Ethical Guidelines in Pandemic Influenza: Recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention

Abstract

Because of the importance of including ethical considerations in planning efforts for pandemic influenza, in February 2005 the Centers for Disease Control and Prevention requested that the Ethics Subcommittee of the Advisory Committee to the Director develop guidance that would serve as a foundation for decision making in preparing for and responding to pandemic influenza. Specifically, the ethics subcommittee was asked to make recommendations regarding ethical considerations relevant to decision making about vaccine and antiviral drug distribution prioritization and development of interventions that would limit individual freedom and create social distancing. The ethics subcommittee identified a number of general ethical considerations including identification of clear goals for pandemic planning, responsibility to maximize preparedness, transparency and public engagement, sound science, commitment to the global community, balancing individual liberty and community interests, diversity in ethical decision making, and commitment to justice. These general ethical considerations are applied to the issues of vaccine and antiviral drug distribution and use of community mitigation interventions.

National pandemic influenza preparedness planning

“…Once surge requirements have been estimated, policy decisions may be needed 15 to enhance critical infrastructure. Plans for all WHO pandemic phases should conform to international ethical, legal, and scientific standards 16 . Once a pandemic preparedness plan is drafted, the planning committee must ensure micro ‐ plans are written and operational at sub‐national levels.…”

A literature review to identify factors that determine policies for influenza vaccination

“…In contrast, we observed over-declarations of how evidence was used, emphasised by adjectives such as "best" or "solid" [35][36][37][38][39][40]. Moreover, primary documents were more likely to highlight the uncertainty of the process [46,59,78], whereas secondary documents were more likely to mention the influence of experts opinions and ethical issues [33,42].…”

“…Frequently, the type of evidence used was not explicitly stated; instead, the term 'scientific evidence' was employed [41][42][43]. The guidelines provided by international organisations, national governments, or advisory boards were often the source of references for scientific studies and used for comparison with the realities in other countries [44,45].…”

Professionalism and Ethics in the Public Health Curriculum

“…For example, CDC has developed guidelines for the fair distribution of drugs and limitations on personal freedoms that might be required during an influenza pandemic. 21 For controversial topics, such as the rationing of scarce resources during a public health emergency, the publication of guidelines or value statements can stimulate public discussion of the problem prior to an actual emergency. 22 In general, guidelines are not meant to be rigidly interpreted and can be reformulated as circumstances change.…”