Ebola Ethics: Public Health Decisions in the 2014 Outbreak

Introduction: Ebola as a Global Ethical Challenge

In March 2014, Ebola first emerged as a major threat within West Africa. It has a mortality rate of up to 90% and often infects different areas of the body simultaneously. This causes the liver and kidneys to become ineffective at disposing of waste, at which point the infected individual begins to experience a loss of bodily fluids and both internal and external bleeding (Garrett, 2014).

The incubation period ranges from two days to three weeks. During this time, those who are infected experience a number of symptoms, including fever, urinary problems, vomiting, headaches, sore throat, and a lack of coordination. Anyone in close proximity to infected individuals increases their own chances of exposure through contact with bodily fluids — such as semen, saliva, urine, blood, and breast milk — or through contact with contaminated surfaces. As a result, the disease spread quickly to different parts of the world and began infecting healthcare workers assisting these patients (Garrett, 2014).

To treat those infected, an untested serum called ZMapp was utilized. It was administered to two American patients and one Spanish nurse. The American patients made full recoveries and resumed their work; however, the Spanish nurse died of Ebola several weeks later. This outcome illustrated the vaccine's mixed results. These circumstances proved problematic, as they highlighted the tension between the urgent need to prevent the epidemic from spreading and the ethical boundaries being challenged by the scope and severity of the disease (Chedekel, 2014). Understanding what transpired requires analyzing the issue, evaluating the moral dimensions of public health options, and justifying a specific response. Together, these elements highlight the ethical challenges encountered throughout the crisis (Garrett, 2014).

Analysis of the Ethical Issue

The primary public health goal was to protect safety by preventing the disease from spreading to other regions. The problem was that cultural practices and a lack of awareness about key warning signs among healthcare workers compounded the crisis. This enabled infected individuals to travel to different regions and potentially spread Ebola to those they came into close contact with. Compounding the difficulty, the vaccines used to treat the condition had never been fully tested, meaning their effects and possible side effects were unknown. For healthcare professionals, these issues created significant challenges in adhering to the highest ethical standards while simultaneously protecting the public. The primary objectives in this context were to contain the disease to certain areas and to protect those at the greatest risk of exposure.

Without decisive action, there was a realistic possibility that the disease could mutate and spread further. Had that occurred, the total number of cases could have skyrocketed, creating a pandemic and paralyzing the global economy through widespread fear. Different stakeholders argued for the use of the ZMapp serum to varying degrees, with their contrasting views rooted in differing interpretations of ethics and their application to the situation.

Many individuals opposed to using an untested vaccine argued that drugs alone would not solve the problem. Instead, they advocated for a fundamentally different approach — one involving public education, stakeholder communication, and coordinated prevention efforts. The relevant legal and judicial landscape underscores how the ethical use of vaccinations depends heavily on the circumstances. The most pertinent legal precedent is Jacobson v. Massachusetts (1905), in which the U.S. Supreme Court found that health officials can require the public to be vaccinated in order to prevent the spread of disease to others (Ciolli, 2008).

This decision effectively allowed states to enact their own vaccination laws requiring most people to receive treatment when they posed a danger to public safety, though certain religious exemptions were permitted. These considerations directly conflict with federal regulations governing medication testing and with the American Medical Association's (AMA) Code of Ethics. The Kefauver-Harris Drug Act of 1962 requires manufacturers to demonstrate that a medication is safe before it is used, while the AMA's stipulations demand that healthcare professionals always act in the safety and best interests of their patients. The use of the ZMapp serum placed these safety guidelines in direct tension with the imperative to protect the public. As a result, legal precedent, federal law, and the AMA's Code of Ethics came into conflict with one another ("Food and Drug Law," 2014; Ciolli, 2008).

Conclusion

The 2014 Ebola crisis illustrated how rapidly an infectious disease can challenge established ethical frameworks, legal standards, and institutional protocols simultaneously. The tension between using an untested vaccine and upholding patient safety guidelines, the conflict between individual liberty and mandatory public health measures, and the difficulty of calibrating a proportionate institutional response all demonstrate how complex ethical decision-making becomes during a large-scale epidemic. Ultimately, the crisis required officials to balance urgency with caution, and the ethical lessons drawn from this episode continue to inform global public health preparedness.

References

Chedekel, L. (2014). Battling Ebola. BU Today. Retrieved from http://www.bu.edu/today/2014/battling-ebola-the-ethical-issues/

Ciolli, A. (2008). Mandatory school vaccinations. Yale Journal of Biology and Medicine, 81(3), 129–137.

Del Rio, C. (2014). Ebola. Annals of Internal Medicine. Retrieved from

Fisher, W. (2014). Protecting healthcare workers from Ebola. Annals of Internal Medicine. Retrieved from

Food and drug law. (2014). Cornell Law School. Retrieved from http://www.law.cornell.edu/wex/food_and_drug_law

Garrett, L. (2014). Ebola: Story of an outbreak. New York, NY: Hachette Books.