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Rising hepatitis C infections puts increasing burden on Australia
Newsdesk Research ethics fund for developing countries In the late 1990s, the conduct of HIV-related trials in Africa raised huge concerns about standards of care in externally sponsored trials in developing countries, especially those funded by commercial or academic
Wellcome Trust
In October, the UK-based Wellcome Trust launched a £4 million funding initiative to support research and research training in the ethics of biomedical research in developing countries. Most research funded by the Trust initiative will be in developing country locations where clinical or community-oriented research takes place. “Research in developing countries, particularly when funded by more affluent countries, raises difficult ethical questions for participants, communities, researchers, and research funders”, says Jo Sumner, the Trust’s policy adviser on biomedical ethics. “The kinds of projects to be funded would be those looking at the ethical, legal, social, and public-policy implications of any part of the research process, from decisions about what biomedical research is undertaken to its implications for policy and practice.” The Trust—which has wellestablished research centres in Africa (Malawi, Kenya, and South Africa) and southeast Asia (Thailand and Vietnam)—funds several vaccine trials in developing countries, including a malaria vaccine trial at its research centre in Kilkfi, Kenya.
Research in a developing country. Patrick Manson investigating transmission of filariasis in Amoy, China, about 1875. Oil painting by Ernest Board (1877–1934).
interests. “Ethical review of research proposals is essential to protect participants”, says Sandy Thomas (Nuffield Council on Bioethics, London, UK). “Relevant clinical and ethical expertise in developing countries must be developed through the promotion of education and training.” At the Africa Centre for Health and Population Studies in Mtubatuba, South Africa (which is supported by the
Wellcome Trust), a study to examine the nature of the relationship between the research centre and the community “raised a number of ethical dilemmas that affect community-based research throughout the world”, says the centre’s director, Michael Bennish. “Most researchers are committed to distributive justice, and one of our dilemmas is how to set boundaries. As a relatively well-funded research institution, what is our responsibility to assist with development in the very poor rural community in which we work, where fewer than 5% of the population have access to clean water?” Another issue is whether members of the community are knowledgeable enough to decide on the research agenda. And if they are not included in the decision, are they simply being exploited? In Bennish’s view, “increasing awareness of ethical issues in international health research, and training persons from developing countries in the basics of ethics, will allow them to enhance the ethical conduct of the very important research carried out in those countries, where the greatest burden of disease is”. Dorothy Bonn
Rising hepatitis C infections puts increasing burden on Australia Hepatitis C infections in Australia have reached a record high of 16 000 new infections each year, with experts warning of a public-health disaster if transmission of the disease remains unchecked. A report by the Australian National Council on AIDS, Hepatitis C, and Related Diseases (Estimates and Projections of the Hepatitis C Virus Epidemic in Australia 2002) estimated that there are currently 210 000 people living with hepatitis C in Australia, but predicted that the number could increase to between 321 000 and 836 000 by 2020. The number of new HCV infections increased from 11 000 per year in 1997 to 16 000 in 2001—a 45% rise— the report found. Of all notifications, 83% were estimated to be due to injecting drug
712
use, 5% due to receipt of blood and 12% due to other transmission routes such as mother-to-baby transmission and via unsterile body piercing and tattooing. “Projections of the number of people living with HCV-related cirrhosis, incident cases of liver failure and hepatocellular carcinoma were all, projected to at least treble by 2020”, the report stated. Gregory Dore, of the National Centre for HIV Epidemiology and Clinical Research, said the prevalence of HCV was 1·5–2%—similar to that in many other western countries. But while the USA had reported a 70% reduction in the incidence of new infections over the past decade, Australia’s incidence had more than doubled, largely due to an increase in the number of injecting drug users. “The Australian epidemic has been
rapidly escalating over the past 5–10 years, which appears to be a phenomenon not happening to that extent in other countries”, Dore said. There was a trend to decreasing prevalence of genotype 1 and an increase in genotype 3, which can be more successfully treated. President of the Australian Hepatitis Council, Stuart Loveday, warned that if transmission of HCV remained unchecked, the financial and social costs would outstrip costs related to HIV/AIDs. “Australia will face not just a public-health crisis, but a public-health disaster,” he said. Loveday reported that Australia was the first country to adopt a national strategy for hepatitis C in 1999–2000, but its implementation remained effectively unfunded. Megan Howe
THE LANCET Infectious Diseases Vol 2 December 2002
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Wellcome Trust
In October, the UK-based Wellcome Trust launched a £4 million funding initiative to support research and research training in the ethics of biomedical research in developing countries. Most research funded by the Trust initiative will be in developing country locations where clinical or community-oriented research takes place. “Research in developing countries, particularly when funded by more affluent countries, raises difficult ethical questions for participants, communities, researchers, and research funders”, says Jo Sumner, the Trust’s policy adviser on biomedical ethics. “The kinds of projects to be funded would be those looking at the ethical, legal, social, and public-policy implications of any part of the research process, from decisions about what biomedical research is undertaken to its implications for policy and practice.” The Trust—which has wellestablished research centres in Africa (Malawi, Kenya, and South Africa) and southeast Asia (Thailand and Vietnam)—funds several vaccine trials in developing countries, including a malaria vaccine trial at its research centre in Kilkfi, Kenya.
Research in a developing country. Patrick Manson investigating transmission of filariasis in Amoy, China, about 1875. Oil painting by Ernest Board (1877–1934).
interests. “Ethical review of research proposals is essential to protect participants”, says Sandy Thomas (Nuffield Council on Bioethics, London, UK). “Relevant clinical and ethical expertise in developing countries must be developed through the promotion of education and training.” At the Africa Centre for Health and Population Studies in Mtubatuba, South Africa (which is supported by the
Wellcome Trust), a study to examine the nature of the relationship between the research centre and the community “raised a number of ethical dilemmas that affect community-based research throughout the world”, says the centre’s director, Michael Bennish. “Most researchers are committed to distributive justice, and one of our dilemmas is how to set boundaries. As a relatively well-funded research institution, what is our responsibility to assist with development in the very poor rural community in which we work, where fewer than 5% of the population have access to clean water?” Another issue is whether members of the community are knowledgeable enough to decide on the research agenda. And if they are not included in the decision, are they simply being exploited? In Bennish’s view, “increasing awareness of ethical issues in international health research, and training persons from developing countries in the basics of ethics, will allow them to enhance the ethical conduct of the very important research carried out in those countries, where the greatest burden of disease is”. Dorothy Bonn
Rising hepatitis C infections puts increasing burden on Australia Hepatitis C infections in Australia have reached a record high of 16 000 new infections each year, with experts warning of a public-health disaster if transmission of the disease remains unchecked. A report by the Australian National Council on AIDS, Hepatitis C, and Related Diseases (Estimates and Projections of the Hepatitis C Virus Epidemic in Australia 2002) estimated that there are currently 210 000 people living with hepatitis C in Australia, but predicted that the number could increase to between 321 000 and 836 000 by 2020. The number of new HCV infections increased from 11 000 per year in 1997 to 16 000 in 2001—a 45% rise— the report found. Of all notifications, 83% were estimated to be due to injecting drug
712
use, 5% due to receipt of blood and 12% due to other transmission routes such as mother-to-baby transmission and via unsterile body piercing and tattooing. “Projections of the number of people living with HCV-related cirrhosis, incident cases of liver failure and hepatocellular carcinoma were all, projected to at least treble by 2020”, the report stated. Gregory Dore, of the National Centre for HIV Epidemiology and Clinical Research, said the prevalence of HCV was 1·5–2%—similar to that in many other western countries. But while the USA had reported a 70% reduction in the incidence of new infections over the past decade, Australia’s incidence had more than doubled, largely due to an increase in the number of injecting drug users. “The Australian epidemic has been
rapidly escalating over the past 5–10 years, which appears to be a phenomenon not happening to that extent in other countries”, Dore said. There was a trend to decreasing prevalence of genotype 1 and an increase in genotype 3, which can be more successfully treated. President of the Australian Hepatitis Council, Stuart Loveday, warned that if transmission of HCV remained unchecked, the financial and social costs would outstrip costs related to HIV/AIDs. “Australia will face not just a public-health crisis, but a public-health disaster,” he said. Loveday reported that Australia was the first country to adopt a national strategy for hepatitis C in 1999–2000, but its implementation remained effectively unfunded. Megan Howe
THE LANCET Infectious Diseases Vol 2 December 2002
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.