Avian Influenza and the Pandemic Threat

Avian and human pandemic influenza planning and response should be based on sound science and public health principles. Discussions on ethics and values, with particular attention to the needs and rights of the economically and socially disadvantaged, should occur in advance of a health crisis. The SARS outbreak demonstrated that health care systems need to be better prepared to address hard ethical choices which quickly arise during a crisis.

Pandemic preparation measures should be founded on widely held ethical values. Decisions are better accepted by the public if the decision-making processes are reasonable, open and transparent, inclusive, responsive and accountable, and respectful of reciprocal obligations. The costs from not having a pre-agreed ethical framework include loss of trust, low morale, fear and misinformation.

Principles

Principles developed at a meeting on Social Justice and Influenza in Bellagio/Italy in July 2006, established that the interests of disadvantaged groups and individuals in planning and responding to avian and pandemic influenza are paramount. The meeting was organized by the Johns Hopkins University with support from the Rockefeller Foundation.  

The principles outline several key initiatives for ensuring equitable pandemic planning and response:

• Communications and messages need to be accessible, current, accurate and understandable by everyone.
• Veterinary and public health planning and response strategies must engage civil society, religious groups, the private sector and aim to include input from disadvantaged groups.
• Intervention and policy evaluation and monitoring efforts should draw attention to the effects on the disadvantaged with an emphasis on avoiding undue burdens and implementation of timely corrective adjustments.
• Scientific and socio-economic data and analyses to inform on avian and pandemic influenza planning and response should be available to developing and developed countries.
• Equitable access to vaccines, antivirals and other appropriate public health and social interventions must be promoted for non-discriminatory treatment for traditionally disadvantaged groups as well as those who are specially disadvantaged in the context of avian and human influenza.

The Joint Centre for Bioethics Working Group at the University of Toronto has identified the following as key ethical issues to address in pandemic planning:

• health workers’ duty to provide care during a communicable disease outbreak;
• restricting liberty in the interest of public health by measures such as quarantine;
• priority setting, including the allocation of scarce resources such as vaccines and antiviral medicines;
• global governance implications, such as travel advisories.

Substantive values identified as critical are in pandemic preparedness planning are: individual liberty, protection of the public from harm, proportionality, privacy, duty to provide care, reciprocity, equity, trust, solidarity and stewardship.