Zimmerman Richard Kent
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, 35l8 Fifth Avenue, Pittsburgh, PA 15261, United States.
Vaccine. 2007 Mar 1;25(11):2019-26. doi: 10.1016/j.vaccine.2006.11.045. Epub 2006 Nov 30.
Rationing of scarce vaccine supplies will likely be required when the next pandemic occurs, raising the questions about how to ration and upon what principles. Because influenza pandemics have differing mortality patterns, such as the 1918 pandemic's "W" shaped curve that effected healthy young adults, the particular pattern should inform rationing. Competing ethical principles for vaccine rationing are utilitarianism and egalitarianism. Vaccine manufacturers and essential healthcare workers can be justified with either principle. Utilitarian principles of choosing based on social worth or those in whom vaccination is most likely to medically succeed raise substantial justice issues. Egalitarian principles of medical neediness and random chance avoid justice concerns and are proposed. A framework that uses multiple principles to address influenza vaccine rationing in light of a shortage is recommended.
当下一场大流行发生时，可能需要对稀缺的疫苗供应进行配给，这就引发了关于如何配给以及依据何种原则进行配给的问题。由于流感大流行具有不同的死亡率模式，比如1918年大流行呈现的影响健康青壮年的“W”形曲线，这种特定模式应可为配给提供依据。疫苗配给中相互竞争的伦理原则是功利主义和平等主义。无论是哪种原则，疫苗制造商和基本医疗保健工作者都有其合理性。基于社会价值或接种最有可能在医学上取得成功的人群来进行选择的功利主义原则引发了重大的公平问题。而基于医疗需求和随机机会的平等主义原则避免了公平问题，因此被提了出来。建议采用一个框架，该框架依据多种原则来应对流感疫苗短缺情况下的配给问题。
