Ethical Approaches to Distribution of Vaccines and Drugs during Pandemic
The World Health Organization publication, “Eleventh Futures Forum on the Ethical Governance of Pandemic Influenza Preparedness” was inspired by the progressive threat from influenza viruses. However, these concerns stem from the ethical perspective in regards to the need for unbiased preparedness plan. For instance, the US national strategy for pandemic flue includes detection and monitoring of outbreaks globally, protecting the American citizens by stockpiling vaccines and antiviral drugs while improving the capacity to produce new ones, and preparedness to respond at local, state, or federal levels in case of an outbreak. While the strategy may meet the ethical criteria established by the WHO, it falls short of capturing other critical elements that may raise ethical concerns, specifically the provision for fairness (WHO, 2008). According to Blumenshine, Reingold, Egerter et al. (2008), different socioeconomic and racial and ethnic groups are exposed to social factors that shape their exposure and vulnerability to influenza virus and timelines and adequacy of treatment. An ethical preparedness plan must call to attention avoidable disparities from such factors through consideration of their potential sources at all levels.
The US distributes vaccines on a seasonal basis, but ethical issues have been raised in regards to disruptions of supplies that place some segments of the population at risk. Respective authorities have responded by pushing manufacturers to scale up the production process with specific emphasis on the technologies needed for different formulations needed by different demographic groups. The UK model emphasizes on ethical handling of the vaccines by outlining storage requirements, ethical ways of procuring centrally purchased vaccines and restrictions for their use, recommendations on stock management and prevention of hazards. In the Russian Federation, vaccine distribution during pandemic is impaired by vaccine hesitancy, a situation compounded by the fact that vaccine hesitant individuals are heterogeneous group comprising of parents, guardians, and health or public workers with reservation about certain vaccines or vaccination in general (RVF, 2017). Spain faces the predicament of inefficient distribution of vaccines in healthcare setting as healthcare personnel od not follow the annual vaccination recommendation for influenza (Domínguez, Godoy, Castilla et al. , 2013), and the low rates of vaccination among the elderly admitted to hospital (Domínguez García, Soldevila, Toledo et al. , 2016).
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Ethical Models Represented by Each Country’s Thinking
The US model of distribution emphasizes of collaboration where optimal access and uptake of vaccines during pandemic is ensured through strong partnership between private firms, regulatory bodies, and international public health stakeholders (Smith, Lipsitch, & Almond, 2011). The US policy towards influenza pandemic is that what affects an individual, affects the whole population if not mitigated. The thinking by the UK can be translated to represent good-decision making where openness, transparency, accountability, and reasonableness are considered paramount to the success of the distribution process. It is evident that the Russian ethical model focuses on treating people with concern and respect by recognizing that everyone matters and has a right to access treatment, the need to keep people informed, and respect of people’s choices. It would be easier to forcibly vaccinate individuals and children whose parents object to the process, but that would be unethical hence the emphasis on informed consent from such hesitant individuals. It is imperative that the Spanish ethical model focuses in keeping things in proportion through provision of accurate information and action that corresponds to the benefits and risks of vaccination. Efforts should be directed towards reduction of misconceptions about vaccines in addition to dissemination of knowledge on benefits.
Ethical Challenges that May Face Countries when the Need for Collaboration Occurs
It is evident that each of the four countries faces a different challenge to its vaccine distribution. The US, being the global superpower recognizes the need for collaboration in good faith to advance a common cause. However, such efforts are limited by policies governing the distribution of vaccines in the respective countries. Such policies are usually developed to address national challenges and fall short of achieving similar outcomes in a global scale. In addition, the need for collaboration may be impeded by the socioeconomic and ethnic and racial parameters highlighted in Blumenshine, Reingold, Egerter et al. (2008) that cause disparities among populations in the respective countries. Measures that have proven to be ethically acceptable for instance in the US may not yield desirable results if the same outbreak occurs in Russia because of cultural differences that influence perceptions of members of the public, and hence ethical considerations by health and public stakeholders in development of policies. For this reason, fairness is difficult to achieve. In addition, technologies for production of needed vaccines may only exist in a single country and the firm contracted to produce the vaccine or drug may be incapacitated by the high demand. This may force selective distribution of the vaccines in contravention of the WHO guidelines for fair and equal treatment.
Measures for Addressing the Challenges
There may be significant ethical challenges where collaboration is needed, but partnerships in cases of global outbreaks are the best option in containing the flu. The WHO publication represents a good start, but recommendations need to be adopted and put into practice to avert potential challenges. Working together must facilitate smooth flow of mutual aid, sharing of information, personal responsibility. Since it is impossible for collaborators to come to the table as equal partners, reciprocity is crucial to guarantee support to those who take increased risk during the pandemic. It is necessary that stakeholders approach the aspect of working together with an open mind for flexibility in adapting to new information and changing scenarios. It is also important to recognize the role of the public in addressing some of the ethical challenges. Participation of the public in policy making is of paramount importance to reduce cases such as vaccine hesitancy that may exacerbate the pandemic. A universal framework must be developed by stakeholder, but it should be comprehensive and flexible to allow modification to suit the needs of target populations. This also requires recognition of the disparities in the population and channeling power and resources based on the risk of vulnerability.
References
Blumenshine, P., Reingold, A., Egerter, S., Mockenhaupt, R., Braveman, P., & Marks, J. (2008). Pandemic influenza planning in the United States from a health disparities perspective. Emerg Infect Dis , 14 (5).
Domínguez García, À., Soldevila, N., Toledo, D., Godoy i García, P., Castilla, J., Force, L., ... & Martín, V. (2016). Factors associated with influenza vaccination of hospitalized elderly patients in Spain. PLoS ONE, 2016, vol. 11, núm. 1, e0147931 .
Domínguez, A., Godoy, P., Castilla, J., Soldevila, N., Toledo, D., Astray, J., ... & Martín, V. (2013). Knowledge of and attitudes to influenza vaccination in healthy primary healthcare workers in Spain, 2011-2012. PloS one , 8 (11), e81200.
RVF. (2017). RVF and Russian health officials address vaccine hesitancy in Russia. http://rostropovich.org/rvf-and-russian-health-officials-address-vaccine-hesitancy-in-russia/.
Smith, J., Lipsitch, M., & Almond, J. W. (2011). Vaccine production, distribution, access, and uptake. The Lancet , 378 (9789), 428-438.
World Health Organization. (2008). Eleventh Futures Forum on the ethical governance of pandemic influenza preparedness. In Eleventh Futures Forum .
