Access to Vaccines

Make and analyze decisions about a fictional flu scenario

Note: This scenario is based on a story line written prior to the COVID-19 pandemic. While similarities with the current conditions exist, this is a fictional exercise. However, this exercise may be upsetting to some people based on their personal experiences with the pandemic and loss. Please participate in an atmosphere of mutual respect and sensitivity.

Read the scenario and come to a decision on your own. Be prepared to explain how you reached your decision.

Scenario

A severe worldwide outbreak of a respiratory virus has occurred. It threatens everybody in your community—healthy young people as well as the very old and very young. The elderly, however, are more likely to die from complications from the virus. You cannot count on receiving federal assistance during this pandemic. This deadly flu has already killed people in your community and exposure to the flu is expected. A vaccine for the virus is being developed and your community is making decisions about how the vaccine can be given out in a fair way. There are enough vaccines to treat more than half of the community members during this wave of the pandemic.

There are ten people who require the vaccine at this time, and you can only treat six. The four individuals who do not receive the vaccine will have to wait, which will put them at risk of severe sickness or death. Which six should receive the flu vaccine?

Woman who thinks she is six weeks pregnant (counts as one person)
Person with diabetes
Nurses’ aide who works at a nursing home
Senior citizen who has 15 grandchildren
Thirteen-year-old twins
Doctor
Elementary school teacher
A person experiencing homelessness who is living in a shelter
A rural rancher

Flu Scenario Student Sheet

Open the Flu Scenario Student Sheet, make a copy of it, and fill it out.

If possible, compare your results with those of some classmates. Who did they choose? Why?

You do not need to agree on the answers but pay attention to differences in viewpoints and opinion.

As always, treat each other with respect.

Ethical Questions

Were those decisions difficult to make? Would you have liked more information? Could you see how reasonable people might disagree with your answers? Did it seem there are no clear right and wrong choices?

Congratulations, you have just wrestled with an ETHICAL QUESTION.

“Who should be saved during a flu outbreak when there is not enough vaccine available for everybody? “

This is considered an ethical question because it has the following components:

Ethical questions often involve the words “ought” or “should,” implying a difficult decision must be made.
There are several alternate solutions, none of which is without some challenging or problematic aspect.
They contain conflicting moral choices and dilemmas, and the underlying values of the people involved may clash.
They have no right or wrong answer which satisfies all parties, but better or worse answers based on well-reasoned justifications.

Source: Bioethics 101, NWABR.org

Learn from the Experts

The COVID-19 pandemic has led to conversations about how a vaccine should be distributed when available. In October 2020, a committee from the National Academies of Sciences considered lessons learned from earlier outbreaks of influenza and Ebola to create a framework that would help individuals make reasoned judgements when holding a diversity of viewpoints and opinions. The committee published the framework to help health authorities make decisions about the best course of action. They relied on ethical principles to guide their approach.

A Framework for Equitable Allocation of COVID-19 Vaccine

Ethical Principle:

Maximum Benefit

What it is:

Doing the most good for people, while also doing the least amount of harm

What this means:

Reducing severe sickness, death, and negative social impacts from COVID-19 for the greatest number of people; improving length of life after treatment.

Ethical Principle:

Equal Concern

What it is:

Considering and treating every person as having equal worth, dignity, and value; protection from discrimination.

What this means:

No rationing based on religion, race, ethnicity, national origin, disability, and other considerations. People providing vital functions such as health care workers can be prioritized.

Random selection (i.e. lottery) is allowed if all things are equal.

Ethical Principle:

Mitigation of Health Inequities

What it is:

Giving priority to those who are worse off and at higher risk.

What this means:

Acknowledging that the virus has significantly harmed some populations more than others. This would prioritize groups of people with higher rates of infections, serious illness, and death rates. Among these groups are older adults in group living settings, people of color, and people with pre-existing health conditions such as diabetes.

Source: A Framework for Equitable Allocation of COVID-19 Vaccine." National Academies of Sciences, Engineering, and Medicine. 2020. Framework for Equitable Allocation of COVID-19 Vaccine. Washington, DC: The National Academies Press. doi: 10.17226/25917.

Using the ethical framework, the committee developed a multi-phased approach to delivering the COVID-19 vaccine:

Are you curious about the rationale used for each phase? You can read a lot more about it here.

Support or Revise Your Decisions

Use the approach outlined by the experts to revise or defend the choices you made earlier. Use the Flu Scenario Student Sheet you copied for your answers.

Are there any other principles of ethics or fairness you would add? You might consider the principles of Respect for Persons or Care.

Next: Part B -- Insulin

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