A strain of influenza has been identified in birds worldwide (avian flu).  This virus (H5N1) has similarities to the Spanish flu, which caused the death of 5% of the world’s population in 1918.  Should human  to human transmission of this virus develop, a  pandemic with profound social, economic and healthcare consequences is possible.  The Geisinger Bioethics Review and Advisory Committee has been asked to provide recommendations on the ethical considerations of an avian flu pandemic to the Geisinger Pandemic Influenza Preparedness Workgroup.

Pandemic Flu Final Recommendations - April 2006 (click here)

General Resources for Pandemic Flu

Utah Pandemic Influenza Hospital and ICU Triage Guidelines
http://www.pandemicflu.utah.gov/plan/med_triage011009.pdf

Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations
http://www.nap.edu/catalog.php?record_id=12749

Ethical and Legal Considerations in Mitigating Pandemic Disease - Workshop Summary
http://books.nap.edu/openbook.php?record_id=11917&page=R1

Community Strategy for Pandemic Influenza Mitigation
http://www.pandemicflu.gov/plan/community/community_mitigation.pdf

Department of Health and Human Services. U.S. Government avian and pandemic flu information.
http://www.pandemicflu.gov

Centers for Disease Control and Prevention.  Avian Influenze (Bird Flu)
http://www.cdc.gov/flu/avian/

World Health Organization.  Epidemic and Pandemic Alert and Response (EPR)
http://www.who.int/csr/disease/avian_influenza/en/

National Strategy for Pandemic Influenza Implementation Plan
Homeland Security Council, May 2006
http://www.whitehouse.gov/homeland/nspi_implementation.pdf

Pennsylvania's Influenza Pandemic Response Plan (IPRP)
http://www.dsf.health.state.pa.us/health/cwp/view.asp?A=178&Q=243414

Pandemic Flu Planning Checklist for Individuals and Families (click here)

Pandemic Flu Planning Guide for Individuals and Families (click here)

Public Health Preparedness
Integrating Public Health and Hospital Preparedness Programs
Rand Corporation
http://www.rand.org/pubs/technical_reports/2006/RAND_TR317.pdf

Reading Resources - Ethics

Ethical considerations in developing a public health response to pandemic influenza
World Health Organization
http://www.who.int/entity/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2c.pdf

Influenza pandemic and professional duty: family or patients first? A survey of hospital employees
BMC Public Health. 2006; 6: 311. 6(311)
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1764890

Potential Penalties for Health Care Professionals Who Refuse to Work During a Pandemic
JAMA. 2008 299(12):1471-1473
http://jama.ama-assn.org/cgi/content/extract/299/12/1471

Pandemic influenza preparedness: an ethical framework to guide decision-making
BMC Med Ethics. 2006; 7: 12.
Published online 2006 December 4. doi: 10.1186/1472-6939-7-12.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17144926

Local public health workers' perceptions toward responding to an influenza pandemic
BMC Public Health. 2006; 6: 99.
Published online 2006 April 18. doi: 10.1186/1471-2458-6-99
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16620372

On pandemics and the duty to care: whose duty? who cares?
BMC Med Ethics. 2006; 7: 5.
Published online 2006 April 20. doi: 10.1186/1472-6939-7-5.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16626488

Local public health workers' perceptions toward responding to an influenza pandemic
BMC Public Health 2006, 6:99 (18 April 2006)
http://www.biomedcentral.com/content/pdf/1471-2458-6-99.pdf

Medical Countermeasures for Pandemic Influenza - Ethics and the Law
JAMA.2006; 295: 554-556.
http://jama.ama-assn.org/cgi/content/extract/295/5/554

Preparing for an influenza pandemic: ethical issues
Bioethics. 2005 Aug;19(4):422-31.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16222857&query_hl=31&itool=pubmed_docsum

Priority setting in hospitals: fairness, inclusiveness, and the problem of institutional power differences
Soc Sci Med. 2005 Dec;61(11):2355-62.
http://www.utoronto.ca/jcb/about/publications/priority_setting_hospitals.pdf

Public Health Strategies for Pandemic Influenza: Ethics and the Law
JAMA 2006;295:1700-1704.
http://jama.ama-assn.org/cgi/content/extract/295/14/1700

Stand on Guard for Thee, Ethical considerations in preparedness planning for pandemic influenza
http://www.jointcentreforbioethics.ca/people/documents/upshur_stand_guard.pdf

Legal, Ethical, Political and Economic Concerns
http://www.fluwikie.com/pmwiki.php?n=Issues.Issues

Who Should Get Influenza Vaccine When Not All Can?
http://www.sciencemag.org/cgi/content/summary/312/5775/854
Young and healthy before old and sick, bioethicists say (click here)