Table 1 Ethics sensitivity parameters

Decision making process:

Preparedness decision-making is deliberative and all-inclusive, with public consultations. Decisions are publicly defensible, which means that decisions are open to scrutiny and the basis upon which decisions are made are publicly accessible to affected stakeholders.

[18,32]

Justification for delineated actions:

All planned actions/activities are adequately explained and justified

[17,23]

Composition of national pandemic planning committee:

Committee formation process is deliberative and composition is all-inclusive with members from national, regional, and district levels; membership include technical and lay person

[23,32]

Communication to at risk population/Information symmetry:

Efforts are outlined in the plan to keep the public continuously informed on all aspects of the planned interventions. Differential messages for various audiences are developed and are culturally and scientifically appropriate, pandemic phase alerts are incorporated into the communication machinery.

[17,23,43]

Prioritization, and allocation of scarce resources:

Triage systems for priority setting in providing critical care, or for allocation of scarce resources (vaccines, intensive care units, hospital beds, human resource allocation, and staffing) during a pandemic are clearly outlined. Plan establishes priority groups nuanced by local contexts

[17,32,43-45]

Healthcare worker duty to care adequately explained:

Plan addresses healthcare worker duty to provide care in pandemic circumstances. That is the issue of special obligations of health care professionals during an outbreak. Are the rights and responsibilities of health care professionals especially in the context of pandemic flu preparedness clarified?

[17,32,43,46]

Limitations of proposed interventions:

Plan frankly acknowledges limitations of various proposed actions or interventions (both pharmaceutical and non-pharmaceutical)

[42]

Leadership and coordination

Plan indicates which agencies will lead various components/actions of the plan

[23,32]

Facilities designation

Facilities where patients would be treated are clearly identifies or designated

[23]

Stockpiling of antiviral, vaccines and personal protective equipment:

Provisions are made for national stockpiling of antivirals, vaccines, and personnel protective equipment; and such provisions are sensitive to locale-specific competing demands

[17,23,43]

Ethics training for healthcare workers

Plan adequately outlines pandemic-specific ethics training for various categories of people working in healthcare setting

[23]

Timelines for planned activities:

Timelines are explicitly defined for all activities outlined in the plan

[23]

Border issues, travel advisories, and trade policies

Plan explicitly and adequately addresses cooperation with neighboring countries.

[23,32,43]

Co-operation with the WHO other development partners, and sister countries

Plan acknowledges the essence of cooperating with these institutions

[23,32]

Ethics consideration in clinical protocols:

Plan-specific operational guidelines/protocols are developed and are ethics-sensitive

[23]

Use of vaccines and antivirals:

Guidelines are issued on how antiviral, vaccines, personal protective equipment should be used during an outbreak (different from allocations). Logistical infrastructure for rapid distribution of stockpiled antivirals, vaccines, and personal protective equipment are in place.

[23,32,43]

Plan review mechanism:

Plan explicitly states a mechanism for continuous review and updates

[23]

Continuity of essential services:

There is evidence of planning to ensure continuity of essential services including non-health sector essential services such as ensuring business continuity, capacity for corpse disposal etc.

[43]

Considerations of equity, social justice, vulnerable groups:

Plan addresses special needs of vulnerable and disadvantaged groups

[21]

Home care management of infected patients:

Plan recommends home care management of infected patients, and provides guidelines

[23]

Social solidarity considerations:

Plans on how to manage complex social spaces are described, importance of social “solidarity” during a pandemic is acknowledged and communicated

[18,43]

Solidarity requires: good, open and honest communication, open collaboration, in a spirit of common purpose, within and between health care institutions, sharing public health information, coordinating health care delivery, transfer of patients, and deployment of human and material resources

Plan adaptability/flexibility:

Outlined actions are flexible and encourage evidence-informed modification as required. That is opportunities to revisit and revise decisions as new information emerges throughout the crisis as well as mechanisms to address disputes and complaints are there.

[18,43]

Preventive ethics consideration

Preparedness actions ably balances emergency ethics and preventive ethics

[46]

Budgeting considerations:

Plan has a budget and sources of funding are indicated

[23]

Outbreak simulations:

Outbreak simulations are incorporated into preparedness activities

[23]

Back up essential personnel

The need for identification and recruitment of additional essential personnel during pandemic outbreak is acknowledged and planned for

[23]

Ethical framework for the plan:

There is a specific ethical framework developed to guide the plan’s implementation

[18,19,47]

Privacy considerations

Plans acknowledges individual rights to privacy, and provides justifications for privacy rights bridging

[23,32]

Proportionality of response:

Guidance exists in the plan to ensure responses to threat are proportional and measured. That is restrictions to individual liberty are carefully thought through and measures taken to protect the public from harm do not exceed what is necessary to address the actual level of risk to, or critical need of, the community.

[18,43]

Compensation programs

There are mechanisms in place to ensure that ethical decision-making is sustained throughout the crisis, and measures to cater for the social and economic cost of poultry destruction, market closure, e.t.c. are outlined.

[18,22,48]