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A vaccine for COVID-19 is urgently needed. Several vaccine trial designs may significantly accelerate vaccine testing and approval, but also increase risks to human subjects. Concerns about whether the public would see such designs as ethical represent an important roadblock to their implementation; accordingly, both the World Health Organization and numerous scholars have called for consulting the public regarding them. We answered these calls by conducting a cross-national survey (n = 5920) in Australia, Canada, Hong Kong, New Zealand, South Africa, Singapore, the United Kingdom, and the United States. The survey explained key differences between traditional vaccine trials and two accelerated designs: a challenge trial or a trial integrating a Phase II safety and immunogenicity trial into a larger Phase III efficacy trial. Respondents' answers to comprehension questions indicate that they largely understood the key differences and ethical trade-offs between the designs from our descriptions. We asked respondents whether they would prefer scientists to conduct traditional trials or one of these two accelerated designs. We found broad majorities prefer for scientists to conduct challenge trials (75%) and integrated trials (63%) over standard trials. Even as respondents acknowledged the risks, they perceived both accelerated trials as similarly ethical to standard trial designs. This high support is consistent across every geography and demographic subgroup we examined, including vulnerable populations. These findings may help assuage some of the concerns surrounding accelerated designs.

Many people living with HIV (PLWHIV) state that they would be willing to take significant risks to be "cured" of the virus. However, how they interpret the word "cure" in this context is not clear. We used a randomized survey to examine whether PLWHIV had a different willingness to take a hypothetical HIV medication if it causes flu-like symptoms, but provides: (a) cure, (b) remission that was labeled "cure", or (c) remission. PLWHIV (n = 454) were more willing to take a medication that provided a "cure" versus a "remission" if the side effects lasted less than 1 year. PLWHIV were more willing to take a medication that provided a remission that was labeled "cure" versus a "remission" (p = 0.01) if the side effects lasted 2 weeks. Clinicians and researchers should be aware of the impact of the word "cure" and ensure that PLWHIV fully understand the possible outcomes of their treatment options.

Ethical guidelines and recommendations for human subjects research typically focus on protecting the individuals who directly participate in that research. However, additional people, including sex partners of research participants, can also face harms and burdens from medical studies. In human immunodeficiency virus (HIV) cure-related research, a persistent ethical and practical challenge surrounds the use of analytical antiretroviral treatment interruptions. The challenge is usually discussed in relation to risks to study participants, but serious dangers accrue to nonparticipants, including sex partners of study participants. This multidisciplinary supplement relays the risks for nonparticipating sex partners in HIV cure-related studies and addresses the ethical dilemmas raised by these studies, with recommendations for researchers, advocates, sponsors, and oversight bodies.

Purpose of reviewSeveral promising experimental pathways exist for long-term control of HIV in the absence of antiretroviral therapy (HIV 'remission') and are now being tested in early clinical studies. These studies can be invasive and pose a host of distinctive risks to participants, as well as to nonparticipants, especially to participants' fetuses, and sexual partners.Recent findingsEthical analyses of these studies have mainly focused on the risks to study participants. They recommend, and some investigators implement, procedures to mitigate risks for participants or to offset them with direct, indirect, and nonmedical benefits. They also suggest ways to keep participants' consent highly voluntary and informed. Rarely do ethicists propose keeping the social value of studies high. Of these recommended responses, only the latter, rarer proposals help address the risk to nonparticipants, as would some novel ways to address that risk.SummaryHIV remission studies pose a number of ethical dilemmas. Many current investigative approaches put the participant at significant risk, but well established guidelines exist for mitigating this risk. Ethical issues that are not being fully addressed include risk to nonparticipants and the need to consider the societal value of studies, for example, their prospective impact on the global HIV burden. VIDEO ABSTRACT.

Antiretroviral therapy is not curative. Given the challenges in providing lifelong therapy to a global population of more than 35 million people living with HIV, there is intense interest in developing a cure for HIV infection. The International AIDS Society convened a group of international experts to develop a scientific strategy for research towards an HIV cure. This Perspective summarizes the group's strategy.

Sometimes, offering someone beneficial care is likely to thwart the similar or more serious medical needs of more people. For example, when acute shortage is strongly predicted to persist, providing the long period on scarce intensive care that a certain COVID‐19 patient needs is sometimes projected to block several future COVID‐19 patients from receiving the shorter periods on intensive care that they will need. Expected utility is typically higher if the former is denied intensive care. A tempting initial account of such cases is that consequentialism supports denying care to that patient and nonconsequentialism supports providing that care. This paper argues that the consequentialist case is more complicated than it may initially seem and that nonconsequentialism sides more readily with denial of the beneficial treatment. It also shows that when denying it would directly enhance public health by a lot, either ethical approach would normally recommend denying it. Practical implications are discussed, including how to address conscientious objection to this shared recommendation. [ABSTRACT FROM AUTHOR]

In many countries, the COVID‐19 pandemic varied starkly between different racial and ethnic groups. Before vaccines were approved, some considered assigning priority access to worse‐hit racial groups. That debate can inform rationing in future pandemics and in some of the many areas outside COVID‐19 that admit of racial health disparities. However, concerns were raised that "race‐responsive" prioritizations would be ruled unlawful for allegedly constituting wrongful discrimination. This legal argument relies on an understanding of discrimination law as demanding color‐blindness. We argue that a, color‐blind understanding of discrimination would be hostile only to one of two rationales for prioritizing the relevant racial minorities in settings of racial health disparities. We also propose a method for incorporating appropriate race‐responsive concerns that is in many ways ethically and legally superior to ones suggested thus far. That method turns artificial intelligence, thanks precisely to its artificial and "black box" nature (features that underlie recent concerns about artificial intelligence's discriminatory potential), into an instrument of social justice. [ABSTRACT FROM AUTHOR]

Problem District hospitals in Nepal struggle to provide essential services such as caesarean sections. Approach Retention of health workers is critical to the delivery of long-term, quality health-care services. To promote retention and enhance performance in rural public hospitals, the Government of Nepal and the Nick Simons Institute progressively implemented a rural staff support programme in remote hospitals. After competitive selection for a compulsory-service scholarship and training, family practice doctors who could do basic surgery, orthopaedics and obstetrics were hired under a binding three-year contract in each participating hospital. Comfortable living quarters and an Internet connection were provided for the resident doctors; in- service training for all staff and capacity development for each hospital's management committee were provided. Local setting Nepal's mountainous landscape, poverty and inequitable rural/urban distribution of health workers pose barriers to adequate health care. Relevant changes Between 2011 and 2015 family practice doctors were maintained in all seven programme hospitals. All hospitals became providers of comprehensive emergency obstetric care and served more patients. Compared with hospitals not within the programme, deliveries increased significantly (203% versus 71% increase, respectively; P=0.002).The programme recently expanded to 14 hospitals. Lessons learnt A package of human resource supports can improve the retention of doctors and the use of remote hospitals. Factors contributing to the success of this programme were compulsory-service scholarship, central personnel management, performance-based incentives and the provision of comfortable living quarters. Probleme Les hopitaux de district du Nepal ont du mal a fournir des services essentiels tels que des cesariennes. Approche Le maintien des professionnels de sante s'avere crucial pour pouvoir fournir des services medicaux de qualite sur le long terme. Afin d'ameliorer ce maintien ainsi que les performances des hopitaux publics situes en zone rurale, le gouvernement nepalais et le Nick Simons Institute ont progressivement mis en place un programme de soutien du personnel dans les hopitaux recules. Apres une selectlon par concours pour beneficier d'une formation et d'une bourse conditlonnee a un service obligatoire, des medecins generalistes pouvant realiser des actes basiques dans le domalne chirurgical, prthopedique et obstetrique ont ete recrutes dans chaque hopital participant au titre d'un contrat de trois ans. Un logement confortable et une connexion Internet ont ete fournis aux medecins residents; dans chaque hopital, l'ensemble du personnel a beneficie d'une formation continue et le comite de gestion d'un renforcement des competences. Environnement local Le relief montagneux du Nepal, la pauvrete et la repartition inequitable des professionnels de sante entre milieu rural / urbain sont autant d'obstacles a l'offre de soins adequats. Changements significatifs Entre 2011 et 2015, les medecins generalistes sont restes dans l'ensemble des sept hopitaux du programme. Tous ces hopitaux ont pu delivrer des soins obstetricaux d'urgence et prendre en charge davantage de patients. Compares a des hopitaux ne faisant pas partie du programme, les soins dispenses ont considerablement augmente (augmentation de 203% contre 71%, respectivement; P=0,002). Le programme a recemment ete etendu a 14 hopitaux. Lecons tirees Des dlspositifs de soutien des ressources humaines peuvent ameliorer le maintien des medecins et le recours aux hopitaux situes dans des zones reculees. Les facteurs qui ont contribue a la reussite de ce programme sont la bourse conditionnee a un service obligatoire, la gestion centralisee du personnel, les primes au rendement et la mise a disposition de logements confortables. Situacion Los hospitales de distrito en Nepal tienen dificultades para proporcionar servicios basicos como cesareas. Enfoque La retencion del personal sanitario es indispensable para suministrar servicios medicos de calidad a largo plazo. Para promover la retencion y mejorar el rendimiento en los hospitales publicos rurales, el Gobierno de Nepal y el Instituto Nick Simons aplicaron de forma progresiva un programa de apoyo al personal rural en hospitales remotos. Tras una seleccion competitiva para una beca de servicio obligatorio y formacion, se contrato en cada hospital participante a medicos de familia que pudieran llevar a cabo una cirugia basica, ortopedias y obstetricia con un contrato vinculante de tres anos. Se proporciono una comoda residencia y conexion a internet a los medicos residentes y tambien formacion en el servido para todo el personal y desarrollo de capacidades para el comite de gestion de cada hospital. Marco regional En Nepal, el paisaje montanoso, la pobreza y la injusta distribucion del personal sanitario entre las zonas rurales y urbanas obstaculizan una adecuada atencion sanitaria. Cambios importantes Entre 2011 y 2015 se mantuvieron medicos de familia en los siete hospitales del programa. Todos los hospitales se volvieron proveedores de atencion obstetrica de emergencia integral y atendieron a mas pacientes. En comparacion con otros hospitales que no se encontraban en el programa, el numero de partos aumento significativamente (aumento del 203% frente al 71 %, respectivamente; P = 0,002). Recientemente, el programa se extendio hasta los 14 hospitales. Lecciones aprendidas Un paquete de apoyo a los recursos humanos puede mejorar la retencion de medicos y el uso de hospitales remotos. Los factores que contribuyeron al exito de este programa fueron la beca de servicio obligatorio, la gerencia central de recursos, los incentivos basados en el rendimiento y la provision de una residencia comoda., Introduction In remote areas, an absence of doctors and nurses leads to poor health outcomes for local populations. (1) To increase access to health-care workers, the World Health Organization recommends [...]

Author(s): Rebecca Kahn 1, Annette Rid 2, Peter G. Smith 3, Nir Eyal 4, Marc Lipsitch 1,5,* Summary points The 2014-2016 Ebola epidemic highlighted variations in the design of randomized [...]

We thank Richard Hayes and colleagues for their commentary [1] on our PLOS Medicine article [2]. We share the desire to learn through rigorous research whether HIV treatment-as-prevention (TasP) works [...]

New Guidelines In June 2013, the WHO issued new guidelines for antiretroviral treatment (ART). The guidelines substantially expand eligibility for ART, recommending initiation at CD4 cell counts [less than or [...]