Efforts to prevent, pandemic must address

(CP) - Efforts to prevent a flu pandemic from occurring and planning for one should prevention fail must pay particular attention to the needs of the disadvantaged and the poor, a group of international experts said in a statement released Friday.

The Bellagio group, as they call themselves, noted small farmers in Asian countries are currently paying the highest price for efforts to stamp out H5N1 avian flu in poultry. And they said the toll on people at the bottom of the socioeconomic ladder will be highest should culling of infected poultry fail to stop a pandemic from igniting.

"Within countries rich and poor, the burden will be felt most by the poorest in those settings," Ruth Faden, executive director of the Berman Bioethics Institute at Johns Hopkins School of Public Health, explained in an interview.

Faden and some colleagues from Johns Hopkins organized a week-long meeting held in June, which drew ethicists, public policy specialists, influenza experts and officials of the United Nations, the World Bank and World Health Organization.

The meeting was funded by the Rockefeller Foundation and was held at the foundation's conference centre in Bellagio, on Italy's Lake Como.

The aim was to brainstorm on whether there are ways to mitigate the impact a flu pandemic would have on society's weakest members.

"The premise going in was . . . a shared set of assumptions that are pretty safe bets, that no matter how this falls out, the burdens - economic and social as well as in terms of burdens of disease and death and disability - will not fall equally across everybody on the globe," Faden said.

"These burdens are going to fall hardest on the people on the bottom."

She said the group understood it could not find fixes for inequities steeped in poverty, racism or sexism. But it felt it might be able to help put the special needs of disadvantaged groups on the pandemic planning radar.

The participants drew up a set of principles for policy makers working in this field. They also devised a series of checklists designed to focus thinking on the where the burden falls when, for instance, decisions are being made to cull backyard flocks or impose movement restrictions on people to try to contain an emerging virus.

Dr. David Nabarro, the UN's system co-ordinator for avian and human influenza, was among the participants. The work, he said, won't level the playing field but could serve as a tool "partly to focus the mind and partly to jog the memory, really.

"There's no magic solution here," Nabarro said from New York. "But I think to have something like this at hand is always useful for individuals and groups who are having to make quite tricky decisions, sometimes in a big hurry."

Another checklist attempts to remind pandemic planners in developed countries that policies will have a different impact on different sectors of society.

Well-to-do and middle-class families would likely be able to manage if schools are closed to slow spread of a pandemic virus. But single working parents could have to choose between work and caring for their children, and kids from low income families who rely on school meals could go hungry.

Likewise, telling people to stockpile food is only a useful recommendation for those who can afford to buy additional foodstuffs - and have a place to store them.

"A general recommendation for people to do X, Y and Z only makes sense if people have the resources to do those things," Faden said.