In its recently published brief, Ethics and Ebola: Public Health Planning and Response, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) considered what lessons might be drawn from U.S. engagement in the global response to the Ebola epidemic. The brief examined two areas of human subjects research ethics that have been particularly controversial in the current Ebola epidemic: clinical trial design and the use of placebos; and the collection, use, and international sharing of biospecimens for research.
Public health emergencies add ethical complexity to the conduct of clinical research and yet the Bioethics Commission recognizes the importance of such research—especially when an emergency presents the best, or only, opportunity to conduct research on potential preventive or therapeutic interventions, as is the case for Ebola. As large clinical trials are planned or already underway in western Africa to investigate experimental Ebola vaccines and therapies, the Commission considered whether it is ethically appropriate to conduct randomized placebo-controlled trials to evaluate these interventions. The Bioethics Commission considered two perspectives on this question, one against and one in support of placebo-controlled trials in the current Ebola epidemic, as well as possible middle grounds, while underscoring ethically relevant aspects of conducting clinical research in the Ebola epidemic that might help to resolve tensions between these two viewpoints, such as the role of different levels of supportive care and responsiveness to the needs of communities in which the research is conducted.
Ultimately the Bioethics Commission recommended that the full range of trial designs that protect and promote the welfare of participants and are capable of yielding credible and reliable data on the safety and effectiveness of the interventions should be considered:
Research during the Ebola epidemic should provide all participants with the best supportive care sustainably available in the community in which the research is conducted.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.