On the random distribution of scarce doses of vaccine in response to the threat of an influenza pandemic: a response to Wardrope

When the first vaccine arrived: An investigation of factors that influenced the intention of health care workers in the national health system of Greece to be vaccinated against the SARS COV-2 virus during the first trimester of vaccine arrival

BACKGROUND

COVID-19 vaccination started in Greece in the last days of December 2020. Health care workers (HCWs) of the public national health system (NHS) were on the frontline and they would be role models for all the citizens.

AIM

Investigation of the intention and hesitation of HCWs (doctors, nurses, and nursing assistants) of the NHS of Greece, regarding the vaccine against SARS COV-2 virus and the factors that affect them, during the first trimester of the availability of vaccines, in the country.

METHODS

A multicenter cross-sectional study was conducted in Greece among health professionals (n = 2484) of the NHS. Data were collected with the use of an online questionnaire through snowballing sampling.

RESULTS

Acceptance of a safe and effective COVID- 19 vaccines was higher among doctors (85.6%), followed by nurses (66.3%), and nursing assistants (64.1%). This study confirms pre-existing research on the interaction of gender, age, quality of personal information, educational level, training by the employer, and cognitive background regarding viruses and vaccines.

CONCLUSION

In conclusion, our study showed that once a vaccine was available, most HCWs were willing to be vaccinated. These findings could be used in the future to tailor communication and promotion campaigns, using anthropocentric strategies.

Ethical values and principles to guide the fair allocation of resources in response to a pandemic: a rapid systematic review

Background

The coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic.

Methods

A rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically.

Results

A total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty.

Conclusions

Allocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00806-8.

Why should HCWs receive priority access to vaccines in a pandemic?

Background

Viral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers (HCWs) should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.

Main text

In this article, we critically evaluate the most common ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.

Conclusions

We argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs.

Prioritising access to pandemic influenza vaccine: a review of the ethics literature

Background

The world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access.

Main text

This paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing different groups as priorities (e.g. those with pre-existing health conditions, the young, the old, health care workers etc.). Different reasons were often suggested as a means of justifying such priority groupings (e.g. appeal to best overall outcomes, fairness, belonging to a vulnerable or ‘at risk’ group etc.). We suggest that much of the literature, wrongly, assumes that we are able to plan priority groups prior to the time of a particular pandemic and development of a particular vaccine. We also point out the surprising absence of various issues from the literature (e.g. how vaccines fit within overall pandemic planning, a lack of specificity about place, issues of global justice etc.).

Conclusions

The literature proposes a wide range of ways to prioritise vaccines, focusing on different groups and ‘principles’. Any plan to use pandemic vaccine must provide justifications for its prioritisation. The focus of this review was influenza pandemic vaccines, but lessons can be learnt for future allocations of coronavirus vaccine, if one becomes available.