political power to represent their interests in decision-making bodies. In such a case, a decision-making body may find it appropriate to subject a disadvantaged group to a higher final size in order to of to decrease the final net size of the entire population and achieve herd immunity.”

“The intervention strategy presented here always carries such risks; and the representation of disadvantaged groups therefore becomes essential, especially for a policy like this.”