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When resources used in the community setting are scarce (e.g., personal protective gear, treatments, vaccine), devise a method for a just distribution.

  • As part of pandemic influenza planning, policymakers should establish a process for setting priorities and promoting equitable access. WHO Ethics in Pandemic Flu
  • The distribution of goods should be guided by criteria specified well in advance of any need to apply them. CDC Ethics in Pandemic Flu
  • Ensure that reasonable alternative options are considered and evaluated, and that final public health policies and plans are designed to most effectively accomplish stated goals while minimizing the potential for harm. APHA Code of Ethics, 4.5.9.
  • [Consider] the likelihood that an individual with disease will experience a medical benefit if provided treatment. WHO Ethics in Pandemic Flu
  • [Consider] the likelihood that an individual at risk of in­fection will become infected/ill if prophylaxis is not provided. WHO Ethics in Pandemic Flu
  • [Consider] the likelihood that an infected individual will infect other persons if not given access to treatment or prophylaxis and infection control measures. WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing groups of people known to be cen­tral to spreading infection or “super-spreaders” (if this strategy is expected to be effective). WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing persons at increased risk of death if infected. WHO Ethics in Pandemic Flu
  • Propose prioritization criteria related to the maintenance of a functioning health-care sys­tem as needed in a crisis situation. WHO Ethics in Pandemic Flu
  • Consider giving priority to essential health-care workers, other workers who provide life-saving services, workers who provide critical services nec­essary for society to function as normally as possible. WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing health-care workers and other essen­tial service providers to help sustain the health-care system. WHO Ethics in Pandemic Flu
  • Where the primary objective is to preserve the function of society, it is necessary to identify certain individuals and groups of persons as ‘key’ to the preservation of society and to accord to them a high priority for the distribution of certain goods such as vaccines and antiviral drugs. CDC Ethics in Pandemic Flu
  • Age-based prioritization criteria should be adopted only after wide public consultation. Such criteria should rely on broad life stages, rather than rank­ing individuals based on differences of only a few years. WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing children and young adults based on the fair innings argument. WHO Ethics in Pandemic Flu
  • Facilitate access to the highest level of treat­ment possible given available resources, with careful attention to the needs of all populations. WHO Ethics in Pandemic Flu
  • Policymakers should ensure that criteria for prior­ity setting do not discriminate against individuals based on inappropriate characteristics, including but not limited to gender, race and ethnicity, religion, political affiliation, national origin, or social or economic status. WHO Ethics in Pandemic Flu
  • Some theoretical distribution criteria that would generally not be ethically supported are: to each according to purchasing power; to each according to what he or she deserves; first come, first served; race, ethnicity, religious belief, gender, sexual orientation, or IQ. CDC Ethics in Pandemic Flu
  • Recognize and act upon the fact that the ethical obligation to provide access to health care is not limited to persons with citizen status only. APHA Code of Ethics, 4.7.6.
  • Even when access to treatment or prophylaxis is limited, the public is entitled to timely and accurate information. WHO Ethics in Pandemic Flu
  • The primary goals of the distribution system should be clearly specified. CDC Ethics in Pandemic Flu
  • An effective communications strategy should be developed to ensure a transparent priority setting process. University of Toronto
  • Governments and the health care sector should publicize a clear rationale for giving priority access to health care services, including antivirals and vaccines, to particular groups, such as front-line health workers and those in emergency services. The decision makers should initiate and facilitate constructive public discussion about these choices. University of Toronto
  • Governments and the health care sector should engage stakeholders in determining what criteria should be used to make resource allocation decisions, should ensure that clear rationales for allocation decisions are publicly accessible, and should provide a justification for any deviation from the pre-determined criteria. University of Toronto
  • [Healthcare institutions] should ensure that providers understand policies regarding the prioritization and utilization of antivirals and vaccines. Indiana University
  • Promote openness among the government, nongovernmental entities, and the public regarding resource allocation and performance improvement. APHA Code of Ethics, 4.12.3.
  • Governments and the health care sector should ensure that there are formal mechanisms in place for stakeholders to bring forward new information, to appeal or raise concerns about particular allocation decisions, and to resolve disputes. University of Toronto