Current thinking on the prevention and control of pandemic disease is informed, to a large extent, by the past century’s experiences with emerging, reemerging, and novel infectious disease threats. A careful examination of community responses to a broad range of infectious diseases, however, reveals enduring dilemmas that must be addressed anew with each pandemic threat. Workshop participants discussed a range of legal and ethical issues that were raised by the great influenza pandemic of 1918; the recent and mercifully short-lived outbreak of severe acute respiratory syndrome (SARS); the ongoing major epidemics such as HIV/AIDS and endemic diseases such as malaria; the efforts to control and eliminate poliovirus; the singular triumph over smallpox; and the threatened 1976 “swine flu” pandemic that wasn’t.2

In his keynote address (see Chapter 1), David Heymann, Executive Director for Communicable Diseases at the World Health Organization (WHO), discussed notable outbreaks of emerging and reemerging diseases in the context of several interrelated issues, each of which—either individually or collectively—carries profound ethical and legal implications:

  • The vulnerability of health workers to infectious disease and their duty to provide care

  • Each country’s responsibility to reduce the international spread of infectious diseases while simultaneously preserving trade

  • Ensuring equitable access to health-care resources

  • Balancing individual rights and the public good

Defined by past epidemics, these issues challenge our highly interconnected world with unprecedented urgency, as we anticipate the next infectious disease pandemic.

In response to this challenge, WHO has been engaged in a process of revising


In that year, several soldiers stationed at Fort Dix, New Jersey contracted a novel respiratory virus, resulting in one death. Upon discovery that the victims were infected with a swine influenza virus, the Centers for Disease Control (CDC)—despite uncertainty as to the transmissibility of the virus—recommended the mass vaccination of the U.S. population. After the federal government agreed to indemnify vaccine manufacturers against claims of adverse reactions, 150 million doses of vaccine were produced. However, when five months passed without a single reported case of influenza, demand for vaccination dwindled (although it was briefly revived due to an outbreak of what proved to be Legionnaire’s Disease). The immunization campaign was finally suspended after the vaccine was linked with Guillain-Barré syndrome (GAO, 2000, 1977; ASTHO, 2002; Sencer and Millar, 2006; Neustadt and Fineberg, 1978).

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