Although I will most likely go down in winter forum history as the girl that would readily kill her “65 year old retired grandpa over a ‘more useful and potentially productive’ 5 year old,” the entire discussion on rationing and dictating who receives vaccines (and in a sense who determines who lives or dies) was very eye-opening. Doctors have long been said to have “God complexes” and criticized for this mentality. However today when you think of it, we were indeed playing the role of a higher power who had to dictate who was worthy of living. It was easy to laugh some of the comments off at the forum in order to take some of the weight from our shoulders. However, when we went into our breakout sessions we soon learned that being put into this decision is certainly stressful and I left the room with my head spinning, doubting whether I knew what criteria for selection was most important to me personally. The easy way out, would just be to give up and pray and hope for the best. However I think it is crucial, with each day new strains of viruses and spread being aided through the growth of infrastructure and commerce, the chances of another pandemic breaking out is likely. I also think it is important to put these measures in place because (just as Dr. Rosoff touched on a little through questions) in the end the people who end up having to make tough decisions (like in the case of Hurricane Katrina as he also spoke about) may be held accountable when the “wrong people are picked” or when socially unacceptable or pleasant decisions are made. Although it doesn’t sound pleasant, but I feel in the case of a pandemic there must be an acceptable loss of life and that we must set up a better system of who receives vaccines. If not, everyone loses in the end. Just some of the many thoughts that were swirling around up in my head.
During today’s first session, we talked about the consequences of “overpreparing” for a potential pandemic. Millions of vaccines have to be thrown away, which is a huge opportunity cost. The funding allocated for such vaccines could have been used for other health efforts, such as reducing national obesity rates, finding a cure for cancer, and general public health efforts. I have two questions that I want to pose. First of all, how do we reduce the costs of pandemic preparedness and vaccine/antiviral drug production? Secondly, how can we reduce general healthcare costs in the United States so that we can ensure a more equitable healthcare system that discriminates less against those who are poor?
Dr. Philip Rosoff, eloquently spoke about the ethical and moral obligation to provide palliative care for victims from the “pandemic”. However, he cautions that this isn’t an endorsement of euthanasia.
How do you think the one can decide how to prioritize between the treating survivors and those expected to die? How does the Hippocratic Oath (i.e. do no harm) conflict with palliative care and euthanasia?
Tier 1: are required to receive the vaccine
- Select government officials (mayor, governor, president, cabinet, Congress, Supreme Court)
- Healthcare/emergency service workers (in direct patient contact)
- Vaccine producers
Tier 2: (tier 2 and below have the choice to refuse the vaccine, which will then be given to the next person of a waiting list)
- Pregnant women
- Public safety
- Active duty domestic military
- Utility workers (workers necessary for basic societal functions)
- Other healthcare workers
- Ages 6 – 24
- Everyone else unless in tier 5
Tier 5: lowest priority group
- Terminal illness
Tier 1- Healthcare frontline, vaccine workers
Tier 2- Ages 13-55, priority to government leaders, public health, military, police, fire
Ages 13-55, priority to utility and transportation workers, telecommunications and IT, undertakers, religious/community leaders, women aged 20-40
Tier 3- Rest of people aged 13-55
Healthy people 7-12
Healthy 6mo-6y and 55-64
Healthy people 65+
Tier 4- people 6mo-64y at risk
Tier 5- Ages 65+ at risk
Must complete each Tier or percentage requirement before start next one
Lottery if can’t complete tier- Non-Transferable
Ranked within tiers
Dr. Wald brings up the major issues of what determinants should be used to choose the recipients of a limited supply of vaccine.
How can we avoid racism, ageism, economism, among other potential bias in the measure systems?
What is the most socially just way?
The WHO Constitution states “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…” Health has become a near universal belief, but there remains a disproportionate fraction of individuals who are neglected when health services are not delivered in a fair and just manner.
What is a human right and how does health fit in that framework?
What is it about healthcare that makes it a moral and social obligation to individuals and how do we know that we have went past that limit?
What are the limits to the rights?
Or would you consider healthcare to NOT be a universal human right?
Dr. Broverman leads a spirited discussion in a resource scarce setting (i.e. low amount of vaccine) who should get this life saving treatment? What criteria could be used? What should one use? Who should make these decisions?