preventing the inevitable effects of avian flu

 on the disadvantaged

Lexie McPhee

Socially and economically disadvantaged individuals and groups are inevitably the worst affected by epidemics as they are often left unprepared. In the case of the avian influenza, or “bird flu,” some may become even more disproportionately underprivileged, the main basis for increasing disadvantage being that many poor or low-income families tend to be more reliant on poultry as a source of income, and highly pathogenic avian influenza in domestic poultry is the primary source of avian flu. In turn, the flu would affect not only the families of the “backyard growers” but also market-oriented producers, contract growers, and more who are involved with domestic poultry and may become excessively lacking as a result of a bird flu epidemic.
            As of right now, our best defense against such an epidemic of avian influenza is prevention and preparation. Important measures to take are regular flu shots, staying on top of personal hygiene, hand washing and using anti-bacterial hand soap, and many other such preventative actions. Preparations include keeping a supply of non-perishable food and bottled water as well as other items in the home,

for ready use if an epidemic hits and people must remain in isolation and/or the stores at which people buy necessities must close. However, most low-income families will not be able to afford the medicines and vaccines that may become available to combat the avian flu, let alone afford to take personal preventative measures such as keeping pricey anti-bacterial soaps handy. Needless to say, homeless and severely poverty-stricken families and individuals will not be able to stockpile foods, medicines, water, money, and other things that will be necessary to have in the case of an epidemic.

Members of ethnic minorities are also at a disadvantage, as they may not have all of the information they need regarding preparedness in a language that they can understand, thus it is necessary to reduce disparities in preparedness among racial and ethnic minorities by examining barriers in underserved communities. There is a low level of awareness about such health threats as avian influenza among ethnic minorities and other vulnerable groups that commonly fall through the cracks of government-led awareness programs, and thus these disadvantaged groups have little voice in implementing, influencing or understanding policy responses to such health emergencies. Thus, even moderate pandemics can inflict a huge burden on the disadvantaged and unprepared, and policy responses may neglect the special needs and rights of the disadvantaged.
             Concern for the interests of the disadvantaged in the situation of the avian flu is important for functional as well as principled reasons. According to the Bellagio group, an international group of experts in public health, animal health, virology, medicine, public policy, economics, bioethics, law and human rights, “health efforts are more likely to succeed in an atmosphere of social solidarity and public trust, including the trust of disadvantaged people. Avian and human pandemic influenza planning and response should therefore not only be based on sound science

 and public health principles, but should also respect and give particular attention to the needs and rights of the disadvantaged, and include processes through which their preferences and interests can be articulated and incorporated.” With support from the Rockefeller Foundation, the Bellagio Meeting on Social Justice and Influenza took place in Bellagio, Italy in July 2006, and considered the threat of avian influenza with a particular focus on the needs and interests of the world’s disadvantaged. The major conclusions of the group’s deliberations are set out in The Bellagio Statement of Principles, which “aim to help governments and intergovernmental and nongovernmental organizations take account of the interests of the disadvantaged in avian and pandemic influenza planning and response. These principles do not exhaust all relevant technical and moral considerations but focus rather on those with the most salience for the needs and rights of disadvantaged peoples.” The Bellagio Statement of Principles is as follows:

I.              All people should have ready access to accurate, up-to-date and easily understood information about avian and human pandemic influenza, public policy responses, and appropriate local and individual actions. Communications should be tailored to overcome obstacles that disadvantaged groups face in accessing such information.
II.           Veterinary and public health strategies should foster wide engagement in planning for and responding to the avian and pandemic influenza threat.  Civil society, religious groups and the private sector should be involved in helping to overcome barriers to effective engagement by disadvantaged groups.
III.         Planning and response should facilitate public involvement in surveillance and reporting of possible cases without fear of discrimination, reprisal or uncompensated loss of livelihood. Recognizing their vulnerability, special efforts are needed to foster reporting by disadvantaged groups, as well as to protect them from negative impacts which could worsen their situation.
IV.        The impact and effectiveness of interventions and policies need to be evaluated and monitored, especially with respect to prospects for providing fair benefits to, and avoiding undue burdens on, disadvantaged groups, so that corrective adjustments can be made in a timely manner.
V.           Developing as well as developed countries should have access to the best available scientific and socio-economic data and analyses to inform avian and pandemic influenza planning and response, including information on the particular burdens and secondary harms that a pandemic and pandemic responses may inflict on disadvantaged groups.
VI.        National and international efforts are needed to promote equitable access to vaccines, antivirals and other appropriate public health and social interventions, both between and within countries, so as to provide fair and non-discriminatory treatment for traditionally disadvantaged groups as well as those who are specially disadvantaged in the context of avian and human influenza.
 
            Thus, it is clear to see that in order to really help the disadvantaged out of major difficulty in the case of an avian flu epidemic, individuals must understand and warn about the problems these groups may endure, and those with more authority must act on these warnings. It is important for governments and relevant institutions to identify those groups that are traditionally disadvantaged (poverty-stricken or low income families and individuals, ethnic minorities, etc.) and those who are likely to become disproportionately disadvantaged by the avian flu (poultry farmers, contract growers, etc.). They must then identify and address the special needs of these disadvantaged groups, and specifically involve them in preparations for/responses to an influenza pandemic.

Information gathered from and available at the website for
The Bellagio Meeting on Social Justice and Influenza
http://www.hopkinsmedicine.org/bioethics/bellagio

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