Disadvantaged Groups in Pandemic Influenza Planning: An Analysis of National Plans

Background: Evidence from previous disasters suggests that socially and economically disadvantaged groups suffer the greatest burdens both within and across countries. The potential for an influenza pandemic to create new or exacerbate existing social inequalities suggests the need to consider a pandemic not only as an urgent public health matter, but also as an urgent ethical and social justice issue. Aims/Methods: Thirty-seven national influenza pandemic plans were reviewed by three researchers to assess how countries addressed the needs and encouraged the participation of disadvantaged groups, in accordance with the recommendations of an international group of experts convened in July 2006. A data extraction instrument was developed to guide textual analysis and keyword searching. Results: Only three plans (8%) noted particular difficulties likely to be encountered by poor persons, and less than one-third of plans (all from high-income countries) made mention of socially disadvantaged groups such as ethnic minorities. Three (8%) plans specifically discussed policies to engage socially or economically disadvantaged groups in the planning process. Plans rarely addressed barriers such as assess to information that disadvantaged groups might face in the implementation of public health interventions. In general, the concept of “vulnerability” present in 20 plans (54%) suggested biological susceptibility to disease rather than to social or economic disadvantage. Conclusions: As plans are further developed, planners should take specific steps to ensure that disadvantaged groups receive appropriate consideration and should incorporate principles of social justice in planning. Furthermore, larger questions of global justice that arise between countries require further discussion and research, as they are likely to prove the most pressing if we hope to avert the most serious injustices that could result from a pandemic.