Dissertation Tania Manríquez Roa

Abstract

A common view in the field of global health is that marked inequities in opportunities for health and health outcomes persist within and between countries, affecting various social groups defined by factors such as socioeconomic status, gender, ethnicity and geographic location. In today's interconnected world, advancing health equity not only creates a fairer global society but also improves the well-being of all, and protects vulnerable populations. In this context, research is required to examine complex global health challenges, whilst clarifying the ethical issues at stake and developing strategies to promote equitable healthcare worldwide. Understanding health equity requires careful consideration of both context and purpose, as traditional equity approaches that simply match health access to needs may fall short when addressing emerging topics in global health.

My thesis comprises three research projects on contemporary global health topics. The first project scrutinises the potential benefits and inherent risks associated with the deployment of different kinds of algorithms in mental health apps. The second investigation examines how COVAX (COVID-19 Vaccines Global Access) allocated vaccines and presents a new strategy for vaccine allocation based on equity considerations during epidemic scenarios. The third project explores self-experimentation in medical research, presenting the first expert consensus study that discusses the value of self-experimentation as a research practice, its associated risks, and the fundamental features to consider when conducting self-experiments. Beyond their significance in global health ethics, these research projects share a common thread. I undertake a critical reflection on equity, presenting three distinct interpretations: equity as fair equality of opportunity in mental health apps; a combined needs-based and proportional equity approach to vaccine distribution; and equity as access to the benefits of medical research in self-experimentation.

My research contributes to three areas within the literature on global health ethics. In digital ethics, I provide a nuanced understanding of mental health apps, arguing for the use of black box algorithms when they perform analytic functions but cautioning against their direct provision of mental health advice. The second project offers fresh insights into epidemic ethics through both empirical research and ethical analysis. I propose a balanced approach that merges two key principles of equity: distributing vaccines proportionally across populations whilst prioritising countries facing urgent needs. In research ethics, I present self-experimentation as a valuable practice that could accelerate the development of medical research and foster innovation, while advocating for clearer international ethics standards. The equity-focused component of the thesis contributes to the urgent global challenge of significant health inequities.

Tania Manríquez Roa