In a press release on June 11, 2009, Dr. Margaret Chan, Director-General of the World Health Organization (WHO), announced the H1N1 influenza pandemic had been raised to a Phase 6 alert, the highest possible WHO classification (see Appendix A for WHO Alert phase descriptions). The WHO press release signaled the official start of the 2009 Influenza Pandemic (WHO, 2009) and public health officials, governments, emergency management planners and ordinary citizens may have feared that the world was facing a possible catastrophic event.
It was not until September 10, 2010 that the WHO declared the H1N1 influenza pandemic downgraded to the post-pandemic alert phase (WHO, 2010a). However, just because WHO declared the flu pandemic of 2009 – 2010 over does not mean H1N1 (commonly known as Swine flu) was eradicated – the virus is still present. Estimates at the end of the flu season in the spring and summer of 2010 put the range of the number of H1N1 deaths worldwide between 12,240 (CDC, 2010) and 18,097 (WHO, 2010b).
Although under 20,000 deaths due to H1N1 influenza in just one flu season is not insignificant, nor is the estimate of 26,000 deaths per year from “seasonal flu” (CDC, 2011), those numbers are not the millions of dead typically associated with an influenza pandemic and they do not represent the numbers used when planning for and discussing the next pandemic. Those numbers also do not represent all the consequences of the 2009 Influenza Pandemic either; millions of people were diagnosed, treated for and survived H1N1, as will no doubt be the case during the next flu pandemic. The range given by the Centers of Disease Control and Prevention for the total number of cases in the United States from April 2009 – March 2010, was between 43 – 88 million (CDC, 2010). Additionally, when considering Pandemic Flu preparations, consideration must also encompass all the caregivers to the sick, both family and professional, and that raises questions about the equity of treatment for all affected directly and indirectly.
When discussing preparedness measures for pandemic flu and for other disasters, both natural and willful, a topic that needs further investigation and inclusion in the discussion must be the rights of individuals during times of extreme distress. Decisions on public policy should be based on ethical treatment of the sick as well as on protecting the healthy. The needs of each group may conflict and the potential dilemmas faced by medical staff, emergency management staff, public officials, and first responders, among others, may demand actions such as medical triage, resource allocation, prioritization guidelines for vaccination and anti-viral medications, quarantines and isolation measures (Levin et al, 2007, Tabery & Mackett, 2008). Tough decisions will have to be made concerning who gets medical help and why, when the capacity of resources cannot meet the surge created by those in need.
Another consequence with ethical...