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Testing a low-cost approach to giving eRIG for rabies PEP: Ethical issues.

Richard A Cash1

  • 1Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.

Indian Journal of Medical Ethics
|July 5, 2019
PubMed
Summary

Lower doses of equine rabies immune globulin (eRIG) were used for dog bite wounds due to shortages and high costs in India. This highlights ethical considerations for drug use in low-income countries.

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Area of Science:

  • Global Health
  • Vaccinology
  • Public Health

Background:

  • Rabies prevention in dog bite victims often involves equine rabies immune globulin (eRIG).
  • Shortages and high costs of eRIG in regions like Himachal Pradesh, India, necessitate exploring alternative dosing strategies.
  • International recommendations for drug dosages may not align with resource constraints in low- and middle-income countries (LMIC).

Purpose of the Study:

  • To discuss the ethical implications of using a reduced dose of eRIG for wound irrigation in dog bite cases.
  • To examine how drug availability and cost influence treatment protocols in LMICs.
  • To address the challenges in conducting comparative studies for drug efficacy in resource-limited settings.

Main Methods:

  • Ethical considerations were analyzed concerning the use of a lower eRIG dose.
  • The study reviewed the impact of drug cost and availability on treatment decisions.
  • Alternative study designs, such as using historical data, were considered due to limitations in case-control studies.

Main Results:

  • A reduced dose of eRIG was employed due to supply limitations and elevated market prices.
  • The practice raises ethical questions regarding the adaptation of international treatment guidelines for LMICs.
  • Investigative approaches in LMICs often rely on historical data rather than prospective comparative trials.

Conclusions:

  • The ethical review of drug and vaccine testing in LMICs requires ongoing international attention.
  • Cost and accessibility are critical factors influencing therapeutic choices in resource-limited healthcare systems.
  • Adaptation of global health recommendations to local economic realities is essential for effective rabies prevention.