Carl Coleman
Publication Date

"The importance given to communication during an infectious disease outbreak can make or break public health efforts, and WHO takes this very seriously." - Dr Marie-Paule Kieny, WHO Assistant Director-General, Health Systems and Innovation

This document outlines the ethical principles that the World Health Organization (WHO) believes should guide communication planning and implementation in the context of infectious disease outbreaks at every level - from frontline workers to policymakers. It makes the case for embedding ethics within the integrated global alert and response system for epidemics and other public health emergencies. In addition to setting forth general principles, it examines how these principles can be adapted to different epidemiological and social circumstances.

WHO observes that decisions during an outbreak need to be made on an urgent basis, often in the context of scientific uncertainty, social and institutional disruption, and an overall climate of fear and distrust. Time pressures and resource constraints may force action without the thorough deliberation, inclusiveness, and transparency that a robust ethical decision-making process demands. Setting up decision-making systems and procedures in advance is, according to WHO, the best way to ensure that ethically appropriate decisions will be made if an outbreak occurs.

Many individuals have helped shape this guidance document, in meetings where they discussed, among other topics, the importance of focusing on broader questions of global health governance, community engagement, knowledge generation, and priority setting. Participants emphasised the need to develop concrete operational tools to help individuals involved in epidemic response efforts to incorporate ethical guidance into practical decision-making.

To support this, the guidance document draws on a variety of ethical principles, which are grouped into seven general categories:

  1. Justice - encompasses two different concepts: equity and procedural justice, the latter of which involves: due process (providing notice to interested persons and an opportunity to be heard), transparency (providing clear and accurate information about the basis for decisions and the process by which they are made), inclusiveness/community engagement (ensuring all relevant stakeholders are able to participate in decisions), accountability (allocating and enforcing responsibility for decisions), and oversight (ensuring appropriate mechanisms for monitoring and review).
  2. Beneficence - underlies society's obligation to meet the basic needs of individuals and communities.
  3. Utility - states that actions are right insofar as they promote the well-being of individuals or communities.
  4. Respect for persons - requires, for example, transparency and truth-telling in the context of carrying out public health and research activities.
  5. Liberty - includes a broad range of social, religious, and political freedom, such as freedom of speech.
  6. Reciprocity - consists of making a "fitting and proportional return" for contributions that people have made.
  7. Solidarity - is a social relation in which a group, community, nation, or global community stands together.

This document is organised around 14 specific guidelines - e.g., involving the local community and rapid data sharing - each of which addresses key aspects of epidemic planning and response. Each guideline is introduced by a series of questions that illustrate the scope of the ethical issues, followed by a more detailed discussion that articulates the rights and obligations of relevant stakeholders.

The reader learns, for example, that "For both pragmatic and ethical reasons, maintaining the population's trust in epidemic response efforts is of fundamental importance. This is possible only if policy-makers and response workers act in a trustworthy manner by applying procedural principles fairly and consistently, being open to review based on new relevant information, and acting with the genuine input of affected communities."

WHO encourages countries, healthcare institutions, international organisations, and others involved in epidemic response efforts to develop practical strategies and tools to apply the principles in this guidance document to their specific settings, taking into account local social, cultural, and political contexts.

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WHO website, December 18 2017.