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Planning for triage of scarce resources in the face of a flu pandemic is not simply an abstract moral dilemma1: it remains unsolved at the highest levels of international planning. Europe remains two to three years away from a state of preparedness for a flu pandemic.2 Previous modelling has shown that a massive and focused use of antivirals and vaccines in places where flu may originate—probably developing countries—is vital to mitigating a pandemic.3 This strategy presupposes that available limited resources will be distributed fairly in developing countries. This presumption is currently unrealistic.
A recent analysis of pandemic preparedness plans worldwide noted three goals of pharmaceutical interventions: reduction of morbidity and mortality (21 plans), continued maintenance of essential services (13 plans), and minimisation of social and economic impacts (13 plans).4 The overarching goal for the early pandemic phases in the World Health Organization's plan is to coordinate maximum international efforts to delay or possibly avert a pandemic. WHO seeks to identify needs and encourage international assistance to resource-poor countries. Yet, its plan contains no specific guidance on allocating the scarce resources needed to achieve the strategic objective. It merely encourages countries to reduce disease burden in the initial outbreak locations.
We face the problem of triaging scarce resources in a context in which donating countries retain effective control over limited resources, recipient countries retain sovereignty over capabilities, and WHO (or another international intermediary) is responsible for setting global allocation priorities.
The global public health community must delineate epidemiological, legal, and ethical principles supporting a multilateral framework through which states, international institutions, and non-governmental organisations can allocate and administer scarce resources during global public health emergencies. A starting point could be a WHO expert consultation that analyses substantive and procedural aspects of this problem and develops the framework for effecting resource triage in global public health emergencies.
Competing interests: None declared.