Abstract
BackgroundMany commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI).MethodsWe critically analyzed the Ghana NISPPI’s sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks.ResultsThis paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI’s text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them.ConclusionsOur analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan’s content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.
Highlights
Many commentators call for a more ethical approach to planning for influenza pandemics
The framework for preparedness and response to pandemic influenza in Ghana Developed using a framework recommended by the World Health Organization (WHO) [25], and organized into five thematic areas, Table 1 Ethics sensitivity parameters
# Ethics sensitivity parameter Decision making process: Justification for delineated actions: Composition of national pandemic planning committee: Communication to at risk population/Information symmetry: Prioritization, and allocation of scarce resources: Healthcare worker duty to care adequately explained: Limitations of proposed interventions: Leadership and coordination Facilities designation Stockpiling of antiviral, vaccines and personal protective equipment: Ethics training for healthcare workers Timelines for planned activities: Border issues, travel advisories, and trade policies Co-operation with the WHO other development partners, and sister countries Ethics consideration in clinical protocols: Use of vaccines and antivirals: Plan review mechanism: Continuity of essential services: Considerations of equity, social justice, vulnerable groups: Home care management of infected patients: Definition
Summary
Many commentators call for a more ethical approach to planning for influenza pandemics. Some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI). The Swine flu pandemic occurred in 2009 (HIN1/09) [3]. Even though no public health expert can. With this understanding, the World Health Organization (WHO) periodically publishes recommendations for countries to use in their own preparations. Previous ones include “the role of WHO and recommendations for national measures before and during pandemics” [5], and a checklist for influenza preparedness, both released in 2005 [6]. In 2006, the WHO released a protocol for rapid response and containment [7], and a draft protocol for rapid response and containment of pandemic influenza in 2007
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