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Volume 14, Number 10—October 2008

Resource Allocation during an Influenza Pandemic

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To the Editor

Considerable progress has been made in the United Kingdom to prepare for an influenza pandemic. After public consultation, an updated national framework (1) was recently published, along with new guidance on ethics (2), surge capacity, and clinical prioritization (3).

As Paranthaman et al. pointed out (4), difficult ethical choices must be made during a pandemic. Therefore, the UK Committee on Ethical Aspects of Pandemic Influenza published the ethical framework (2) designed to assist with and support the ethical aspects of policy and clinical decision making during and after an influenza pandemic. The fundamental principle underpinning the ethical framework is equal concern and respect, and it is expected that this principle, supported by 7 others listed in the guidance, will be used by clinicians, managers, and healthcare planners to develop policies on clinical issues for use during a pandemic. It is recognized and acknowledged within the document that the weight of a given principle will vary according to the circumstance.

Equally relevant is the interim guidance on surge capacity and prioritization in health services (3), which sets out a framework for the health service response in the United Kingdom during a pandemic and which advocates the wider use of the clinical triage criteria described for critical care by Christian et al (5). The proposed use of clinical triage at the primary care/secondary care interface starts to address the issue raised by Paranthaman et al. of who should be admitted to a hospital. This guidance expands early UK guidelines on the management of influenza-like illness during a pandemic.

We agree with Paranthaman et al. that early surveillance data are needed to rapidly inform clinical care guidelines in a pandemic. Therefore, efforts are ongoing to increase the resilience of health surveillance data gathering systems in the United Kingdom and to develop clinical systems for specific use during a pandemic. At the onset of a pandemic, it is intended that data will be gathered on the first few hundred patients by using a modification of the Web-based avian influenza management system of the Health Protection Agency. These data will provide important virologic and epidemiologic information to characterize the pandemic virus and inform modeling assumptions to validate “now casting” or real-time mathematical models (6) being developed in the United Kingdom and Europe to estimate the likely spread and impact of the pandemic. Furthermore, pilot projects are in preparation to develop clinical data collection systems in secondary care to assess treatments and outcomes during a pandemic.

In conclusion, contingency decisions outside normal patient pathways will be needed; the UK guidance, based on current knowledge and understanding, will help clinicians make difficult decisions on patient prioritization, plan surge capacity, build resilience into existing surveillance systems, and develop new systems that seek to inform the best use of resources to deliver optimal clinical care during an influenza pandemic. These decisions will be revised and modified to reflect new developments in the science.


Nick F. PhinComments to Author  and Lindsey Davies
Author affiliations: Health Protection Agency Centre for Infections, London, UK (N.F. Phin); Department of Health, London (L. Davies)



  1. Department of Health. Pandemic flu: a national framework for responding to an influenza pandemic. 2007. London: The Department, 2007. [cited 2008 Jul 21]. Available from
  2. Department of Health. Responding to pandemic influenza—the ethical framework for policy and planning. London: The Department; 2007. [cited 2008 Jul 21]. Available from
  3. Department of Health. Pandemic influenza: surge capacity and prioritisation in health services—provisional UK guidance. London: The Department; 2007. [cited 2008 Jul 21]. Available from
  4. Paranthaman  K, Conlon  CP, Parker  C, McCarthy  N. Resource allocation during an influenza pandemic. Emerg Infect Dis. 2008;14:5202. DOIPubMedGoogle Scholar
  5. Christian  MD, Hawryluck  L, Wax  RS, Cook  T, Lazar  NM, Herridge  MS, Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175:137781. DOIPubMedGoogle Scholar
  6. European Centre for Communicable Disease Control. Now casting and short term forecasting during influenza pandemics. A focused developmental ECDC workshop. 2007. [cited 2008 Jul 21]. Available from


Cite This Article

DOI: 10.3201/eid1410.080371

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Nick F. Phin, Pandemic Influenza Office, Respiratory Diseases Department, Health Protection Agency Centre for Infections, Collindale, London NW9 5EQ, UK;

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Page created: July 13, 2010
Page updated: July 13, 2010
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.