Examples of global health emergencies potentially within the scope of this inquiry
- Major outbreaks of infectious disease where there is currently no effective treatment or vaccine: for example the 2018 outbreaks of Lassa fever in Nigeria, Nipah in India, and Ebola in the DRC
- Physical and mental health impacts on civilians in conflict zones: for example in Syria, Yemen, Myanmar, DRC, Ukraine
- The provision of health care for displaced persons: for example in refugee settlements in Lebanon
- Health impacts of natural and human-induced disasters such as the 2010 Haiti earthquake; the 2011 Fukushima nuclear accident in the aftermath of earthquake and tsunami; and typhoon Haiyan in 2013
There is no single agreed definition of a ‘global health emergency’, or indeed of the related concepts of a ‘public health emergency of international concern’ or of a ‘global health threat’: various definitions are used for different purposes. For the purposes of this project, we are concerned with identifying those threats to public health that have the capacity to have global impact, and that may potentially challenge standard approaches to research ethics. Such threats are associated with ‘radically non-ideal circumstances’ in which to conduct research; where, at the same time, research may play an important role in achieving an effective response, both now and in the future. We recognise that there are a number of major threats to public health at a global level that fall outside this definition (for example, the increasing health burden of non-communicable diseases), on the basis that their nature does not challenge current research norms in this way. Our working definition should not be seen as categorising these global health threats as being more or less significant, or deserving of resources.
We suggest that for the purposes of this inquiry, a global health emergency is characterised by the following features:
- It is triggered by a disruptive shock – a sudden and significant change from the ordinary course of events.
- This disruption entails risks of significant harm to health both for individuals, and at population level.
- The effectiveness of the response is directly linked to the timeliness with which the response is undertaken.
- The health threat may extend beyond national borders and is a matter of regional and international concern: this may be in terms of the potential for direct impact on other countries and / or in the need for an international element in the response.
- There are barriers hindering effective response, for example in terms of scientific uncertainty, availability of resources, or disrupted infrastructure.
Questions 1 and 2
1. Please comment on this working definition of a global health emergency.
2. What might be the ethical implications of defining global health emergencies in this (or other) ways?