Prioritising access to pandemic influenza vaccine: a review of the ethics literature

Abstract

Background: The world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access.Main text: This paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing different groups as priorities (e.g. those with pre-existing health conditions, the young, the old, health care workers etc.). Different reasons were often suggested as a means of justifying such priority groupings (e.g. appeal to best overall outcomes, fairness, belonging to a vulnerable or 'at risk' group etc.). We suggest that much of the literature, wrongly, assumes that we are able to plan priority groups prior to the time of a particular pandemic and development of a particular vaccine. We also point out the surprising absence of various issues from the literature (e.g. how vaccines fit within overall pandemic planning, a lack of specificity about place, issues of global justice etc.). Conclusions: The literature proposes a wide range of ways to prioritise vaccines, focusing on different groups and 'principles'. Any plan to use pandemic vaccine must provide justifications for its prioritisation. The focus of this review was influenza pandemic vaccines, but lessons can be learnt for future allocations of coronavirus vaccine, if one becomes available.

The role of IS in the covid-19 pandemic: A liquid-modern perspective

“…Inherently mutable covid-19 case definitions (Bedford et al, 2020; ( Tsang et al, 2020 ) frequently reorder the course of action demanded of the people the definitions are designed to protect. Similarly, the common practice of ordering pandemic priorities is not necessarily desirable because ‘changing conditions lead to changing priorities’ ( Williams & Dawson, 2020 ). Implementation of control measures to combat virus spread are defined and imposed on a nation-by-nation basis ( Nanni et al, 2020 ).…”

“…The long-term is of little perceivable interest in liquid modernity. To mitigate adiaphorization decision-makers must consider the long-term impacts of control measures under significant pressures of real-time implementation and scrutiny, with ‘the most ethically contentious’ measures in pandemic-response typically those that require people to change their behaviour ( Williams & Dawson, 2020 ). A liquid-modern lens expects that those least able to contribute to liquid-modern priorities will fall further outside the scope of collective care during the crisis: in the context of control, it is ironically those groups perhaps least spatiotemporally impacted by pandemic control measures – the chronically poor ( UNICEF press release, May 2020 ), the homeless ( WIRED, April 2020 ), asylum seekers ( World Economic Forum, April 2020 ) and nursing home residents ( The Economist3, May 2020 ) – who suffer most during lockdown.…”

“…Liquid modernity’s uneven spread, particularly between developed and developing sectors and regions, implies that the emergent task for policymakers now is, in fact, to find local solutions for global problems ( Bauman, 2004 ; our italics ). The pandemic highlights this situation quite clearly when, for example, control measures reasonably suggested in one region are inappropriate for another or when vaccine research customarily assumes ‘the conditions of a liberal western democracy’ because the ‘overwhelming majority’ of pandemic vaccine literature originates in Europe and North America ( Williams & Dawson, 2020 ). Liquid differentiation ( Turner, 2003 ) intensifies the scaling complexity associated with all technological interventions and highlights regional differences in the rate of assumed modern progress, where developing nations maintain greater reliance on solid infrastructures, with developed nations evidently more liquid.…”

“…In the context of the pandemic, we must make distinctions between what we must try to control, and what we should not even try to control. The common pre-vaccine prioritisation of groups for vaccine access, for example, can be fatally counterproductive as conditions change ( Williams & Dawson, 2020 ). With our temporal horizon effectively “framed” by the present, postponing pandemic mitigations based on any prioritisation criteria is fraught with danger.…”

“…All control measures, while potentially stimulating benefit in one area, will necessarily destabilise another. Country of residence, for example, will likely become ‘a significant contributing factor’ determining access to vaccine ( Williams & Dawson, 2020 ). If solid interventions, structures and systems are designed with the knowledge that they are being undermined, conceptualisations of the optimal balance between solidity and liquidity may be inspired.…”