Crafting a rational pandemic vaccine allocation policy: Evaluating alternative approaches

Supplies of vaccines for pandemic diseases, such as avian influenza, will likely be limited immediately following an outbreak. Therefore, initial supplies will have to be allocated among potential recipients until sufficient quantities become available. Advance planning for allocation is essential as a disease could spread rapidly nationwide. Moreover, a pandemic presents not only health risks but also significant economic and strategic threats. A task force of the Department of Health and Human Services is developing national guidelines based primarily on the need to safeguard defense and security. However, this is only one approach to prioritization. Competing approaches can best be differentiated based on four underlying bioethical values on which they rely. Beneficence, the imperative to do good for others, calls for helping individuals most in need. Nonmaleficence, the dictate to avoid causing harm, advises against inappropriate decisions that divert supplies from optimal uses. Justice, the directive to allocate scarce resources equitably, requires a process that is fairness and reasoned. Utilitarianism, the principle of doing the greatest good for the greatest number of people, favors allocations that protect society overall without regard for individual need. Given the potential threat to the entire country's manpower infrastructure, policy considerations would favor utilitarianism. However, optimal protection requires that it be applied more broadly than the DHHS task force has done. Priority categories should include those who represent the greatest threat of contagion, including health care workers and public health personnel, and should also include some vulnerable people for their own safety.