Ethics, global health and Zika virus infection: a view from Brazil

Bangladesh Journal of Bioethics

This paper argues that Zika virus infection has its ethical implications beyond the reproductive health of women. It claims that Zika virus infection like public health emergency exposes the underlying health determinants and health status of women. Therefore, ethical mitigation of Zika like public health emergencies should consider these underlying health determinants and health status of women. For, undermining and overlooking these underlying determinants and health status of women, during the public health emergencies, enhance the health inequities. The recent Zika virus infection in Brazil has triggered different ethics consultation and has prompted to outline ethical recommendations. However, the recommendations have either focused on the reproductive health of women or on the core strategies of public health emergency. Considering this as a gap in perspective to prepare for Zika like public health emergencies, this paper argues that it is the underlying holistic health of wom...

Einstein (São Paulo), 2016

Philosophy, Ethics, and Humanities in Medicine, 2017

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized.

American Journal of Public Health, 2017

In late 2015, an increase in the number of infants born with microcephaly in poor communities in northeast Brazil prompted investigation of antenatal Zika infection as the cause. Zika now circulates in 69 countries, and has affected pregnancies of women in 29 countries.Public health officials, policymakers, and international organizations are considering interventions to address health consequences of the Zika epidemic. To date, public health responses have focused on mosquito vector eradication, sexual and reproductive health services, knowledge and technology including diagnostic test and vaccine development, and health system preparedness.We summarize responses to date and apply human rights and related principles including nondiscrimination, participation, the legal and policy context, and accountability to identify shortcomings and to offer suggestions for more equitable, effective, and sustainable Zika responses.

Voices in Bioethics, 2017

As a woman who believes wholeheartedly in the human right to safe and legal access to abortion regardless of circumstance, it is rare I find myself balking at a movement to extend legal access to abortion. However, in the case of Brazil's Zika epidemic, I am struck by an ethical dilemma. Brazil, a historically pro-life country, is currently considering reforming their anti-abortion laws exclusively in cases of fetal defects caused by Zika infection. I strongly believe reproductive rights are human rights, however, if the only exceptions made in allowing safe and legal access to abortion are in cases of a disabled fetus, we as ethicists must pause. The fact that in Brazil, a country with a strong moral and legal belief in fetal personhood, lawmakers are willing to abandon this belief solely in cases of the physically and intellectually disabled presents dangerous infringements on disabled individuals' rights. Furthermore, advocating for legal abortion solely in the case of fetal disability is ethically wrong and has historically eugenic undertones. As a pro-choice individual, it is essential to consider the ethical concerns that exist even in movements advocating for anti-abortion law reform.

Global Public Health, 2020

During health emergencies, the security agenda tends to impose itself over the human rights agenda. That happened when Brazil became the Zika-related PHEIC epicentre in 2016. While the federal government promoted a 'war against the mosquito' Aedes aegypti, some social actors emphasised the social determinants of health and women's rights. This article presents the United Nations Population Fund (UNFPA) led campaign 'More Rights, Less Zika' as a consistent example of the positive effects the coordination between global and local actors might have on health initiatives. We conducted field research in Recife, Northeast of Brazil, one of the campaign's target cities, where we interviewed main local actors. The campaign focussed on disseminating women's sexual and reproductive rights as an alternative to the strategy of the federal government, primarily focussed on controlling the vector, postponing pregnancies, and the use of repellent. Despite its scale limitations, the campaign demonstrates that a right-based approach can contribute to increasing the security of communities during health emergencies. The case also suggests that coordinating global actors' actions with local actors improves the quality of global health initiatives, which is particularly important when a conservative agenda opposing women's rights gains leverage in Brazil and other States.

Ciência & Saúde Coletiva

The study of global health agenda-setting and issue-prioritization has been one of the key aspects of a critical literature that, in recent years, has aimed to identify the political dimensions of global health governance and to shed light on points of tension, exclusion, and inequality. This essay speaks to this critical global health literature, focusing on the construction of the category of emergencies of international concern. Considering the case of the outbreak of zika and congenital syndrome in Brazil in 2016, it explores the conditions enabling the construction of an emergency. We question the factors and conditions around this public health event that were considered during the decision-making process and that transcended material, more objective data regarding zika’s epidemiology, its morbimortality, or its association with congenital malformations. We conclude that the securitized context and the growing relevance of risk to global health are important conditions for und...

Revista Ethica, 2018

In this paper we will explore the widespread of congenital Zika virus syndrome in Brazil associated with abyssal social inequalities as a trigger to push for abortion legalization from a human rights perspective. Brazil has a very restrictive regulation on abortion, which allows the procedure only when the life of the mother is in danger, in cases of pregnancy resulting from sexual violence, and when the fetus suffers from anencephaly. Due to the growing influence of ultra-conservative forces in the Parliament, the legislative debate on abortion has been blocked for many years in Brazil, making social movements seek the courts for advancements in this area. In this paper, we will present general data on the Zika epidemic, social inequalities and unequal access to health services as a background for the discussion on advancing abortion legalization in the country through judicial procedures, from a human rights perspective.

Cadernos de saude publica, 2018

Recently, the Zika virus epidemic has caused a setting of health emergency in Brazil. This event has mobilized several stakeholders to look at this reality-where women, men and children born with the marks of these diagnoses are differently affected-as one with vectors, illnesses and obscure diagnosis situations. Recalling this recent memory means summoning the political realms to demand the commitment to the health of the population in contexts of health emergencies and their repercussions in the daily life. The Zika virus epidemic is characterized as a total social fact 1 , precisely because it synthesizes several determinations about epidemic processes by combining factors of economic and social inequality and revealing processes of vulnerability. This situation triggers a chronology of events that establish and dismiss the emergency: in November 2015, the Brazilian Ministry of Health issued a National Public Health Emergency 2 ; in February 2016, the World Health Organization (WHO) classified the Zika virus epidemic as a public health emergency of international concern 3 ; in March 2016, the Protocol for Surveillance and Response to the Occurrence of Microcephaly Related to Zika Virus Infection 4 was published; in November 2016, the WHO no longer considered the Zika virus as an international emergency 5 ; and, in May 2017, the Brazilian Ministry of Health declared the end of the emergency 6. These sequential events, responsible for inaugurating and ceasing emergencies, do not suspend the living experience: babies will grow up and need, in addition to rehabilitation services, nurseries and schools able to receive them; and parents and relatives will need to work and most likely will be burdened by their exhausting routines. The emotional vulnerability to which professionals and users of health system are submitted are equivalent within a chain of iniquities and search for knowledge. Moreover, this chronology delimits a process that risks sexual and reproductive rights in the name of securitization of epidemics 7 , reinforcing fears and stigmatization. If, on the one hand, international agencies and the Brazilian government position themselves and qualify emergencies, on the other, by anticipating them very closely, the scientific field-both clinicians and researchers-mobilizes itself for answers 8,9,10. Given this context, the National Network of Specialists of Zika and Related Diseases (RENEZIKA), among others, and studies on the biological and social aspects had the initiative of coming forward in a cooperation between national and international researchers to investigate and propose articulations for action.

In this presentation I try to analyze some ethical aspects of the outbreak of zika virus infection in Brazil.