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In the event of a global flu outbreak, some government leaders could have higher priority to receive vaccines than infants and toddlers.

Think that's unfair? Morally wrong? Or the right move to keep leadership intact?

The Pima County Health Department wants to know your opinion.

The department, which has been preparing for the possibility of a massive pandemic flu outbreak for more than four years now, is adding a new component to its plan — input from the public.

Department officials held a private meeting and discussion Saturday about the ethics involved in handling an outbreak with about 65 community members, including neighborhood leaders and local activists. At least two ethicists from Tucson hospitals also attended.

The health department is also asking the public at large to help by filling out a questionnaire on its Web site.

It asks respondents to answer such questions as how to rank the types of patients hospitals should admit first in the event of a pandemic — should it be according to who is most sick, or by occupation, first-come first- served, youngest to oldest, by insurance, by who is most likely to improve with care?

Increased awareness about some of those difficult choices is another department goal.

"If people understand what's going on, there's a bigger chance of buy-in, if and when if happens," said Dr. Michelle McDonald, the department's chief medical officer.

"There will be three major ethical issues — short supplies of critical things, restrictions of freedom (as) places will be closed, and there will be personal and community interests to balance."

A pandemic creates unique issues for jurisdictions trying to handle widespread illness in their communities.

Primarily, it means they won't be getting help from other places. It could mean shelves in grocery stores aren't restocked, gas is in short supply, and cities won't be able to operate as normal because of ill employees.

"Many people will be asked to make choices," McDonald said.

The scenario isn't hypothetical. History shows between two and three pandemic flu outbreaks every century, with variations of severity.

The last one occurred in 1968. That outbreak, often called the "Hong Kong flu," resulted in 34,000 deaths in the U.S.

In 1957 and 1958, the "Asian flu" resulted in 70,000 U.S. deaths.

The worst pandemic flu in the last century was the 1918 "Spanish flu," which infected between 30 and 40 percent of the population and resulted in more than a half-million deaths in the United States and between 20 million and 100 million deaths worldwide.

"Is there going to be another pandemic? Yeah, there is absolutely, no question," said Dr. Bob England, director of the Maricopa County Health Department.

"If it gets going, it's going to go very fast. … But panic does not have to happen if you communicate well, tell the truth and give people something rational to do."

Health officials recommend that individuals and families have an emergency plan, including an emergency supply of water and both human and pet food, and a comprehensive first-aid kit.