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Pandemic Vaccination: Who to Vaccinate?

Fears of the spread of pandemic influenza in the UK continue to grow. Three apparently previously healthy patients have died here. There are now plans for widespread immunisation later in the year – though initially this is likely to be restricted to those at highest risk, and those in 'vital' professions.

Who should be vaccinated? This is a question of distributive justice.

Initially, there will be insufficient vaccine to vaccinate everyone.

Computer models of infectious disease can now predict how a disease like influenza will spread under various strategies of distribution of vaccines or drugs like Tamiflu. The Institute for Emergent Infections has done this kind of modelling for Tamiflu. The results are striking. The most lives are saved if the drug is used quickly and widely at the beginning of an epidemic, even risking early run out.

Of course, saving the most lives may not be our highest priority. We might wish to give priority to those in greatest need, or those most likely to die, or to those who will be treating the sick.

Science can tell us a disease is likely to spread, and who is likely to die but it cannot tell us who should die. That is an ethical question. (See Arinaminpathy, N., J. Savulescu, McLean, A. (2009). "Effective use of a Limited Antiviral Stockpile for Pandemic Influenza " Journal of Bioethical Inquiry 6(2): 171-179.) It depends on a theory of justice.

In my view, we should distribute vaccines to save the most lives. But that is not the dogma of the NHS. The NHS is egalitarian: it holds to a principle of equal treatment for equal need. Distributing vaccines according to a principle of need may have the outcome that more people die.

What these debates need is good science to tell us how many excess deaths will result under various theories of distributive justice.

Until we face up to the numbers of people who die for the sake of our own particular moral code, we are not really doing practical ethics.

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