Ethics of pandemic planning in India

Devnani et al discuss various ethical dimensions of the public health measures to be taken when planning for an influenza pandemic (1). In a developing country like India which is diverse, multicultural, over populated and undergoing rapid but unequal growth, ethical pandemic planning must address existing health inequalities.

In India, inequalities in health indicators can be seen according to gender, caste, religion, ethnicity, economic status, and location. To illustrate, children among scheduled castes and scheduled tribes below three years of age are twice as likely to be malnourished as are children of other groups (2). The same is true of access to healthcare. For instance, the rural/urban ratio of hospital beds is 1:15 and the rural/urban ratio of doctors is 1:6 (2). Improving the health of a population and reducing health inequalities will depend upon how effectively the social determinants of health are addressed.

Such disparities pose a greater threat during a pandemic outbreak when there will be increased pressure on scarce resources such as drugs and vaccines. Existing health inequalities are likely to be aggravated if those in power favour their own friends, families or ethnic groups (3, 4).

In India, authorities involved in pandemic planning must be required to ensure that healthcare institutions serving rural, low income, isolated and indigenous communities are well equipped to provide the necessary care, and that existing health inequalities are not exacerbated while putting the pandemic plan into action.