Pandemic ethics: The boy who cried ‘flu’!

The headlines in the last week have been dramatic. California has declared a state of emergency. The World Health Organisation has raised its pandemic alert status to level 5 – its second highest level. The UK government is about to post leaflets to every household providing information on how to reduce spread of an outbreak of H1N1 influenza (swine flu).

It is not clear whether the threatened pandemic will eventuate. But the response to a possible or to a real pandemic raises a number of ethical questions. This blog will hopefully address some of those questions in the coming days. But here is one to start with. How ought the government to respond to the threat of pandemic influenza?

The response to the outbreak has been criticised. Some have accused the media (and the WHO) of overstating the threat, while others have pointed out to the many deaths and human rights violations worldwide that have been obscured by all the attention on swine flu. After all there were similar headlines and television pictures in relation to bird flu in Cambodia and Thailand in 2003/4, and before that about SARS in Hong Kong and Canada. Neither of those illnesses turned out to be the major threats that were described in lurid terms at the time. The media has lost confidence in its (and in scientists') ability to discriminate real threats from exaggerated ones. If we were wrong about those viruses perhaps we are wrong to be worried now about swine flu?

But of course it is easy with hindsight to say that we should not have worried so much about avian influenza or SARS. At the time of those outbreaks we didn’t know whether or not they would spread more widely and kill large numbers of the general population or whether they would fizzle out. There is a difference between the judgements that we make at the time (in the face of uncertainty) and the judgements that we make in retrospect (when we know all the facts). This maps on to a distinction that philosophers have made between an ‘evidence-relative’ sense of “ought” and a ‘fact-relative’ sense of “ought”.

The government ought (in an evidence relative sense) to respond to the risk of a global pandemic on the basis of the best available evidence about the possible behaviour of this virus and the consequences if different measures are taken. Even if this turns out to be a mild and forgettable outbreak of illness (and lets hope that it does) it would still have been right for the government to take it seriously.

Sooner or later there will be a real wolf in the field.

Mad journalism disease – more contagious than swine flu? Guardian 30/5/09

Swine flu and hype – a media illness Ben Goldacre Guardian 29/5/09

Swine flu? A panic stoked in order to posture and spend Guardian 29/5/09

Swine flu pandemic alert raised to level five Guardian 30/5/09

The real victims of swine flu Guardian 30/5/09

Swine flu: Fingers crossed for a forgettable epidemic Angela McLean Daily Telegraph 1/5/09

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