Constructing an ethical framework for priority allocation of pandemic vaccines

被引：6

作者：

Fielding, J. ^{[1
,2
]}

Sullivan, S. G. ^{[3
,4
]}

Beard, F. ^{[5
,6
]}

Macartney, K. ^{[5
,7
]}

Williams, J. ^{[8
]}

Dawson, A. ^{[8
,9
]}

Gilbert, G. L. ^{[8
,9
]}

Massey, P. ^{[10
,11
]}

Crooks, K. ^{[10
,12
]}

Moss, R. ^{[13
]}

McCaw, J. M. ^{[1
,2
,13
,14
]}

McVernon, J. ^{[1
,2
,13
]}

机构：

[1] Univ Melbourne, Victorian Infect Dis Lab, Epidemiol Unit, Melbourne, Vic, Australia

[2] Royal Melbourne Hosp, Peter Doherty Inst Infect & Immun Melbourne, Melbourne, Vic, Australia

[3] Royal Melbourne Hosp, WHO Collaborating Ctr Reference & Res Influenza, Melbourne, Vic, Australia

[4] Univ Melbourne, Peter Doherty Inst Infect & Immun, Doherty Dept, Melbourne, Vic, Australia

[5] Sydney Childrens Hosp Network, Natl Ctr Immunisat Res & Surveillance, Westmead, NSW, Australia

[6] Univ Sydney, Sch Publ Hlth, Sydney, NSW, Australia

[7] Univ Sydney, Discipline Child & Adolescent Hlth, Sydney, NSW, Australia

[8] Univ Sydney, Sch Publ Hlth, Sydney Hlth Eth, Sydney, NSW, Australia

[9] Univ Sydney, Marie Bashir Inst Emerging Infect & Biosecur, Sydney, NSW, Australia

[10] Populat Hlth, Hunter New England Local Hlth Dist, Wallsend, NSW, Australia

[11] James Cook Univ, Coll Med & Dent, Townsville, Qld, Australia

[12] Charles Darwin Univ, Menzies Sch Hlth Res, Darwin, NT, Australia

[13] Univ Melbourne, Melbourne Sch Populat & Global Hlth, Modelling & Simulat Unit, Melbourne, Vic, Australia

[14] Univ Melbourne, Sch Math & Stat, Melbourne, Vic, Australia

来源：

VACCINE | 2021年 / 39卷 / 05期

基金：

英国医学研究理事会;

关键词：

Pandemic vaccine; Vaccine allocation; Vaccine ethics; Priority populations; PUBLIC-HEALTH; INFLUENZA;

D O I：

10.1016/j.vaccine.2020.12.053

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: Allocation of scarce resources during a pandemic extends to the allocation of vaccines when they eventually become available. We describe a framework for priority vaccine allocation that employed a cross-disciplinary approach, guided by ethical considerations and informed by local risk assessment. Methods: Published and grey literature was reviewed, and augmented by consultation with key informants, to collate past experience, existing guidelines and emerging strategies for pandemic vaccine deployment. Identified ethical issues and decision-making processes were also included. Concurrently, simulation modelling studies estimated the likely impacts of alternative vaccine allocation approaches. Assembled evidence was presented to a workshop of national experts in pandemic preparedness, vaccine strategy, implementation and ethics. All of this evidence was then used to generate a proposed ethical framework for vaccine priorities best suited to the Australian context. Findings: Published and emerging guidance for priority pandemic vaccine distribution differed widely with respect to strategic objectives, specification of target groups, and explicit discussion of ethical considerations and decision-making processes. Flexibility in response was universally emphasised, informed by real-time assessment of the pandemic impact level, and identification of disproportionately affected groups. Model outputs aided identification of vaccine approaches most likely to achieve overarching goals in pandemics of varying transmissibility and severity. Pandemic response aims deemed most relevant for an Australian framework were: creating and maintaining trust, promoting equity, and reducing harmful outcomes. Interpretation: Defining clear and ethically-defendable objectives for pandemic response in context aids development of flexible and adaptive decision support frameworks and facilitates clear communication and engagement activities. (C) 2020 Elsevier Ltd. All rights reserved.

引用

页码：797 / 804

页数：8

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