Ethical and Practical Considerations for an Agreement to Ensure Equitable Vaccine Access Comment on "More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap".

This paper discusses the potential of an international agreement to ensure equitable vaccine distribution, addressing the failures witnessed during the COVID-19 pandemic. COVAX was unable to prevent vaccine monopolization and unequal distribution, which led to significant disparities in vaccination rates and avoidable deaths. Any future agreement on equitable vaccine distribution must address ethical and practical issues to ensure global health equity and access. The proposed agreement should recognize healthcare as a human right and consider vaccines beyond mere commodities, emphasizing the social responsibility of pharmaceutical companies to prioritize affordability, availability, and accessibility, particularly for low-income countries (LICs). Voluntary licensing agreements are suggested as a means to enhance access to essential medicines. The paper also outlines the necessity of international cooperation, with robust compliance mechanisms, to effectively enforce such an agreement and mitigate future health crises.

Use of animals for scientific and educational purposes by Mexican institutions.

In Mexico, it is not known which institutions use animals for scientific purposes. This work reports, based on data requested from the National Institute of Transparency, Access to Information and Protection of Personal Data (INAI), the types of institutions that use animals for research and how many of these have an ethics committee. Research centres, colleges, hospitals, national institutes, technical colleges, and public universities are the types of institutions that report using animals for experimentation. Only 54% of institutions have ethics committees. Mexican institutions from 2015 to 2021 used a total of 2,112,786 animals. Mammals are the most widely used animal group. The scientific purposes for using animals depend on the type of institution that uses them. In Mexico, it is necessary to update the regulations in order to regulate the use, protection and the care of laboratory animals.

En México se desconoce cuáles son las instituciones que utilizan animales con fines científicos. Se reporta, a partir de datos solicitados al Instituto Nacional de Transparencia, Acceso a la Información y Protección de Datos Personales (INAI), los tipos de instituciones que usan animales y cuántas poseen un comité interno para el cuidado y uso de los animales de laboratorio. Los centros de investigación, colegios, hospitales, institutos nacionales, tecnológicos y universidades públicas son los tipos de instituciones que reportaron usar animales. El 54% de las instituciones poseen comités de ética. Un total de 2,112,786 animales fueron usados por instituciones del 2015 al 2021. Los mamíferos es el grupo animal más utilizado. El uso de los animales se encuentra en función del tipo de institución que los utiliza. En México, es necesario actualizar la normatividad, con el fin de regular el uso, la protección y el cuidado de los animales de laboratorio.

How Populism Affects Bioethics.

This article aims at raising awareness about the intersection of populism and bioethics. It argues that illiberal forms of populism may have negative consequences on the evolution of bioethics as a discipline and on its practical objectives. It identifies at least seven potential negative effects: (1) The rise of populist leaders fosters "epistemological populism," devaluing the expert and scientific perspectives on which bioethics is usually based, potentially steering policies away from evidence-based foundations. (2) The impact of "moral populism" is evident in legislative prioritization of the "morality of common people," often solicited through popular consultations on issues like abortion, drug legalization, or LGBT issues. (3) Populist distrust in autonomous governmental agencies and advisory bodies, including national bioethics commissions, can compromise expert advice, challenging both their authority and decisions. (4) Populists may erode transparency by undermining institutions responsible for it, hindering access to vital information for bioethical research. (5) "Medical populism" creates adversarial dynamics, prompting politicians to make simplistic healthcare policy decisions based on political rather than informed criteria, adversely affecting vulnerable populations. (6) Radical-right populist parties' "welfare chauvinism" may shape healthcare policies, impacting service access and resource allocation, disproportionately affecting vulnerable groups such as migrants, but indirectly affecting the rest of the population. (7) Nationalist sentiments associated with populism may obstruct international collaborations, posing challenges for global bioethics that seeks to address ethical concerns beyond national borders. In summary, these dynamics raise significant bioethical concerns encompassing evidence-based decision-making, transparency, healthcare equity, and global collaboration. How bioethicists may respond to these challenges is discussed.

The Numbers of Animals Used in Mexico for Scientific and Educational Purposes.

In Mexico, there are no official public and reliably reported data on the total number and species of non-human animals used for scientific purposes. The aim of the current study was to calculate the total numbers of animals used for scientific and educational purposes in Mexico, from January 2015 to October 2021, based on data requested from the National Institute of Transparency, Access to Information and Protection of Personal Data (INAI, in Spanish). In this period, authorised laboratory animal facilities reported the use of 5,437,263 animals for scientific and educational purposes. However, these data should be viewed with caution, since there is no official register of all Mexican institutions that use animals for these purposes. The use of various species of different taxonomic groups was reported, including mammals, birds, reptiles, amphibians, fish and invertebrates. The main scientific purposes of this animal use were: technological development; innovation; laboratory testing; production of biologicals; quality control; diagnostic purposes; basic and applied research; and education. A robust system for the licensing and approval of animal use, as well as a means to ensure compliance with the relevant regulations, are both urgently required. In addition, in order to regulate animal use, monitor animal care and protect their welfare, the creation of a publicly accessible national database that records the number and species of the animals used is imperative.

Exploración del discurso de los enfermos crónicos sobre la legalización de la muerte asistida / Exploring the Discourse of Chronically-Ill Patients about the Legalization of Medically-Assisted Death / Exploração do discurso dos doentes crônicos sobre a legalização da morte medicamente assistida

Introducción: las enfermedades crónicas van en aumento e implican múltiples consecuencias que, en un determinado momento, con el paso de los años, pueden llegar a un estado terminal de la enfermedad. El objetivo de este estudio fue analizar el discurso de enfermos crónicos sobre la muerte digna, la eutanasia y el suicidio médicamente asistido para visibilizar la necesidad de la regulación de la muerte digna. Materiales y métodos: se llevó a cabo una investigación cualitativa que se inserta dentro del paradigma del construccionismo social, mediante entrevistas a enfermos crónicos de la Ciudad de México, utilizando una guía semiestructurada. Se empleó el análisis del discurso para encontrar convergencias y diferencias en los discursos. Resultados: se entrevistaron siete personas vía telefónica de enero a marzo del 2022. Las principales enfermedades fueron: lupus, cáncer, artritis, diabetes y ovarios poliquísticos. Los discursos convergen hacia una muerte digna sin dolor, sufrimiento, tranquila y en casa. Coinciden sus discursos en legalizar la eutanasia y el suicidio médicamente asistido; sin embargo, hay divergencias en cuanto a solicitarlas. Conclusiones: la experiencia de la enfermedad crónica es un factor importante para aceptar en un futuro la muerte médicamente asistida, sin ser una carga para otros y evitar el dolor y sufrimiento al final de la vida. La religión influye en las decisiones, pero se puede observar una mayor apertura para aceptar la legalización de la muerte médicamente asistida.

Introduction: Chronic diseases are increasing in frequency and entail multiple consequences that can eventually lead to death. The study aim was to analyze the discourse of chronically-ill patients on death with dignity, euthanasia, and medically-assisted suicide to highlight the need for regulation of death with dignity. Materials and Methods: A qualitative study was conducted within the paradigm of social constructionism. A semi-structured guide was used to conduct interviews with chronically-ill patients in Mexico City. Discourse analysis was performed to identify convergences and differences in the discourses. Results: Seven interviews were conducted by telephone from January to March 2022. The main diseases of the interviewees were lupus, cancer, arthritis, diabetes, and polycystic ovaries. The discourses converged toward a preference for dignified death without pain or suffering that was calm, and occurred at home. The discourses included the topics of legalizing euthanasia and medically-assisted suicide, but the patients differed on whether or not these should be requested. Conclusions: The experience of chronic illness was an important factor in accepting medically-assisted death for the patients, who did not wish to be a burden on others and wanted to avoid pain and suffering at the end of their lives. Religion influenced the patients' decisions, but there was openness to accepting legalization of medically-assisted death.

Introdução: a incidência das doenças crônicas vem aumentando, e têm múltiplas consequências que num determinado momento, ao longo dos anos, podem chegar a um estado terminal da doença. O objetivo deste estudo foi analisar o discurso de pessoas com doenças crônicas sobre morte digna, eutanásia e suicídio medicamente assistido para tornar visível a necessidade de regulamentar a morte digna. Materiais e métodos: foi realizada uma pesquisa qualitativa que se insere no paradigma do construcionismo social. Entrevistas com pacientes crônicos na Cidade do México foram realizadas usando um guia semiestruturado. A análise do discurso foi utilizada para encontrar convergências e divergências nos discursos. Resultados: foram realizadas sete entrevistas por telefone no período de janeiro a março de 2022. As principais doenças foram lúpus, câncer, artrite, diabetes e ovários policísticos. Os discursos convergem para uma morte digna sem dor, sofrimento, tranquila e em casa. Seus discursos coincidem na legalização da eutanásia e do suicídio medicamente assistido; entretanto, há divergências quanto à sua solicitação. Conclusões: a experiência da doença crônica é um fator importante para aceitar a morte medicamente assistida no futuro, sem ser um fardo para os outros e evitando a dor e o sofrimento no final da vida. A religião influencia nas decisões, mas observase uma maior abertura para aceitar a legalização da morte medicamente assistida.

COVID-19 Health Passes: Practical and Ethical Issues.

Several countries have implemented COVID-19 health passes or certificates to promote a safer return to in-person social activities. These passes have been proposed as a way to prove that someone has been vaccinated, has recovered from the disease, or has negative results on a diagnostic test. However, many people have questioned their ethical justification. This article presents some practical and ethical problems to consider in the event of wishing to implement these passes. Among the former, it is questioned how accurate diagnostic tests are as a means of ensuring that a person is not contagious, whether vaccination guarantees immunity, the fact that health passes can be forged, whether they encourage vaccination, and the problem that there is no universally recognized health pass. Among the ethical issues, it is discussed whether health passes promote discrimination and inequality and whether they violate rights to privacy and freedom. It is concluded that health passes have enough ethical justification to be implemented.

Bioethics, globalization and pandemics.

Bioethics should pay more attention to globalization and some of its consequences than it has done so far. The COVID-19 pandemic would not have been possible without globalization, which has also increased some of its negative consequences. Globalization has intensified wildlife trade in the world. One of the main hypotheses about the origin of this pandemic is that it originated in illegal forms of wildlife trade in China. In the last 30 or 40 years, there have been zoonotic outbreaks at a much frequent pace than before, many of those have been related to wildlife trade. Legal and illegal wildlife trade has grown in the shadow of globalization. Second, globalization has had a huge impact on the redistribution of wealth in the world. Since 1990 income inequality has increased in most high- and in many middle- and low-income countries. A country's level of pre-COVID income inequality is the best predictor of the COVID death rate. These two issues are not unrelated. People living in poverty in LMIC tend to suffer more from infectious diseases and tend to be marginalized from the health sector. Additionally, poverty tends to reproduce the conditions under which zoonotic diseases can more easily spread.

Placebo-controlled trials of Covid-19 vaccines - Are they still ethical?

A World Health Organization (WHO) Ad Hoc Expert Group on the Next Steps for Covid-19 Vaccine Evaluation recently recommended placebo-controlled trials (PCT) of Covid-19 vaccines. PCTs are ethically acceptable when there is no proven effective and safe treatment for a certain condition. However, there are already some vaccines that have been approved and which have high levels of efficacy and safety. Any new vaccine under development must be tested against the most effective vaccines available. PCTs go against the participants' best interests, by putting them in a position of disadvantage while taking part in a trial, compared with people who are not in the trial and who could get vaccinated. Particularly in high-income countries, many people are getting vaccinated. This means that, following a recent trend in clinical trials, PCTs would have to be conducted in low- and middle-income countries, where there a number of advantages for drug companies, but where fatality rates of Covid-19 are, in many cases, much higher. For this and other reasons having to do with equal rights, participants in control groups should be protected with the most effective vaccines available.

Bioethics training in reproductive health in Mexico.

Bioethical approaches to reproductive health have been of utmost importance for the last three decades in Mexico. As Mexican laws regarding abortion, assisted reproduction, and conscientious objection have been modified, a number of social actors with an interest in these areas have realized that they have to educate the different agents who take part in these procedures in a bioethical approach to reproductive health and rights. This strategy was first used in Mexico by the Catholic Church and many Catholic universities. Advocates, scientists, and feminist organizations, as well as some public universities, have also realized that a grounding in bioethics could help health providers to have an ethical frame that supports the provision of abortion services. Bioethics is also a good framework for supporting the legalization of abortion and for more liberal laws regarding assisted reproduction. So, for the last few years, one of the priorities of these two sides, Catholic and secular groups, has been to train healthcare personnel, lawyers, and members of ethics committees and members of Congress in the application of their respective bioethical perspectives.

Abortion and conscientious objection: rethinking conflicting rights in the Mexican context.

Since 2007, when Mexico City decriminalized abortion during the first trimester, a debate has been taking place regarding abortion and the right to conscientious objection (CO). Many people argue that, since the provision of abortions (or "legal terminations of pregnancy" as they are called under Mexico City's law) is now a statutory duty of healthcare personnel there can be no place for "conscientious objection." Others claim that, even if such an objection were to be allowed, it should not be seen as a right, since talk about a right to CO may lead to a slippery slope where we may end up recognizing a right to disobey the law. In this paper, I argue that there is a right to CO and that this may be justified through the notions of autonomy and integrity, which a liberal democracy should respect. However, it cannot be an absolute right, and in the case of abortion, it conflicts with women's reproductive rights. Therefore, CO should be carefully regulated so that it does not obstruct the exercise of women's reproductive rights. Regulation should address questions about who is entitled to object, how such objection should take place, and what can legitimately be objected to.