WHO template and recommendations

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Ethical issues in responding topandemic
influenza

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Learning Objectives

• Describe the major ethical issues that must be
  considered when responding to pandemic influenza
• Discuss ethical considerations in pandemic
  influenza response strategies.
• Develop ways to address the major ethical issues
  during pandemic influenza response

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Overview of the session

• 1) Ethical issues in pandemic influenza (PI)
  preparedness and response
• 2) WHO project on addressing ethical issues in PI
  planning
• 3) Ethical issues in pandemic influenza response
  strategies

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Ethical issues in pandemic preparedness and
response
What is Ethics ?
A discipline dealing with what is right and wrong
and with moral duties, obligations, and rights. A
process for reaching agreement when values are in
conflict.
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Ethical issues in pandemic preparedness and
response

• A) Ethical and human rights issues in public
  health measures

• Surveillance information dissemination
• Measures to prevent animal-to-human transmission
  (culling, etc.)
• Quarantine, isolation and social distancing
• International travel and border control
• (International Health Regulations)

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Ethical issues in pandemic preparedness and
response

• B) Equitable access to health care in a pandemic

• How to allocate vaccines, antivirals and hospital
  care
• Should some population groups have priority?
• For example, should health care workers be
  prioritized to receive Oseltamivir or a vaccine?
• How to allocate resources (in advance and during
  the pandemic) between pandemic influenza and
  other health needs

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Ethical issues in pandemic preparedness and
response
C) Obligations of (and to) healthcare workers in
a pandemic

• Do health care workers (HCWs) have a duty to care
  in the event of a pandemic? If so, is it
  unlimited?
• Are obligations of healthcare workers dependent
  on their receiving special protections or on
  direct or implied commitments made when they
  entered the profession?
• Should HCWs receive priority treatment,
  prophylaxis or vaccine?
• Which persons are included ( "professionals" or
  others?)
• How and by whom should obligations be formulated
  and enforced?

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Ethical issues in pandemic preparedness and
response

• Obligations among countries international
  organizations

• How should governments balance their duties to
  their own population versus to other countries
  and populations?
• Is there a reciprocal obligation between
  developing countries providing surveillance and
  specimen and developed countries providing
  treatment and vaccines?
• What role can and should international
  organizations (such as WHO) play in addressing
  cross-border risks and obligations?

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Ethical issues in pandemic preparedness and
response
Importance of Planning and Preparedness

• Since many of these questions are difficult to
  answer, countries should prepare and discuss them
  ahead of time, and make sure that the public has
  been engaged in the decision-making process.

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WHO project on ethical issues in pandemic planning
Objective
Formulation of guidance for Member States on how
to address the ethical issues that arise in the
preparation and response to a potential
influenza pandemic.
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WHO project on ethical issues in pandemic
planning

• Publication a of document on Ethical
  Considerations for Pandemic Influenza Planning
• Dissemination through various channels
• WHO, MoH, NGOs
• UN Interagency Committee on Bioethics
• Global Summit of National Bioethics Advisory
  Bodies
• Conferences
• Regional and country support activities
  contextualisation

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Ethical issues in rapid containment
Public Health Ethics Principles

• Public Health Necessity
• Reasonable and effective means
• Proportionality
• Distributive Justice
• Trust and Transparency
• Siracusa Principles (Human Rights) Limitations
  on human rights must be based on a legitimate
  objective, be the least restrictive and intrusive
  means and not be arbitrary, unreasonable or
  discriminatory

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Ethical issues in pandemic influenza response
Prophylaxis/treatment with neuraminidase
inhibitors

• During pandemic influenza response, antivirals
  will be available for everyone who requires them
• Informed consent
• Language
• Risks benefits
• Right to refuse prophylaxis/treatment
• Special care with pregnant women and infants
• However, other types of care, such as hospital
  beds and mechanically-assisted ventilation, may
  be in short supply
• include prioritization criteria in
  country-level planning

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Ethical issues in pandemic influenza response
Isolation, quarantine, and social distancing
Employees of Stewart Holmes Wholesale Drug Co.
Seattle, 1918 Courtesy of Grace Loudon Mc Adam
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Ethical issues in pandemic influenza response
Isolation, quarantine, and social distancing