Victorian Infectious Diseases Laboratory Epidemiology Unit, The University of Melbourne and Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity Melbourne, Australia.
World Health Organization Collaborating Centre for Reference & Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
Vaccine. 2021 Jan 29;39(5):797-804. doi: 10.1016/j.vaccine.2020.12.053. Epub 2021 Jan 3.
Allocation of scarce resources during a pandemic extends to the allocation of vaccines when they eventually become available. We describe a framework for priority vaccine allocation that employed a cross-disciplinary approach, guided by ethical considerations and informed by local risk assessment.
Published and grey literature was reviewed, and augmented by consultation with key informants, to collate past experience, existing guidelines and emerging strategies for pandemic vaccine deployment. Identified ethical issues and decision-making processes were also included. Concurrently, simulation modelling studies estimated the likely impacts of alternative vaccine allocation approaches. Assembled evidence was presented to a workshop of national experts in pandemic preparedness, vaccine strategy, implementation and ethics. All of this evidence was then used to generate a proposed ethical framework for vaccine priorities best suited to the Australian context.
Published and emerging guidance for priority pandemic vaccine distribution differed widely with respect to strategic objectives, specification of target groups, and explicit discussion of ethical considerations and decision-making processes. Flexibility in response was universally emphasised, informed by real-time assessment of the pandemic impact level, and identification of disproportionately affected groups. Model outputs aided identification of vaccine approaches most likely to achieve overarching goals in pandemics of varying transmissibility and severity. Pandemic response aims deemed most relevant for an Australian framework were: creating and maintaining trust, promoting equity, and reducing harmful outcomes.
Defining clear and ethically-defendable objectives for pandemic response in context aids development of flexible and adaptive decision support frameworks and facilitates clear communication and engagement activities.
在大流行期间，稀缺资源的分配扩展到疫苗的分配，一旦疫苗最终可用。我们描述了一种基于跨学科方法的优先疫苗分配框架，该方法以伦理考虑为指导，并根据当地风险评估提供信息。
审查了已发表和灰色文献，并通过与主要信息提供者协商进行了补充，以收集过去的经验、现有的指南和大流行疫苗部署的新兴策略。还包括确定的伦理问题和决策过程。同时，模拟模型研究估计了替代疫苗分配方法的可能影响。将收集到的证据提交给一个关于大流行准备、疫苗策略、实施和伦理的国家专家研讨会。然后，利用所有这些证据生成一个适合澳大利亚背景的疫苗优先事项的拟议伦理框架。
关于优先大流行疫苗分发的已发表和新兴指南在战略目标、目标群体的具体规定以及对伦理问题和决策过程的明确讨论方面存在很大差异。普遍强调了灵活应对，这是根据大流行影响水平的实时评估和确定受影响程度不同的群体来实现的。模型输出有助于确定在传染性和严重程度不同的大流行中最有可能实现总体目标的疫苗方法。被认为与澳大利亚框架最相关的大流行应对目标是：建立和维护信任、促进公平和减少有害后果。
在上下文中为大流行应对定义明确和具有道德可辩护性的目标有助于制定灵活和适应性的决策支持框架，并促进明确的沟通和参与活动。
