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Background: Many commentators call for a more ethical approach to planning for influenza pandemics. In the developed
world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the
attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI).
Methods: We critically analyzed the Ghana NISPPI�s sensitivity to ethics issues to determine how well it reflects ethical
commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and
relevant ethics frameworks.
Results: This paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical
issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the
duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also
pays scant attention to use of vaccines and antivirals, border issues and co-operation with neighboring countries, justification
for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination,
and budgeting are quite detailed. With respect to presentation, the NISPPI�s text is organized around five thematic
areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them.
Conclusions: Our analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan�s content
and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of
ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources
and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk
of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs
from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.