social and ethical implication of bioweapons

Ethical concerns

Bioterrorism poses real dangers and societies possess a moral obligation to mitigate that risk. Nevertheless, discussions of biodefense preparedness can lead to political battles, involve serious questions of research ethics, challenge the boundaries of professional obligation, and require important value judgments once ready for implementation. Mistakes in any of these sensitive areas can jeopardize the integrity of healthcare professionals and public health officials and their established bond of trust with the public.

Bio defense vaccine development and implementation may be one of the remedy to offence the bio weapon application in the war field. There are several ethical challenges most notably in three areas:

1. Establishing informed consent during clinical testing,

2. Defining professional obligations of healthcare workers to participate in vaccine development research

3. Fairly allocating vaccines once developed.

Ethical standards of informed consent require autonomous authorization from participants with decision-making capacity informed of the risks and benefits of the research.

There is panoply of diverse ethical considerations and challenges that must be discussed or debated that relate to biodefense. In this paper, we review eight vital ethical issues related to bioterrorism and at the end propose specific recommendations to be incorporated into policies that relate to bioterrorism. These eight considerations are:

1. Allocation of resources and personnel and cost benefit analysis. 2. Triage assessment. 3. Clinical testing of potential therapies or vaccines in young children and older adults. 4. Preventing unauthorized individuals from entering research laboratories. 5. Dual-use: publication of papers containing useful information that also could be used to create bioweapons. 6. Dual-use: curtailing the development of harmful technologies while promoting beneficial applications by scientists of these technologies. 7. Restriction of personal freedoms. 8. Allocation of educational resources.

In particular, this principle must extend to all members of society. As one challenging example, the development of biodefense vaccines could require development and testing of novel methods of delivery whose risks and benefits are largely unknown, making informed consent difficult or impossible. There is considerable uncertainty is adverse events, absent defined or known risks of exposure. Thus, disclosing the risks and benefits of participation in trials absent a current and tangible bioterrorism threat may be especially difficult.

Pox virus can be used as a bioweapon but it is hard to image how, for instance, a healthcare worker should think about the personal risks and potential benefits of participating in a trial of a novel smallpox vaccine—the frequency and severity of a future attack is virtually incalculable, and the marginal benefits therefore are hard to conceptualize. Thus, often the risks as well as the benefits of biodefense are and will remain unknown until after their implementation.

In such cases, we especially need to acknowledge the limitations of informed consent and insure that additional ethical safeguards are in place.

The fledgling attempts to get healthcare workers to accept smallpox vaccination as part of the 2002–2003 Federal plan to create smallpox response teams illustrated this struggle. The plan faced stiff opposition from individuals, institutions, and professional organizations. Even after legislation clarified liability concerns, health care professionals responded meagerly. A well-founded case establishing a professional obligation for healthcare workers to participate in such research based on national security interests has not yet been developed, given that healthcare workers signed up for patient care, not national defense.

Unlike the case of routine seasonal influenza where the risks are clear and moral obligations of the healthcare provider unambiguous, in the setting of bioterrorism, collective responsibility to promote public health preparedness but not necessarily a specific individual obligation. Once vaccines are developed, tested and are ready for implementation other tough ethical choices will need to be made. These include deciding who gets priority in receiving first dosing of vaccines, and what freedoms can be limited for the sake of the public good. These choices may well raise serious questions about where our personal and civic obligations lay in the setting of pandemic or bioterrorism conditions.

Social concerns

 Our major defense strategies against bioweapons have been similar to our major defense strategies against chemical warfare. Organized nations agreed to conventions such as the Geneva Convention regarding the prohibition of certain types of weapons including biological and chemical warfare. The prohibition codified by these conventions was supported by a shared sense across the international community of their unacceptability with the understanding that violations of these conventions would be enforced by some form of recognition and prosecution as war crimes. Indeed, the rise of terrorism in the 21st century, combined with the actual use of anthrax as a biological weapon, has created a second social shift in the consideration of vaccines for biodefense. We now struggle with the conceptualization of a threat or enemy that is nationless and borderless, an enemy who will not agree to certain conventions in war and peace, and an enemy who often lacks even a commitment to self-preservation and survival of its people in pursuit of its ideology.

These concerns have developed during a time when science and technology have developed to the point of containing and controlling biological agents effectively as bioweapons. Simultaneously the ability to travel safely and rapidly to deploy those bioweapons internationally is easier than ever.

Mass communication, with rapid and better broadcast than ever, equips terrorists with the ability to publish their threats and demands, leaving large populations feeling vulnerable to further attacks. Thus we have witnessed the emergence of a global need for biodefense against bioterrorism that goes beyond conventions and treaties and the jurisdiction of war tribunals.

 Just as nations before recognized a need to agree to prohibit the use of bioweapons in times of peace and wars, nations now might agree for a need to collaborate internationally to develop vaccines against bioterrorism.

In preparation for potential bioterrorist use of smallpox in 2003 and 2004, public health officials gave consideration to a number of strategies including ring vaccination of those in direct contact with diagnosed smallpox patients in the event of an attack, preparatory vaccination of first responders, and voluntary population vaccination. In recent years, the military had to deal with personnel refusing anthrax vaccinations despite the vaccine’s licensure and track record of safety. Similarly, following presumed exposures in October 2001, postal workers and other civilians likewise refused anthrax vaccine when offered. Furthermore, during the execution of the National Smallpox Vaccination Program, healthcare workers refused smallpox vaccination. Since some bioweapons result in contagion, refusal of vaccination affects more than personal risk.

Should the government depend upon commercial interests to produce sufficient quantities of safe and effective vaccines? Can we permit private companies to manufacture and distribute such vaccines freely? What steps should society take to prevent sales to those who might use the bioweapons and benefit from the immunity due to the vaccine? What is our basis for restricting their availability? Such challenges require further debate and rational decision-making.