Policy Forum Allocating Scarce Resources in a Pandemic: Ethical and Public Policy Dimensions

With avian flu popping up around the globe, federal, state, and local governments along with hospitals are now fully engaged in pandemic preparedness planning. Undoubtedly, considerations of the history of the 1918 Spanish flu gives these efforts a sense of urgency. A 1918-like pandemic, under a worst-case scenario, would hit large regions of the country at the same time, thus forcing local communities to rely on their own resources; the duration of active infections would be weeks or even months. However, Hurricane Katrina, deeply embedded in the American consciousness, must also inform our preparedness planning. We remember the spectacular failure of federal, state, and local governments despite years of anticipating the disaster. And we remember the disturbing images of the poorest and most vulnerable populations being left behind. Katrina raised fundamental issues of social justice. It is clear that no amount of planning and preparation can undo the cumulative political, economic, and social inequalities faced by a population as reflected in inequitable access to health care services and disparities in health status. In a pandemic, society would again be allocating scarce, life-saving resources. Quite simply, the health care systems would be overwhelmed