Pandemic Influenza Planning: An Extraordinary Ethical Dilemma for Local Government Officials

• Date: 01 September 2009
• Published date: 01 September 2009
• DOI: http://doi.org/10.1111/j.1540-6210.2009.02032.x

Pandemic Inf‌l uenza Planning 823

P. Edward French

Mississippi State University

Eric S. Raymond

University of Georgia

Eric S. Raymond is a doctoral student

in the Department of Political Science at the

University of Georgia. His research interests

include American politics and institutions,

local government, urban policies, homeland

security, and emergency management.

E-mail: eraymond@uga.edu

 e possibility of an inf‌l uenza pandemic occurring

within the next two decades is very real; the role of

local governments in comprehensive preparation for

this global threat is crucial.  e federal government has

provided broad guidelines for state and local of‌f‌i cials who

are ultimately responsible for emergency response and

lifesaving services, vaccination and antiviral use, and the

provision of other critical support. Much of this inf‌l uenza

pandemic preparedness has occurred under conditions

of uncertainty, and these government actions may have

unprecedented legal and ethical implications.  is study

evaluates the pandemic inf‌l uenza policies of eight large

U.S. cities to determine how Department of Health and

Human Services recommendations with ethical and

legal implications have been addressed.  e authors f‌i nd

that several important aspects of these guidelines are

vague in many plans, and input from key stakeholders is

inadequate.

The 1918 inf‌l uenza pandemic killed more than

50 million people worldwide, with an estimat-

ed 675,000 deaths in the United States alone

during the outbreak (DHHS 2007). A pandemic of

this proportion occurring today would extrapolate

to 1.9 million deaths in the United States and 180

million to 369 million deaths globally if public health

interventions are not instigated (Osterholm 2005).

 e impact on cities, states, the nation, and the global

community would be devastating. Experts note that

there have been between 10 and 13 inf‌l uenza pan-

demics in the world since the early 1700s, and they

estimate that a pandemic will occur every 30 to 50

years (Knapp 2006).  e last one occurred in 1968.

Based on this information, the probability of another

pandemic within the next quarter century is very real.

 e likelihood of its arrival means that emergency

plans coordinating federal, state, and local responses

must be in place.  e role of local governments in the

planning and implementation processes is paramount.

Planning for this health threat, however, can present

numerous obstacles. Whether a pandemic will be

caused by avian inf‌l uenza or another virus is dif‌f‌i cult

to predict. While the federal government has stock-

piled vaccine against the H5N1 strain, which is the

most likely viral source, this vaccine has been shown

to produce the desired level of antibody needed to

reduce the risk of contracting inf‌l uenza in only

45 percent of healthy adults in a clinical study

(Progress Report 2007). Also, pandemics occur in

waves and endure for at least 18 months. Government

of‌f‌i cials must be prepared to face the f‌i rst wave with-

out an ef‌f ective vaccine and with a limited amount of

antiviral medications. Experts note that the imple-

mentation of nonpharmaceutical interventions during

this time period is perhaps the most crucial element in

limiting the ef‌f ects and dissemination of a deadly virus

(Grinberg 2007). Such interventions may include

hospital infection control, decreased social mixing and

increased social distance, isolation and quarantine,

and international travel and border controls.

A myriad of ethical issues will arise with the next

inf‌l uenza pandemic. Some of the decisions regarding

these matters will be unprecedented. While banning

public outings, closing public schools, and ask-

ing employees to stay at home may be troublesome

measures for local public of‌f‌i cials to undertake, the

decisions regarding the allocation of limited resources

such as vaccines and antivirals, the imposition of

restrictive measures on the public such as isolation

and quarantines, and the level of risk that the public

workforce should be expected to face while assisting

individuals infected with the inf‌l uenza virus are much

more formidable (Scanlon 2004; Upshur et al. 2007).

While the federal government will provide only broad

guidelines for state and local government actors,

specif‌i c decisions regarding vaccination at the local

level, maintenance of emergency response and lifesav-

ing services, and provision of other critical needs may

have unprecedented legal and ethical implications.

Whether the next pandemic starts in the United

States or abroad, it will only be a matter of time

before local government of‌f‌i cials see their f‌i rst case.

Extensive pandemic inf‌l uenza preparedness is crucial,

and much of this preparedness has occurred under

P. Edward French is an assistant

professor in the Department of Political

Science and Public Administration

at Mississippi State University. He is

the coauthor of three books and has

published in numerous academic journals.

His teaching and research interests

encompass local government administra-

tion, including human resource issues,

risk management, and selected topics in

public management and policy.

E-mail: efrench@ps.msstate.edu

Pandemic Inf‌l uenza Planning: An Extraordinary Ethical

Dilemma for Local Government Of‌f‌i cials

Tough Public

Policy Choices

Confronting

America