TESTING AIDS VACCINES IN THAILAND IS UNETHICAL
Written by Evelyne Shuster, Ph. D., to
The Philadelphia Inquirer,
April, 1997

Just four years ago, it was thought a good idea to begin AIDS-prevention vaccine trials in Uganda and Rwanda. Following genocidal slaughter in Rwanda, no one now thinks ethical vaccine trials can be conducted there. The new candidate country is Thailand. But doing AIDS vaccine trials in Thailand is also ethically unacceptable.

Presumably, Thailand has qualified as the AIDS testing ground for American scientists because it has a fast growing HIV-infection rate in a high-risk population. It has been suggested that it would make ethical and medical sense to being testing there: AIDS vaccine trials in Thailand would require fewer people (minimizing the risks), and be the fastest way to determine whether AIDS vaccines work (maximizing efficiency). But countries like Thailand and Uganda have no health care infrastructure and almost no medical capacity. They are burdened with human rights violations, social, economic and political problems that make them the least suitable to host ethical-clinical trials. Governments “volunteer” their citizens for experimentation because they see it as the only way to attract American money and expertise. To test AIDS vaccines in poor countries like Uganda and Rwanda where problems include famine and genocide along with HIV-infection and AIDS is a vicious exploitation of the poor by rich nations. It is wrong.

Thailand raises additional ethical problems. Those who will be enrolled as experimental subjects are those who face high risks of getting the disease. They are the so-called “sex-workers.” This euphemism has been convenient to designate the young girls (often as young as 12 years old) who have been sold by their fathers for the purpose of being sexually exploited by a male-dominated country. These young girls and women are denied basic human rights and health care. They have no governmental protection, no education, or decent living conditions. They are the forgotten victims of a society that devalues women, and is indifferent to their fate. Subject to oppression, and reduced to (sex) slavery they are in no position to give free and informed consent. To use these women in AIDS vaccine trials is morally outrageous. We should know better and try to help improve living and human rights conditions, before we can think of using these poor countries for our own benefit.

No safeguards will be sufficient to protect these young women against exploitation. If protection is the goal, we must do the following:

• The U.S. should make every effort to stop sex-slave exploitation of young women and force the Thai government to punish human rights violations and to close the booming sex industry.

• American scientists must resist doing in other countries what they would not or could not do in the United States. Expendable and vulnerable people should not and cannot be the first candidates for risk and sacrifice. The American research industry must fight the temptation to go to the readiest source of supply: the poor, the ignorant, the dependent, the “captive” where free, informed consent is a mockery.

• Americans should and must resist being agents of oppression. They must deny requests by governments to do research on vulnerable people, until these governments respect basic human rights, and address the social, economic and political problems that plague the people.

Finally, it might be that testing AIDS vaccines in Thailand is the fastest way to determine the efficacy of a particular HIV-vaccine. But efficiency is not an ethical value. Let us not forget with Hans Jonas that “progress is an optional goal, not an unconditional commitment,” and that efficiency “has nothing sacred about it.” To conduct research in Thailand, Uganda or Rwanda “erodes our own moral values and will make our most dazzling scientific triumphs not worth having.” We, Americans, must proceed with patience and dignity if we want to preserve our nation’s moral integrity.

EDITOR'S NOTE:
Evelyne Shuster, Ph.D., is a philosopher and medical ethicist at the Department of Veterans Affairs. She is a former member of the Ethics Committee of the American Society for Reproduction Medicine.