The WHO urges all countries to have a pandemic influenza plan in place and suggests that planners must consider ethical issues raised by responses to a pandemic. Some countries have developed plans, but few attend to ethics of vaccine rationing. The literature offers normative arguments for this purpose but they tend to focus on generalities and are insufficiently sensitive to context. We build upon the findings from our review of the literature and propose a new framework for prioritising pandemic vaccines.
We suggest that due to the unpredictability of virus characteristics, uncertainties in vaccine development, efficacy and effectiveness of the vaccine, as well as the potential differing impact on different population groups, no single answer as to how to guide priorities for pandemic vaccines can be produced in advance. Instead we propose a staged framework as follows: Step 1: define a set of procedures that must necessarily underpin resource allocation in pandemic situations as a foundational requirement (this can be proposed and discussed in advance). Step 2: define a clear aim or set of aims for the pandemic vaccination programme (this can be debated in advance, but can only be finalised once the nature of the virus and vaccine are known). Step 3: propose a flexible and dynamic set of questions to guide decision making about priorities. Some priorities may be determined in advance of a pandemic, e.g. where there are important and ongoing commitments to certain groups. Others will be decided in view of the particular pandemic situation.