PoPulationand Public HealtH etHics

infrastructures are of ethical significance in much the same way human rights
are for individual access to health care and essential medicines for malaria.
Moreover, the idea that medicines and interventions that target a given person
occur in a vacuum is inherently false. Consider the case of a population
where malaria is highly prevalent, as described in the case study. Treatment
or preventive chemoprophylaxis of a person has impacts beyond that individual.
It decreases the population reserve of malaria that can be transmitted to
other persons in the population. Similarly, although a malaria vaccine is not
available at present, current vaccine research against malaria, if successful,
would benefit entire communities, not only the persons who are vaccinated,
by achieving herd immunity for the population and, thereby, vastly decreasing
transmission and epidemics in the entire population. Hence, even for
targeted interventions, the individual choice, human rights and autonomybased
ethics frames neglect such broader and often population-level impact
of a health intervention for any given person.
Standards on development aid and effectiveness:
Reconciling global and regional priorities
While solidarity among nations might, in theory, help overcome injustice due
to malaria’s disproportionate impact on lMICs and tropical, resource-limited
countries, the traditional Westphalian model of independent sovereign nations
may preclude the actual implementation of such solutions. Furthermore,
development aid is often ineffective and does not reach the intended target
populations. In other cases, ‘authoritative aid’ materializes when there is a gap
between what the donor countries want targeted with their aid (e.g., disease
A versus B) and what the local population deems as a priority public health
issue. Such mismatches between aid recipients and donors are an important
ethical issue. Poorly targeted development aid not only results in waste of
scarce resources, it sustains the pressing public health burdens in lMICs.
As a response to this ethical dilemma and to accelerate progress towards the
Millennium Development Goals (MDgs), and recognizing the need to reform
aid delivery and management to achieve improved effectiveness and results,
donor countries and aid organizations have developed a reform, with measurable
recommendations, called the Paris Declaration on Aid Effectiveness.
In 2005, more than 100 signatories, including donor and developing-country
Worldwide and local anti-malaria initiatives
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