PLANNING FOR AN INFLUENZA PANDEMIC: SOCIAL JUSTICE AND DISADVANTAGED GROUPS

Poor women and children whose chickens are their only source of independent income and small-scale farmers who are struggling to overcome severe poverty and achieve stable livelihoods are particularly vulnerable.4 The potential for a pandemic to exacerbate existing social and economic inequalities underscores the importance of considering a pandemic not only as a pressing public health issue, but also as an urgent matter of social justice. Social Justice and Pandemic Influenza Social justice is concerned with how features of the social structure result in systematic inequalities and disadvantages in well-being.5 In the context of planning for and responding to a pandemic, social justice demands that attention be given to groups characterized by severe poverty or by features that contribute to subordinate social status and power, such as gender, race, ethnicity, and religion.6 Although the World Health Organization holds that pandemic influenza plans should include consideration of "ethical issues," its Checklist for Influenza Pandemic Preparedness Planning does not specifically address the needs of socially and economically disadvantaged groups.7 Similarly, although a number of articles and reports have addressed important ethical considerations raised by the threat of a pandemic8-including four working papers prepared as part of the WHO's initiative on ethical issues in influenza pandemic planning9-only one published paper explicitly frames a pandemic as an important social justice issue.10 To address this gap, an international panel of experts in public health, animal health, virology, medicine, public policy, economics, bioethics, law, and human rights met in Bellagio, Italy, in July 2006.11 The panel, which came to be called "the Bellagio Group," was comprised of twenty-four individuals from eleven countries and convened by two of the authors with support from the Rockefeller Foundation.