Social Justice Is a Global Issue: Ethical Pandemic Planning (Letters) (Letter to the Editor‪)‬

To the Editor: The Centers for Disease Control and Prevention is pleased to see "Planning for an Influenza Pandemic: Social Justice and Disadvantaged Groups," by Lori Uscher-Pines and colleagues (Jul-Aug 2007). As representatives of CDC's Public Health Ethics Committee, we recognize the importance of a robust ethical framework for public health that attends to issues of social justice and addresses the needs of vulnerable populations who might be adversely affected by a pandemic. We also agree with Lawrence Gostin, who pointed out in a commentary in the same issue that social justice requires more than fair distribution of benefits and burdens--it requires action. CDC has established both an external Ethics Subcommittee of the Advisory Committee to the Director, composed of leading ethicists from throughout the United States, and an internal CDC Public Health Ethics Committee. The Ethics Subcommittee is collaborating with CDC to develop ethics guidance. Ethical Guidelines in Pandemic Influenza, which was released in March 2007, recognizes the importance of addressing the needs of populations likely to be marginalized, of developing fair procedural justice mechanisms, and of diversity in ethical decision-making. It serves as a resource for CDC decision-makers as well as CDC's state and local partners. It informs CDC's operational plan for detecting and responding to a pandemic of avian influenza (http:// www.cdc.gov/flu/pandemic/OPLAN/ BaseOPLAN.pdf), which in turn cascades into the plans of the Department of Health and Human Services and the U.S. government as a whole.