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Harm reduction to play role in ebola vaccine

For several years now, vaping advocates have been pointing out that sensible policies of "harm reduction" would save lives in the war against smoking deaths. The gist of the argument goes like this: although there are still questions about the health effects of long term vaping, it is patently clear to any common sense observer that the practice is "orders of magnitude less dangerous" than conventional smoking (in the words of British health advocate Peter Hajek), and could save lives if encouraged in the short run, while research continues.

The opposing camp in public health advocacy insists that we must wait until vaping is proven to be 100% safe, and more effective as a quit aid than all other methods put together, before giving it full approval. Their arguments seem motivated more by their visceral revulsion against the image of something that looks like smoking than by an interest in saving more lives in the here and now. Not to mention the fact that their hard line is built on the fantasy that anything can be 100% safe.

When it comes to e-cigarettes, the battle lines are drawn between harm reductionists and vape-bashers.

How does this dichotomy play out when it comes to halting the Ebola epidemic in its tracks?

A considerable body of prominent medical specialists is advocating forging ahead with a vaccine, even before there is time to conduct the usual round of controlled research studies. Even before such a vaccine is proven completely safe and effective. Because it will save lives in the here and now. Could it be that someone will make the connection between the two campaigns against two deadly epidemics, Ebola and smoking? If harm reduction is good public health policy when fighting Ebola, why wouldn't it be good policy when fighting smoking?

Adrian Hill, a British physician who heads the prestigious Jenner Institute, said at a recent WHO conference that the Ebola crisis has forced medics to thrown the usual timelines "out the window". A new vaccine could be tried out on health workers as early as November. "That would be an extremely fast pace compared with the typical timeline for developing a new vaccine," according to National Public Radio in the US. Five to ten years is the average, says NPR.

Researchers at the US National Institutes of Health, at Jenner, and at pharma company GlaxoSmithKline are compressing the usual steps to meet the November deadline. This will mean that when the vaccine is first used, no one will be sure whether it will work or not. "All of our norms change when thousands of new cases of Ebola are happening all the time and 50 to 60 percent of these people are dying," says Nancy Kass, a professor of public health ethics at John Hopkins University in Baltimore. "That changes the rules about what we have to lose when we try something new."

Another ethical issue is the administration of placibo vaccines, normally part of any the best research, "controlled" research. Since it is expected that the placebo is not likely to be as effective, the research subjects receiving it will be expected to have a higher death rate. "Any decision to give a placebo to healthcare and other frontline workers [in Ebola control] will be controversial; many consider it to be unethical, given these individuals’ work caring for Ebola patients, and the risks that they face in doing so," says an article in the journal Scientific American.

If harm reduction is good policy concerning vaccine development for a deadly virus, it should be good policy when fighting a deadly habit. Maybe someone will see that this time around.