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Letter from the editor | 302

Principles and decisions

Viruses are simple but sophisticated organisms. They have no efficient mechanism for correcting genetic errors that occur during replication, meaning that changes to their genome are incorporated into future generations. These mutations can be harmless, or they can make the virus more efficient—which is all the more undesirable when humans are the hosts.

A year after the WHO classified the COVID-19 outbreak as a pandemic, there are three SARS-CoV-2 variants of concern, from more than 300 strains identified to date. One was detected in the United Kingdom, another in Brazil, and the third in South Africa. Although little is known about them, since our knowledge is acquired in real time as the virus evolves, there are indications that these variants are more transmissible, and in some cases, more lethal than the versions prevalent at the beginning of the pandemic. This issue’s cover article (page 18) explains what we know about the variants, how mutations occur, and why it is important to monitor the virus’s evolution to ensure vaccines remain effective.

With the national rolling average deaths per day approaching 3,000, health teams in Brazil are facing difficult decisions about how best to allocate scarce resources, such as ICU beds and respirators. Bioethics is a multidisciplinary research field focused on the limits and purpose of human interventions in life. Using bioethics committees to apply this knowledge in hospitals is an important process in many complex situations. Unfortunately, less than 10% of Brazilian hospitals have such committees, as shown in the article on page 30.

Bioethics principles also guide a central discussion for areas of research such as the development of drugs and vaccines: the use of animals in trials and studies. Although alternative methods have advanced significantly, there is still no substitute for animal models when research involves multiple interactions in complex and interdependent systems, such as evaluating the trajectory of a molecule in an organism after administration. Even so, these principles serve to guide the use of animals as test subjects, reducing the practice to a minimum and replacing them whenever possible. The article on page 50 addresses the subject, currently a hot topic due to the approaching deadline for  Brazil to commit to other methods for certain tests, such as quality control for injectable products.

Another current debate related to bioethics is the unequal distribution of COVID-19 vaccines between richer and poorer countries. The fact that the majority of vaccines are only available to nations that can afford them shows that the gap between developed and developing countries is also present in health. While billions of dollars were invested in the pursuit of treatments and vaccines for COVID-19, which in just one year infected 125 million people and killed 2.7 million, a group of 20 diseases classified as neglected tropical diseases kills half a million people annually and receives very little funding or interest. A WHO report released this year, described in an article on page 42, states that although 600 million fewer people are at risk than a decade ago, many of these infectious diseases are not the subject of coordinated research and public policy efforts.