OWSD Nigeria National Chapter Presents "Ethics in Science through the Lens of COVID-19 Pandemic"

November 25, 2020

OWSD Nigeria National Chapter University of Port Harcourt Branch series of scientific communications: Florence O. Nduka on Ethics in Science through the Lens of COVID-19 Pandemic

Ethics in Science through the Lens of COVID-19 Pandemic

By

Professor Florence O. Nduka

Science has always been seen as pragmatic and the rampart in a surging ocean of confusing and polarizing ideas and nothing has put science on the frontlines in recent times than the COVID-19 Pandemic. Science and its practitioners have tried to live up to its goals of systematic observation, analyses and logical conclusions. It depends on evidence and is not swayed by conflicts or political shades and persuasions. COVID-19 provides the perfect picture of the flux in scientific research and the painstaking efforts at observations, trying to understand the facts and proffering possible conclusions. COVID-19 from its inception in China in December of 2019, to its becoming a global emergency in late January, 2020 and finally upgraded to a pandemic on March 11 2020, by the World Health Organization (WHO) has spurred the scientific world into action from availability of the genetic sequence of the virus SAR-CoV-2 which led to a flurry in diagnostics through case managements, information management and issuance of public health guidelines and public safety measures. Though the pandemic came with unusual pressure and urgency scientists knew they still have to operate within the ethics of the profession and uphold the moral guidelines that distinguish what is right and wrong. Major ethical principles operate within and across science disciplines and viewed through the COVID-19 lens how have scientists fared in  upholding these ethics as they race against time to limit the spread of this contagious virus with an elegant name.

1.  Duty to Society: This ethical principle encourages researchers to embark on research that must contribute to the well-being of society. The race to stem the tide of COVID-19 showcases a duty to society. The concern of majority if not all of the scientific researches embarked on was to stave the infection and improve the wellbeing of the affected. The genome of the virus was quickly analysed to provide a road map towards understanding its nature, providing accurate diagnostic tests and working towards long term control. The transmission pathway was quickly researched to understand how it moves from one host to another. Some hiccups were experienced given the novel nature of the virus but serious effort was made at educating the public with the available information that it is a respiratory infection transmitted through droplets emitted through sneezing, coughing and by touching contaminated surfaces.  The symptoms of fever, chills, headache, and coughing, sneezing, shortness of breath or difficulty in breathing, loss of sense of smell and taste and diarrhea were put on the front burner. Advice was issued on the need to report to healthcare facilities if one experienced these symptoms in different combinations. The public was also informed of the vulnerability of the elderly especially those with underlying conditions that can complicate the course of infection and the risk  of transmission posed by the large pool of asymptomatic younger population. This November pregnant women,  individuals with chronic kidney diseases and children with sickle cell anaemia have been added to the vulnerable list (CDC, 2020). Countries were encouraged to do massive testing of their population in order to have accurate data to plan and to isolate the infected in a bid to limit the spread. As a duty to society public health guidelines were put in place to slow the spread of the virus. The new normal of frequent hand washing with soap and water,  use of  alcohol based sanitizers if water is not readily available, wearing of a face mask, avoiding crowded spaces, sneezing and coughing into the elbows, avoiding touching of  the face with contaminated hands and Social Distancing are now the passwords of social interactions and optimal living. Self-isolation and quarantine were recommended on contact with possible high risk individuals or visits to high risk areas. Aggressive lockdowns were issued as stop gap remedies to flatten the curve of infection. Massive awareness campaign was mounted by science advocates and major policy change enacted by different global governments to sensitize and enforce these guidelines for the well being of society. Research in the areas of possible and probable treatments and preventive vaccines went on overdrive to find the right molecules or combination of molecules that can be administered for relief of symptoms or keeping the infection out through improved immune systems. The World Health Organization has been at the fore front of this duty to society working with a coalition of partners and scientists in the tracking of the pandemic, advising on critical interventions and distributing vital medical supplies.
2. Another major principle is that researchers should not expose participants to unnecessary risks. At each point in time the welfare of the research participant must be paramount and the goal should strive for the benefits of the research to outweigh the risks.  This is called Beneficence. The current race for an effective vaccine is an example of science standing in the beneficence ethic by following all necessary protocol of vaccine development despite the urgency being experienced and the death toll rising from infections by the virus. Though there is enormous pressure from political circles and increasing numbers of infection the vaccine journey is following the course of ensuring that safety of participants in trials and that of end users are not sacrificed on the altar of efficacy and shortened processes. All the steps are being followed and data properly analyzed to show evidence based trail and trend before approval can be given for mass usage. There are about 48 candidate vaccines on the WHO draft vaccine landscape undergoing various stages of trials with many in phase 3 clinical trials and the world is hopeful that through rigorous laborious efforts that the scientific world would soon deliver for use a safe and effective vaccine against COVID-19. The announcements by Pfizer and Moderna of vaccine candidates with 90% and 95% effectiveness respectively have elicited excitement and optimism that there is light at the end of the tunnel to protect a large number of the populace from the infection. However caution is still been exercised as the safety profiles of the vaccines are monitored and evaluated. Of course this step supports the need to obtain informed consent from participants and volunteers have enthusiastically enrolled to be part of the study.
3. Integrity:  Weinbaum et al., (2019) captured the ethic of integrity thus “Researchers should demonstrate honesty and truthfulness. They should not fabricate data, falsify results, or omit relevant data. They should report findings fully, minimize or eliminate bias in their methods, and disclose underlying assumptions”.
3. This was what drove the late Dr. Li Wenliang a Chinese Ophthalmologist from Wuhan to alert his colleagues on a new disease similar to SARS he has seen patients show up with at his hospital. He wanted this information to go out with an advice to friends and families to wear protective gears. He was harassed by the repressive officials of his country and later died from the infection. But the truth he told which was termed rumour was later vindicated. In our own clime of Nigeria, the Director-General Nigeria Centre for Disease Control, Dr. Chikwe Ihekweazu has been a powerful voice of scientific truth constantly drawing attention to the need to observe guidelines, improve facilities at surveillance and response and has evolved an efficient supply chain and appropriate use of Personal Protective Equipment (PPE) especially to health workers. He showed the example of self isolating for two weeks on his return from an official assignment to a high risk country China. The Director General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus has not failed to speak truth to power in this pandemic. He has stood his ground calling out on the need not to politicize the virus and to the fact that there are no “magic solutions” to the outbreak but just hard work from leaders and society at all levels (VOA News, 2020). Dr Ghebreyesus clearly stated on October 26, 2020 that “Science continues to tell us the truth about this virus. How to contain it, suppress it and stop it from returning, and how to save lives among those it reaches. Countries that have followed the science have suppressed the virus and minimized deaths. Where there has been political division at the national level, where there has been blatant disrespect for science and health professionals, confusion has spread, and cases and deaths have mounted”. A most respected and steady voice of Science and the truth it stands for is Dr. Anthony Fauci (79 years), Director of the National Institute of Allergy and Infectious Diseases, USA, who has been waging an unending battle with the Government and people of United States of America to key into the simple guidelines that will help to keep the infection numbers low.  His prediction in June 2020 that America will see unprecedented surge in infection levels and number of deaths from October if they continued on the road of opening up the economy and refusing to wear masks has come to pass and cases still rising. He joins the scientific community to be cautiously optimistic of vaccines and their effects on this virus. He said “The Calvary is coming but the Calvary is not yet here. Let the hope of a vaccine motivate us more to strictly follow the guidelines”. Many Scientists have upheld this ethic during this pandemic. Clearly and honestly stating the facts of this pandemic as they understood it. They did not hesitate to state that there were many things still evolving given the fact that they were dealing with a novel virus and were humble to say I do not know for now or for sure.  Data from different laboratories and groups are being reported, processed and analyzed to give a holistic view to the unfolding scenario. Recently  Global Health Now(GHN) news of October 2020, reported that Italian cancer researchers unexpectedly discovered that some participants of a lung cancer screening trial showed SARS-CoV-2 antibodies dating back to September 2019 long before their index case of COVID-19 in January of 2020. This finding could reshape the history of the pandemic as the Chinese officials are already implying that this indicates that the virus did not originate in Wuhan but that Wuhan only sounded an early alarm to the presence of the disease.
4. In following the Non-discrimination ethic, attention has also been drawn to the gender issues arising from the pandemic. Many frontline health workers are females and maybe at higher risk of being infected and taking the infection home to their families as they carry out their care giving chores at home. Women also provide the majority of unpaid care work, including health-care work, in the home. The additional care burden associated with COVID-19 needs to be recognized and should be incorporated into policy-making and response measures.  Therefore effort must be made to ensure that PPEs which adequately protects the female are provided to these workers. Data also show higher mortality rate among males than females which is another pressure point for the females as they lose spouses, partners and male family members that provide necessary support in the household. The restrictions and attendant economic downturns have also escalated gender based violence with women and children being at the receiving end and science advocates are calling for policies that can protect and bring succor to these victims. WHO (2020) calls on Member States and their partners to include responses to violence against women, and particularly intimate partner violence, as an essential service within the COVID-19 response. Also the fact that access to reproductive health interventions and other routine vaccinations and monitoring of intervention effort in some morbid conditions are being hampered by focused attention on the pandemic and fall outs of the restrictions. These could lead to some disadvantages to the females such as maternal mortality, unwanted pregnancies and resurge of preventable infections hence the need for shifts in policies to address these needs.
5.  Privacy and confidentiality issues arise given the digital modes employed in addressing the pandemic including contact tracing, cell phone monitors and private data being shared online as people worked remotely. The unfettered access to private mobile technologies may pose a violation though can be employed in the public interest.

Conclusion

​ Looking through the lens of the pandemic Science seems to have tried to maintain ethical standards even under extreme pressure. Guidelines were put in place to slow the rate of transmission and to give health systems a window of operation without being overwhelmed. The only disturbing element in the operations was the intransigent human being who loved his pleasures more than he respected the voice of science and the mechanisms of nature. If only we all listened and obeyed especially the young who thought they were invincible (but data show that they form a significant percentage of the dead, about 20% in America) the outcome would have been better. Hopefully lessons have been learned on many sides from the government, the people and scientists. There were missteps by scientists in the early days some of which went against the tenets of ethics that saw even published works retracted and flip flops in mode of transmission but the tenacity to perform a duty to society at lower risks with integrity and honesty while protecting the confidentiality was not in doubt. It shone through. Science must not forget that it only uncovers what is already in existence and must look to nature to understand its Laws and become a cooperating link, a voice of Truth.

References

Centers for Disease Control (2020): Vulnerable groups for COVID-19. www.cdc.gov Accessed 20/11/2020

Global Health Now (GHN) News October (2020): Italian Cancer Researchers uncover SARS-CoV-2 Antibodies. www.globalhealthnow.org Accessed 7/11/2020.

Voice of America News October 26, 2020: WHO Director warns “Don’t politicize COVID-19 pandemic”. www.voanews.org Accessed November 18, 2020.

Weinbaum, C., Landree, E., Blumenthal, T., Gutierrez, C. (2019): Ethics in Scientific Research pp. 118. Publisher Rand Corporation, Santa Monica, California.

World Health Organization (2020): Gender and COVID-19 Advocacy Brief 14/5/2020. www.who.int Accessed 20/11/2020.