The Greenwall Foundation has awarded a grant to the Johns Hopkins Bloomberg School of Public Health to examine the ethical challenges of mass administration of antibiotics—an intervention that could save the lives of children in low- and middle-income countries, but that could potentially pose risks to the broader community and the children themselves later in life by making those same antibiotics less effective for treating bacterial infections. The project will be led by Anthony So, MD, MPA, professor of the practice in the Department of International Health at the Bloomberg School, and Matthew DeCamp, MD, PhD, associate professor in the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.
The project aims to develop a bioethics framework, informed by key stakeholder interviews and expert consultations, that will serve to shape the decision-making of funders, researchers, and communities around the mass drug administration of antibiotics.
Mass drug administration (MDA) of antibiotics involves routinely administering drugs that fight bacterial infections to an entire at-risk community or population, whether or not individuals have a specific disease. MDA of antibiotics has been used in campaigns against trachoma, a leading cause of blindness afflicting 2 million people per year. More recently, a study has applied such treatment twice yearly to young children, without disease, and found a significant mortality benefit. The mechanism is not known. Yet MDA raises challenging and relatively unexplored bioethical issues at the intersection of public health, research, and clinical ethics. In places where MDA might reduce mortality among at-risk children, are there any longer-term, but less certain consequences for those individuals or communities? How should benefits now be weighed against risks in the future, such as increased drug resistance? MDA poses these and other interesting ethical questions.
This project will close this knowledge gap through in-depth interviews with key stakeholders that will identify the critical ethical issues in MDA. Findings will inform the future development of a decision tool that will help ensure ethical considerations are integrated into study design and policymaking around MDA.
The Greenwall Foundation seeks to make bioethics integral to decisions in health care, policy, and research. It is a nationally recognized private foundation that supports efforts to expand bioethics knowledge that can improve clinical, biomedical, and public health decision-making, policy, and practice.
