One aspect of planning for pandemic influenza is deciding who will be prioritised for scarce pandemic vaccine. Vaccine production cannot begin until the pandemic virus strain is identified and initial production will be insufficient to meet demand. While governments plan to vaccinate everyone who wants it, decisions must be made about who to vaccinate first. Many different strategies are suggested with different operational requirements and ethical characteristics; most involve prioritising the medically vulnerable, i.e. directly protecting those most likely to become seriously ill with pandemic influenza. An alternative strategy is to employ a vaccination distribution strategy that explicitly aims for population benefits rather than individual protection. This involves prioritising the vaccination of those groups most likely to spread pandemic influenza, such as primary school children, with the aim of indirectly protecting the population from infection. These distribution strategies differ markedly in how they distribute the benefits, burdens and risks of infection and immunisation across population at a time of public health emergency.
The aims of vaccination programs are value-based because they involve decisions about who and what is most important. In a pandemic, aims might include protecting vulnerable people, ensuring fair access, saving the most lives, protecting the most people, and maintaining social order. Taking into account the different barriers and facilitators for effective implementation, we assess ethical justifications for and against direct and indirect protection strategies for pandemic influenza vaccine in light of these different aims in the Australian context.