The flu has an interesting history with respect to health care rationing in the United States. Consider that just about two years ago, the American public faced a shortage of influenza vaccine. Dire predictions were made about how many people might perish, and rationing protocols were created. However, many of the rationing protocols were ignored. Luckily, that flu season did not result in the horrible fatalities that were predicted. For these reasons, problems of health care rationing around issues of (...) the flu were postponed, rather than resolved.Over the last year, the public has focused its anxious attention on the possible avian influenza pandemic. Last week I noticed that at least once each day I heard mention in some discussion or another of the threat of this disease becoming easily transmissible from human to human. (shrink)

This paper is about an avian influenza outbreak in South Africa’s commercial ostrich industry. The outbreak was managed according to international best practice and led to the destruction of 30,000 ostriches in two of South Africa’s provinces. However, the industry has a long history of managing low pathogenic avian influenza outbreaks in a different way. We use the 2004 outbreak and earlier approaches to managing disease to shed light on recent debates on how we might live (...) differently with livestock diseases. The paper is based on in-depth interviews with farmers, veterinarians, scientists and agriculture officials. (shrink)

In recent time there has been ample discussion concerning censorship of research conducted in two labs involved in avian influenza virus research. Much of the debate has centered on the question whether the methods and results should reach to open disclosure given the “dual use” nature of this research which can be used for nefarious purposes.

Moates, Anne The prospect of a virulent human influenza pandemic causing large scale mortality and morbidity is a cause for global concern. The most likely candidate is the avian or 'bird' flu which is a strain of influenza virus named because it is found in birds. There are three groups of flu viruses, influenza A, B and C. Type A viruses are able to infect a wide variety of warm-blooded animals. B and C types are mostly (...) confined to humans. Avian influenza is caused by a Type A virus and typically affects birds' respiratory, digestive and nervous systems.[1]. (shrink)

A recent controversy over the US National Science Advisory Board for Biosecurity's recommendation to censor two publications on genetically modified H5N1 avian influenza has generated concern over the threat to scientific freedom such censorship presents. In this paper, I argue that in the case of these studies, appeals to scientific freedom are not sufficient to motivate a rejection of censorship. I then use this conclusion to draw broader concerns about the ethics of dual-use research.

The virulence of a virus is determined by its ability to adversely affect the host cell, host organism or population of host organisms. Influenza A viruses have been responsible for four pandemics of severe human respiratory disease this century. Avian species harbour a large reservoir of influenza virus strains, which can contribute genes to potential new pandemic human strains. The fundamental importance of understanding the role of each of these genes in determining virulence in birds and humans (...) was dramatically emphasised by the recent direct transmission of avian influenza A viruses to humans, causing fatal infection but not community spread. An understanding of the factors involved in transmission between avian and mammalian species should assist in the development of better surveillance strategies for early recognition of influenza A virus strains having human pandemic potential, and possibly in the design of anti‐viral strategies. BioEssays 25:657–671, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

For last couple of years, the subcontinent of India has witnessed a number of influenza epidemic outbreaks. History reveals influenza epidemic to be a constant but neglected companion of India. Considering the repeated occurrences of the event on Indian soil, including influenza A H1N1 after 2009-10 pandemic event, a check to the planning measures has been done at national level. A literature survey on the initiative measures, planning accomplishments etc. reveals that it is only after the emergence (...) of A H5N1, national health authorities have began planning efforts to mitigate and respond to influenza outbreaks. This paper outlines the evolution of Indian pandemic planning that can be traced in the research literature, summarize the accomplishments, and explain the importance of pandemic planning in India. Pandemic influenza, as it is commonly known, emerges, evolves, attacks, and sways a large part of world declaring public health emergency in a short span. Several outbreak events such as SARS, Avian influenza A H5N1, and H1N1 have demonstrated the need of international concern for public health emergency and had established the value of planning in advance. Preparedness planning in India is found to be at its nascent stage and it needs further improvement at multiple aspects to tackle the future public health crises, to rectify ethical failures. (shrink)

Scientists and policy‐makers have long understood that the products of research can often be used for good or evil. Nuclear fission research can be used to generate electricity or create a powerful bomb. Studies on the genetics of human populations can be used to understand relationships between different groups or to perpetuate racist ideologies. While the notion that scientific research often has beneficial and harmful uses has been discussed before, the threat of bioterrorism—a concern that has only grown since 2001—has (...) led to increased awareness about the need to prevent the misuse of biomedical research, particularly when it involves dangerous pathogens or toxins. In 2012, the concern was ratcheted up another notch by two papers reporting the results of research on genetically engineered strains of the H5N1 avian influenza virus. Although the H5N1 papers have potential scientific and social value, some scientists and policy‐makers opposed their publication because they feared that terrorists (or others with nefarious motives) could use the research to create a bioweapon that could trigger a global pandemic. The H5N1 papers raise difficult questions concerning the ethics of knowledge. Should scientific research with dangerous applications be published? Should some types of research be kept secret or not be conducted at all? What type of government oversight of dangerous research is appropriate? In this essay, I will develop a framework for thinking about the ethics of knowledge and apply it to the H5N1 controversy, focusing on issues related to publication. I will argue that redacted publication would have been a reasonable response to the dilemmas posed by the H5N1 papers if not for practical and legal problems with this option. Given these problems, full publication seems appropriate. (shrink)

The threat posed by avian influenza appears to be rising, yet global and national health programs are preparing only fitfully. A lethal form of avian flu has rooted itself deeply into the poultry flocks of poor Asian countries that will have a hard time eradicating it. Every so often a sick bird infects a human, who usually dies from the encounter, and on rare occasions the virus seems to have spread from one person to another before the (...) chain of infection dies out. All it would take to set off a raging global pandemic would be for the virus to mutate into a form that is readily transmissible among humans. Severe Acute Respiratory Syndrome garnered a great deal of public attention because it was novel and its potential for spread was unknown. However, the SARS corona virus is significantly less virulent than pandemic influenza viral infections. (shrink)

The threat posed by avian influenza appears to be rising, yet global and national health programs are preparing only fitfully. A lethal form of avian flu has rooted itself deeply into the poultry flocks of poor Asian countries that will have a hard time eradicating it. Every so often a sick bird infects a human, who usually dies from the encounter, and on rare occasions the virus seems to have spread from one person to another before the (...) chain of infection dies out. All it would take to set off a raging global pandemic would be for the virus to mutate into a form that is readily transmissible among humans.Severe Acute Respiratory Syndrome garnered a great deal of public attention because it was novel and its potential for spread was unknown. However, the SARS corona virus is significantly less virulent than pandemic influenza viral infections. (shrink)

We hypothesise that some influenza virus adaptations to poultry may explain why the barrier for human‐to‐human transmission is not easily overcome once the virus has crossed from wild birds to chickens. Since the cluster of human infections with H5N1 influenza in Hong Kong in 1997, chickens have been recognized as the major source of avian influenza virus infection in humans. Although often severe, these infections have been limited in their subsequent human‐to‐human transmission, and the feared H5N1 (...) pandemic has not yet occurred. Here we examine virus adaptations selected for during replication in chickens and other gallinaceous poultry. These include altered receptor binding and increased pH of fusion of the haemagglutinin as well as stalk deletions of the neuraminidase protein. This knowledge could aid the delivery of vaccines and increase our ability to prioritize research efforts on those viruses from the diverse array of avian influenza viruses that have greatest human pandemic potential. (shrink)

This survey aimed to illustrate factors that contribute to nurses' fear when faced with a possible human-to-human avian flu pandemic and their willingness to care for patients with avian flu in Taiwan. The participants were nursing students with a lesser nursing credential who were currently enrolled in a bachelor degree program in a private university in southern Taiwan. Nearly 42% of the nurses did not think that, if there were an outbreak of avian flu, their working hospitals (...) would have sufficient infection control measures and equipment to prevent nosocomial infection in their working environment. About 57% of the nurse participants indicated that they were willing to care for patients infected with avian influenza. Nurses' fear about an unknown infectious disease, such as the H5N1 influenza virus, could easily be heightened to levels above those occurring during the 2003 severe acute respiratory syndrome outbreak in Taiwan. (shrink)

After viral entry into the cell, the nuclear envelope poses a major cellular barrier that needs to be overcome upon adaptation of highly pathogenic avian influenza viruses (HPAIV) to the new host. To ensure efficient viral transcription and replication in the nucleus of the host cell, the viral polymerase complex of avian influenza viruses needs to switch from recognition of avian to mammalian components of the nuclear import machinery. Recent evidence suggests that influenza viruses (...) have evolved different mechanisms to utilize importin‐α isoforms as components of this machinery, bridging pre‐ and post‐nuclear import on both sides of the nuclear envelope. (shrink)

This article takes two events in the ongoing story of a predicted UK avian flu epidemic—“the dead parrot” (October 2005) and “the dying swan” (April 2006)—and examines the role and use of three interconnected metaphor scenarios (related to the notions of “journey,” “war,” and “house”) in the UK press coverage about avian influenza in 2005 and 2006. These represent fundamental descriptive and explanatory structures that derive from culturally or phenomenologically salient objects or experiences, and which allow journalists, (...) scientists, and policymakers to reduce the complexity of the threat posed by a disease and to promote risk-management strategies for the disease that appear to make instinctive or intuitive sense to experts and the public. Although similar metaphor scenarios may be used over time, the kinds of reporting they are associated with and the policy scenarios that result from these framings differ depending on the perceived proximity of the disease threat. (shrink)

In 2004 a survey was conducted in the member states of the European Union designed to gain greater insight into the views on control strategies for foot and mouth disease, classical swine fever, and avian influenza with respect to the epidemiological, economic and social-ethical consequences of each of these animal diseases. This article presents the results of the social-ethical survey. A selection of stakeholders from each member state was asked to prioritize issues for the prevention and control of (...) these diseases. A majority of stakeholders chose preventive measures as the preferred issue. An analysis was done to determine whether there were differences in views expressed by stakeholders from member states with a history of recent epidemics and ones without such a history, and whether there were regional differences. There were no differences between member states with or without a history of recent epidemics. There were indeed regional differences between the priority orders from Northern and Southern Europe on the one hand, and from Eastern Europe on the other. (shrink)

H5N1 avian influenza has reportedly claimed the lives of 186 persons worldwide, 77 of whom resided in Indonesia. On February 7, 2007, the government of Indonesia announced that it would withhold strains of H5N1 avian influenza virus from the World Health Organization. On the same day, Indonesia signed a memorandum of agreement with Baxter Healthcare, a United States-based company, to purchase samples and presumably ensure access to subsequent vaccines at a discount.

One Health is a novel paradigm that recognizes that human and non-human animal health is interlinked through our shared environment. Increasingly prominent in public health responses to zoonoses, OH differs from traditional approaches to animal-borne infectious risks, because it also aims to promote the health of animals and ecological systems. Despite the widespread adoption of OH, culling remains a key component of institutional responses to the risks of zoonoses. Using the threats posed by highly pathogenic avian influenza viruses (...) to human and animal health, economic activity and food security as a case exemplar, we explore whether culling and other standard control measures for animal-borne infectious disease might be justified as part of OH approaches. Our central premise is that OH requires us to reformulate ‘health’ as universal good that is best shared across species boundaries such that human health and well-being are contingent upon identifying and meeting the relevant sets of human and non-human interests and shared dependencies. Our purpose is to further nascent discussions about the ethical dimensions of OH and begin to describe the principles around which a public health agenda that truly seeks to co-promote human and non-human health could potentially begin to be implemented. (shrink)

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many (...) were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Genetic resources are a key resource for much biomedical research. Pathogenic genetic resources are of value in the identification, surveillance, understanding, and development of vaccines, treatments, and other responses to major public threats such as pandemic influenza outbreaks. Significant attempts have been made to improve the international governance of infectious disease over the last decade, but the handling of pathogenic genetic resources remains contentious and problematic. The need to address the deficiencies in current arrangements (e.g., the World Health Organization's (...) Pandemic Influenza Preparedness Framework) is urgent because future outbreaks are likely to revert to the past situation in which developed states secured vaccine supplies for their own populations while leaving developing countries vulnerable to the pandemic. Thereby, the collaboration of developed countries with vital international systems such as the Global Influenza Surveillance and Response System is disincentivized. The current international approach to pathogenic genetic resources is based on the sovereign rights of states and access and benefit-sharing arrangements that stem from those rights. While this approach is consistent with international rules on other types of genetic resources, herein I argue that this is an inappropriate approach to pathogens on both political (serving public health goals) and ethical grounds (e.g., equity and justice). Instead I argue for a (modified) common heritage approach to pathogenic genetic resources, based on their intrinsic qualities (e.g., rapid mutation, easy transmissibility) and their value to global efforts to respond to disease outbreaks. I will further argue for de-linking access to these resources from benefit-sharing requirements; explaining that while there are strong justifications for both, their linkage (particularly for pathogenic genetic resources) is problematic and detrimental to the achievement of its intended goals (i.e., ensuring equitable benefit-sharing in return for access being granted). (shrink)

Emerging infectious diseases such as Ebola, Hendra, SARS, West Nile, Hepatitis E and avian influenza have led to a renewed recognition of how diseases in human beings, wildlife and livestock are interlinked. The changing prevalence and spread of such infections are largely determined by human activities and changes in environment and climate—where the latter are often also caused by human activities. Since the beginning of the 21st century, these insights have been brought together under the heading of OneHealth—a (...) concept that calls for interdisciplinary collaboration between various sciences as well as professional practices to promote and protect the health of human and non-human animals and the natural environment. Just as insights from public health have led to a broadened focus for health policy and medical care, from treating individual patients to protecting and promoting population health, OneHealth calls for an even broader perspective, including a concern for the environment and animals, and for social-cultural factors that affect human, animal and environmental health. OneHealth not only covers collaborative work to understand and control zoonotic diseases, but also other ways in which interactions between animals, plants and humans may positively or negatively impact on each other’s health. Thus, studies in veterinary medicine and environmental sciences may lead to new insights in human medicine, and vice versa. Acknowledgment of the links between environmental, animal and social health is of course not a novel insight. Hippocrates already pointed to the importance of a clean environment as a requirement for good health; the early public health movements emphasized hygienic living conditions including good-quality housing, sewage systems and clean air and water; and the founders of modern medicine such as William Osler and Rudolf Virchow promoted …. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens (n = 2259) and poultry farmers (n = 100) judged three practical (...) cases, which illustrate the dilemma of improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)

As a member of the National Science Advisory Board for Biosecurity, I was involved in early deliberations about the appropriateness of publishing this avian influenza research when manuscripts were referred to us from two scientific journals during their review process, via the U.S. government. As described by David Resnik in this issue, we grappled with benefits and risks, and in our initial, unanimous decision recommended limited publication, alerting the world to the possibility of evolved transmissibility in these viruses (...) but with redaction of the exact genetic mutations that would enable anyone skilled in the art to synthesize these potentially dangerous viruses. However, after additional discussion, both internal and external to the board, we were asked to reconsider the situation, and this time a majority voted in favor of full publication. I was one of the minority that opposed full publication. Resnik points to the difficulties of performing a formal risk‐benefit assessment without the means of quantifying these two terms and suggests application of reasoning based on the precautionary principle instead. This makes sense. But there are three other issues that should be highlighted. (shrink)

Although the term "Bioethics" literally means "Life Ethics," there is a frequent differentiation of Christian bioethicists into those focusing on medical issues versus those focusing on environmental issues. Yet, many challenges to human and environmental health are interdependent, suggesting the need for greater collaboration. After exploring the historical trajectories that have led to these two distinct foci in Christian ethics, this essay will argue for a greater collaboration between the two specializations and make some suggestions concerning how collaboration may be (...) facilitated. As an illustration of this thesis, I examine avian influenza as a case study. (shrink)

The current COVID-19 pandemic has reactivated ancient metaphors but also initiated a new vocabulary: social distancing, lockdown, self-isolation, and sheltering in place. Terminology is not ethically neutral but reflects prevailing value systems. I will argue that there are two metaphorical vocabularies at work: an authoritarian one and a liberal one. Missing is an ecological vocabulary. It has been known for a long time that emerging infectious diseases are associated with the destruction of functioning ecosystems and biodiversity. Ebola and avian (...) influenza viruses have been significant warnings. Obviously, this pandemic will not be the last one. As the planet is our common home, the major metaphor to explore is sheltering at this home. (shrink)

Taiwan was affected by an outbreak of severe acute respiratory syndrome (SARS) in early 2003. A questionnaire survey was conducted to determine (1) the perceptions of risk of SARS infection in nurses; (2) the proportion of nurses considering leaving their job; and (3) work as well as non-work factors related to nurses' consideration of leaving their job because of the SARS outbreak. Nearly three quarters (71.9%) of the participants believed they were 'at great risk of exposure to SARS', 49.9% felt'an (...) increase in workload', and 32.4% thought that people avoided them because of their job; 7.6% of the nurses not only considered that they should not care for SARS patients but were looking for another job or considering resignation. The main predictors of nurses' consideration of leaving their job were shorter tenure, increased work stress, perceived risk of fatality from SARS, and affected social relationships. The findings are important in view of potential impending threats of pandemics such as avian influenza. (shrink)

In recent years, the world knew many challenges concerning the propagation of infectious diseases such as avian influenza, Ebola, SARS-CoV-2, etc. These epidemics caused a change in the healthy balance of humanity. Also, the epidemics disrupt the economies and social activities of countries around the world. Mathematical modeling is a vital means to represent and control the propagation of infectious diseases. In this paper, we consider a stochastic epidemic model with a Markov process and delay, which generalizes many (...) models existing in the literature. In addition, we show the stochastic threshold for the extinction of the disease. Furthermore, numerical examples are discussed to confirm the theoretical result. (shrink)

This piece outlines concrete cases of benefit sharing that occur in relation to the sharing of human (biological) samples. For example, it surveys Indonesia’s decision, in 2006, to stop sharing virus samples of H5N1 (avian influenza) with the WHO Global Influenza Surveillance Network (GISN). It also outlines some of the ethical issues that arise in these cases.

In 2004 a survey was conducted in the member states of the European Union designed to gain greater insight into the views on control strategies for foot and mouth disease, classical swine fever, and avian influenza with respect to the epidemiological, economic and social-ethical consequences of each of these animal diseases. This article presents the results of the social-ethical survey. A selection of stakeholders from each member state was asked to prioritize issues for the prevention and control of (...) these diseases. A majority of stakeholders chose preventive measures as the preferred issue. An analysis was done to determine whether there were differences in views expressed by stakeholders from member states with a history of recent epidemics and ones without such a history, and whether there were regional differences. There were no differences between member states with or without a history of recent epidemics. There were indeed regional differences between the priority orders from Northern and Southern Europe on the one hand, and from Eastern Europe on the other. (shrink)

This paper examines the case of a recent H5N1virus (avian influenza) outbreak in West Bengal, an eastern state of India, and argues that poorly executed pandemic management may be viewed as a moral lapse. It further argues that pandemic management initiatives are intimately related to the concept of health as a social 'good' and to the moral responsibility of protection from foreseeable social harm from an infectious disease. The initiatives, therefore, have to be guided by special moral obligations (...) towards biorisk reduction, obligations which remain unfulfilled when a public body entrusted with the responsibility fails to manage satisfactorily the prevention and control of the infection. The overall conclusion is that pandemic management has a moral dimension. The gravity of the threat that fatal infectious diseases pose for public health creates special moral obligations for public bodies in pandemic situations. However, the paper views the West Bengal case as a learning opportunity, and considers the lapses cited as challenges that better, more effectively conducted pandemic management can prepare for. It is hoped that this paper will provoke constructive bioethical deliberations, particularly pertinent to the developing world, on how to ensure that the obligations towards health are fulfilled ethically and more effectively. (shrink)

In the biomedical field, calls for the generation of new regulations or for the amendment of existing regulations often follow the emergence of apparently new research practices (such as embryonic stem cell research), clinical practices (such as facial transplantation) and entities (such as Avian Influenza/’Bird Flu’). Calls for regulatory responses also arise as a result of controversies which bring to light longstanding practices, such as the call for increased regulation of human tissue collections that followed the discovery of (...) unauthorised post-mortem organ retention. Whilst it seems obvious that new regulations should only be generated if existing regulations are inadequate (a practice referred to in this paper as ‘regulatory syncretism’), this does not always occur in practice. This paper examines the conceptual steps involved in generating regulatory responses to emerging phenomena. Two decision points are identified. First, a stance is taken as to whether the emerging phenomenon raises unique ethical or legal issues (exceptionalism versus non-exceptionalism). Second, the decision is made as to whether new regulation should be generated only for truly unique phenomena (syncretism versus asyncretism). It is argued here that it is important to make a careful assessment of novelty, followed by a reflective and deliberate choice of regulatory syncretism or asyncretism, since each type of regulatory response has advantages which need to be harnessed and disadvantages which need to be managed—something that can only occur if regulators are attentive to the choices they are making. (shrink)

The recent appearance of an extremely widespread avian influenza virus (H5N1) that has crossed to humans in highly pathogenic form has lead to speculation that another outbreak of pandemic influenza could be imminent. However, neither the timing of the pandemic, nor the nature and epidemiology of the virus, can be predicted. This uncertainty presents major difficulties in identifying relevant ethical issues in decision-making. If the next pandemic is relatively mild, decisions may be restricted to prioritizing access to (...) essential health services during the peak of the pandemic. If the virus is more pathogenic, social stability may be threatened. It is clear that, irrespective of the nature of the next pandemic, health professionals will have a key role in decisions about allocating scarce health resources during its acute stages. It is essential that they are not forced to make decisions without the support of established guidance or protocols. Any such guidance must be practical (decisions will often have to be made rapidly on the basis of imperfect information), reasoned, based upon sound moral principles, and must enjoy as far as possible the confidence of the wider population. This paper looks in brief at some of the ethical issues that need to be considered when planning a response to pandemic flu. (shrink)

Ford, Norman Following on from the previous article by Anne Moates, I will take for granted the need for all infected birds to be tracked down and destroyed. I am assuming the scenario that some human beings may be infected by a mutated form of the highly pathogenic H5N1 avian influenza so that this modified bird flu virus can be transmitted from human to human by social contact. Some of the ethical issues that arise in this possible scenario (...) need to be briefly considered. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens and poultry farmers judged three practical cases, which illustrate the dilemma of (...) improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)

Humanity entered the twenty-first century with revolutionary achievements in biomedical research. At the same time multiple “dual-use” results have been published. The battle against infectious diseases is meeting new challenges, with newly emerging and re-emerging infections. Both natural disaster epidemics, such as SARS, avian influenza, haemorrhagic fevers, XDR and MDR tuberculosis and many others, and the possibility of intentional mis-use, such as letters containing anthrax spores in USA, 2001, have raised awareness of the real threats. Many great men, (...) including Goethe, Spinoza, J.B. Shaw, Fr. Engels, J.F. Kennedy and others, have recognized that liberty is also a responsibility. That is why the liberty to decide now represents an acknowledged necessity: biomedical research should be supported, conducted and published with appropriate measures to prevent potential “dual use”. Biomedical scientists should work according to the ethical principles of their Code of Conduct, an analogue of Hippocrates Oath of doctors; and they should inform government, society and their juniors about the problem. National science consulting boards of experts should be created to prepare guidelines and control the problem at state level. An international board should develop minimum standards to be applicable by each country. Bio-preparedness is considered another key-measure. (shrink)

Censorship in the area of public health has become increasingly important in many parts of the world for a number of reasons. Groups with vested interest in public health policy are motivated to censor material. As governments, corporations, and organizations champion competing visions of public health issues, the more incentive there may be to censor. This is true in a number of circumstances: curtailing access to information regarding the health and welfare of soldiers in the Kuwait and Iraq wars, poor (...) health conditions in Aboriginal communities, downplaying epidemics to bolster economies, and so forth. This paper will look at the use of a computer worm (the benevolent health worm) to disseminate vital information in␣situations where public health is threatened by government censorship and where there is great risk for those who ‹speak out’. The discussion of the benevolent health worm is focused on the Peoples’ Republic of China (China) drawing on three public health crises: HIV/AIDS, SARS and Avian Influenza. Ethical issues are examined first in a general fashion and then in a specific manner which uses the duty-based moral philosophy of Confucianism and a Western human rights-based analysis. Technical, political and legal issues will also be examined to the extent that they better inform the ethical debate. (shrink)

Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related (...) morbidity and mortality than those targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

Emotions are complex reactions that allow individuals to cope with significant positive and negative events. Research on emotion was pioneered by Darwin’s (1871) work on emotional expressions in humans and animals. But Darwin was concerned mainly with facial and bodily expressions of significance for humans, citing mainly examples from mammals (e.g., apes, dogs, and cats). In birds, emotional expressions are less evident for a human observer, so a different approach is needed. Understanding avian emotions will provide key evolutionary information (...) on the evolution of related behaviors and brain circuitry. Birds and mammals are thought to have evolved from different groups of Mesozoic reptiles, theropod dinosaurs and therapsids, respectively, and therefore their common ancestor is likely to be a basal reptile living about 300 million years ago, during the Carboniferous or Permian. Yet, birds and mammals exhibit extensive convergence in terms of relative brain size, high levels of activity, sleep/wakefulness cycles, endothermy, and social behavior, among others. This article focuses on two basic emotions with negative valence: fear and frustration. Fear is related to the anticipation of dangerous or threatening stimuli (e.g., predators or aggressive conspecifics). Frustration is related to unexpected reward omissions or devaluations (e.g., loss of food or sexual resources). These results have implications for an understanding of the conditions that promote fear and frustration, and for the evolution of supporting brain circuitry. (shrink)

This is a description of an avian-shaped feature that rests below a network of cellular structures found on a mound within the Argyre Basin of Mars in Mars Global Surveyor image M14-02185, acquired on April 30, 2000, and released to the public on April 4, 2001. The area examined is located near 48.0° South, 55.1° West. The formation is approximately 2,400 meters long from the tip of its beak to the tip of its farthest tail feather. There is a (...) minimum of six different variations in appearance of the surface material over this small area. Utilizing the public targeting request form provided on the Mars Global Surveyor (MGS) website, co-author Miller secured a second image of the area that was obtained on July 3, 2006, showing this feature under different conditions S20-00165. The new image was then released to the public on August 11, 2006. A third image of the formation identified as MGS S13-01480 was acquired on December 15, 2005, and although officially processed on June 20, 2006, it was not made available to the public until August 22, 2009, on NASA’s Planetary Data System (PDS) website. All three of the MGS images reveal defining aspects of this avian feature, including a head, beak, body, eye, leg, foot, toes, wing, and feathers. When taken together, these components induce the visual impression of an avian-shaped formation that exhibits a unique set of proportional features. Adjoining this formation is a composite of complex cellular features that form a compartmentalized infrastructure. The three authors who are veterinarians provide a critical analysis of the avian features, and the geologist and geoscientist authors examine natural mechanisms that could contribute to the formation of this feature. An extensive search of comparable regions within and beyond the area of the Argyre Basin was conducted. A list of these sites is provided, and terrestrial comparisons are also offered. (shrink)

Avian Flu Pandemic – Flight of the Healthcare Worker? Content Type Journal Article Pages 365-385 DOI 10.1007/s10730-009-9114-9 Authors Robert B. Shabanowitz, Geisinger Medical Center, Dept. of OB/GYN 100 North Academy Avenue Danville PA 17822-2920 USA Judith E. Reardon, Geisinger Medical Center Center for Health Research 100 North Academy Avenue Danville PA 17822-3003 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4.

Aboitiz et al. suggest that the mammalian isocortex is derived from the dorsal cortex of reptiles and birds, and that there has been a major divergence in the connectivity patterns (and hence function) of the mammalian and reptilian/avian hippocampus. There is considerable evidence to suggest, however, that the avian hippocampus serves the exact same function as the mammalian hippocampus.

Influenza mandates in health care institutions are recommended by professional associations as an effective way to prevent the contraction of influenza by patients from health care workers. Health care institutions with such mandates must operate within civil rights frameworks. A recent set of cases against health care institutions with influenza mandates reveals the liabilities posed by federal law that protects employees from religious discrimination. This article examines this legal framework and draws important lessons from this litigation for (...) health care institutions. We argue counterintuitively that providing religious exemptions from influenza mandates may expose health care institutions to more liability than not providing a formal exemption. (shrink)

The study of animal behavior, and particularly avian behavior, has advanced significantly in the past 50 years. In the early 1960s, both ethologists and psychologists were likely to see birds as simple automatons, incapable of complex cognitive processing. Indeed, the term “avian cognition“ was considered an oxymoron. Avian social interaction was also seen as based on rigid, if sometimes complicated, patterns. The possible effect of social interaction on cognition, or vice versa, was therefore something almost never discussed. (...) Two paradigm shifts—one concerning animal cognition and one concerning social interaction—began to change perceptions in, respectively, the early 1970s and 1980s, but only more recently have researchers actively investigated how these two areas intersect in the study of avian behavior. The fruits of such intersection can be seen in the various papers for this special issue. I provide some brief background material before addressing the striking findings of current projects. In some cases, researchers have adapted early classic methods and in other cases have devised new paradigms, but in all instances have demonstrated avian capacities that were once thought to be the exclusive domain of humans or at least nonhuman primates. Keywords: avian cognition; avian social learning; avian observational learning; avian communication. (shrink)

The study of animal behavior, and particularly avian behavior, has advanced significantly in the past 50 years. In the early 1960s, both ethologists and psychologists were likely to see birds as simple automatons, incapable of complex cognitive processing. Indeed, the term “avian cognition” was considered an oxymoron. Avian social interaction was also seen as based on rigid, if sometimes complicated, patterns. The possible effect of social interaction on cognition, or vice versa, was therefore something almost never discussed. (...) Two paradigm shifts—one concerning animal cognition and one concerning social interaction—began to change perceptions in, respectively, the early 1970s and 1980s, but only more recently have researchers actively investigated how these two areas intersect in the study of avian behavior. The fruits of such intersection can be seen in the various papers for this special issue. I provide some brief background material before addressing the striking findings of current projects. In some cases, researchers have adapted early classic methods and in other cases have devised new paradigms, but in all instances have demonstrated avian capacities that were once thought to be the exclusive domain of humans or at least nonhuman primates. Keywords: avian cognition; avian social learning; avian observational learning; avian communication. (shrink)

Should government have the power to place limits on a scientific pursuit that holds the potential for both good and harm—on what is called “dual‐use research”? That is the highly charged question surrounding research to genetically modify influenza A (H5N1) to render it more easily transmissible from human to human. There is seldom a “right” answer to dual‐use research, but a fair, inclusive, and transparent process—building on the NSABB model—should improve decision‐making. A local institutional panel should evaluate dual‐use research (...) based on the following structured ethical framework. (shrink)