Thursday, November 23, 2006

Who gets the vaccine?

When (and not “if”) a flu pandemic strikes, one of the most critical issues will involve the medical ethics of providing scare resources to the community. Hospitals and Health Regions across North America are having conversations on the guidelines to follow in delivering a scarce treatment such as a vaccine, or respirators to people who are hospitalized. Who should be first in line? Who decides this?

The following is an article from – an online newspaper serving South Carolina.

N.C. panel prepares for morals of flu pandemic Associated PressRaleigh With a flu pandemic inevitable, North Carolina's medical professionals must prepare now for what could be wrenching moral decisions about who will be treated and who won't if the illness overwhelms hospital resources, members of a state task force said. The Task Force on Ethics and Pandemic Influenza Planning met recently to discuss a strong set of ethical guidelines for the state's doctors and nurses in the event of a global outbreak of a new and more virulent strain of flu virus. The list would help them decide who gets priority for medical care in the face of a wave of flu-stricken patients that would rapidly outstrip the supply of hospital beds, medicine and equipment."

It's going to exceed our capacity," Philip Rosoff, director of clinical ethics at Duke Hospital, said during a four-hour meeting of the task force Monday. "The more stringent and robust our guidelines are, the less chance there is for decisions being made for arbitrary and morally unjustifiable reasons. "Medical authorities say the next flu pandemic is long overdue and inevitable, based on the history of three deadly outbreaks in the 20th century: the Spanish flu pandemic of 1918-19, which killed 50 million to 100 million people worldwide; the Asian flu pandemic of 1957; and the Hong Kong flu pandemic of 1968.Hospitals across North Carolina are already at 85 percent to 90 percent capacity, and even a mild pandemic would force doctors and nurses to ration medicine and equipment.

The 40-member task force, a joint project of the North Carolina Institute of Medicine and the state Division of Public Health that began meeting in May, wrestled with the wisdom of giving children priority for scarce anti-viral drugs and vaccines.They also worried whether their guidelines would cut off the poor and disadvantaged, or Hispanic immigrants.They debated a scenario involving three gravely ill patients - a 10-year-old with a 30 percent chance of survival, a 40-year-old doctor with a 25 percent chance and a 65-year-old retiree with a 10 percent chance - whom all needed the only ventilator available to help them breathe."

Let's say I've got a hospital full of 85-year-olds on ventilators and I've got a 20-year-old who needs a ventilator: Do I take an 85-year-old off and give it to the 20-year-old?" Rosoff asked. The task force settled on two broad guidelines for rationing vaccines, anti-viral drugs and medical equipment during a flu pandemic. The first is to assure that crucial functions of society aren't disrupted. That means giving priority for vaccines and anti-viral medication to health care workers, police, firefighters and employees of critical industries such as utilities. The second is to reduce the number of deaths and infections and prevent the spread of the illness. The panel is due to issue a report in the spring.

In earlier meetings, members had discussed the responsibility of doctors and nurses to provide care during a pandemic, along with a hospital's responsibility to make sure those workers are safe, properly trained to handle unfamiliar tasks and paid for service during a crisis. The panel also has drafted recommendations about the movement of people during a pandemic, including the use of quarantine and the closing of schools, churches and other mass gatherings. Leaders of the task force have so far resisted issuing strict directives. But John Morrow, health director for Pitt County, called for a more direct approach."We're up here at 30,000 feet making these broad, philosophical statements, but nobody's going to read a paper like that," he said. "We've got folks with 100 doses of vaccine and everybody wants it, and we've got to give them specific guidelines on who gets it and why."

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“The time to plan is when you have time to plan.”

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