Ethics and the AIDS pandemic in the developing world

Traditional ethics provide insight, but often fall short of guiding the complex biomedical ethical concerns of research conducted in developing countries. The need to create research within a framework that is appropriate to the social, medical, and political context of developing countries is examined through the current AIDS pandemic in sub-Saharan Africa. A specific case study focuses on this issue. Over 70 percent of the 40 million people with HIV/AIDS live in sub-Saharan Africa. With at least one in five African adults infected with the disease, sub-Saharan Africa is now acknowledged as the epicenter of HIV/AIDS. The scale and scope of the disease in the environment of a developing economy presents unique issues that challenge the role and practices of traditional ethics in healthcare research programs. Medical research within developing countries, particularly for HIV/AIDS, requires a distinctive approach. For these populations, investigators must incorporate new thinking into traditional biomedical research ethics which will address the role of innovation; access to treatment; the impact of fear, stigma, and denial; concerns around autonomy for vulnerable populations; capacity building; and sustainable care to communities. Since May 1999, Secure the Future, a philanthropic program that focuses on care and support for women and children infected and affected by HIV/AIDS, has attempted to fulfill these ethical concepts in its processes. The program is a public and private sector partnership between governments, communities, practitioners, academia, and Bristol-Myers Squibb Company to respond to AIDS in five countries in sub-Saharan African countries: Botswana, Lesotho, Namibia, South Africa, and Swaziland. To ensure symmetry between ethical principles and local context, collaborative projects undergo a comprehensive review process. This includes review and approval by a national secretariat to ensure projects support objectives of national policies and local communities; approval by an ethics committee comprised of participating institutions; blinded peer review; and an examination by an external advisory board comprised of local and international medical experts, persons living with AIDS (PLWA), religious communities, governments, and nongovernmental organizations (NGOs). An independent monitor also oversees the approved programs. Cost-effective and practical interventions against HIV/AIDS must encompass ethical approaches appropriate to the contexts of the respective developing countries. Lessons learned to date are to focus on innovation; establish unassailable ethical standards that are sensitive to local contexts; ensure transparent communications among partners and the broader community; and build sustainable capacity.     

Lockdown cardiomyopathy: from a COVID-19 pandemic to a loneliness pandemic

Social distancing/isolation is vital for infection control but can adversely impact on mental health. As the spread of COVID-19 is contained, mental health issues will surface with particular concerns for elderly, isolated populations. We present a case of Takotsubo cardiomyopathy related to lockdown anxiety.Key words: global health, heart failure, lockdown, mental health, old age psychiatry, Takotsubo cardiomyopathy     

Rational policymaking during a pandemic

Policymaking during a pandemic can be extremely challenging. As COVID-19 is a new disease and its global impacts are unprecedented, decisions are taken in a highly uncertain, complex, and rapidly changing environment. In such a context, in which human lives and the economy are at stake, we argue that using ideas and constructs from modern decision theory, even informally, will make policymaking a more responsible and transparent process.     

Multinational impact of the 1968 Hong Kong influenza pandemic: evidence for a smoldering pandemic

BACKGROUND: The first pandemic season of A/H3N2 influenza virus (1968/1969) resulted in significant mortality in the United States, but it was the second pandemic season of A/H3N2 influenza virus (1969/1970) that caused the majority of deaths in England. We further explored the global pattern of mortality caused by the pandemic during this period. METHODS: We estimated the influenza-related excess mortality in 6 countries (United States, Canada, England and Wales, France, Japan, and Australia) using national vital statistics by age for 1967-1978. Geographical and temporal pandemic patterns in mortality were compared with the genetic drift of the influenza viruses by analyzing hemagglutinin and neuraminidase sequences from GenBank. RESULTS: In North America, the majority of influenza-related deaths in 1968/1969 and 1969/1970 occurred during the first pandemic season (United States, 70%; Canada, 54%). Conversely, in Europe and Asia, the pattern was reversed: 70% of deaths occurred during the second pandemic season. The second pandemic season coincided with a drift in the neuraminidase antigen. CONCLUSION: We found a consistent pattern of mortality being delayed until the second pandemic season of A/H3N2 circulation in Europe and Asia. We hypothesize that this phenomenon may be explained by higher preexisting neuraminidase immunity (from the A/H2N2 era) in Europe and Asia than in North America, combined with a subsequent drift in the neuraminidase antigen during 1969/1970.     

Swine flu pandemic: a global concern

Recently WHO has again declared Influenza pandemic due to the outbreak of H1N1 which has infected over 254,206 people in 80 countries, with 625 deaths. Our lab has started working on the proteome analysis of H1N1, 2009 out break strains.