Ethics Conference on Asian Flu Pandemic

Ethical considerations among Response to H1N1 Pandemic in

China

China CDC, CFETPHuilai Ma, Guang Zeng

Ethics Conference on Asian Flu Pandemic

General Ethical Considerations during response to pandemic

H1N1

• Balancing potentially conflicting individual and community interests

• Evidence base for public health measures

• Resource constraints

– Limited resources and immediate health-care needs

Ethics Conference on Asian Flu Pandemic

Factors affecting Public health policy during pandemic H1N1 in

China

• A new influenza virus emerges:– Four different genes

• Estimated case fatality ratio (CFR)– 0.4% (range 0.3% to 1.5%)– Clinical severity

• WHO raised Level of influenza pandemic alert at phase 6 on June 11, 2009

Ethics Conference on Asian Flu Pandemic

Fundamental Realities of China

• > 1.3 billion population– >700 million rural population

• High and variable population density

• About 140 million migrant population

Ethics Conference on Asian Flu Pandemic

Significant Rural-Urban Differences in Medical Resources in China

Hospital beds/1000 population, 2008

0

1

2

3

4

5

City County Township

0

1

2

3

4

5

6

City County Township

Health professionals/1000 population, 2008

Ethics Conference on Asian Flu Pandemic

Amend statute on management of the pandemic H1N1 in due time

Category B notifiable DiseaseAdopt Category A Diseases

StageⅠ: April 30

Managed as a Quarantinable Disease”

Ethics Conference on Asian Flu Pandemic

Confirmed pandemic (H1N1) influenza cases: China (as of June 11, 2010)

June 11Community transmission occurred

May 29First documented transmission

May 111st imported case documentedN

um

ber

of

Case

s

May June 2009

• Quarantine and Isolation• Free treatment • Strategy for prevention school outbreak

Ethics Conference on Asian Flu Pandemic

Management of Close Contacts

If fever or If fever or respiratory respiratory symptomssymptoms

• Transfer to designated medical service institution• Advise to stay home for isolation and treatment• Start specimen collection and testing immediately• Conduct medical observation for all close contacts

Close Close ContactsContacts

Reporting & Investigation

Medical ServiceMedical Service

Medical check-up

CDCCDC

End medical observation for

all close contacts

If tested (-) for H1N1 influenza

Endmedical

observation

If close contacts showed no symptoms after 7 days of medical observation

Ethics Conference on Asian Flu Pandemic

CFETP finding: highlight the need to prevent transmission by droplets and fomites during a pandemic H1N1

Ethics Conference on Asian Flu Pandemic

Population at High Risk for Developing Severe H1N1 Infection

Ethics Conference on Asian Flu Pandemic

Amend statute on management of the pandemic H1N1 in due time

Category B notifiable DiseaseAdopt Category A Diseases

StageⅠ: April 30

Managed as a Quarantinable Disease

Category B notifiable DiseaseAdopt Category B Diseases

StageⅡ: July 10

Managed as a Surveillance Disease

Ethics Conference on Asian Flu Pandemic

Confirmed pandemic (H1N1) influenza cases: China (as of Feb.

21, 2010)

May June July Aug. Sep. Oct. Nov. Dec. Jan. Feb.

2009 2010

Num

ber

of

Case

s (×

1000

)

June 11Community transmission occurred

14

10

6

2

Sept. 16Pandemic (H1N1) vaccination startedStrategy for reduce fatality rate

Ethics Conference on Asian Flu Pandemic

“Severe Patients First” Principle

• Specify treatment responsibilities for different levels of medical providers

• Arrange for patients in hospitalization based on patient condition and available resources

Severity Treatment

Mild patients Community healthcare institutions

High risk patients Designated hospitals

Severe/critical patients Designated tertiary hospitals with strong capability

Ethics Conference on Asian Flu Pandemic

Help people in need

• Enhanced cooperation among financial, human resource and social security departments

• Provided assistance to people with financial difficulties– Needs-based– Various forms of assistance– Improved contents of assistance

• Gave priority to treatment of hospitalized patients

Ethics Conference on Asian Flu Pandemic

Vaccination Strategy in China

• Make sure the vaccines were:– Well-informed of benefits as well as potential risks– Voluntary– Free of charge

• The following areas were vaccinated first– Areas with outbreaks– Areas with high population density and mobilization

• High priority group was selected by local government– Public service personnel at critical positions– Patients with chronic diseases– Pregnant women– Children aged 6-35 months– Others

Ethics Conference on Asian Flu Pandemic

Thank you!

Ethics Conference on Asian Flu Pandemic

Ethics Conference on Asian Flu Pandemic

Isolation and Quarantine

• Was the decision on isolation and quarantine ethical?

• Ethics problems include:– Should isolation and quarantine be

implemented? – How should isolation and quarantine be

carried out?

Ethics Conference on Asian Flu Pandemic

Treatment Prioritization

• If not all patients can receive medical treatment, which patients should be treated first?

• What is the criteria for hospitalization?• What is the criteria for receiving intensive

care?• How to provide medical services in

western region, where resources are less abundant?

Ethics Conference on Asian Flu Pandemic

Ethical issues to be incorporated into the current

draft plan

• Is airport temperature check necessary?

• Is quarantine of contacts necessary?• Containment at source country vs.

quarantine• Priority of fund use