Geneva Health Forum Archive

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Ethical Issues in Pandemic Preparedness

Author(s): A. A. Appiah1, P. L. Forson*1
Affiliation(s): 1Health, African Peace Network, Accra, Ghana

Ethical Issues in Pandemic Preparedness, Public Health Response, Rights, Welfare and Ideals, Transparency and Public Engagement, Resource constraints


Many of the conferences, meetings, and workshops convened in anticipation of a pandemic have focused on the specific strategies that can be used in fighting such a pandemic. The contributors to this abstract take a different tack and consider the creation of ethical guidelines for governments, health-care systems, and clinicians to be used in planning for and responding to a pandemic.


Many critical ethical issues arise in pan¬demic planning, preparedness and re¬sponse including:
1) priority access to medications, vaccines and intensive care unit beds, given the potential shortage of these essential resources;
2) obligations health-care workers have notwithstanding risks to their own health and the health of their families;
3) surveillance, isolation, quarantine and social-distancing measures to be undertaken in a way that respects ethical norms.
In order that response efforts in the event of a pandemic would be hastened, a publicly-discussed ethical framework is essential to maintain public trust, promote compliance, and minimize social disruption and economic loss. There is the need to assist social and political leaders at all levels who influence policy decisions about the incorporation of ethical considerations into national pandemic preparedness plans. Since specific decisions will depend on local circumstances and cultural values, it will be necessary to adapt global guidance to the regional and country-level context, with full respect to the principles and laws of international human rights. Public health measures that involve major costs should be reserved for situations where they can be reasonably expected to make a difference to the consequences of a pandemic. Preparedness planning for a pandemic involves balancing potentially conflicting individual and community interests. In emergency situations, the enjoyment of individual human rights and civil liberties may have to be limited in the public interest.


Public engagement and involvement of relevant stakeholders should be part of all aspects of planning. In order that public engagement in preparedness planning be meaningful, effective modes of communicating with and educating the public about the issues involved are essential. The principles of outbreak communication are: trust; transparency; communicating to the public early, dialogue with the public; and planning. Advance planning will allow the development of strategies that will reach the entire population and that are linguistically and culturally appropriate. While all countries must make reasonable efforts to prepare for a pandemic, differences in access to resources mean that what is reasonable for one country may not be reasonable for another. In developing countries, limited resources and immediate health-care needs may make it difficult to develop and implement comprehensive plans. In some cases, it may be possible to generate resources by using available funds more efficiently. The process for setting priorities and promoting equitable access involves civil society and other major stakeholders in the decision-making process so that decisions about the criteria to be used in allocating scarce resources are made in an open, transparent, and inclusive manner. Despite the criteria selected to govern the allocation of therapeutic and preventive measures, certain basics will be essential in all plans:
1) facilitating access to the highest level of treatment;
2) providing clinicians with clear and transparent screening and treatment protocols;
3) proposing prioritization criteria related to the maintenance of a functioning health-care system as needed in a crisis situation.

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