On Wednesday, September 17 at 4:00 pm, the University of Toronto’s Joint Centre for Bioethics will be hosting a panel discussion on the ethical concerns brought to light by the Ebola outbreak in West Africa.

Dr. Jennifer Gibson, the Sun Life Financial Chair in Bioethics, director of the U of T Joint Centre for Bioethics, and assistant professor at the Institute of Health Policy, Management & Evaluation will be serving as the mediator of the session.

One of the major issues of concern is whether or not it is ethically sound to administer untested drugs and vaccines to treat the Ebola virus disease (EVD).

“These experimental agents are unproven and hence cannot be considered ‘treatments’ – they are potential treatments, but we won’t know for sure until they have been tested for safety and efficacy,” said Gibson.

She also refers to the WHO report, which states, “They concluded unanimously that it would be acceptable on both ethical and evidential grounds to use as potential treatments or for prevention unregistered interventions that have shown promising results in the laboratory and in animal models but have not yet been evaluated for safety and efficacy in humans, provided that certain conditions are met.”

“I can say that industry participated actively in the WHO Consultation in September and that two vaccines are already in development and being tested,” said Gibson, with regard to the popular notion of the pharmaceutical industry’s disinterest in developing drugs to treat EVD.

“Although [incentivizing] the development of vaccines (or therapeutics for that matter) may be a challenge, the bigger challenge may be in producing them fast enough once tested,” said Gibson.

“Accelerating their production is an obvious goal, but the production process itself is rate-limiting. As a result, even if the vaccines and therapeutics are shown to be safe and effective, they are not likely to be available immediately in sufficient supply to meet demand,” she added.

Keeping in mind the scarcity of treatments that might be available given the aforementioned production limitations, even if treatments are developed, equitable distribution of the resources might be an area of ethical concern.

“Equity is concerned with how the benefits/harms of particular interventions (e.g., treatment, vaccine) are distributed across those who are affected,” said Gibson. “This is in contrast to utility considerations, which are primarily concerned with generating the greatest net benefit from the intervention,” she added. “In practice, both equity and utility considerations are relevant as what we are seeking to distribute equitably is an intervention that generates a net benefit, or put differently, that actually meets the clinical need.”

Gibson added, “However, as a general principle of equity, access to interventions should be based on clinical need and not on factors such as race, religion, gender, social or socioeconomic status, etc.”

Gibson mentioned that the question of equitable distribution is not new and has been encountered in the past, in the context of the SARS and H1N1 outbreaks.

“It is also important to point out that different considerations are likely to be relevant for the distribution of vaccines compared to treatments in the context of a disease outbreak like Ebola. For example, given how essential they are to meeting patient and population health needs, priority for access to vaccines might be given in the first instance to health workers and then as more vaccine becomes available, to the wider population,” she noted.

Ethical concerns plague the question. “There are no simple solutions to the question of what constitutes an equitable distribution,” Gibson said, “However, it is widely agreed that there needs to multi-stakeholder involvement, including the affected communities, in defining the distributive principles (or criteria) and transparency in how these principles are set and applied.”

The seminar has an impressive lineup of speakers from the WHO, University of Ibadan in Nigeria, Queens University, Ryerson University, and U of T. It will take place on the second floor of the Pharmacy Building, in addition to being streamed online.