Public engagement on pandemic ethics in Minnesota: A focus on vulnerable populations

Groups suffering health disparities are likely to suffer disproportionately during a severe influenza pandemic. Heightened vulnerability may stem from poor underlying health, poor access to health care, inability to stockpile, and increased exposure due to crowded living conditions. In 2009 we conducted extensive public engagements to identify the overarching ethical objectives that should guide the state's health department in rationing scarce resources during a severe pandemic, including perspectives about protecting public health, preserving critical infrastructures and being fair. We led large community forums and small group engagements. Participants were diverse with respect to race, ethnicity, gender, age, employment, disability/ability, geography and income. This presentation will report findings concerning vulnerable groups, highlighting engagements conducted in vulnerable communities. It will also illustrate how public engagement findings influenced 2009 H1N1 response in Minnesota. Participants were asked specifically to identify and reflect on access barriers to rationed resources. The definition of “critical infrastructures” was fraught with tension. Participants identified systems vulnerable populations depend on that could be imperiled, and, they fear, likely to be forgotten during pandemic planning; yet they were concerned about defining infrastructures so broadly that resources would not be left for vulnerable groups and the general population. Some participants expressed fear of stigmatization if vulnerable groups were prioritized; others thought that those traditionally at the back of the health care line should have first access in a pandemic. Participants generally agreed that while rationing during a crisis cannot redress existing disparities, above all rationing should not exacerbate disparities.