It is still remarkably difficult for public health officials charged with developing and implementing pandemic influenza preparedness plans at the community level-where care is delivered-to obtain clear, concrete, and consistent guidance on how to construct plans that are both ethical and actionable. As of mid-2007, most of the federal and state pandemic plans filed with the Centers for Disease Control and Prevention, describing how public health officials will coordinate public agencies and private entities in the event of an outbreak, failed to include ethical guidance for first responders responsible for providing essential services and making fair decisions during a public health emergency. A survey of these plans, published in the American Journal of Public Health in June 2007, noted that planners were following a federal template that did not require them to be specific about how their plans met the test of public health ethics during a disaster: preparing first responders to act fairly when forced to think differently about their duties and priorities within their communities.
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