Get the shot…

This is a hypothetical situation. Any resemblance to fact is coincidental.

A virulent strain of influenza sweeps across the country. While the vaccine is quite effective in preventing infection in people who receive it, vaccine uptake is not high this year, and Emergency visits for respiratory infections have skyrocketed. Unfortunately, an unusually high number of those who get sick from this strain end up in critical condition, requiring some level of respiratory support. ICUs are full and hospitals have invoked contingency measures such as surgery cancellations and early discharges to manage the influx.

With no peak in sight, it becomes clear that the system will need to make some decisions about who will receive access to critical care beds and supports like vaccine and ventilators.  There will  be difficult conversations about who can and cannot be saved.

Questions for discussion and consideration:

1. How should we decide which of two (or more) patients will receive access to a limited resource such as a ventilator? What criteria should be considered?
2. How might we increase vaccination rates? What will we need to think about as we discuss options such as mandatory vaccinations?
3. What do we need to have in place to support patients, families and staff when we have a life-and-death need that severely outstrips availability?

Resources

There are a number of frameworks and tools to support decision making in public health emergencies such as pandemics and disasters. View the National Collaborating Centre for Healthy Public Policy resource on public health ethics for more information.

Resource allocation decisions are difficult but they can be supported by having effective allocation policies in place before an emergency. Daniels and Sabin’s Accountability for Reasonableness framework provides a good basis for development of ethical policies. See this adaptation by the Royal Victoria Regional Health Centre in Ontario.

See also our case from a few months ago, about allocating drugs during a shortage.