Bioética e vacinas para covid-19: entre a urgência e o cuidado
DOI:
https://doi.org/10.26512/rbb.v17.2025.60161Palavras-chave:
Bioética, SARS-Cov-2, Pandemia, Políticas de imunizaçãoResumo
O desenvolvimento e distribuição de vacinas contra a covid-19 levantaram questões bioéticas importantes, refletindo a tensão entre a urgência de combater a pandemia e a necessidade de assegurar práticas eticamente adequadas em saúde pública e pesquisa clínica. O objetivo deste trabalho é analisar as questões bioéticas envolvidas no desenvolvimento da vacina contra a covid-19. Para tanto, realizou-se uma revisão integrativa que teve como pergunta norteadora: “quais os aspectos bioéticos apontados na literatura a respeito do desenvolvimento da vacina de COVID19”?. Foram selecionados 37 artigos cujos conteúdos foram discutidos em quatro categorias que sintetizam os principais problemas bioéticos analisados: desafios bioéticos impostos pelo contexto pandêmico; desenvolvimento da vacina e a necessidade dos estudos de desafio humano; políticas de vacinação; e logística de distribuição da vacina. O trabalho conclui destacando a relevância das abordagens éticas em todas as etapas do processo de vacinação, desde o desenvolvimento até a implementação, visando a assegurar práticas justas e transparentes que promovam o bem-estar coletivo.
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Referências
Bardin L. Análise de conteúdo. Edições 70. 2008.
Bramstedt KA. Unicorn Poo and Blessed Waters: COVID-19 Quackery and FDA Warning Letters. Therapeutic Innovation & Regulatory Science, 55(1):239-244, 2021. DOI: https://doi.org/10.1007/s43441-020-00224-1.
Broockman D, Kalla J, Guerrero A, Budolfson M, Eyal N, Jewell NP, Magalhaes M, Sekhon JS. Broad cross-national public support for accelerated COVID-19 vaccine trial designs. Vaccine, 39(2):309-316, 2021. DOI: https://doi.org/10.1016/j.vaccine.2020.11.072.
Bull S, Jamrozik E, Binik A, Parker MJ. SARS-CoV-2 challenge studies: ethics and risk minimisation. Journal of Medical Ethics, 47(12):e79, 2021. DOI: https://doi.org/10.1136/medethics-2020-106504.
Cunha T, Garrafa V. Vulnerability. Cambridge Quarterly of Healthcare Ethics, 25(2):197-208, 2016. DOI: https://doi.org/10.1017/S096318011500050X.
Cunha T, Lorenzo C. Bioética global na perspectiva da bioética crítica. Revista Bioética, 22(1), 2014. Disponível em: https://www.scielo.br/j/bioet/a/pXtsDt8qV8kQ6SHmBm6LSyv/. Acesso em: 30 de março de 2026.
Emanuel EJ, Luna F, Schaefer GO, Tan KC, Wolff J. Enhancing the WHO’s Proposed Framework for Distributing COVID-19 Vaccines Among Countries. American Journal of Public Health, 111(3):371-373, 2021. DOI: https://doi.org/10.2105/AJPH.2020.306098.
Emanuel EJ, Persad G, Kern A, Buchanan A, Fabre C, Halliday D, Heath J, Herzog L, Leland RJ, Lemango ET, Luna F, McCoy MS, Norheim OF, Ottersen T, Schaefer GO, Tan KC, Wellman CH, Wolff J, Richardson HS. An ethical framework for global vaccine allocation. Science, 369(6509):1309-1312, 2020. DOI: https://doi.org/10.1126/science.abe2803.
Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, Farahmandian N, Miresmaeili SM, Bahreini E. A comprehensive review of COVID-19 characteristics. Biological Procedures Online, 22(1):19, 2020. DOI: https://doi.org/10.1186/s12575-020-00128-2.
Eyal N. Why Challenge Trials of SARS-CoV-2 Vaccines Could Be Ethical Despite Risk of Severe Adverse Events. Ethics and Human Research, 42(4):24-34, 2020. DOI: https://doi.org/10.1002/eahr.500056.
Eyal N, Lipsitch M. How to Test Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines Ethically Even After One Is Available. Clinical Infectious Diseases, 73(12):2332-2334, 2021. DOI: https://doi.org/10.1093/cid/ciab182.
Eyal N, Lipsitch M, Smith PG. Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure. The Journal of Infectious Diseases, 221(11):1752-1756, 2020. DOI: https://doi.org/10.1093/infdis/jiaa152.
Ferreira Caceres MM, Sosa JP, Lawrence JA, Sestacovschi C, Tidd-Johnson A, Rasool MHU, Gadamidi VK, Ozair S, Pandav K, Cuevas-Lou C, Parrish M, Rodriguez I, Fernandez JP. The impact of misinformation on the COVID-19 pandemic. AIMS Public Health, 9(2):262-277, 2022. DOI: https://doi.org/10.3934/publichealth.2022018.
Friesen P, Caplan AL, Miller JE. COVID-19 vaccine research and the trouble with clinical equipoise. The Lancet, 397(10274):576, 2021. DOI: https://doi.org/10.1016/S0140-6736(21)00198-7.
Fritz M, Gries T, Redlin M. The effectiveness of vaccination, testing, and lockdown strategies against COVID-19. International Journal of Health Economics and Management, 23(4):585-607, 2023. DOI: https://doi.org/10.1007/s10754-023-09352-1.
Garcia LF, Fernandes MS, Moreno JD, Goldim JR. Mapping Bioethics in Latin America: History, Theoretical Models, and Scientific Output. Journal of Bioethical Inquiry, 16:323-331, 2019. DOI: https://doi.org/10.1007/s11673-019-09903-7.
Giubilini A, Savulescu J, Wilkinson D. Queue questions: Ethics of COVID-19 vaccine prioritization. Bioethics, 35(4):348-355, 2021. DOI: https://doi.org/10.1111/bioe.12858.
Grady C, Shah S, Miller F, Danis M, Nicolini M, Ochoa J, Taylor H, Wendler D, Rid A. So much at stake: Ethical tradeoffs in accelerating SARS-CoV-2 vaccine development. Vaccine, 38(41):6381-6387, 2020. DOI: https://doi.org/10.1016/j.vaccine.2020.08.017.
Guerrini BCJ, Sherkow JS, Meyer MN, Zettler PJ. Self-experimentation, ethics, and regulation of vaccines. Science, 369(6511):1570-1572, 2020. DOI: https://doi.org/10.1126/science.abe1963.
Gur-Arie R, Jamrozik E, Kingori P. No Jab, No Job? Ethical Issues in Mandatory COVID-19 Vaccination of Healthcare Personnel. BMJ Global Health, 6(2):1-5, 2021. DOI: https://doi.org/10.1136/bmjgh-2020-004877.
Han E, Tan MMJ, Turk E, Sridhar D, Leung GM, Shibuya K, Asgari N, Oh J, García-Basteiro AL, Hanefeld J, Cook AR, Hsu LY, Teo YY, Heymann D, Clark H, McKee M, Legido-Quigley H. Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe. The Lancet, 396(10261):1525-1534, 2020. DOI: https://doi.org/10.1016/S0140-6736(20)32007-9.
Hao Y, Wang Y, Wang M, Zhou L, Shi J, Cao J, Wang D. The origins of COVID-19 pandemic: A brief overview. Transboundary and Emerging Diseases, 69(6):3181-3197, 2022. DOI: https://doi.org/10.1111/tbed.14732.
Hedgecoe AM. Critical Bioethics: Beyond the Social Science Critique of Applied Ethics. Bioethics, 18(2):120-143, 2004. DOI: https://doi.org/10.1111/j.1467-8519.2004.00385.x.
Heriot GS, Jamrozik E. Not in my backyard: COVID-19 vaccine development requires someone to be infected somewhere. Medical Journal of Australia, 214(4):150-152.e1, 2021. DOI: https://doi.org/10.5694/mja2.50930.
Hofner B, Asikanius E, Jacquet W, Framke T, Oude Rengerink K, Aguirre Dávila L, Grünewald M, Klinglmüller F, Posch M, Leacy FP, Lang T, Koch A, Zinserling J, Roesextra K. Vaccine Development during a Pandemic: General Lessons for Clinical Trial Design. Statistics in Biopharmaceutical Research, 1-13, 2023. DOI: https://doi.org/10.1080/19466315.2023.2211538.
Holm S. Controlled human infection with SARS-CoV-2 to study COVID-19 vaccines and treatments: bioethics in Utopia. Journal of Medical Ethics, 46(9):569-573, 2020. DOI: https://doi.org/10.1136/medethics-2020-106476.
Holzer F, Luna F, Manríquez Roa T, Biller-Andorno N. A matter of priority: equitable access to COVID-19 vaccines. Swiss Medical Weekly, 151:w20488, 2021. DOI: https://doi.org/10.4414/smw.2021.20488.
Iserson K. Healthcare Ethics During a Pandemic. Western Journal of Emergency Medicine, 21(3), 2020. DOI: https://doi.org/10.5811/westjem.2020.4.47549.
Jackson K, Bazeley P. Qualitative Data Analysis with NVivo. SAGE Publications. 2019.
Jamrozik E, Selgelid MJ. COVID-19 human challenge studies: ethical issues. The Lancet Infectious Diseases, 20(8):e198-e203, 2020. DOI: https://doi.org/10.1016/S1473-3099(20)30438-2.
Jecker NS, Wightman AG, Diekema DS. Vaccine ethics: an ethical framework for global distribution of COVID-19 vaccines. Journal of Medical Ethics, 1-?, 2021. DOI: https://doi.org/10.1136/medethics-2020-107036.
Kamble PH, Dubhashi SP. Expedited COVID-19 vaccine trials: A rat-race with challenges and ethical issues. Pan African Medical Journal, 36(206):1-6, 2020. DOI: https://doi.org/10.11604/pamj.2020.36.206.23977.
Kaur G, Kaur C. COVID-19 and the Rise of the New Experience Economy. FIIB Business Review, 9(4):239-248, 2020. DOI: https://doi.org/10.1177/2319714520958575.
Koirala A, Joo YJ, Khatami A, Chiu C, Britton PN. Vaccines for COVID-19: The current state of play. Paediatric Respiratory Reviews, 35:43-49, 2020. DOI: https://doi.org/10.1016/j.prrv.2020.06.010.
Li M, Wang H, Tian L, Pang Z, Yang Q, Huang T, Fan J, Song L, Tong Y, Fan H. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduction and Targeted Therapy, 7(1):146, 2022. DOI: https://doi.org/10.1038/s41392-022-00996-y.
Lirios CG. Critical Bioethics in Clinical Research and Trials: A Meta-Analysis with Simulated Data in Latin America. Clinical Research and Clinical Trials, 13(4):13-15, 2025. DOI: https://doi.org/10.31579/2693-4779/299.
Lorenzo C. Teoria crítica e bioética: um exercício de fundamentação. In: Porto D, Garrafa V, Martins GZ, Barbosa S (orgs.). Bioéticas, poderes e injustiças: 10 anos depois. Conselho Federal de Medicina. p. 173-189, 2012.
Maestre BR. Vacunas contra la COVID-19 y ética: ¿cuándo me tocará a mí? Journal of Healthcare Quality Research, 36(2):57-58, 2021. DOI: https://doi.org/10.1016/j.jhqr.2021.02.003.
Monrad JT. Ethical considerations for epidemic vaccine trials. Journal of Medical Ethics, 46(7):465-469, 2020. DOI: https://doi.org/10.1136/medethics-2020-106235.
Park JJH, Mogg R, Smith GE, Nakimuli-Mpungu E, Jehan F, Rayner CR, Condo J, Decloedt EH, Nachega JB, Reis G, Mills EJ. How COVID-19 has fundamentally changed clinical research in global health. The Lancet Global Health, 9(5):e711-e720, 2021. DOI: https://doi.org/10.1016/S2214-109X(20)30542-8.
Porto D, Garrafa V. Bioética de intervenção: considerações sobre a economia de mercado. Revista Bioética, 13(1):111-123, 2005. Disponível em: http://revistabioetica.cfm.org.br/index.php/revista_bioetica/article/view/96/91. Acesso em: 30 de março de 2026.
Rid A, Lipsitch M, Miller FG. The Ethics of Continuing Placebo in SARS-CoV-2 Vaccine Trials. JAMA, 325(3):219, 2021. DOI: https://doi.org/10.1001/jama.2020.25053.
Rocha da Cunha T, Nicolás Biscioni D. Bases teóricas e metodológicas da Bioética Crítica frente os desafios do Antropoceno. O Mundo da Saúde, 47(1), 2023. DOI: https://doi.org/10.15343/0104-7809.202347e15072023P.
Rothstein MA, Parmet WE, Reiss DR. Employer-Mandated Vaccination for COVID-19. American Journal of Public Health, 111(6):1061-1064, 2021. DOI: https://doi.org/10.2105/AJPH.2020.306166.
Sathian B, Asim M, Banerjee I, Pizarro AB, Roy B, Van Teijlingen ER, Nascimento IJB do, Alhamad HK. Impact of COVID-19 on clinical trials and clinical research: A systematic review. Nepal Journal of Epidemiology, 10(3):878-887, 2020. DOI: https://doi.org/10.3126/nje.v10i3.31622.
Schoch-Spana M, Brunson EK, Long R, Ruth A, Ravi SJ, Trotochaud M, Borio L, Brewer J, Buccina J, Connell N, Hall LL, Kass N, Kirkland A, Koonin L, Larson H, Lu BF, Omer SB, Orenstein WA, Poland GA, White A. The public’s role in COVID-19 vaccination: Human-centered recommendations to enhance pandemic vaccine awareness, access, and acceptance in the United States. Vaccine, 39(40):6004-6012, 2021. DOI: https://doi.org/10.1016/j.vaccine.2020.10.059.
Smith MJ, Ahmad A, Arawi T, Dawson A, Emanuel EJ, Garani-Papadatos T, Ghimire P, Iliyasu Z, Lei R, Mastroleo I, Mathur R, Okeibunor J, Parker M, Saenz C, Thomé B, Upshur REG, Voo TC. Top five ethical lessons of COVID-19 that the world must learn. Wellcome Open Research, 6:1-9, 2021. DOI: https://doi.org/10.12688/wellcomeopenres.16568.1.
Solbakk JH, Bentzen HB, Kari A, Heggestad T, Robertsen A, Alnæs AH, Pedersen R, Bernabe R. ¿Volver a qué? El papel de la ética de la investigación en época de pandemia. Revista Redbioética/UNESCO, 2(22):102-128, 2020. Disponível em: https://unesdoc.unesco.org/ark:/48223/pf0000378561. Acesso em: 30 de março de 2026.
Souza MT de, Silva MD da, Carvalho R de. Integrative review: what is it? How to do it? Einstein (São Paulo), 8(1):102-106, 2010. DOI: https://doi.org/10.1590/s1679-45082010rw1134.
Spinola SM, Zimet GD, Ott MA, Katz BP. Human Challenge Studies Are Unlikely to Accelerate Coronavirus Vaccine Licensure Due to Ethical and Practical Issues. The Journal of Infectious Diseases, 222(9):1572-1574, 2020. DOI: https://doi.org/10.1093/infdis/jiaa457.
Steel R, Buchak L, Eyal N. Why continuing uncertainties are no reason to postpone challenge trials for coronavirus vaccines. Journal of Medical Ethics, 46(12):808-812, 2020. DOI: https://doi.org/10.1136/medethics-2020-106501.
Steuwer B, Jamrozik E, Eyal N. Prioritizing second-generation SARS-CoV-2 vaccines through low-dosage challenge studies. International Journal of Infectious Diseases, 105:307-311, 2021. DOI: https://doi.org/10.1016/j.ijid.2021.02.038.
Supady A, Curtis JR, Brown CE, Duerschmied D, von Zepelin LA, Moss M, Brodie D. Ethical obligations for supporting healthcare workers during the COVID-19 pandemic. European Respiratory Journal, 57(2):3-6, 2021. DOI: https://doi.org/10.1183/13993003.00124-2021.
Ubel PA. Vaccinating Health Care Employees — Do They All Deserve Early Access? New England Journal of Medicine, 384(10):e39, 2021. DOI: https://doi.org/10.1056/nejmpv2101203.
Van Tassel K, Shachar C, Hoffman S. Covid-19 Vaccine Injuries — Preventing Inequities in Compensation. New England Journal of Medicine, 384(10):e34, 2021. DOI: https://doi.org/10.1056/NEJMp2034438.
Vizcaíno G, Esparza J. Perspectiva de los dilemas éticos relacionados con la pandemia COVID-19. Investigación Clínica, 61(4):393-405, 2020. DOI: https://doi.org/10.22209/ic.v61n4a07.
Wendler D, Ochoa J, Millum J, Grady C, Taylor HA. COVID-19 vaccine trial ethics once we have efficacious vaccines. Science, 370(6522):1277-1279, 2020. DOI: https://doi.org/10.1126/science.abf5084.
Williams E, Craig K, Chiu C, Davies H, Ellis S, Emerson C, Jamrozik E, Jefford M, Kang G, Kapulu M, Kolstoe SE, Littler K, Lockett A, Messer JE, McShane H, Saenz C, Selgelid MJ, Shah S, Yamazaki N. Ethics review of COVID-19 human challenge studies: A joint HRA/WHO workshop. Vaccine, 40(26):3484-3489, 2022. DOI: https://doi.org/10.1016/j.vaccine.2022.02.004.
Williams I, Essue B, Nouvet E, Sandman L, Razavi SD, Noorulhuda M, Goold S, Danis M, Biemba G, Abelson J, Kapiriri L. Priority setting during the COVID-19 pandemic: going beyond vaccines. BMJ Global Health, 6(1):e004686, 2021. DOI: https://doi.org/10.1136/bmjgh-2020-004686.
World Health Organization. Expert Committee on Biological Standardization: Human Challenge Trials for Vaccine Development: regulatory considerations. WHO Technical Report Series. 2016. Disponível em: https://www.who.int/biologicals/expert_committee/Human_challenge_Trials_IK_final.pdf. Acesso em: 30 de março de 2026.
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