Transparent Communication in High Risk Infections: A Bioethical Perspective

Introduction

Biomedical sciences are expected to observe intently, hypothesise on the observations, assess the hypotheses in light of the accumulating body of relevant evidence, and theorise for scientific objectivity (Gillet 2006) to arrive at the conclusions which go to ensure the healthy survival of mankind. This process demands a seamless cross flux of ideas and information among scientific bodies across the national barriers to attain the cherished goal. However, such an exchange and implementation of ideas and concepts are almost always encompassed by socio-ethical issues which in turn have profound policymaking and economic ramifications.

The recent news about emergence of the resistant bacteria carrying New Delhi Metallobetalactamases-1 (NDM-1) supergene has stirred the scientific community with reports in an international journal about its existence in India, then criticism about its naming after a city of India, followed by denials of its existence and then subtle acceptance of its being there. The whole episode has left a bad taste in biomedical fraternity due to inapt handling (Kumaraswami et al. 2010; Nataraj 2010).

In the recent past, we have seen the inclusion of protocols for sharing classified information on potentially dangerous infections in the agenda of academic, public and policy discussions. In this backdrop, we are attempting to touch upon the bioethical principles in risk communication of threatening infections.

Awareness of the Risk

The milieu of an infectious outbreak has many inherent convolutions which require resolution before any effective communication is initiated. Hence, it is vital to perceive the magnitude and nature of risk before it is communicated. The process starts with risk perception and understanding. It is the subjective perception of a risk or danger and often a casualty of incompletely understood probability, biased coverage in media, and ambiguous personal experiences. These result in risks being miscalculated (Nibsett and Ross 1987). The trajectory of an outbreak is tempered by individual behaviour, which being subjective, is a function of many factors (Sandman 1994) lik:

• ▪ Threat: The perceived peril of an infectious risk by the masses based upon the observed disease reactions, media exposures of medical facts about the virulence and health consequences of it.

• ▪ Available measures: The ready availability of measures to tackle the risk and the degree of efficacy of those measures which are publicised.

• ▪ Vulnerability: How vulnerable is the population in question and how probable is the likelihood of the infectious threat to jeopardise high-risk groups like pregnant, paediatric and geriatric populations go a long way in modulating how a risk is perceived.

• ▪ Unprecedented nature: The relative uniqueness of the risk is attended by greater importance being accorded to it by the public.

• ▪ Media coverage: The extent and nature of sensationalism, alarm and hype that is sounded by the media decide the final public reaction to the imminent threat.

• ▪ Proximity: The individual proximity to the risk is a determinant of public behaviour in the sense that people close to the outbreak exercise more precautionary measures and deal with the outbreak with far greater seriousness as compared to those who are far removed geographically.

• ▪ Retrospection: The past recall of adverse events due to an infectious outbreak definitely primes public assessment of the present situation and thereby greater compliance in pharmaceutical interventions (preventive and curative) and quarantine measures.

• ▪ Personal safety: It is often uppermost of the concerns amongst individuals and information and understanding about any infectious hazard is processed by people as a factor of individual safety to a great extent. Future scenario: The potential of the threat at hand to affect future generations prompts proactive public behaviour to tackle and limit the cause and restrict its progression over time.

Risk Communication

Communicating risk of an unpredictable, poorly defined infectious threat to public and scientific communities and drawing up measures to tackle it, is an arduous, herculean task for a heterogeneous, sprawling country, which needs to be meticulously planned and formulated before execution. Limited availability of finances in economically growing nations necessitates optimal resource allocation in times of such urgent need. Legislation, public health concerns and government agencies are posed with more or less...