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New University of Oxford research brings to light important ethical considerations in Nipah virus outbreak control, its treatment, and research into vaccines.

Fruit bat in tree© Bishnu Sarangi / Pixabay


Published in the Journal of Medical Ethics, the research was jointly carried out by Dr Tess JohnsonDr Euzebiusz JamrozikDr Tara Hurst, Professor Phaik Yeong Cheah and Professor Michael Parker, bringing together researchers from the Pandemic Sciences Institute, Ethox Centre (Oxford Population Health), Centre for Tropical Medicine and Global Health (Nuffield Department of Medicine), Mahidol-Oxford Tropical Medicine Research (Mahidol University) and Royal Melbourne Hospital Department of Medicine (University of Melbourne).

Outbreaks of Nipah virus occur in countries in South-East Asia, including Singapore, Malaysia, Bangladesh and India. Typically spread by bats, the disease can be fatal in up to 75% of cases.

The virus is identified as a priority pathogen by the World Health Organization and is receiving increasing attention among scientists and policymakers working towards epidemic and pandemic preparedness.

Despite this trend, there has been almost no bioethical research 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 also not present for other priority pathogens. They outline potential issues in public health ethics including 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 whose health burden may increase significantly in the future, it is crucial that these questions are raised and addressed.

Author Dr Euzebiusz Jamrozik said: “This paper highlights the case of the 2023 Nipah virus outbreak in Kerala (India), when public health authorities used lockdown 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 be informed by ethical considerations, including the results of local community engagement activities.”

The full paper is available to download on the Journal of Medical Ethics website.