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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.

Sunny Borgohain, M Sc student, Jamsetji Tata Centre for Disaster Management, Tata Institute of Social Sciences, VN Purav Marg, Deonar, Mumbai 400 088 INDIA e-mail: [email protected]


  1. Devnani M, Gupta AK, Devnani B. Planning and response to influenza A (H1N1) pandemic: ethics, equity and justice. Indian J Med Ethics. 2011 Oct-Dec; 8(4): 237-40.
  2. Deogaonkar, M. Socio-economic inequality and its effect on healthcare delivery in India: inequality and healthcare. Electronic Journal of Sociology. 2004.
  3. Kumar S, Quinn SC. Existing health inequalities in India: informing preparedness planning for an influenza pandemic. Health Policy Plan. 2012 Sep:27(6):516-26.
  4. World Health Organization. Addressing ethical issues in pandemic influenza planning. Discussion Papers[Internet]. Geneva: WHO; 2008[cited 2012 Sep 19]. Available from:
About the Authors

Sunny Borgohain ([email protected])

M Sc student

Jamsetji Tata Centre for Disaster Management, Tata Institute of Social Sciences, VN Purav Marg, Deonar, Mumbai 400 088




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