Letters

Social Justice Is a Global Issue: Ethical Pandemic Planning

To the Editor:

The Centers for Disease Control and Prevention is pleased to see "Planning for an Influenza Pandemic: Social Justice and Disadvantaged Groups," by Lori Uscher-Pines and colleagues (Jul-Aug 2007). As representatives of CDC's Public Health Ethics Committee, we recognize the importance of a robust ethical framework for public health that attends to issues of social justice and addresses the needs of vulnerable populations who might be adversely affected by a pandemic. We also agree with Lawrence Gostin, who pointed out in a commentary in the same issue that social justice requires more than fair distribution of benefits and burdens—it requires action.

CDC has established both an external Ethics Subcommittee of the Advisory Committee to the Director, composed of leading ethicists from throughout the United States, and an internal CDC Public Health Ethics Committee. The Ethics Subcommittee is collaborating with CDC to develop ethics guidance. Ethical Guidelines in Pandemic Influenza, which was released in March 2007, recognizes the importance of addressing the needs of populations likely to be marginalized, of developing fair procedural justice mechanisms, and of diversity in ethical decision-making. It serves as a resource for CDC decision-makers as well as CDC's state and local partners. It informs CDC's operational plan for detecting and responding to a pandemic of avian influenza (http://www.cdc.gov/flu/pandemic/OPLAN/BaseOPLAN.pdf), which in turn cascades into the plans of the Department of Health and Human Services and the U.S. government as a whole.

Uscher-Pines and colleagues point out that social justice is a global issue. We agree. CDC's vision is "Healthy people in a healthy world through prevention." CDC and other U.S. government agencies have invested significant resources to help prepare developing nations for an influenza pandemic. The efforts undertaken include building capacity to investigate avian influenza and implementing control measures in countries most likely to be impacted by a pandemic. CDC partners with governments to help build workforces and systems to detect and respond to epidemics through Field Epidemiology Training Programs. The Global Diseases Detection Program extends CDC partnerships to include laboratories and population-based surveillance and response. CDC also supports the World Health Organization's Collaborating Center for Surveillance, Epidemiology and Control of Influenza by providing technical assistance and training. These efforts are conducted both for humanitarian reasons and because it is in the world's interest to control potential pandemics wherever they emerge, as illustrated by the successful global response to severe acute respiratory syndrome.

As public health officials continue to prepare for a possible pandemic of avian influenza, it is important to emphasize the value of grounding these efforts in an ethical framework. Addressing the needs of disadvantaged and vulnerable groups is a vital part of that.

Drue Barrett

Mark White

Centers for Disease Control and Prevention

To the Editor:

The article by Lori Uscher-Pines and colleagues addresses an important issue in the great enterprise of preparing societies for the next pandemic: considering the needs of minority and deprived groups and involving them in the preparation process. This article is one of a number of publications appearing in the past two years that undertake remote analyses of published national pandemic plans. These analyses are valuable as they can suggest lacunae, and this particular article is especially helpful because Uscher-Pines and colleagues have found that the English-language plans they have addressed do not directly mention this significant topic. Though the seminal guidance, WHO's 2005 checklist for pandemic planners, mentions the necessity of involving the whole community at a number of points, it does not specifically mention minority groups (WHO is updating is pandemic preparedness guidance in 2008 and will close gaps like this).

However, remote analyses of these plans face a number of methodological challenges, and so it may be wrong to conclude that the minority groups issue is quite as neglected as Uscher-Pines et al. suggest. Working with the European Commission and WHO European Region, The European Centre for Disease Prevention and Control (ECDC...