Abstract
Malaria is still a significant cause of death and suffering throughout much of the developing world. Fortunately, the global community provides significant (though, not sufficient) resources to combat the disease and the parasite that causes it. How ought we to allocate these resources? One option is to purchase and distribute perhaps the best tool we have to prevent malaria: insecticide-treated nets. Another route would see us invest in research and development of a novel biotechnology that could eradicate the disease in perpetuity. If we choose to spend our money on insecticide-treated nets, we will be rescuing current individuals at risk of being infected with the parasite. Though, we can be almost certain there will be future individuals who will also need rescuing. If we instead invest in the novel biotechnology, we could benefit countless future individuals who never have to experience the threat of malaria. Hence, this would mean that some number of current individuals will die due to the lack of insecticide-treated nets that otherwise could have saved their lives. So, ought we to rescue current, identifiable individuals, or ought we invest in research for the sake of the future? After an exploration of the duty to rescue and cost-effectiveness analysis, I suggest we look towards the literature on intergenerational justice for a justifiable answer to the question of how we ought to allocate our malaria resources.
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Notes
ITNs also generate significant corollary benefits.
It could also have other significant co-benefits. For instance, gene drives could: help eradicate other vector-borne diseases (such as zika, dengue, chikungunya, and others); could help control invasive species and preserve biodiversity; and could increase crop yields. Some of the research done on gene drive solutions to malaria could help develop the technology in these other areas as well.
I should note that while my focus will be on the specific case malaria, the discussion generalizes to many different kinds of decisions.
I should note that the WHO’s estimates are lower than other estimates. For instance, the Institute of Health Metrics and Evaluation has released estimates that are nearly double that of the WHO. See (World Health Organization 2018a, 37).
There is a new vaccine that will begin pilot introduction in 2019. See: (World Health Organization 2018b).
Of course, it is possible to eliminate malaria with the traditional methods. This has been accomplished and in many parts of the world. But, for the reasons I cite below, relying exclusively upon traditional methods for the complete elimination of malaria would be difficult.
Of course, the population has increased significantly even in this short time span, especially in the developing where world malaria is endemic. So, some of this parity is slightly misleading.
Only female mosquitoes bite and thus only female mosquitoes are vectors for malaria.
This kind of dilemma is similar to the one described by Johann Frick with respect to HIV/AIDS treatment and prevention. See: (Frick 2015).
The duty to rescue is also similar to what Rawls called “the duty to assist.” Though, Rawls’ duty applies to state institutions as opposed to individuals. See: (Rawls 2002, 106).
For an attempt to institutionalize the duty, see: (Rulli and Millum 2016).
Such a requirement has been criticized as being “overdemanding.” For a critical discussion of such an objection, Cf. (Sonderholm 2013).
For instance, it was estimated that ITNs cost roughly $5 to $17 per QALY produced. See: (Jamison and World Bank 2006, 45).
Though, it may not need to be one of scarcity. I’ll say something about this in the conclusion.
And, for Rawls, to say that the basic structure is just is to say that it abides by the two principles of justice (as constrained by the just savings principle). See: (Rawls 1999, 266).
This is similar to (yet different from) the discussion had by Brock and Wikler on permanent and temporary scarcity. See: (Brock and Wikler 2009).
For a discussion about how difficult decisions like the one being explored can lead to changes in funding, see: (Beauchamp and Childress 2013, 280).
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Acknowledgements
For helpful comments and discussion, I’d like to thank Amy Zhou, John Evans, Craig Callender, Reuven Brandt, Christopher Preston, Theron Pummer, Kian Mintz-Woo, Richard Arneson, and the participants of the International Society for Environmental Ethics’ special session at the 2019 American Philosophical Association’s Pacific Division meeting, the participants of the “Global Justice” workshop at Fudan University, as well as the participants of UCSD’s First Annual Gene Drive Conference.
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Callies, D.E. Bednets or Biotechnology: To Rescue Current Persons or Research for the Future?. Fudan J. Hum. Soc. Sci. 13, 559–572 (2020). https://doi.org/10.1007/s40647-020-00290-7
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DOI: https://doi.org/10.1007/s40647-020-00290-7