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Canadian survey on pandemic flu preparations

Paul Ritvo13*, Kumanan Wilson2, JL Gibson37, C Guglietti1, CS Tracy34, JX Nie14, AR Jadad5, REG Upshur36 and the University of Toronto Joint Centre for Bioethics Pandemic Ethics Working Group

Author affiliations

1 School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, M3J 1P3, Canada

2 Ottawa Health Research Institute, Department of Medicine, University of Ottawa, 725 Parkdale Ave, Ottawa, K1Y 4E9, Canada

3 University of Toronto Joint Centre for Bioethics, 155 College, Street, Suite 754, Toronto, M5T 1P8, Canada

4 Primary Care Research Unit, Sunnybrook and Women's College Health, Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada

5 Centre for Global eHealth Innovation, Toronto General Hospital, R Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, M5G 2C4, Canada

6 Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, 3rd Floor, Toronto, M5T 1W7, Canada

7 Department of Health Policy, Management, & Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, M5T 1P8

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Citation and License

BMC Public Health 2010, 10:125  doi:10.1186/1471-2458-10-125

Published: 11 March 2010



The management of pandemic influenza creates public health challenges.

An ethical framework, 'Stand on Guard for Thee: ethical considerations in pandemic influenza preparedness' that served as a template for the World Health Organization's global consultation on pandemic planning, was transformed into a survey administered to a random sample of 500 Canadians to obtain opinions on key ethical issues in pandemic preparedness planning.


All framework authors and additional investigators created items that were pilot-tested with volunteers of both sexes and all socioeconomic strata. Surveys were telephone administered with random sampling achieved via random digit dialing (RDD). Eligible participants were adults, 18 years or older, with per province stratification equaling provincial percent of national population. Descriptive results were tabulated and logistic regression analyses were used to assess whether demographic factors were significantly associated with outcomes.


5464 calls identified 559 eligible participants of whom 88.5% completed surveys. Over 90% of subjects agreed the most important goal of pandemic influenza preparations was saving lives, with 41% endorsing saving lives solely in Canada and 50% endorsing saving lives globally as the highest priority. Older age (OR = 8.51, p < 0.05) and current employment (OR = 9.48, p < 0.05) were associated with an endorsement of saving lives globally as highest priority. About 90% of respondents supported the obligation of health care workers to report to work and face influenza pandemic risks excepting those with a serious health condition that increased risks. Over 84% supported the government's provision of disability insurance and death benefits for health care workers facing elevated risk. Strong majorities favored stocking adequate protective antiviral dosages for all Canadians (92%) and, if effective, influenza vaccinations (95%). Over 70% agreed Canada should provide international assistance to poorer countries for pandemic preparation, even if resources for Canadians were reduced. While 92% of this group, believed provision should be 7 to 10% of all resources generated, 43% believed the provision should be greater than 10%.


Results suggest trust in public health officials to make difficult decisions, providing emphasis on reciprocity and respect for individual rights.