Ethics and health

Addressing ethical issues in pandemic influenza planning

Examining the wide range of issues raised by a potential influenza pandemic

Cover of publication

The Ethics team of the Department of Ethics, Equity, Trade and Human Rights (ETH) has been working on a project to study the wide range of challenging ethical issues raised by a potential influenza pandemic. WHO aims to provide Member States with comprehensive, practical guidance on how to incorporate ethical (and related human rights and legal) considerations into their plans and preparation for, and response to, pandemic influenza.


A technical meeting was held on 18-19 May 2006 in Geneva to examine the major issues and an international consultation was held on 24-25 October 2006. The conclusions and recommendations of these meetings were used to develop a WHO guidance document entitled

Ethical considerations in developing a public health response to pandemic influenza: Contents

  • Introduction
  • General ethical considerations
  • Priority setting and equitable access to therapeutic and prophylactic measures
  • Isolation, quarantine, border control and social-distancing measures
  • The role and obligations of health-care workers during an outbreak of pandemic influenza
  • Developing a multilateral response to an outbreak of pandemic
  • References
  • Additional bibliography and links

Working in collaboration with the Department of Epidemic and Pandemic Alert and Response (EPR), four working groups were established consisting of a principal consultant (chair) and a multidisciplinary group of 5–10 experts who examined four key areas for which ethical guidance is most critical. Four papers were produced which served as a background for the global consultation. They were published in 2008 in order to complement the WHO guidance document "Ethical considerations in developing a public health response to pandemic influenza”, by providing a more comprehensive analysis of the ethical and policy issues which WHO considered in its deliberations.

Discussion Papers: Addressing ethical issues in pandemic influenza planning

  • Working group 1: Equitable access to therapeutic and prophylactic measures
  • Working group 2: Ethics of public health measures in response to pandemic influenza
  • Working group 3:The role and obligations of health-care workers during an outbreak of pandemic influenza
  • Working group 4: Issues that arise between governments when developing a multilateral response to a potential outbreak of pandemic influenza

Technical Consultation on “Research Ethics in International Epidemic Response”, Geneva, 10-11 June 2009.

In response to the request for additional guidance, WHO's Global Influenza Programme and the Ethics and Health team jointly convened a technical consultation on “Research Ethics in International Epidemic Response.” This meeting brought together experts of international organizations, government agencies and ministries, professional medical associations, academic and research institutions, as well as staff of various WHO departments and Regional Offices, to

  • identify and elucidate the ethical issues related to public health research and related activities during infectious disease outbreaks,
  • provide WHO with urgently-needed guidance in this area, with specific focus on the question of whether and how prospective ethical review should take place for these activities, and
  • provide practical guidance to public health practitioners and researchers in the field.

The discussion occurred in the context of the current influenza A(H1N1) event (which was declared a “pandemic” on 11 June 2009, the second day of the meeting), but it was noted during the meeting that the suggestions and approaches developed by the group could be extended to other infectious disease emergencies as well.

Related documents and initiatives

Ethical and legal considerations in mitigating pandemic disease: workshop summary

Board on Global Health – Institute of Medicine - US National Academies Press, 2007

In order to focus on the profound ethical and legal issues inherent in various pandemic disease mitigation approaches that are being proposed domestically and internationally, the Institute of Medicine’s Forum on Microbial Threats convened a public workshop and released the workshop summary entitled Ethical and Legal Considerations in Mitigating Pandemic Disease.

The workshop explored lessons learned from past pandemics, identified barriers to equitable and effective responses to future pandemics, and examined opportunities to overcome these obstacles through research, policy, legislation, communication, and community engagement.

Eleventh Futures Forum on Ethical Governance of Pandemic Preparedness

The Eleventh Futures Forum reviewed some countries’ experience in applying ethical governance approaches to a major contemporary policy concern for WHO and its Member States: preparedness for an influenza pandemic. The topic provided a concrete policy-making example that participants could use to discuss broader and more generic ethical governance approaches in European health systems. This report describes the ethical considerations used in pandemic influenza planning in the WHO European Region, WHO’s work on incorporating ethical considerations in the development of such plans, some possible guiding principles for ethical decision-making, the ethical frameworks for pandemic influenza planning in three countries (Norway, Switzerland and the United Kingdom), national decision-making structures for planning and response (with a case study from Belgium), the issue of public participation in ethical questions in pandemic influenza preparedness, and the Forum’s conclusions.