Photo: uncultured(flickr)

Human subjects research has always been rife with ethical concerns, especially when research is being conducted in the developing world. At first glance, demographic and health surveillance (DHS) research can appear to have less potential for harm than direct-intervention drug trials. Not so, says a recent bulletin from the World Health Organization.

DHS research is defined as “long-term monitoring of specifically defined populations, typically residing in a small geographic region.” The authors of the August 2008 bulletin article say that while DHS research has led to many life-saving findings, including vaccine development, the invention of oral rehydration solution, and the link between early cessation of breastfeeding and malnutrition, it comes with a special set of ethical complications.

For example, when a disease surveillance team with the resources to provide comprehensive health care to a community is stationed in a poverty-stricken area, what is their obligation to the community? Do they treat people for only those diseases that they study? Do they only treat study participants? How does project staff go about obtaining informed consent from the community members? If there are monetary gains to be made by study subjects, what consequences might that have? If the DHS group provides health care or other services in a community for a long period of time, what happens to the community when they leave?

Ethical quandaries are certainly not limited to DHS research. As global health and development topics increasingly capture the attention of resource-rich universities and researchers, it is important to remember that the potential for harm rises along with the potential for good.

Malaria nets. Photo: Tomas de la Maza (flickr)

Is malaria's reign of terror coming to an end?

Every year, 500 million people fall seriously ill with malaria — a disease that induces fever, chills, nausea, flu-like illness and, without treatment, coma and death. More than 1 million people die each year from malaria — almost all in the developing world. The near-universal poverty of its victims is one reason it has not received the attention, and therefore the money, necessary to secure its demise.

Even in the face of these scary statistics, malaria may be about to meet it's match. The Economist reports a renewed sense of interest in its eradication, mainly because it jeopardizes the UN's Millennium Development Goals, a set of benchmarks in health, education and human welfare that world leaders committed to attain by 2015.

There's a cost-benefit rationale, too. Malaria costs Africa upwards of $12 billion a year in health expenses and lost productivity. Yet a five-year eradication plan might cost as little as $2.2 billion a year, according to a report by Malaria No More and McKinsey & Company.

With these numbers in mind, last week the UN unveiled a new campaign to fight malaria at its most critical spots. The Roll Back Malaria (RBM) Partnership — created to "enable sustained delivery and use of the most effective prevention and treatment for those affected most by malaria — staged the first World Malaria Day last week. It coincided with a UN plan to spray inside houses and distribute insecticide-treated bed nets to "all people at risk" of the disease by the end of 2010.

Any effort to stamp out malaria must deal with an added layer of complexity. When diminished but not destroyed, malaria can come back with a vengeance. Any letup in the eradication campaign may end up actually increasing the numbers of those at risk.

But considering how much malaria undermines the war on poverty, a risk taken to ensure its eradication may be a risk worth taking.