Pandemic Ethics

The party line and the flu-line

It has emerged over the weekend that the UK government ignored the advice of a key panel of scientific advisors in the formulation of its pandemic response. The panel advised against the mass prescription of antivirals (Tamiflu) because of the fear that this would accelerate resistance of the virus (see also this previous post in the pandemic ethics series). An expert in influenza, Hugh Pennington, has even called for the national flu hotline to be shut down. It appears that the government may have been influenced in its pandemic response by political sensitivities.

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Pandemic ethics: Mild flu and Tamiflu – the patient’s dilemma

In recent days there have been reports of a jump in the number of cases of H1N1 influenza (swine flu) in the UK. There have been 29 deaths associated with pandemic influenza in the UK, and there are 652 people in hospital in England with the flu. Faced with the prospect of primary health care services becoming overwhelmed, the government has set up a telephone hotline to allow those affected by the flu to access antiviral drugs (for example oseltamivir or Tamiflu) without needing to see a doctor. But there are also suggestions that not all patients with flu-like symptoms should be treated. Patients with mild or vague symptoms of the flu, without other medical conditions that put them at particular risk, may not be given medication.

This sets up a problem for patients who develop mild flu-like symptoms. Although there is only a small chance of them becoming seriously ill or dying from the flu it is possible that early treatment with anti-virals would reduce that risk. (Antivirals were only effective in trials if given in the first 48 hours of illness) Should they demand treatment from their doctor in the hope of avoiding a serious complication of influenza? Should they exaggerate their symptoms? If the doctor refuses, should the patient self-treat with medications that they have obtained privately (for example over the internet)? There is a form of the classic prisoner’s dilemma involved in such questions.

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Pandemic Vaccination: Who to Vaccinate?

Fears of the spread of pandemic influenza in the UK continue to grow. Three apparently previously healthy patients have died here. There are now plans for widespread immunisation later in the year – though initially this is likely to be restricted to those at highest risk, and those in 'vital' professions.

Who should be vaccinated? This is a question of distributive justice.

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Pandemic ethics: Party to the flu (or vigilante vaccination)

A public health expert has warned yesterday against the idea of swine-flu parties, arguing that it may undermine the fight against the emerging pandemic. But others, including James Delingpole in the Telegraph have embraced the idea, hoping that mild influenza now will protect against more serious illness later. Exposure parties might be thought of as a form of vigilante vaccination against influenza.

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Pandemic ethics: all pigs are equal

In the last few days the influenza pandemic has led to over 800 deaths, with another 240,000 expected in coming months. There has been rioting over the government response to the pandemic leading to 8 protesters and 7 police being injured.

Hang on. Are we talking about the same pandemic?

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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?

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