Elsevier

Vaccine

Volume 29, Issue 17, 12 April 2011, Pages 3111-3117
Vaccine

Review
Public engagement on ethical principles in allocating scarce resources during an influenza pandemic

https://doi.org/10.1016/j.vaccine.2011.02.032Get rights and content

Abstract

Objectives

To investigate the views of students, support staff and academic staff at the University of Alberta in Edmonton, Canada on the allocation of scarce resources during an influenza pandemic to discover if there were any shared values.

Methods

A web-based questionnaire was circulated to students, support staff and academic staff asking them how they would rank the priority of eleven different groups for access to scarce resources. They were also asked to select one of seven priority access plans.

Results

The highest priority was given to health care workers by 89% of respondents, closely followed by emergency workers (85%). Only 12.7% of respondents gave politicians high priority. Respondents favored the “Save the most lives” priority access (39.9%) (N = 5220).

Conclusion

Current policies in place for the allocation of scarce resources during an influenza pandemic may not properly reflect the views of the general public. Further public consultation should be undertaken in order to uncover how they would allocate scarce resources.

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.

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