OBJECTIVE:To explore social equity, health planning, regulatory and ethical dilemmas in responding to a pandemic influenza (H5N1) outbreak, and the adequacy of protocols and standards such as the International Health Regulations (2005). APPROACH:This paper analyses the role of legal and ethical considerations for pandemic preparedness, including an exploration of the relevance of cross-jurisdictional and cross-cultural perspectives in assessing the validity of goals for harmonisation of laws and policies both within and between nations. Australian and international experience is reviewed in various areas, including distribution of vaccines during a pandemic, the distribution of authority between national and local levels of government, and global and regional equity issues for poorer countries. CONCLUSION:This paper finds that questions such as those of distributional justice (resource allocation) and regulatory frameworks raise important issues about the cultural and ethical acceptability of planning measures. Serious doubt is cast on a 'one size fits all' approach to international planning for managing a pandemic. It is concluded that a more nuanced approach than that contained in international guidelines may be required if an effective response is to be constructed internationally. IMPLICATIONS:The paper commends the wisdom of reliance on 'soft law', international guidance that leaves plenty of room for each nation to construct its response in conformity with its own cultural and value requirements.

译文

目的:探讨应对大流行性流感(H5N1)暴发时的社会公平性,卫生计划,监管和道德困境,以及《国际卫生条例(2005)》等协议和标准的充分性。
方法:本文分析了大流行防范的法律和道德考虑因素的作用,包括探讨跨司法管辖区和跨文化的观点在评估国家内部和国家之间协调法律和政策目标的有效性方面的相关性。对澳大利亚和国际经验的各个方面进行了回顾,包括大流行期间疫苗的分配,国家和地方政府之间的权限分配以及较贫穷国家的全球和区域公平问题。
结论:本文发现诸如分配正义(资源分配)和监管框架等问题提出了有关计划措施的文化和伦理可接受性的重要问题。在应对流感大流行的国际规划中,“一刀切”的做法令人严重怀疑。结论是,如果要在国际上作出有效的反应,可能需要比国际准则中所包含的方法更细微的方法。
启示:本文赞扬了依赖“软法”的智慧,国际法为每个国家留出了足够的空间来根据自己的文化和价值要求来构建其应对措施。

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