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Rethinking Who Should Be Considered 'Essential' During a Pandemic Flu Outbreak

October 03, 2008

Not only are doctors, nurses, and firefighters essential during a severe pandemic influenza outbreak. So, too, are truck drivers, communications personnel, and utility workers. That's the conclusion of a Johns Hopkins University article to be published in the journal of Biosecurity and Bioterrorism. The report, led by Nancy Kass, Sc.D, Deputy Director of Public Health for the Johns Hopkins Berman Institute of Bioethics, provides ethical guidance for pandemic planning that ensures a skeletal infrastructure remain intact at all times. Dr. Kass says, "when preparing for a severe pandemic flu it is crucial for leaders to recognize that if the public has limited or no access to food, water, sewage systems, fuel and communications, the secondary consequences may cause greater sickness death and social breakdown than the virus itself."

The authors represent a wide-range of expertise in several areas of pandemic emergency planning both at the state and federal levels. After examining several accepted public health rationing strategies that give priority to all healthcare workers and those most susceptible to illness, the authors propose a new strategy that gives priority to a more diverse group. "Alongside healthcare workers and first responders, priority should be given to the people who provide the public with basic essentials for good health and well-being, ranging from grocery store employees and communications personnel to truck drivers and utility workers," says Dr. Kass.

The report recognizes that given the widespread and sustained nature of a pandemic, federal assistance will be spread thin and local jurisdictions must develop their own preparedness plans to ensure they are capable of sustained self-sufficiency. Encouraging and working with local businesses to develop their own response plans can help reduce the burden on local governments during a pandemic. Similarly, individuals and families who can afford it should do their best to prepare for any disaster. The paper notes, the more initiative the general public exercises in stockpiling several weeks' worth of food, water, paper goods, batteries medicines, and other needed supplies, the less vulnerable they will be to a break in the supply chain. In fact, the report emphasizes, it is important for leaders to communicate to the middle class and the wealthy that it is their responsibility to prepare for self-sufficiency in order to free up scarce supplies and allow first responders to direct their attention towards those too poor or vulnerable to prepare themselves.

The article lays out a set of ethics rules and principles to help guide and frame a pandemic response strategy that is evidence-based, transparent, fair, and recognizes the burdens the public may face. Dr. Kass points out the "consideration of ethics are critical not only in having respectful and inclusive discussion and engaging with the public fairly, but it also improves the likelihood of public health and medical success through increased cooperation and understanding of government plans."
Other authors of this paper include: Jean Otto, DrPH, Senior Epidemiologist, Department of Defense, Global Emerging Infections Surveillance and Response System, Armed Forces Health Surveillance Center, Walter Reed Army Institute of Research; Daniel O'Brien, JD, Principal Counsel, Office of the Maryland Attorney General, Department of Health and Mental Hygiene; and Mathew Minson, MD, Senior Medical Officer for Strategic Initiatives, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services.

Johns Hopkins Berman Institute of Bioethics