ReviewPublic engagement on ethical principles in allocating scarce resources during an influenza pandemic
Introduction
Pandemic influenza preparations have set the stage for hard choices to be made about who will receive scarce resources, including antivirals, vaccines and critical care, and who will not. When a plentiful supply exists, the allocation of many health related resources in health care systems such as Canada's (where physician and hospital services, including many public health services, are provided by a publicly funded and administered health care system) is made to those who have the greatest need for them. However, in extreme circumstances, such as pandemic influenza, the basis for allocating resources that are scarce may be based upon very different ethical principles. Whether or not allocation decisions are supported by the population will largely depend upon shared values, if those exist. The authors of this paper were members of the University of Alberta's Public Health Response Committee. This committee's mandate included developing a pandemic plan for a large western Canadian university. As part of the development of this plan, we created and administered a survey to, in part, solicit opinion on acceptable bases for allocation decisions.
Section snippets
Methods
A web-based questionnaire was designed and distributed on September 20, 2006 via email to all students, support staff and academic staff at the University of Alberta in Edmonton, Canada as part of the University's planning for pandemic influenza [1]. An e-mail reminder was sent on October 2, 2006 and data collection ceased on November 2, 2006. Two of the questions related to health care resource allocation during a pandemic. The first requested respondents to individually rank the priority of
Results
The web-based questionnaire was e-mailed to 40,086 individuals and had a 13% response rate (5225 respondents) that was higher for females (15.9%; 3657/23,044) than for males (8.9%; 1521/17,029). Five respondents were excluded because of age reporting errors yielding 5200 for analysis. A range of 93.5% (4882/5220; politicians group) to 94.5% (4934/5220; health care group) of the respondents answered the question on ranking the priority of eleven groups. Five percent (273/5220) of the respondents
Discussion
As part of planning for pandemic influenza, the WHO called for detailed work to be done on the prioritization of scarce resources, and in particular, the allocation of vaccines and antivirals, in a 2004 report developed out of a consultation held in 2002 [2]. It provided guidance in that report with explicit examples of goals that could be set (i.e. reduction of mortality) as well as suggested priority groups (i.e. essential service providers) to be considered. It acknowledged that different
Conclusion
Decision-making regarding scarce resources before and during a pandemic influenza must be based on the best scientific evidence available. Prioritization must be subject to changes based upon newly available information. However, even with the best evidence, such decisions are inherently ethical in nature. Decisions must be made in a just way. In working towards a just distribution, we must engage the public. What will and will not be accepted by our communities will largely depend upon whether
Acknowledgements
The authors wish to thank Lawrence Gostin and Tim Caulfield for reviewing a draft of this manuscript and providing very thoughtful feedback. Thanks are also owed to Gergely Hegedus and Elizabeth Robertson, who provided research assistance. Finally, we wish to thank Anna Kuranicheva for providing editorial assistance.
Competing interests: The authors declare that they have no competing interests.
References (29)
- et al.
Triage in medicine, part II: underlying values and principles
Ann Emerg Med
(2007) - et al.
Are you prepared to deal with a high-risk respiratory illness?
J Emerg Nurs
(2007) - Office of the Vice-Provost (Information Technology). Questionnaire on knowledge and attitudes towards pandemic...
WHO guidelines on the use of vaccines and antivirals during influenza pandemics
(2004)- et al.
Priority setting for pandemic influenza: an analysis of national preparedness plans
PLoS Med
(2006) - et al.
Pandemic influenza preparedness: an ethical framework to guide decision-making
BMC Med Ethics
(2006) - et al.
Ethics in a pandemic: a survey of the state pandemic influenza plans
Am J Public Health
(2007) Medical countermeasures for pandemic influenza: ethics the law
JAMA
(2006)- et al.
Justice, health and healthcare
Am J Public Health
(2008) A theory and definition of public health law
J Health Care L & Pol’y
(2007)