Health justice for the most vulnerable billion: climate change, ethics, and vector borne disease

More than half the world is at risk of vector-borne diseases (VBDs) such as malaria, arboviruses (including dengue and Zika) and tropical parasites (including filariasis, onchocerciasis, Chagas, trypanosomiasis, schistosomiasis). Emerging evidence suggests climate change will drive a net increase in infection risk. VBDs account for one sixth of the global burden of disease, but this burden is borne inequitably by the one billion poorest and most vulnerable people, particularly children and pregnant women. There is thus a moral imperative for improved disease control programs, epidemic forecasting using climate data, and climate change mitigation strategies that can help to protect the vulnerable from increasing harms and injustice.

VBDs are complex. Understanding their epidemiology and responding to the ethical issues they raise requires a detailed understanding of their transmission, future climate trends, and the public goods aspects of their control – i.e. the ways in which benefits and harms from infection, resistance, and treatment go beyond the individual to involve entire communities. This gives rise to unique requirements for funding, and inclusive control models: for example, even asymptomatic carriers may have moral obligations to be involved in mass drug treatment if elimination is to be successful.

The current project will address each of these complexities in detail through three papers on (1) Current VBD epidemiology, climate effects, and research efforts, (2) Conceptual and public goods aspects of VBD control, and (3) Ethical priorities for VBD control and research.