Avoiding Exceptionalism and Silver Bullets: Lessons from Public Health Ethics and Alzheimer's Disease

Abstract

Lynch et al.' s (2021) work "Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non- Pandemic Diseases" (Lynch et al. 2021) is an essential contribution by a leading working group in the field of ethics and regulation of unproven biomedical interventions. We agree that the response to the COVID-19 pandemic should motivate changes to the social institutions and regulations of health-care and research for other public health problems. Advocacy should focus less on silver bullets' Operation Warp Speed (OWS) levels of funding for developing biomedical interventions and Emergency Use Authorization (EUA) standards of access to unproven interventions outside trials and more, as the authors state, on improving collaboration, research (prioritization, design, and data sharing), and availability of clinical trials and monitored unproven interventions (i.e. Expanded Access pathway). We also believe that desperate patients and families with severe diseases or conditions deserve an ethical justification for restricting their claims of OWS funding and EUA access. Lynch et al. provide two arguments to do this: significant difference and harm to others. The "significant differences" argument only works from an ethical exceptionalist point of view. However, this point of view should be replaced with ethical universalism. The main ethical argument for restricting EUA and OWS is then its potential harm to others.