Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs
Vertical aid programs are special programs that are created to “target a particular disease, sector or technical intervention” (PBE 267). These programs are implemented in times to sudden disaster, such as the Cholera outbreak in Dr. Armans Asadour’s case. Vertical aid programs are set out to eliminated or control the specific disease. Although this is the goal, the site in which the doctors work in often have medicine to treat illnesses. In case 8.2, “Ethics and Humanitarian Aid: Vertical Aid programs”, Dr. Asadour brings up the question of whether or not vertical aid programs should accept/help patients without Cholera, and whether or not vertical aid programs actually bring about beneficial change. I firmly believe that vertical aid programs are most beneficial if the program follows its goal. In the case of Dr. Asadour, I believe that the programs should not accept people that do not have Cholera or Cholera symptoms.
Looking from a policy standpoint, this is a tough decision both ethically as well as logistically. However, the pros out weigh the cons; the doctors should only help those that have Cholera. The doctors of the vertical aid program were sent out for a specific goal: stop the Cholera outbreak. Cholera is an infectious and often fatal bacterial disease, which is easily contracted from infected water supplies (CDC). Given the fact the outbreak occurred in a heavily dense population of refuges, the impact of such a deadly disease should be given precedent. By allowing others come for unrelated medical treatments will only waste resources when battling against time. It is more important to control the disease that can do the most harm to the most amounts of people than spreading the aid to others.
Looking from a doctor’s standpoint, I can see how this decision to turn away easily treatable injured people can be conflicting to their morals. These doctors however are not in control of the situation and must look at it from a utilitarian standpoint. The most lives can be saved by first preventing the outbreak of Cholera. That being said, the doctors working in the field are working for a NGO for a specific cause, and should respect the decision of the NGO when committing to the job.
This case specifically reminds me of the most recent Ebola outbreak. At the time a vertical aid program was establish, where people were sent into countries to contain the virus as well as money being spent to find a cure . Due to the rapid response and focused goal of preventing the spread of this disease, the transmission of Ebola in West Africa was controlled. The increase of funding to combat Ebola has given countries in the area the experience and tools to rapidly identify any additional cases and to limit transmission(CDC).
Over all, I believe that Dr. Asadour has good reasons to be wary of his and the other doctors actions; however, he is not looking at the impact of his actions in a larger picture. Before the outbreak, the population had the diseases that they are seeking help for. They were surviving and were not posing immediate harm onto others. At the time of the outbreak, people were being infected with Cholera, and the disease was spreading rapidly. It would be logically sound to control the damage of the Cholera before attempting to help everyone else. That being said, I believe only after the outbreak has been contained, should the doctors be able to help others with non-Cholera related diseases.
Resources
Beauchamp, Tom L., and James F. Childress. Principals of Biomedical Ethics. New York: Oxford U.P., 1983. Print.
“Cholera – Vibrio cholerae infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2016. Web. 15 Apr. 2017.
“2014-2016 Ebola Outbreak in West Africa.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 22 June 2016. Web. 15 Apr. 2017.
Hi Alex,
I completely agree with you that when there is an epidemic like Ebola or Cholera, vertical aid programs may be necessary in order to help make the outbreak less deadly. However, I don’t think that vertical aid programs are the most effective solution to these problems.
In the case about using a vertical aid program to battle the cholera outbreak, I believe that merely treating those infected isn’t the best option to end the outbreak. Ideally, the goal of intervention programs should be to educate and provide resources in order to prevent the epidemic from becoming full-blown. For example, as you said in your post, Cholera is caused by bacteria from contaminated water supplies. The main treatment for those infected is rehydration, and antibiotics if the case is more severe. While I do think vertical aid programs are necessary to treat those ill with Cholera, I think more resources should be allocated to developing a system to educate residents on how to sanitize their water and maybe implement sanitation stations that provide clean water. If there are no public health or education measures put in place, the epidemic will be very hard to control because people will unknowingly come into contact with contaminated water.
One big issue with vertical aid programs is that the community becomes dependent on the aid, instead of becoming equipped to deal with the issue on their own. I think if supporters were more willing to allocate some resources used in vertical aid programs to public health improvement (education, sanitation, etc.), these communities would be more sustainable and overall health would improve.
Works Cited
Waldman, Ronald J., et al. “The Cure for Cholera — Improving Access to Safe
Water and Sanitation.” New England Journal of Medicine, 13 Feb. 2013,
doi:10.1056/NEJMp1214179. Accessed 15 Apr. 2017.
Hi Alex and Tori,
Thank you both for the insightful thoughts on this complex issue. I’d like to address some of my own thoughts regarding certain aspects of each of your postings, as I think that this is an area of healthcare that needs attention. I agree with Alex’s points that vertical aid programs are necessary in times of stress and disaster in a community, and that it is necessary to have programs implementing measures to deal with emergency. Allocation of resources comes into play in this argument in a triage sense, that those who are most sick receive the help from resources available to the country and in that sense a system of allocation is in place. Many of the vertical aid programs currently in place are a result of private funding, however, and governments must make use of the resources they have through foundations and movements.
I do agree with Tori, however, that vertical aid programs essentially detract from the health of the overall population. Ideally, there would be enough funding from private and public sectors permitting appropriate vertical aid measures to assist in times of distress and also horizontal aid programs attending to the rest of the population’s health. This case, however, rarely occurs and countries must make do with what they have at certain points. I’m curious as to see both of your thoughts on resource allocation and its role in vertical and horizontal aid programs –should it play a part and, if so, how much should governments concern themselves with the issue? Below is the citation of another blog discussing the issue in terms of global health policy I found useful in providing arguments for both sides of the issue.
Thanks,
Elisabeth Crusey
Student at NYU-Wagner (vm716). “In Pursuit of Better Global Health, Should We Follow a Horizontal or Vertical Approach?” Global Health Policy at NYU-Wagner. NYU-Wagner, 16 Oct. 2011. Web. 16 Apr. 2017. .
Hi Alex and Tori,
Thank you both for the insightful thoughts on this complex issue. I’d like to address some of my own thoughts regarding certain aspects of each of your postings, as I think that this is an area of healthcare that needs attention. I agree with Alex’s points that vertical aid programs are necessary in times of stress and disaster in a community, and that it is necessary to have programs implementing measures to deal with emergency. Allocation of resources comes into play in this argument in a triage sense, that those who are most sick receive the help from resources available to the country and in that sense a system of allocation is in place. Many of the vertical aid programs currently in place are a result of private funding, however, and governments must make use of the resources they have through foundations and movements.
I do agree with Tori, however, that vertical aid programs essentially detract from the health of the overall population. Ideally, there would be enough funding from private and public sectors permitting appropriate vertical aid measures to assist in times of distress and also horizontal aid programs attending to the rest of the population’s health. This case, however, rarely occurs and countries must make do with what they have at certain points. I’m curious as to see both of your thoughts on resource allocation and its role in vertical and horizontal aid programs –should it play a part and, if so, how much should governments concern themselves with the issue? Below is the citation of another blog discussing the issue in terms of global health policy I found useful in providing arguments for both sides of the issue.
Thanks,
Elisabeth Crusey
Student at NYU-Wagner (vm716). “In Pursuit of Better Global Health, Should We Follow a Horizontal or Vertical Approach?” Global Health Policy at NYU-Wagner. NYU-Wagner, 16 Oct. 2011. Web. 16 Apr. 2017. .
I agree with your assessment that vertical aid programs should remain focused on treating and containing only the original disease mandated under the program. This is a relatively simple yet effective way to prevent the over-involvement of medical aid providers in foreign countries. The reason these aid providers are utilized in the first place is because the country facing the medical crisis is not equipped to deal with or control a disease outbreak, and foreign aid can certainly be exploited to provide medical resources for issues far beyond the scope of the original health crisis. Doing this undermines the country’s domestic healthcare system by making it reliant on foreign infrastructure and medical professionals for basic or routine care. Such medical care and infrastructure should either already exist or be developed by the country as a long-term investment.
Additionally, the vertical aid programs allow the countries in need to retain maximum autonomy over their own healthcare systems. Rather than letting a country like the United States gain temporary control over their healthcare system, the vertical aid program forces aid providers to operate under a limited scope, letting the host country deal with the “normal” healthcare burden while the additional problems are managed by outside actors. While you state that communities become reliant on vertical aid programs, I still see this as one of the best alternatives to limit reliance. By focusing on a single disease, the only possible reliance that could develop would be for treating the specific illness, which is greatly preferable to becoming reliant on basic healthcare services. Ideally, the foreign aid providers would still work with communities to develop their own systems for dealing with potential future disease outbreaks, though this could take many years and require substantial funding (1).
1. Giffin, R; Robinson, S. Infrastructure and Health Care Delivery Systems. National Academy of Science. 2009.