Earlier this year, Dr Amir Attaran (2016) demanded that the 2016 Olympic and Paralympic Games ‘be postponed, moved, or both as a precautionary concession’ against the spread of Zika virus (ZIKV). He cites the view of the International Olympic Committee (IOC) that Olympism ‘seeks to create… social responsibility and respect for universal fundamental ethical principles', and he asks, ‘how socially responsible or ethical is it to spread disease?’
ZIKV is mainly transmitted by female Aedes mosquitoes, especially Aedes aegypti, and its main risk is to pregnant women. In October 2015 the emergence of ZIKV in northern Brazil was associated with increased numbers of infants with microcephaly. By 3 February 2016, almost 4800 cases of microcephaly were notified in Brazil, compared with the expected 150−200 annual cases. Evidence indicates a causal link between ZIKV exposure among pregnant women and babies' development of microcephaly (Ladhani et al, 2016).
Attaran's question about social responsibility and ethics is rhetorical and pejorative. Deliberately spreading disease is not only both socially irresponsible and unethical, the example of HIV shows that perpetrators are open to criminal prosecution. So would it be socially responsible and ethical for the IOC and World Health Organization (WHO) to postpone or cancel the Olympics? After all, in a statement from a committee appointed by the WHO (2016), ZIKV infection was recognised as a Public Health Emergency of International Concern and it was noted that mass gatherings may contribute to the global spread of a communicable disease.
However, I believe it would have been unethical to have postponed or cancelled the Olympics on account of the ZIKV threat. Public health seeks to balance the rights and responsibilities of the individual with those of the community, and if ethics are to usefully address this tension, practical considerations must be acknowledged. Singer (1979: 2) pointed out: ‘an ethical judgment that is no good in practice must suffer from a theoretical defect… for the whole point of ethical judgments is to guide practice.’
Neither individuals nor communities take kindly to having their freedoms curbed, even if this would help reduce the spread of infection. For example, there is no getting round the fact that many health workers choose not to wash their hands, even when they know that it can prevent infections spreading—surely this is an unethical practice? Thus, when the WHO (2009: 5) reviewed 77 hand hygiene peer-reviewed articles published between 1981 and 2008, it reported: ‘Adherence of [health care workers] to recommended hand hygiene procedures has been reported as variable, with mean baseline rates ranging from 5% to 89% and an overall average of 38.7%.’
At a societal level, the medical profession has acknowledged that mass gatherings are a fact of life, with the establishment of a speciality devoted to the medical study of such phenomena. October 2010 saw the first international Lancet Conference on Mass Gathering Medicine: Implications and Opportunities for Global Health Security, held in Saudi Arabia (Al Turki, 2016).
As Barasheed et al (2014) note, the Hajj is the world's largest mass gathering, during which up to 3 million Muslim pilgrims assemble in Mecca, where a range of factors increases the risk of catching respiratory viruses. There is also the related Umrah, which sees 6 million pilgrims arrive throughout the year (Soliman et al, 2015). Alshammari and Mikler (2016) recall the spread of disease at various mass gatherings such as Neisseria meningitidis W135, which spread globally following outbreaks during the Hajj seasons of 2000 and 2001, and several measles outbreaks that occurred in Austria and Switzerland at the 2008 European Football Championships, spreading into France, Germany and Spain. When Soliman et al (2016) considered the risk of Hajj and Umrah pilgrims contracting Middle East respiratory syndrome coronavirus—which by December 2014 resulted in a mortality rate of 355/822 in Saudi Arabia—they suggested that up to seven Hajj pilgrims and up to 10 Umrah pilgrims each year could be affected. The evidence that mass gatherings can hasten global spread of infectious diseases is clear. Yet it is equally clear that considerable social disruption—possibly violent disruption—could ensue if certain mass gatherings, such as the Hajj or the Olympics, were to be cancelled for public health reasons.
So given the practical dimension to ethics highlighted by Singer (1979), although it may well be rational to cancel or postpone the Rio Olympics on account of ZIKV, it would also be unethical.