Key Ethical Issues Discussed at CDC-Sponsored International, Regional Meetings to Explore Cultural Perspectives and Contexts on Pandemic Influenza Preparedness and Response

Abstract

Background: Recognizing the importance of having a broad exploration of how cultural perspectives may shape thinking about ethical considerations, the Centers for Disease Control and Prevention (CDC) funded four regional meetings in Africa, Asia, Latin America, and the Eastern Mediterranean to explore these perspectives relevant to pandemic influenza preparedness and response. The meetings were attended by 168 health professionals, scientists, academics, ethicists, religious leaders, and other community members representing 40 countries in these regions. Methods: We reviewed the meeting reports, notes and stories and mapped outcomes to the key ethical challenges for pandemic influenza response described in the World Health Organization’s (WHO’s) guidance, Ethical Considerations in Developing a Public Health Response to Pandemic Influenza: transparency and public engagement, allocation of resources, social distancing, obligations to and of healthcare workers, and international collaboration. Results: The important role of transparency and public engagement were widely accepted among participants. However, there was general agreement that no "one size fits all" approach to allocating resources can address the variety of economic, cultural and other contextual factors that must be taken into account. The importance of social distancing as a tool to limit disease transmission was also recognized, but the difficulties associated with this measure were acknowledged. There was agreement that healthcare workers often have competing obligations and that government has a responsibility to assist healthcare workers in doing their job by providing appropriate training and equipment. Finally, there was agreement about the importance of international collaboration for combating global health threats. Conclusion: Although some cultural differences in the values that frame pandemic preparedness and response efforts were observed, participants generally agreed on the key ethical principles discussed in the WHO’s guidance. Most significantly the input gathered from these regional meetings pointed to the important role that procedural ethics can play in bringing people and countries together to respond to the shared health threat posed by a pandemic influenza despite the existence of cultural differences.

Telemedicine in the face of the COVID-19 pandemic

“…The above measure could be justified given the crisis situation. 36 However, in normal times, telemedicine services must guarantee and assure access and security, that is a special concern for the application of telemedicine. But, with more comprehensive standards and regulations ensuring strong privacy and security protections, the benefits, improving the accessibility, quality, and effectiveness of health care outweigh the risks.…”

‘Tiny Iceland’ preparing for Ebola in a globalized world

“…During the elaboration of these plans, communication among the different levels of the healthcare system and supporting agencies, such as the DCPEM, had been clearly defined, and proved to be useful in the preparedness for Ebola. Further, as found important in preparedness activities for pandemic influenzae elsewhere [44], honesty, transparency in communication, and sharing of information from managers to front-line health professionals, was found to be critical. It gave a feeling of being involved, and mitigated the fear that is so frequently encountered during epidemics [38].…”

“…The members of the ETT pointed out that they had never worked together as a team under circumstances that demanded strict adherence to infectious control procedures. This eroded trust, compounded by the laissez-faire attitude of some of its members during the preparation exercises, possibly due to other competing tasks in a busy hospital and insufficient resources that hampered full participation [44]. Further, it was a constraint that simulation exercises were not an option, found to be an important element in preparation for epidemics [35].…”

Fairness, Ethnicity, and COVID-19 Ethics

“…Social scientific work on people’s perceptions of a doctor’s duty of care extending to the protection of doctors themselves shaped their advice to frontline staff on working with insufficient personal protective equipment, shielding, and redeployment (Bensimon et al 2012 ). Empirical work on the role of cultural perspectives and contexts in pandemic responses (Lor et al 2016 ) were used to develop advice for doctors around the importance of considering a patient’s context when making decisions about care priorities. As the Royal College of Physicians guidance shows, it is possible to do things differently and ultimately equitably when developing ethical guidance to best reflect the context within which that guidance will be used.…”