1. Ethics Conference on Asian Flu Pandemic Ethical considerations among Response to H1N1 Pandemic in China China CDC, CFETP Huilai Ma, Guang Zeng

2. 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

3. 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

4. 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

5. Ethics Conference on Asian Flu Pandemic Significant Rural-Urban Differences in Medical Resources in China Hospital beds/1000 population, 2008Health professionals/1000 population, 2008

6. Ethics Conference on Asian Flu Pandemic Amend statute on management of the pandemic H1N1 in due time Category B notifiable Disease Adopt Category A Diseases Stage Ⅰ : April 30 Managed as a Quarantinable Disease”

7. Ethics Conference on Asian Flu Pandemic Confirmed pandemic (H1N1) influenza cases: China (as of June 11, 2010) June 11 Community transmission occurred May 29 First documented transmission May 11 1 st imported case documented Number of Cases May June 2009 Quarantine and Isolation Free treatment Strategy for prevention school outbreak

8. Ethics Conference on Asian Flu Pandemic Management of Close Contacts If fever or respiratory symptoms 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 Contacts Reporting & Investigation Medical Service Medical check-up CDC End medical observation for all close contacts If tested (-) for H1N1 influenza End medical observation If close contacts showed no symptoms after 7 days of medical observation

9. Ethics Conference on Asian Flu Pandemic CFETP finding: highlight the need to prevent transmission by droplets and fomites during a pandemic H1N1

10. Ethics Conference on Asian Flu Pandemic Population at High Risk for Developing Severe H1N1 Infection

11. Ethics Conference on Asian Flu Pandemic Amend statute on management of the pandemic H1N1 in due time Category B notifiable Disease Adopt Category A Diseases Stage Ⅰ : April 30 Managed as a Quarantinable Disease Category B notifiable Disease Adopt Category B Diseases Stage Ⅱ : July 10 Managed as a Surveillance Disease

12. 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 Number of Cases (×1000) June 11 Community transmission occurred 14 10 6 2 Sept. 16 Pandemic (H1N1) vaccination started Strategy for reduce fatality rate

13. 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 SeverityTreatment Mild patientsCommunity healthcare institutions High risk patientsDesignated hospitals Severe/critical patientsDesignated tertiary hospitals with strong capability

14. 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

15. 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

16. Ethics Conference on Asian Flu Pandemic Thank you!

17. Ethics Conference on Asian Flu Pandemic

18. 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?

19. 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?

20. 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