Dr Laura Shanner is a wonderful public speaker.
At her IPP talk on October 22, she covered a gamut of topics, from public policy to personal responsibility, and painted a picture of epidemology that showed we were unprepared in Canada for the SARS outbreaks of the early nougthies, a remnant of public health legislation that was and is often outdated.
She covered some basic terminology to explain outbreaks, epidemics and pandemics, and went over historical examples, such as the Black Plague pandemic in Europe, and more recent ones such as the Ebola epidemic in West Africa. She also gave some estimates over how large a pandemic might need to be before its ripple effect throughout a population could bring life as we know to a halt. (The answer: Initially not that large, on the order of 15-20% of people affected directly, with a much larger, secondary ripple effect that spreads out and causes much greater disruption.)
A recurring theme throughout her presentation was the need to prepare NOW, rather than having to apply some form of ‘lifeboat ethics’ at the time of a major event, when ethical choices about who might receive treatment and who might not will always result in outcomes that are far less than ideal. Lifeboat ethics are always an exercise in tragic choices, in her words.
Dr Shanner also brought home some excellent points about how our own brains get in the way of being prepared, for an array of different reasons, such as our tendency not to pay heed to probabilistic predictions, being in denial of what might happen or what is happening around us (the latter witnessed during in the Ebola outbreak), and so forth.
Since the SARS outbreak, a whole body of work has sprung up that purports to provide ethical guidelines for public health preparedness and that outlines a framework for steps to take in reaction to events. She used these a couple of specific articles to go over some examples, and these articles turn out to be available online:
- R.E.G. Upshur, “Principles for the Justification of Public Health Intervention“
- J.F. Childress et al., “Public Health Ethics: Mapping the Terrain“
The response taken by public health officials needs to be effective, proportional, necessary, infringes on individuals as little as possible and can be justified publicly (in the Childress version). Upshur’s article has a similar framework that also includes the notion of reciprocity–how health care workers can be expect to be treated in return for potentially putting their lives on the line. Upshur also specifically invokes John Sutart Mill’s harm principle to help qualify how a public health response might need be formed.
There was much, much more discussed at Dr Shanner’s IPP talk, and I cannot go into all of it here. She started out with a disclaimer that she did not want to be alarmist, but the message in the end was clear: There is a great deal of work left to be done in the public health policy arena before we can consider ourselves well prepared, not just in developing nations, but also in those places that are considered reasonably well off, such as Canada.
Dinner at Asteras on Wesley Street after the talk was equally excellent, and a lively conversation continued until almost 9 PM. Overall, a wonderful evening and one that more than lived up to the expectations of an IPP talk!