Despite efforts to eradicate malaria, this disease continues to infect hundreds of millions of people and cause an estimated 800,000 deaths annually.1 Where the disease is endemic — often concentrated in the poor, rural areas of developing countries — most of these deaths occur in young children and pregnant women.2
Research addressing this disease occurs primarily on three fronts: vector control, discovery of new antimalarials (or antimalarial combinations) and the development of vaccines. In this article, we consider the specific problem of conducting clinical malaria research in endemic regions of developing countries. Widespread malaria conditions provide the most reflective research data for study and therefore attracts scientists from developed countries. Although we do not distinguish these researchers from their sponsor, we are aware that each role raises specific considerations. Moreover, the disparities created by transnational “overseas” collaborations raises many ethical dilemmas, some of which have been discussed in detail elsewhere.3
In respect to the responsibilities that malaria researchers have towards trial participants, our approach is to develop a rights-duty framework that can ensure a reasonable agreement for all parties involved in transnational studies. To do so, it is necessary to consider the scientific objectives of researchers working with(in) the trial community and the prevailing ethical norms that they must follow, and ones which they might follow. What we find interesting are the different motivations that a “moral ought” and an optional choice [End Page 296] may provide in motivating the researchers to fulfil obligations towards the research community.
In the first section, we identify two practical forms of moral duty: perfect and imperfect. According to Kant, there are duties which we are morally bound to regardless of our inclinations — perfect duties — to which Kant gives the example of making false promises. Then there are duties which one should follow unwaveringly, but one can choose when and how to apply: “imperfect duties”, like cultivating one’s talents or helping others should always be done, but there are often choices about which talents we develop and which persons we help. (Although each can be sub-categorised as duties to oneself and duties to others, we do not need to delve any further than our bipartite description.) It is interesting that, accordingly, perfect duties should often be enforced by external laws, while imperfect duties should not. How these differ from one another is illustrated in an analysis of a malaria vaccine trial (MVT) that was conducted in Gambia between 2002 and 2004. While the researchers involved in this study complied with ethical requirements as required by standards of research ethics, they also went beyond what was obligated of them by providing additional health care to the research participants.4
However, the needs of trial participants in a developed context are very different from those in developing countries: in the latter case, patients will often have little or no access to a local healthcare system and if additional health care is merely optional, then there is no real onus for researchers to provide this. Therefore, it has been argued that in some circumstances, imperfect duties, while perhaps not as morally weighty as those which are considered as “perfect”, should also be counted as blameworthy when not fulfilled. The point being that although researchers will meet minimal ethical conditions for international research, they have an obligation to offer some medical assistance because of the circumstances of the research participants. In the second section, we show the limitations of the Kantian approach, because it still biases any agreement in favour of the researchers: a strictly deontological approach frames any agreement in the terms of the intentions of the researchers, and as such, it seems that the research participants can only be grateful for the additional beneficial actions of the researchers without being able to lay moral claim to them.
In the third and final section, we argue that ensuring an ethical agreement between international researchers and research participants requires an altogether different approach. Instead of finding the obligations of researchers as praise- or blameworthy in terms of finding an internal motivation...