Oct. 3, 2006 The influenza pandemic of 1918 killed more than 50 million people. In the face of the possibility that another virulent pandemic might occur, a group of international experts convened by The Johns Hopkins University is urgently calling on policymakers and public health officials to disseminate a new set of principles to better take into account the interests of those who will be the worst affected: the world's most poor and disadvantaged.
"There are both practical and ethical reasons why policymakers and public health officials should focus on the most vulnerable populations. We have little hope of averting a pandemic if poor villagers are afraid to report sick birds or possible human cases to public health authorities," said Ruth Faden, PhD, MPH, executive director of the Berman Bioethics Institute and Philip Franklin Wagley Professor of Biomedical Ethics at Johns Hopkins Bloomberg School of Public Health. "At the same time, because it is inevitable that the poor will suffer most during a pandemic, it is especially unjust to also impose most of the burden of prevention upon them."
Named for the Rockefeller Foundation's Study and Conference Center in Bellagio, Italy, where international experts in economics, epidemiology, ethics, human rights, poultry production, public and animal health and public policy came together to craft it, the Bellagio Statement of Principles represents a new framework for how to approach pandemic prevention and response planning. Examined through the lens of leading social justice theory, current public health plans too often fail to properly take into account the world's most vulnerable populations, according to the group. The principles also make reference to new checklists developed in Bellagio that urge policymakers and health officials to urgently take action such as:
- Specifically make available accurate, up-to-date and easily understood information about avian and human pandemic influenza for disadvantaged groups.
- Actively seek input from traditionally disadvantaged groups, followed by deliberate sharing of planned public policy responses with such groups.
- Significantly increase the degree of public involvement in the surveillance and reporting of possible cases, without fear of discrimination or uncompensated loss of livelihood.
- Identify and address any obstacles that disadvantaged groups may face in benefiting from preparedness plans.
Experts from U.S. universities, Southeast Asian nations and organizations such as CARE International, Human Rights Watch, the World Bank, the World Health Organization, the United Nations, and others participated in the Bellagio Meeting. The group encourages policymakers to download the Bellagio Statement of Principles and the checklists at http://www.bioethicsinstitute.org. The materials are available in Arabic, Chinese, English, French, Russian and Spanish. Since the meeting of experts was held July 24-28, 2006, additional cases of (H5N1) avian influenza have been reported.
"While avian and human pandemic influenza planning and response should be based on sound science and public health principles, attention should also be paid to the needs and rights of the disadvantaged," said Ruth Karron, MD, professor of International Health and Pediatrics at Johns Hopkins Bloomberg School of Public Health. "That hasn't really happened on a widespread scale yet, and is in part what prompted the Bellagio meeting in the first place."
"There is much work to do, and it will not be easy," said Judith Rodin, president of the Rockefeller Foundation, which sponsored the meeting. "With the Bellagio Statement of Principles, we have a better sense of how we might move forward to prevent or at least mitigate unjust outcomes for the world's most vulnerable populations. It's not only better public policy, but the right thing to do."
"In the last year I have met with many professionals who are hard at work responding to avian influenza and preparing for a possible influenza pandemic," said Bellagio Meeting participant David Nabarro, senior United Nations System influenza coordinator. "They seek to ensure continuity of basic needs, relief services, economic systems and governance for populations facing adversity. They often ask whether there is an easily accessible source of information on how to address the rights and interests of disadvantaged people. The checklists are an important and practical tool designed to help planners to this end. I also anticipate that they will evolve as a result of experience with their use in field settings."
Ruth Karron agrees, adding that "while we believe the new framework has relevance beyond pandemics, we also want to continue to learn more from people living and working in the affected areas. We hope to hear about the utility of the principles and checklists as they are employed in 'real world' situations. This is part of why it's important to disseminate the principles and checklists as widely as possible."
"The Bellagio Statement of Principles is just the beginning," said Ruth Faden. "It starts the debate on how we should re-think our approach with ethical considerations in mind. We want to hear from policymakers and public health practitioners. And we want to emphasize that this work is a living document that will be modified over time by multiple users in multiple contexts. We'll adjust our strategies to encourage the adoption of the principles and use of the checklists, and make this less about a top-down approach, and more about one that -- for the benefit of those worst affected - simply works."
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