Reversal of a hard-won gain?

A recent article by the WHO Ad Hoc Expert Group on the Next Steps for Covid-19 Vaccine Evaluation in the New England Journal of Medicine supported as “ethically appropriate” the use of placebo in ongoing as well as future Covid vaccine trials. Trial sponsors are “not ethically obligated to unblind treatment assignments” after a vaccine receives emergency use authorisation so placebo recipients can get the vaccine. Furthermore, the Group says, even after vaccines are licensed, it is ethical for trial sponsors to use placebo in settings where vaccines are not available. This provoked strong reactions in ethicists across the globe who considered the current restrictions on the use of placebo had settled a hotly debated issue. In this Theme issue, we present ten reasoned articles by ethicists from six continents, examining the group’s dictum for its potential impact on trial participants in poor countries, and on future research. The authors explore whether placebo is permissible in specific circumstances, how the root causes of vaccine shortages affect the framing of the ethical question, and the possibility of a global authority empowered to regulate global research.

The Covid-19 pandemic continues to overwhelm us, and the issue contains some responses to its effects on life, death and research, including an interview with a doctor/survivor of the virus, and an alternative philosophic perspective from Japan.

The plight of India’s migrant workers, the economy’s mainstay, came to global attention when, after the first lockdown, they were mercilessly abandoned and had to walk back to their villages or starve. A study looks at the hardships faced by deprived Adivasi women back home, as a result of this and other effects of the lockdown. Another examines the media’s gaze on migrants prior to the pandemic and how their voices were never heard.

Cover credit: “Only still waters reflect things undistorted”, courtesy of Dr Jayashree Kulkarni

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Thank You, Reviewers!

We are grateful to our reviewers for the dedicated work they put into evaluating and improving submissions. Besides our core group of Editors, we thank the editorial board members and others who reviewed manuscripts during the year 2020-21.