The Bellagio Meeting on Social Justice and Influenza


With support from the Rockefeller Foundation, an international group of experts in public health, animal health, virology, medicine, public policy, economics, bioethics, law and human rights met in Bellagio, Italy from 24 to 28 July 2006 to consider questions of social justice and the threat of avian and human pandemic influenza, with a particular remit to focus on the needs and interests of the world’s disadvantaged.

Although it is generally recognized that the next influenza pandemic could have far-reaching consequences in terms of morbidity and mortality, comparatively little attention has been paid to the ways in which a pandemic could have a disproportionately negative impact on socially and economically disadvantaged groups. As an example, even before a pandemic occurs, poultry farmers, are currently bearing a large part of the burden of efforts to contain the spread of highly pathogenic avian influenza in domestic birds.

The last severe influenza pandemic, which occurred in 1918, resulted in particularly high mortality rates in developing countries, as well as among the poor in developed countries, such as the United States. These and other considerations suggest there is a particular need to address the needs and interests of the world’s disadvantaged while preparing for, and responding to, the threat of an influenza pandemic.

A group of 24 experts from 11 countries met in Bellagio, Italy to explore these issues in depth. The consensus of the group was that efforts to prepare for and respond to the threat of an influenza pandemic should take account of the needs and interests of the disadvantaged. Members of Group have issued a Statement of Principles for incorporating considerations of social justice in pandemic planning response. A series of Checklists has also been developed to aid in incorporating these principles into preparedness and response efforts. More detail, including comments from the meeting’s organizers and participants, is included in the Publications.



Bellagio Statement of Principles


Socially and economically disadvantaged groups and individuals are almost always the worst affected by epidemics.  Too often, they have little voice in making and implementing policy responses to health emergencies – responses which, in turn, commonly neglect the needs and rights of the disadvantaged.

Consideration for the interests of the disadvantaged is important for practical as well as ethical reasons:   public health efforts are more likely to succeed in an atmosphere of social solidarity and public trust, including the trust of disadvantaged people.  Avian and human pandemic influenza planning and response should therefore not only be based on sound science and public health principles, but should also respect and give particular attention to the needs and rights of the disadvantaged, and include processes through which their preferences and interests can be articulated and incorporated.    

The following principles aim to help governments and intergovernmental and nongovernmental organizations take account of the interests of the disadvantaged in avian and pandemic influenza planning and response. “Checklists” of the type attached to this statement provide a ready means of ensuring that this occurs. These principles do not exhaust all relevant technical and moral considerations but focus rather on those with the most salience for the needs and rights of disadvantaged peoples.


I.       All people should have ready access to accurate, up-to-date and easily understood information about avian and human pandemic influenza, public policy responses, and appropriate local and individual actions. Communications should be tailored to overcome obstacles that disadvantaged groups face in accessing such information.

II.      Veterinary and public health strategies should foster wide engagement in planning for and responding to the avian and pandemic influenza threat.  Civil society, religious groups and the private sector should be involved in helping to overcome barriers to effective engagement by disadvantaged groups.

III.     Planning and response should facilitate public involvement in surveillance and reporting of possible cases without fear of discrimination, reprisal or uncompensated loss of livelihood. Recognizing their vulnerability, special efforts are needed to foster reporting by disadvantaged groups, as well as to protect them from negative impacts which could worsen their situation.

IV.     The impact and effectiveness of interventions and policies need to be evaluated and monitored, especially with respect to prospects for providing fair benefits to, and avoiding undue burdens on, disadvantaged groups, so that corrective adjustments can be made in a timely manner.

V.      Developing as well as developed countries should have access to the best available scientific and socio-economic data and analyses to inform avian and pandemic influenza planning and response, including information on the particular burdens and secondary harms that a pandemic and pandemic responses may inflict on disadvantaged groups.

VI.     National and international efforts are needed to promote equitable access to vaccines, antivirals and other appropriate public health and social interventions, both between and within countries, so as to provide fair and non-discriminatory treatment for traditionally disadvantaged groups as well as those who are specially disadvantaged in the context of avian and human influenza.


Checklists for Pandemic Influenza Preparedness and Response Plans


Group Members  

Joseph AMON
Director, HIV/AIDS Program
Human Rights Watch
New York City, New York,, United States
Katherine C. BOND  
Associate Director, Southeast Asia Regional Program
Rockefeller Foundation
Bangkok, Thailand
Lead Adviser, Office of the Chief Economist, East Asia and Pacific Region
The World Bank
Washington, DC, United States
James B. Duke Professor of Public Policy Studies and Philosophy
Duke University
Durham, North Carolina, United States
Alexander M. CAPRON
Director, Department of Ethics, Trade, Human Rights and Health Law
World Health Organiziation
Geneva, Switzerland
Research Associate, International Health
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Patrick S. DUGGAN
Research Coordinator, Berman Bioethics Institute
Johns Hopkins University
Baltimore, Maryland, United States
Ruth R. FADEN        
Executive Director, Berman Bioethics Insititute
Johns Hopkins University
Baltimore, Maryland, United States
Bruce G. GELLIN     
Director, National Vaccine Program Office
U. S. Department of Health & Human Services
Washington, DC, United States
Ian GUST   
Professorial Fellow, Department of Microbiology and Immunology
University of Melbourne
Melbourne, Victoria, Australia
Ruth A. KARRON   
Professor of International Health and Pediatrics
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Kausar S. KHAN                  
Associate Professor of Community Health Sciences
Aga Khan University
Karachi, Pakistan
Professor of Bioethics and Community Health
University of Malawi College of Medicine
Blantyre, Malawi
Senior UN System Coordinator for Avian and Human Influenza
United Nations
New York City, New York, United States
(Joining on Thursday 27 July)
Abdulsalami NASIDI     
Task Force for Avian Influenza
Nigerian Federal Ministry of Health
Abuja, Nigeria
NGUYEN Tien Dung
Head, Virology Department
National Institute of Veterinary Research
Hanoi, Vietnam
Joachim OTTE       
Pro-Poor Livestock Policy Initiative
Food and Agriculture Organization
Rome, Italy
Professor of Environmental Health Sciences
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Sanjay SINHO
Director of Health Programs
CARE International
Atlanta, Georgia, United States
Policy Adviser
United Nations System Influenza Co-ordination Office
New York City, New York, United States
Senior Scientist and Secretary, Avian Influenza Expert Team
Indonesian Ministry of Health
Jakarta, Indonesia
Thai Parliament
Bangkok, Thailand
Sarasin VIRAPHOL   
Executive Vice President
Charoen Pokphand (CP) Group
Bangkok, Thailand
Executive Associate Dean
Tsinghua University School of Public Policy and Management
Beijing, China
Derek YACH
Director of Health Equity
Rockefeller Foundation
New York City, New York, United States
(Joining on Thursday 27 July)
ZENG Guang
Leading Epidemiologist         
Chinese Center of Disease Control and Prevention
Beijing, China