Avril Lavigne once sang, “Tell me, why’d you have to go and make things so complicated?” Since that was from her 2002 album Let Go, chances are she was not singing to the Zika virus…unless she knew something that we didn’t at the time. But nowadays her Complicated song could certainly apply to nearly everything about the Zika virus…including the Zika vaccines that are currently under development.

I’ve previously written about how the Zika virus has turned out to be a trickier than initially thought. But what’s so complicated about Zika vaccines besides the fact that vaccine development in general is complicated? Well, the biggest risk of Zika infection is to pregnant women, because the virus can cause devastating birth defects in the fetus. Therefore, pregnant women could certainly use a Zika vaccine for protection, but….  Don’t we usually avoid testing vaccines or other medications on pregnant women, because of potential risk to the fetus and the woman and the many changes a body undergoes while pregnant? A pregnant woman is not the same as a non-pregnant woman in many ways physiologically. A two-weeks pregnant woman is not the same as 2-months pregnant woman. One pregnant woman is not the same as another pregnant woman. These physiologic changes and ethical issues make Zika vaccine development and testing more…complicated, as Lavigne sang, “Uh huh, uh huh. That’s the way it is.” Time to call in the ethics experts.

That’s what the Wellcome Trust did in supporting the formation of the “Ethics Working Group on Zika Virus Research & Pregnancy.” Consider this a Justice League of ethics, vaccine, infectious disease, Zika, and OB/GYN experts that included Ruth Faden, PhD, MPH, Founder and former Director of the Johns Hopkins Berman Institute of Bioethics and the inaugural Philip Franklin Wagley Professor of Biomedical Ethics at Johns Hopkins University, Annie Lyerly, MD, MA, Professor of Social Medicine at the University of North Carolina, and Maggie Little, BPhil, PhD, Director of the Kennedy Institute of Ethics and Professor of Philosophy at Georgetown University. The website lists other members of the Working Group. Their role was to provide guidance to the scientific, health, and policy communities on how to proceed with Zika vaccine development, testing, and roll-out (if and when it occurs) with regards to pregnant women and women of child-bearing age.

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