A scoping review on ethical considerations during Nipah Virus disease outbreak response in Low- and Middle-Income Countries

Abstract

Nipah virus (NiV) is a fatal zoonotic virus with a case fatality of up to 75%, causing severe outbreaks in low- and middle-income countries (LMICs) primarily in South and Southeast Asia. Since it's highly transmissible and there are no approved medications or vaccines, public health responses often involve measures that raise significant ethical concerns. This review investigated the ethical issues arising during the response to NiV disease outbreak. The study was conducted according to Arksey and O'Malley’s framework, informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used to guide the search for relevant evidence. A total of thirteen papers were reviewed out of the 197 papers found from the search strategy by two independent reviewers. Nine main themes on ethical issues were identified: Public health measures (n=5 papers), communication and infodemics (n=4), Resources constraints (n=4), equitable distribution of resources (n=3), vaccine and research ethics (n=2), community engagement (n=2), stigmatization (n=2), ethics of culling (n=1 handling of deceased subjects (n=1). Results generated indicate that ethical challenges arising during One Health response to NiV disease are not given the attention that they deserve. Kerala's decentralized governance model provides useful guidance for responding to outbreaks in an ethical manner. There is a common agreement that equitable distribution of resources, communication, and public health responses during zoonotic disease outbreaks must be ethically grounded to enable smooth responses towards outbreaks of the NiV and related zoonotic diseases. To be ethically prepared for NiV disease outbreaks, public health systems must incorporate ethical interventions both locally and internationally. It is also important to address injustice, encourage community engagement, and fund research towards NiV disease response and prevention.