The ethical considerations of primordial pandemic prevention from a one health perspective.

Background: The coronavirus disease 2019 (COVID-19) pandemic has left a devastating global toll. As such, there is a strong impetus to prevent future global pandemics. Ethical considerations are an integral element of pandemic preparedness and response plans and should be incorporated into any pandemic prevention plan to explicitly examine the incorporated values from various stakeholders. Our study aims to determine the ethical considerations of primordial pandemic prevention from a One Health perspective.

Methods: This was a prospective Delphi consensus seeking-study. We aimed to recruit a purposive, globally representative sample of experts in the fields of public health ethics, One Health ethics, pandemic ethics and pandemic prevention. Two rounds were completed between November 2021, and January 2022. The first round consisted of open-ended questions to establish ethical considerations for primordial pandemic prevention. Thematic analysis was used to uncover themes. The second-round presented the ethical consideration results of the first round, and asked participants to rate the importance of each of them.

Results: The first-round had 27 participants, and the second-round had 25 participants. Both rounds had global representation from all intended fields of expertise. There were five ethical considerations for which consensus was achieved: Promoting equity, global collective effort, distributive justice, evidence-based efficiency and the interconnectedness of humans, animals and the environment.

Conclusions: Our study identified five ethical considerations for primordial pandemic prevention from a globally representative sample. The findings will contribute to current and future pandemic prevention policy, and expand ethics research in the fields of One Health, pandemic prevention and zoonotic disease control.