The World Health Organization (WHO) plans to issue a report in January on ethical issues raised by pandemic influenza planning, such as how to provide fair access to available drugs and vaccines, WHO officials said today after 2 days of meetings in Geneva.

More than 30 leading experts on pandemic flu, ethics, and public health attended the meetings Oct 24 and 25, WHO spokesman Gregory Hartl said at a news teleconference today.

"This was not designed to reach any conclusions, but to raise issues," Hartl said. "The idea was to get people talking about these issues before the pandemic started."

Dr. Alex Capron, a professor of law and medicine at the University of Southern California, said the discussions focused on four main topics: equitable access to therapeutic and prophylactic measures; ethical aspects of interventions such as quarantine and social distancing; what healthcare workers should be expected to do during an outbreak and what obligations are owed them; and issues that arise between governments when developing a multilateral response to a pandemic.

The WHO report will stress the need to have broad public involvement in decisions and to base choices on an accurate understanding of the pandemic, officials said.

"The recognition that emerged very strongly [at the meetings] was that it was going to be essential to have public engagement in all aspects of planning and a frank and candid recognition that the questions of the pandemic are going to be not just technical questions, but also ethical questions," Capron said.

He said the WHO is not aiming for "a single set of prescriptions for all circumstances." Instead, everyone involved in planning will be dealing with "the need for trading off among a number of different ethical values."

He cited several examples: the principle of utility, which stresses the need to "maximize welfare"; the principle of fairness, which emphasizes justice; the principle of liberty, which says individuals should be able to make their own choices as much as possible; and the principle of reciprocity, which says that people who contribute to the public good are owed something in return.

"These may point in different directions," Capron said.

In response to a question about vaccine rationing, Capron said, "One of the things that emerged very strongly is the necessity for good ethics to rest on good facts." Some at the meeting challenged the assumption that children and elderly people will be at greatest risk, and suggested, he said, that health agencies may need "contingency plans depending on what the virus turns out to be like, how it behaves."

In an apparent reference to suggestions that the pandemic may hit young, healthy adults hardest, as occurred in the 1918 pandemic, Capron added, "The assumption that the youngest or oldest are most at risk is the assumption that applies to seasonal influenza, [which] may or may not be the case here."

Dr. Elaine Gadd, a senior medical officer and ethics specialist with the United Kingdom Department of Health, seconded Capron´s comments. "It´s very important that any plans are responsive to the actual characteristics of the pandemic, which we do not know in advance. Any plan must be capable of amendment in light of the actual facts."

In response to another question about vaccine allocation, Dr. Richard Heymann, the WHO director-general´s acting special representative for pandemic flu, said the groups that will most need protection include health workers and their families along with police and fire fighters.

As for journalists, Heymann said he hopes they can be protected too. "But it has to be decided by the local community and the countries," he added. "WHO just meets and makes broad recommendations and studies the issues." (Experts say no vaccine well-matched to the pandemic virus will be available for at least the first several months of a pandemic, and after that it will be in short supply.)

A report on the ethics meeting will be drafted and circulated to participants and other stakeholders in November, with a goal of publishing the report and some "guiding points" in January, said Dr. Andreas Reis, a WHO technical officer for ethics and health.