In the near future, experts predict, an influenza pandemic will likely spread throughout the world. Many countries have been creating a contingency plan in order to mitigate the severe health and social consequences of such an event. Examination of the pandemic plans of Canada, the United Kingdom and the United States, from an ethical perspective, raises several concerns. One: scarcity of human and material resources is assumed to be severe. Plans focus on prioritization but do not identify resources that (...) would be optimally required to reduce deaths and other serious consequences. Hence, these plans do not facilitate a truly informed choice at the political level where decisions have to be made on how much to invest now in order to reduce scarcity when a pandemic occurs. Two: mass vaccination is considered to be the most important instrument for reducing the impact of infection, yet pandemic plans do not provide concrete estimates of the benefits and burdens of vaccination to assure everyone that the balance is highly favorable. Three: pandemic plans make extraordinary demands on health care workers, yet professional organizations and unions may not have been involved in the plans' formulation and they have not been assured that authorities will aim to protect and support health care workers in a way that corresponds to the demands made on them. Four: all sectors of society and all individuals will be affected by a pandemic and everyone's collaboration will be required. Yet, it appears that the various populations have been inadequately informed by occasional media reports. Hence, it is essential that plans are developed and communication programs implemented that will not only inform but also create an atmosphere of mutual trust and solidarity; qualities that at the time of a pandemic will be much needed. (shrink)

Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related (...) morbidity and mortality than those targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

For last couple of years, the subcontinent of India has witnessed a number of influenza epidemic outbreaks. History reveals influenza epidemic to be a constant but neglected companion of India. Considering the repeated occurrences of the event on Indian soil, including influenza A H1N1 after 2009-10 pandemic event, a check to the planning measures has been done at national level. A literature survey on the initiative measures, planning accomplishments etc. reveals that it is only after the emergence (...) of A H5N1, national health authorities have began planning efforts to mitigate and respond to influenza outbreaks. This paper outlines the evolution of Indian pandemic planning that can be traced in the research literature, summarize the accomplishments, and explain the importance of pandemic planning in India. Pandemic influenza, as it is commonly known, emerges, evolves, attacks, and sways a large part of world declaring public health emergency in a short span. Several outbreak events such as SARS, Avian influenza A H5N1, and H1N1 have demonstrated the need of international concern for public health emergency and had established the value of planning in advance. Preparedness planning in India is found to be at its nascent stage and it needs further improvement at multiple aspects to tackle the future public health crises, to rectify ethical failures. (shrink)

The virulence of a virus is determined by its ability to adversely affect the host cell, host organism or population of host organisms. Influenza A viruses have been responsible for four pandemics of severe human respiratory disease this century. Avian species harbour a large reservoir of influenza virus strains, which can contribute genes to potential new pandemic human strains. The fundamental importance of understanding the role of each of these genes in determining virulence in birds and humans was (...) dramatically emphasised by the recent direct transmission of avian influenza A viruses to humans, causing fatal infection but not community spread. An understanding of the factors involved in transmission between avian and mammalian species should assist in the development of better surveillance strategies for early recognition of influenza A virus strains having human pandemic potential, and possibly in the design of anti‐viral strategies. BioEssays 25:657–671, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

The threat posed by avian influenza appears to be rising, yet global and national health programs are preparing only fitfully. A lethal form of avian flu has rooted itself deeply into the poultry flocks of poor Asian countries that will have a hard time eradicating it. Every so often a sick bird infects a human, who usually dies from the encounter, and on rare occasions the virus seems to have spread from one person to another before the chain of (...) infection dies out. All it would take to set off a raging global pandemic would be for the virus to mutate into a form that is readily transmissible among humans.Severe Acute Respiratory Syndrome garnered a great deal of public attention because it was novel and its potential for spread was unknown. However, the SARS corona virus is significantly less virulent than pandemic influenza viral infections. (shrink)

Objectives: Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study’s objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. Design: A survey among nursing home physicians. Setting & Participants: We sent a questionnaire to all (...) (356) nursing homes in the Netherlands, to be completed by one of the physicians. Results: We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p < 0.03). Conclusions: In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures. (shrink)

Should government have the power to place limits on a scientific pursuit that holds the potential for both good and harm—on what is called “dual‐use research”? That is the highly charged question surrounding research to genetically modify influenza A (H5N1) to render it more easily transmissible from human to human. There is seldom a “right” answer to dual‐use research, but a fair, inclusive, and transparent process—building on the NSABB model—should improve decision‐making. A local institutional panel should evaluate dual‐use research (...) based on the following structured ethical framework. (shrink)

In December 2006, Indonesia decided to stop sending influenza virus specimens to the World Health Organization’s Global Influenza Surveillance Network (GISN). Indonesia justified its actions by claiming that they were in protest of the injustice of GISN. Its actions stimulated negotiations to improve the workings of GISN by developing and implementing a more just framework for ‘sharing influenza viruses and other benefits’. These negotiations eventually led to the adoption of a new framework for virus and benefit sharing (...) in May 2011, at the World Health Assembly meeting. In this article, we critically evaluate Indonesia’s claims about the unjustness of GISN. We show that arguments based on the values of ownership, contribution and reciprocity work together to support Indonesia’s claim that it was owed an equal share in the benefits of GISN and, in turn, that GISN was unjust because of its failure to ensure this. We also use these values to evaluate the newly agreed upon framework for virus and benefit sharing. We suggest the new framework fails to give proper consideration to the values of ownership, contribution and reciprocity and, as a result, that it is fundamentally unjust. (shrink)

Influenza mandates in health care institutions are recommended by professional associations as an effective way to prevent the contraction of influenza by patients from health care workers. Health care institutions with such mandates must operate within civil rights frameworks. A recent set of cases against health care institutions with influenza mandates reveals the liabilities posed by federal law that protects employees from religious discrimination. This article examines this legal framework and draws important lessons from this litigation for (...) health care institutions. We argue counterintuitively that providing religious exemptions from influenza mandates may expose health care institutions to more liability than not providing a formal exemption. (shrink)

While public health ethics typically deals with issues wherein individual well-being competes with the population’s wellbeing, it also deals with competing groups’ well-being. Public health responses to the Chicago heat wave and Hurricane Katrina were strongly criticized, in part, because certain groups of people experienced far greater and longer-lasting losses compared to others. Diff erences in experience were largely due to socio-economic-political disadvantages or vulnerabilities. This article is written in light of the recent fi rst and second “waves” of the (...) H1N1 pandemic in Canada. Its focus is on people living in the community with a mental health or addiction problem during the pandemic and, more specifi cally, in the context of supplies of anti-viral medications and vaccines being limited. The article explores how certain social justice concerns may increase the risks of serious illness or death for these people and the kinds of compensatory responses that might be implemented. (shrink)

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. (...) The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. (shrink)

We hypothesise that some influenza virus adaptations to poultry may explain why the barrier for human‐to‐human transmission is not easily overcome once the virus has crossed from wild birds to chickens. Since the cluster of human infections with H5N1 influenza in Hong Kong in 1997, chickens have been recognized as the major source of avian influenza virus infection in humans. Although often severe, these infections have been limited in their subsequent human‐to‐human transmission, and the feared H5N1 pandemic (...) has not yet occurred. Here we examine virus adaptations selected for during replication in chickens and other gallinaceous poultry. These include altered receptor binding and increased pH of fusion of the haemagglutinin as well as stalk deletions of the neuraminidase protein. This knowledge could aid the delivery of vaccines and increase our ability to prioritize research efforts on those viruses from the diverse array of avian influenza viruses that have greatest human pandemic potential. (shrink)

Con questa ricerca vorremmo soffermarci su quattro punti che riteniamo fondamentali per la comprensione dell'influenza delle fonti neoplatoniche nella Firenze del Quattrocento. Il punto di partenza è l'analisi dei rapporti tra i due massimi esponenti del neoplatonismo fiorentino: Pico della Mirandola e Marsilio Ficino, autori fondamentali non solo per le loro interpretazioni, ma anche per aver riscoperto e tradotto, dopo secoli di silenzio, i tesori del pensiero greco. Non si comprenderebbe l'influenza delle fonti neoplatoniche antiche nel Quattrocento senza (...) rendere conto del confronto – spesso molto aspro – tra i due protagonisti pricipali della riscoperta rinascimentale di Platone e di tutta la tradizione neoplatonica. Il secondo punto affronta un'importante interpretazione in senso tomista dell'opera di Pico, quella di Giovanni di Napoli, che aiuta ad intendere tanto le differenze tra il mirandolano e Ficino, quanto ad introdurre all'influenza importantissima dello Pseudo-Dionigi in tutto il dibattito filosofico del tardo Quattrocento. Il terzo punto cerca di affrontare un tema fondamentale: l'esigenza di definire e organizzare nuovi ordini del sapere. Dal recupero del passato emergevano nuove contraddizioni e nuove esigenze, non si trattava affatto di una semplice imitazione dell'antico, ma al contrario, significava farlo rivivere in nuove forme e costruire nuovi sistemi dei saperi capaci di rispondere alle esigenze culturali e politiche che stavano alla base della nascita del moderno. L'ultimo punto riguarda invece un'analisi specifica tra il pensiero di Giovanni Pico e lo Pseudo-Dionigi, discorso che ovviamente comporta anche l'analisi di altre fonti fondamentali, in particolare Damascio. Parole chiave: Neoplatonismo fiorentino, Giovanni Pico, della Mirandola, Marsilio Ficino, Pseudo-Areopagita. (shrink)

: Because an influenza pandemic would create the most serious hardships for those who already face most serious hardships, countries should take special measures to mitigate the effect of a pandemic on existing social inequalities. Unfortunately, there is little evidence that anybody is thinking about that.

Analysis of the quotations from Leo Tolstoy’s «What I Believe», that Nietzsche copied out and worked on in late 1887-early 1888, shows that after reading this book Nietzsche significantly changed his attitude toward Christianity. Before that he did not see any difference between the teachings of Jesus Christ and historic Christianity, but from that moment on, following Tolstoy, he draws a sharp opposition between them. Still persisting in a very negative assessment of historical Christianity, he acknowledges the teaching of Christ (...) as positive insofar as it contributes to the unfolding of the internal capabilities of the human being. (shrink)

Just allocation of resources for control of infectious diseases can be profoundly influenced by the dynamics of those diseases. In this paper we discuss the use of antiviral drugs for treatment of pandemic influenza. While the primary effect of such drugs is to alleviate and shorten the duration of symptoms for treated individuals, they can have a secondary effect of reducing transmission in the community. However, existing stockpiles may be insufficient for all clinical cases. Here we use simple mathematical (...) models to present scenarios where the optimum policies to minimise morbidity and mortality, with a limited drug stockpile, are not always the most intuitively obvious and may conflict with theories of justice. We discuss ethical implications of these findings. (shrink)

The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...) the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics. (shrink)

In this article we aim to assess the ethical desirability of self-test diagnostic kits for influenza, focusing in particular on the potential benefits and challenges posed by a new, mobile phone-based tool currently being developed by i-sense, an interdisciplinary research collaboration based at University College London and funded by the Engineering and Physical Sciences Research Council. Our study adopts an empirical ethics approach, supplementing an initial review into the ethical considerations posed by such technologies with qualitative data from three (...) focus groups. Overall, we map a range of possible considerations both for and against the use of such technologies, synthesizing evidence from a range of secondary literature, as well as identifying several new considerations previously overlooked. We argue that no single consideration marks these technologies as either entirely permissible or impermissible but rather tools which have the potential to incur certain costs and benefits, and that context is important in determining these. In the latter stages of the article, we explain how developers of such technologies might seek to mitigate such costs and reflect on the possible limitations of the empirical ethics method brought out during the study. Not applicable. (shrink)

L'idea di relazionare la dimensionalità dello spazio ad una legge fisica, contenuta nel primo scritto di Kant "Pensieri sulla veridica estima delle forze vive", svela un modo di guardare i rapporti tra Fisica e Matematica così nuovo ed originale che potè essere sviluppato e compreso nella sua plenitudine soltanto nel secolo XX. Ci riferiamo qui ala prospettiva aperta da Ehrenfest nel suo "In what way does it become manifest in the fundamental laws of physics that space has three dimensions?". In (...) questo saggio si cerca di comprendere alcune delle radici fisiche, filosofiche e teologiche dell’approccio di Kant a questo problema, e la sua inserzione nel dibattito delle idee che sostengono la concezione meccanicista del Mondo. In primo luogo, si sottolinea che da una lettura attenta del suo Gedanken von der wahren Schätzung der lebendigen Kräfte si può concludere che - al contrario di quanto viene normalmente creduto - Kant non riuscì a dimostrare la sua congettura che la tridimensionalità dello spazio possa essere fondata sulla legge di gravitazione di Newton, secondo la quale la forza tra due corpi va come l'inverso del quadrato della distanza che li separa; in realtà, egli si limitò a giustificare la tridimensionalità della estensione. Dopo aver considerato la distinzione fra estensione e spazio, si fa notare che la catena logica della congettura del giovane Kant, presuppone la forza come concetto basilare, intrinseco alle sostanze. È mediante questa forza che si stabiliscono le relazioni tra le sostanze, le quali, a sua volta, creano l'ordine su cui viene basato il concetto di spazio. Si deve badare che la coerenza del suo argomento richiede, in ultima analisi, concepire la percezione, cioè, l'interazione fra le sostanze e l'anima, come risultato della medesima forza di lunga portata. Inoltre, si dimostra che l'argomento di Kant non poteva essere costrutto su una intelaiatura puramente newtoniana nel 1747. Infatti, egli costruì sua dimostrazione a partire da una concezione del mondo basata sul legato di Cartesio (soprattutto l'idea di um ordine cosmico) e Leibniz (l'esistenza di una forza che precede l'estensione e l'idea di spazio relativo) alla quale sovrappone, in modo ibrido, la legge di gravitazione di Newton. Si argomenta che questa scelta fu fortemente influenzata da alcune idee teologiche del Giovane Kant che divergono da quelle di Cartesio, Newton e Leibniz. Fu questo carattere ibrido del suo approccio che permise a Kant di trattare la questione della dimensionalità dello spazio come un problema di fisica, ma, che, allo stesso tempo, a causa delle sue limitazioni intrinsiche, portò Kant a provare appena la tridimensionalità della estensione. (shrink)

One of the societal problems in a new influenza pandemic will be how to use the scarce medical resources that are available for prevention and treatment, and what medical, epidemiological and ethical justifications can be given for the choices that have to be made. Many things may become scarce: personal protective equipment, antiviral drugs, hospital beds, mechanical ventilation, vaccination, etc. In this paper I discuss two general ethical principles for priority setting (utility and equity) and explain how these principles (...) will often point in diverging directions. Moreover, each of these principles can be understood in different, again often competing, ways. Notwithstanding these controversies and conflicts, in the context of pandemic response there are at least some points of convergence: several policies can be justified by appeal to different ethical principles and theories. Convergence may be found with respect to a focus on saving the most lives (instead of other aggregative accounts); giving priority antiviral prophylaxis and therapy for life-saving pandemic responders; and, partly depending on epidemiology of the pandemic, to prioritise vaccination of children. Although decision-making about access to intensive care will involve choices with immediate tragic implications, the ethical complexity of these choices is relatively modest (although decisions will not be easy): there are persuasive moral reasons for giving priority to patients who are expected to benefit most within the shortest time. Finally, in the last section I tentatively argue that constraints on people’s freedom, as necessary for an effective public health approach, may support giving somewhat more weight to saving the most lives, than to concerns of equity. (shrink)

When in October 2016 I started working on my book Jorge Mario Bergoglio. An intellectual biography I did not have the slightest idea of ​​the importance played by the figure and work of Gaston Fessard in the formation of Bergoglio’s thought. There was nothing to suggest that Gaston Fessard could be a relevant author for the intellectual formation of the future Pope. I was struck by the polar and dialectical model of thought that animated him, the possibility of harmonizing opposites, (...) of inviting concepts to a common table that apparently could not be approached, because it places them in a higher plane in which they find their synthesis. This paradigm, of the Church and of the Society of Jesus as complexio oppositorum, finds its verification, according to Bergoglio, in the way in which the Jesuits have achieved the inculturation of the faith in the indigenous peoples of Latin America. Bergoglio rereads Ignatius in the light of a dialectical model. As he will say in one of the interviews he gave me on the occasion of the writing of my book: “In Ignatian spirituality there is always this bipolar tension”. It is certainly an original, uncommon reading of Ignatius’s thought. It is the ideal factor that allows us to explain why Bergoglio, when in 1986 he went to Frankfurt to write his doctoral thesis, chose the Guardinian essay dedicated to the polar opposition. When I concluded my volume on the intellectual biography of the future Pontiff in February 2017, one element, however, remained obscure. Where, from which author had Bergoglio drawn his polar model? Where did your antinomic reading of Ignatian spirituality come from? Not by Guardini discovered philosophically in 1986. Francis indicated the starting point of his intellectual formation. The reading of Fessard’s La dialectique des Exercices spirituels de saint Ignace de Loyola, published in 1956, is the work that “ had a great influence “ on him. It is the work that clarifies Bergoglio’s antinomian thought, his subsequent ideal encounter with Guardini’s philosophy. (shrink)

This study aims at ascertaining the existence of an organic legal policy in marriage matters, one which was followed by Roman Emperors in the IV and V centuries, in particular by Constantine. It is also aimed at showing that this policy corresponded to Christian ideas as expressed by various Church Fathers. This research was carried out in a careful way with attention to the chronology of the writings examined, and with a comparative analysis of every single essay that was subsequently (...) treated. (shrink)

Influencia de la Escolástica italiana en la Neoescolástica argentina. Presencia de Rosmini en el pensamiento argentino. Por A. A. Caturelli.--La influencia filosófica de Benedetto Croce en la Argentina, por R. M. Agoglia.--Presencia e influencia de Michele Federico Sciacca en Argentina: su obra, sus visitas, su persona, por M. G. Casas.--Un caso eccezionale nella filosofia uruguayana: Fernando Beltramo, di D. G. Grecchi.

A core idea underlying nudging is that it helps individuals to achieve their own goals, yet many nudges actually aim at collective goals or specifically target the benefit of others. An example is nudging healthcare workers to be vaccinated against influenza. I distinguish between self‐regarding nudges, which primarily benefit the nudgee, and other‐regarding nudges, which mainly benefit others, and argue that the default justificatory reason to legitimize self‐regarding nudges, namely the ‘as judged by themselves’ standard, does not apply and (...) that we need to look for other justifications. I examine several possible moral justifications to support strong other‐regarding nudges, namely beneficence, the harm principle and solidarity. (shrink)

Department of Medical Education, Flinders University of South Australia, GPO Box 2100, Adelaide SA 5001. Tel. : +61-8-7225-1111; Fax: +61-8-8204-5675; Email: lee0359{at}flinders.edu.au ' + u + '@ ' + d + ' '/ /- ->.This paper analyses the role of communication strategies in pandemic influenza planning. Our central concern is with the extent to which nations are using communication to address issues of social justice. Issues associated with disadvantage and vulnerability to infection in the event of an influenza (...) pandemic raise distinct questions about how well less well off groups will be protected. The potential for a public health emergency of this type to exacerbate existing inequalities, making those in less well off positions worse off, makes social justice an important consideration for pandemic planners. National PI plans offer insights into the ways that nations may use communication to address issues of disadvantage, thereby providing a way of examining how communication strategies are presented and their potential to mitigate inequities. Our research reviewed 12 national PI plans and assessed the extent to which nations are using communication to assist and limit possible harms to less well off groups. We outline in this paper some important issues and considerations associated with social justice and flu planning, in particular if and how plans are addressing inequalities. CiteULike Connotea Del.icio.us What's this? (shrink)

Epidemics that were probably influenza have been reported throughout recorded history. There were 13 fairly severe epidemics during the 18th century and 12 during the 19th century. Probably 8 of these 25 were influenza pandemics. In the 20th century there have been 4 pandemics (1918/19, 1957/58, 1968/69 and 1977) due to the emergence of new subtypes of influenza A virus. The great pandemic of 1918/19 caused an estimated 20 million deaths. Between pandemics usually there have been epidemics (...) of varying severity at intervals of one to three years and a trickle of sporadic cases every winter. The morbidity and mortality rates have varied greatly from epidemic to epidemic and from place to place during the same epidemic. Generally the morbidity has been lowest in people over 60 years of age, but, except for 1918/19, the mortality has been predominantly in old people. The epidemic behaviour of influenza has been so erratic and difficult to understand that there are still a few scientists who consider that extraterrestrial influences operate. These views are not taken seriously by most virologists but there are puzzling aspects of influenza that are not yet understood. (shrink)

In this article, we draw on the thinking about incompleteness and conviviality grounded in Afro‐communitarianism ethics from the Global South to argue that adults aged 65 years and above have a prima facie responsibility to vaccinate against influenza. Notably, adults aged 65 years and above have a duty of conviviality to act in ways that limit harm to them and others. This article is intrinsically valuable to promote epistemic justice, thereby contributing towards the decolonisation of the global healthcare system. (...) Moreover, this project has social significance in contributing to mitigation efforts against future public health challenges associated with population ageing in resource‐limited developing African nations, wherein the impact of population transition will be felt most. (shrink)

We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic , in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was (...) based upon an economic rationality and the second upon a humanitarian rationality. The implications for public support and the long-term sustainability of new global norms, networks, and regulations in global public health are discussed. (shrink)

Wardrope argues against my proposed non-consequentialist policy for the distribution of scarce influenza vaccine in the face of a pandemic. According to him, even if one accepts what he calls my deontological ethical theory, it does not follow that we are required to agree with my proposed randomised allocation of doses of vaccine by means of a lottery. He argues in particular that I fail to consider fully the prophylactic role of vaccination whereby it serves to protect from infection (...) more people than are vaccinated. He concludes that: ‘The benefits and burdens of vaccination are provided impartially and far more effectively by targeted vaccination than impartial lotteries.’ He has shown convincingly that this conclusion can be established in the case of his particular envisaged scenario. However, Wardrope gives no reason to suppose that, in the circumstances that we actually face, targeted vaccination would constitute impartial treatment of citizens in the UK. I readily agree with Wardrope that if it should treat its citizens justly and impartially, it does not necessarily follow that the state should distribute vaccinations of the basis of a lottery. That will be a reasonable thing to do only if certain assumptions are made. These assumptions will not always be reasonable. However, they are reasonable ones to make in the actual circumstances that currently apply. (shrink)

Ethical problems are addressed in various ways within countries in planning for and response to pandemic influenza. Here we report on a qualitative study, in which 46 policymakers in Malawi and Ghana were interviewed on how they identified and resolved ethical problems. The study results revealed that ethical problems involving conflicts of values and choices were raised in reference to the extent and role of resources and nature of public health interventions, including the extent and processes of decision making, (...) reasoning, and justification. There is a need for an ethical framework within pandemic preparedness plans to resolve and avert these problems. (shrink)

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on (...) fairness accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation. (shrink)

Background The world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access. Main text This paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing (...) different groups as priorities. Different reasons were often suggested as a means of justifying such priority groupings. We suggest that much of the literature, wrongly, assumes that we are able to plan priority groups prior to the time of a particular pandemic and development of a particular vaccine. We also point out the surprising absence of various issues from the literature. Conclusions The literature proposes a wide range of ways to prioritise vaccines, focusing on different groups and ‘principles’. Any plan to use pandemic vaccine must provide justifications for its prioritisation. The focus of this review was influenza pandemic vaccines, but lessons can be learnt for future allocations of coronavirus vaccine, if one becomes available. (shrink)

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature (...) focusing specifically on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature (...) focusing specifically on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

Many nursing homes have an influenza vaccination policy in which it is assumed that express (proxy) consent is not necessary. Tacit consent procedures are more efficient if one aims at high vaccination rates. In this paper I focus on incompetent residents and proxy consent. Tacit proxy consent for vaccination implies a deviance of standard proxy consent requirements. I analyse several arguments that may possibly support such a deviance. The primary reason to offer influenza vaccination is that vaccinated persons (...) have a significantly reduced risk of getting the flu. This reason however cannot support the assumption that each nursing home resident is ‘better off ’ if she is vaccinated. Neither can it support tacit proxy consent policies. More promising are arguments that take the collective nature of infectious diseases into account. A potentially strong, but ultimately insufficient, argument for non‐express consent is that vaccination contributes to prevention of harm to others. Other arguments emphasise the importance of group protection: herd immunity. I discuss three collective reasons for aiming at herd immunity: solidarity, a common interest in reducing the risk of illness, and a common interest in the prevention of an influenza outbreak. The latter argument appears to be most important. An outbreak is not just detrimental to the health of residents; it is detrimental to their everyday social life as well. Outbreaks can be seen as a collective evil. My analysis shows that there are valid (though not necessarily sufficient) moral arguments for a tacit proxy consent policy. (shrink)

In recent time there has been ample discussion concerning censorship of research conducted in two labs involved in avian influenza virus research. Much of the debate has centered on the question whether the methods and results should reach to open disclosure given the “dual use” nature of this research which can be used for nefarious purposes.

Healthcare workers are often assumed to have a duty to work, even if faced with personal risk. This is particularly so for professionals. However, the health service also depends on non-professionals, such as porters, cooks and cleaners. The duty to work is currently under scrutiny because of the ongoing challenge of responding to pandemic influenza, where an effective response depends on most uninfected HCWs continuing to work, despite personal risk. This paper reports findings of a survey of HCWs conducted (...) across three National Health Service trusts in the West Midlands, UK, to establish whether HCWs’ likelihood of working during a pandemic is associated with views about the duty to work. The sense that HCWs felt that they had a duty to work despite personal risk emerged strongly regardless of professional status. Besides a strong sense that everyone should pull together, all kinds of HCWs recognised a duty to work even in difficult circumstances, which correlated strongly with their stated likelihood of working. This suggests that HCWs’ decisions about whether or not they are prepared to work during a pandemic are closely linked to their sense of duty. However, respondents’ sense of the duty to work may conflict with their sense of duty to family, as well as other factors such as a perceived lack of reciprocity from their employers. Interestingly, nearly 25% of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families. (shrink)