Whose Burden, Whose Benefit? Revisiting Ethical Trade-Offs in the WHO Guidelines on Scaling Up Mass Azithromycin Administration

The authors critique the World Health Organization’s (WHO) cautious approach to mass azithromycin administration (MDAA) to reduce childhood mortality in high-burden, low-resource settings due to concerns about antimicrobial resistance (AMR). This approach insufficiently addresses justice and equity considerations, and revised WHO guidelines should place greater emphasis on these ethical considerations, expanding eligibility for MDAA based on context-specific criteria and community input.