Pandemic preparedness beyond influenza: The ethics of addressing other infectious disease pandemics

The persistent threat of H5N1influenza along with the 2009/2010 H1N1influenza pandemic has led to a concerted effort to develop government and nongovernmental pandemic preparedness plans. However, despite significant scholarship in this area, a disconnect continues to exist between the values of public health and the broader ethics of pandemic planning for infectious diseases beyond influenza. The preponderance of literature on influenza-specific pandemic planning has led some to the erroneous assumption that the moral considerations for an influenza pandemic can be easily or systematically translated to other infectious disease outbreaks.

In this paper we argue that at least two important moral differences exist between planning for influenza pandemics (as currently conceived) and planning for pandemics of other infectious diseases. First, planning for influenza pandemics has traditionally conflated the concept of ‘pandemic' with ‘emergency' such that most plans almost exclusively deal in considerations that arise as a result of an acute surge of health resource utilization. As a consequence, absent from traditional pandemic planning are ethical considerations surrounding the possibility of a protracted and more incremental impact on the health system, in addition to the absence of moral arguments for the prevention of pandemics and the recovery of persons and society from pandemics, should they occur. This oversight, in turn, leads to a second important moral difference from traditional influenza pandemic planning, namely, that the moral questions surrounding infectious disease pandemics encompass more than merely preparing for the effects of a pandemic on a health system's resources during a pandemic response phase.