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This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness and autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages.

In this paper we propose a consistent definition of the risk and crisis communication process in the context of public health emergency (PHERCC), which comprises six key elements: evidence, initiator, channel, public, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we define an ethical framework to help designing, governing and evaluating PHERCC strategies. The presented framework is based on effectiveness and justice, intended as fairness. It comprises five principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework, simplifying its implementation with real life examples and scenarios. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix, including the role of censorship and the regulation of free speech; education and empowerment of the public; trust, data access, and contextualization; feedback bias and bias propagation; and reflections revolving around the is-ought issue.

This study investigates the generation of synthetic disinformation by OpenAI's Large Language Models (LLMs) through prompt engineering and explores their responsiveness to emotional prompting. Leveraging various LLM iterations using davinci-002, davinci-003, gpt-3.5-turbo and gpt-4, we designed experiments to assess their success in producing disinformation. Our findings, based on a corpus of 19,800 synthetic disinformation social media posts, reveal that all LLMs by OpenAI can successfully produce disinformation, and that they effectively respond to emotional prompting, indicating their nuanced understanding of emotional cues in text generation. When prompted politely, all examined LLMs consistently generate disinformation at a high frequency. Conversely, when prompted impolitely, the frequency of disinformation production diminishes, as the models often refuse to generate disinformation and instead caution users that the tool is not intended for such purposes. This research contributes to the ongoing discourse surrounding responsible development and application of AI technologies, particularly in mitigating the spread of disinformation and promoting transparency in AI-generated content., Comment: 14 pages, 3 figures

Artificial intelligence is changing the way we create and evaluate information, and this is happening during an infodemic, which has been having dramatic effects on global health. In this paper we evaluate whether recruited individuals can distinguish disinformation from accurate information, structured in the form of tweets, and determine whether a tweet is organic or synthetic, i.e., whether it has been written by a Twitter user or by the AI model GPT-3. Our results show that GPT-3 is a double-edge sword, which, in comparison with humans, can produce accurate information that is easier to understand, but can also produce more compelling disinformation. We also show that humans cannot distinguish tweets generated by GPT-3 from tweets written by human users. Starting from our results, we reflect on the dangers of AI for disinformation, and on how we can improve information campaigns to benefit global health., Comment: dataset and software: https://osf.io/9ntgf 29 pages, 4 figures, 13 supplementary figures

This paper presents a study on the use of AI models for the classification of case reports on assisted suicide procedures. The database of the five Dutch regional bioethics committees was scraped to collect the 72 case reports available in English. We trained several AI models for classification according to the categories defined by the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act. We also conducted a related project to fine-tune an OpenAI GPT-3.5-turbo large language model for generating new fictional but plausible cases. As AI is increasingly being used for judgement, it is possible to imagine an application in decision-making regarding assisted suicide. Here we explore two arising questions: feasibility and ethics, with the aim of contributing to a critical assessment of the potential role of AI in decision-making in highly sensitive areas.

Artificial intelligence (AI) is changing the way we create and evaluate information, and this is happening during an infodemic, which has been having marked effects on global health. Here, we evaluate whether recruited individuals can distinguish disinformation from accurate information, structured in the form of tweets, and determine whether a tweet is organic or synthetic, i.e., whether it has been written by a Twitter user or by the AI model GPT-3. The results of our preregistered study, including 697 participants, show that GPT-3 is a double-edge sword: In comparison with humans, it can produce accurate information that is easier to understand, but it can also produce more compelling disinformation. We also show that humans cannot distinguish between tweets generated by GPT-3 and written by real Twitter users. Starting from our results, we reflect on the dangers of AI for disinformation and on how information campaigns can be improved to benefit global health.

Background: Prenatal genetic testing, in particular non-invasive prenatal testing (NIPT), as well as screening for risks associated with pregnancy, and counseling, play pivotal roles in reproductive healthcare, offering valuable information about the health of the fetus to expectant parents. This study aims to delve into the perspectives and experiences of women considering genetic testing and screening during pregnancy, focusing on their decision-making processes and the implications for informed consent. Methods: A nationwide qualitative study was conducted in Switzerland, involving in-depth interviews with women who were 1 to 2 years post-partum, covered by basic compulsory Swiss insurance, including women with a migration background. Thematic analysis was employed to identify key themes and patterns in the data. Results: The findings underscore the significance of effective communication during prenatal counseling, suggesting that healthcare providers could not only convey technical information but also support women in their decision-making processes. Women need comprehensive information about genetic testing and its implications, as well as the reasons for screening during pregnancy, as there might be a need to bridge knowledge gaps and clarify misconceptions. Furthermore, the study highlights the multifaceted nature of decision-making, with women considering factors such as uncertainty, values, emotional responses, and societal support systems. The concept of acceptance emerged as a crucial theme, with some women expressing their readiness to love and accept their child, regardless of genetic anomalies or disabilities. Conclusion: This study offers valuable insights into the perspectives and needs of women regarding prenatal genetic testing, screening, and counseling in Switzerland. It underscores the importance of enhancing the clinical interaction and informed consent process by providing comprehensive information, addressing misconceptions, and supporting

Equal access to vaccines has been one of the key ethical challenges during the COVID-19 pandemic. Most scholars consider the massive purchase and hoarding of vaccines by high-income countries, especially at the beginning of the pandemic, to be unjust towards the vulnerable living in low-income countries. A recent proposal by Andreas Albertsen of a vaccine tax has been put forward to remedy this problem. Under such a scheme, high-income countries would pay a contribution, conceptualised as a vaccine tax, dedicated to buying vaccines and distributing them to low and middle-income countries. Proceeding from this proposal, we critically assess the feasibility of a vaccine tax and suggest how to conceptualise and implement a vaccine tax in practice. We present our 'VaxTax model' and explore its comparative advantages and disadvantages while considering other possible measures to address the global vaccine access problem, also in view of future pandemics and disease outbreaks. Keywords: COVID-19; Ethics; Health Care Economics and Organizations

What has the past reaction to the COVID-19 pandemic taught us? We have seen that many low and middle-income countries (LMICs) still lack access to vaccines, and it seems little progress has been made in the last few months and year. This article discusses whether the current strategies, most notably, vaccine donations by the international community and the COVID-19 global access facility COVAX, offer meaningful solutions to tackle the problem. At the centre of our analysis, we compare the concepts of “donations” and “charity” with “vaccine equity” and the “empowerment” of poorer countries. We suggest that the achievement of fair global vaccine production requires that our global approach is supportive of the idea of empowerment. We, therefore, need structural reforms, which would most importantly include capacity building, to positively impact this goal and to take the interests of the global poor seriously.

Widely circulating anti-vaccine misinformation online has been constituting a large obstacle for the success of COVID-19 vaccination campaigns and for the well-being of people during the pandemic. In this paper we discuss strategies to mitigate negative effects of online anti-vaccine contents on public health and to prevent hesitant individuals from falling prey of the traps set by anti-vaccine disinformation spreaders. Here we discuss the importance of filling information voids and understanding trends and concerns that shape the vaccine debate, and we highlight the relevance of building resilience to vaccine misinformation by strengthening public health and digital literacy.

Sanctions are increasingly used by national states and the international community to put economic and political pressure on target countries, with the aim of effecting a shift in foreign or internal policies. In this paper, we argue that sanctions should never be imposed on healthcare products—diagnostic, curative or preventive—or on any other good or service that can be reasonably expected to entail direct negative consequences on access to healthcare in the sanctioned state. In addition, we propose the establishment of a supranational task force to review and monitor sanctions to ensure they do not violate the right to health, or to mandate existing organisations to monitor the effects sanctions have on healthcare systems. We discuss these issues considering key ethical and human rights aspects, including justice, vulnerability, proportionality and responsibility. We discuss how responsibility should be shared between states or organisations imposing the sanctions, and states targeted by sanctions. Sanctioned states should make efforts to mitigate effects of economic sanctions by prioritising spending in the interest of their citizens’ health.

Background: The recent introduction of COVID-19 certificates in several countries, including the introduction of the European green pass, has been met with protests and concerns by a fraction of the population. In Italy, the green pass has been used as a nudging measure to incentivize vaccinations because a valid green pass is needed to enter restaurants, bars, museums, or stadiums. As of December 2021, a valid green pass can be obtained by being fully vaccinated with an approved vaccine, recovered from COVID-19, or tested. However, a green pass obtained with a test has a short validity (48 hours for the rapid test, 72 hours for the polymerase chain reaction test) and does not allow access to several indoor public places. Objective: This study aims to understand and describe the concerns of individuals opposed to the green pass in Italy, the main arguments of their discussions, and their characterization. Methods: We collected data from Telegram chats and analyzed the arguments and concerns that were raised by the users by using a mixed methods approach. Results: Most individuals opposing the green pass share antivaccine views, but doubts and concerns about vaccines are generally not among the arguments raised to oppose the green pass. Instead, the discussion revolves around the legal aspects and the definition of personal freedom. We explain the differences and similarities between antivaccine and anti–green pass discourses, and we discuss the ethical ramifications of our research, focusing on the use of Telegram chats as a social listening tool for public health. Conclusions: A large portion of individuals opposed to the green pass share antivaccine views. We suggest public health and political institutions to provide a legal explanation and a context for the use of the green pass, as well as to continue focusing on vaccine communication to inform vaccine-hesitant individuals. Further work is needed to define a consensual ethical framework for social listening for

Our bodies can be designed and modified in accordance with our ideals of health and well-being. These increasingly targeted and personalized interventions will be more effective than current therapies. Here we review technologies to alter mood, and explore the ethics of bioengineering approaches to mental health.

Vaccinations are without doubt one of the greatest achievements of modern medicine, and there is hope that they can constitute a solution to halt the ongoing COVID-19 pandemic. However, the anti-vaccination movement is currently on the rise, spreading online misinformation about vaccine safety and causing a worrying reduction in vaccination rates worldwide. In this historical time, it is imperative to understand the reasons of vaccine hesitancy, and to find effective strategies to dismantle the rhetoric of anti-vaccination supporters. For this reason, we analyzed the behavior of anti-vaccination supporters on the platform Twitter. Here we identify that anti-vaccination supporters, in comparison with pro-vaccination supporters, share conspiracy theories and make use of emotional language. We demonstrate that anti-vaccination supporters are more engaged in discussions on Twitter and share their contents from a pull of strong influencers. We show that the movement’s success relies on a strong sense of community, based on the contents produced by a small fraction of profiles, with the community at large serving as a sounding board for anti-vaccination discourse to circulate online. Our data demonstrate that Donald Trump, before his profile was suspended, was the main driver of vaccine misinformation on Twitter. Based on these results, we welcome policies that aim at halting the circulation of false information about vaccines by targeting the anti-vaccination community on Twitter. Based on our data, we also propose solutions to improve the communication strategy of health organizations and build a community of engaged influencers that support the dissemination of scientific insights, including issues related to vaccines and their safety.

The Toll pathway regulates the cellular response to infection via the transcriptional upregulation of antimicrobial peptides. In , apart from its role in innate immunity, this pathway has also been reported to be important for the elimination of loser cells in a process referred to as cell competition, which can be locally triggered by secreted factors released from winner cells. In this work, we provide evidence that the inhibition of Toll signaling not only increases the fitness of loser cells, but also bestows a clonal growth advantage on wild-type cells. We further demonstrate that this growth advantage depends on basal infection levels since it is no longer present under axenic conditions but exacerbated upon intense pathogen exposure. Thus, the Toll pathway functions as a fine-tuned pro-apoptotic and anti-proliferative regulator, underlining the existence of a trade-off between innate immunity and growth during development.

The elimination of unfit cells from a tissue is a process known in Drosophila and mammals as cell competition. In a well-studied paradigm "loser" cells that are heterozygous mutant for a haploinsufficient ribosomal protein gene are eliminated from developing tissues via apoptosis when surrounded by fitter wild-type cells, referred to as "winner" cells. However, the mechanisms underlying the induction of this phenomenon are not fully understood. Here we report that a CCAAT-Enhancer-Binding Protein (C/EBP), Xrp1, which is known to help maintaining genomic stability after genotoxic stress, is necessary for the elimination of loser clones in cell competition. In loser cells, Xrp1 is transcriptionally upregulated by an autoregulatory loop and is able to trigger apoptosis - driving cell elimination. We further show that Xrp1 acts in the nucleus to regulate the transcription of several genes that have been previously involved in cell competition. We therefore speculate that Xrp1 might play a fundamental role as a molecular caretaker of the genomic integrity of tissues.