Swine Flu: Victims and Vectors

Leslie Francis is Professor of Philosophy, Professor of Law, and Adjunct Professor of Internal Medicine in the Division of Medical Ethics and Humanities at the University of Utah.  Margaret P. Battin is Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine in the Division of Medical Ethics and Humanities at the University of Utah.  Together with Jay A. Jacobson and Charles B. Smith, they wrote The Patient as Victim and Vector: Ethics and Infectious Disease which explores how traditional and new issues in clinical medicine, research, public health, and health policy might look different if infectious disease were treated as central. The authors argue that both practice and policy must recognize that a patient with a communicable infectious disease is not only a victim of that disease, but also a potential vector- someone who may transmit an illness that will sicken or kill others.  In the post below Francis and Battin look specifically at the H1N1 outbreak.

The recent outbreak of H1N1 influenza in Mexico has been greeted with great concern to prevent spread. Trips have been cancelled, travelers have been quarantined, schools have been closed, and sporting events will go uncontested. Preventing spread is important, to be sure, especially of a novel agent with unknown infectivity and lethality. But there is a down side to all the worry about spread: it encourages us to think of each other as vectors, sources of disease to be feared.

We are all vectors or potential; that’s a biological fact. But it’s only one side of our biology. We’re “way-station” selves, breeding grounds and launching pads for literally trillions of microorganisms, all the time—but we’re also recipients of them too. In short: we’re all victims,
just as we are vectors. We live in a state of perpetual uncertainty about whether we’re victims, vectors, or both, at any given time.

As we are caught up in the fear of pandemic spread, we need to remember our victim-side, too. There’s been some discussion of this in the press reports: stories of empty hotels, the cancelled U-17 Concacaf tournament, travelers quarantined in airports, workers without
childcare, or pigs slaughtered unnecessarily in Egypt. But there have been no comprehensive reminders that people stricken with the flu or suspected as vectors are victims as well and in need of support: medical care if they are ill, economic consideration if their livelihoods are
lost, and just plain concern when events that are important to them must be cancelled to enforce the social distancing that is hoped to prevent spread.

In pandemic planning, much effort has been devoted to preventing disease spread. We are seeing the importance of these measures in the current situation. As fears wane, or refocus on later, perhaps more virulent phases of an epidemic or on future emergences of new infectious diseases, however, it is equally important for us to plan for victims and to ask what we owe them. Such planning efforts may be particularly important to encourage the sharing of epidemiological data in the future, if the economic impacts on Mexico are dire and left unattended, where data sharing and international cooperation is crucial in disease control. That’s a prudential imperative, but it’s an ethical one, too. After all, we’re all in this together,working together not only to prevent the spread of infectious disease but also to mitigate the impact of disease where it strikes.