In this activity, we will discuss the fundamental values that leaders in community health contexts should consider. There are no solutions-- only tradeoffs! How would you defend each value against the alternatives?
For the past several months there has been a sustained human-to-human transmission of a novel strain of avian influenza. Your community was first affected three weeks ago, and since then, there have been over 500 cases and 50 deaths. Tamiflu is the only drug that may effectively reduce the mortality of ill patients and limit infection of exposed persons. It is considered somewhat effective, particularly if given within the first 48 hours of exposure, but becomes less effective if given later. Supplies of oseltamivir are limited, and hospitals across the country are independently making decisions to govern the allocation of antivirals within their institutions. In your community, the six major academic medical centers have recently established six different protocols regarding prioritization of access to care:
HOSPITAL A: Workers First
Recognizing the importance of protecting its workforce in order to minimize absenteeism and ensure continuous response capacity, Hospital A has decided to use its remaining cache of oseltamivir for prophylaxis of staff who are exposed while caring for influenza patients.
HOSPITAL B: Sickest First
In an effort to save its very ill patients, Hospital B has decided to reserve its remaining cache of oseltamivir for treatment of the sickest influenza patients.
HOSPITAL C: Maximum Life-years
In order to maximize survival rates, Hospital C has decided to reserve its remaining cache of oseltamivir for treatment of the patients most likely to benefit, namely those who present within 48 hours of disease onset.
HOSPITAL D: First Come, First Served
Assuming that its cache of oseltamivir will soon be depleted regardless of distribution strategy, Hospital D is using the antiviral for prophylaxis of exposed staff and treatment of all probable and confirmed cases, regardless of severity.
HOSPITAL E: Youngest First
Recognizing that it will not be able to treat all presenting patients Hospital E has decided to give priority to younger patients because they have had fewer years of life and if they die it is a greater loss.
HOSPITAL F: Market
Unable to gauge the true demand for oseltamivir, Hospital F establishes a market for the distribution of the drug and sells a portion of the supply each day to whomever can pay the most. This auction approach will provide funds that enable Hospital F to care for patients who cannot afford to purchase oseltamivir.