Ethical Vaccine Distribution Planning for Pandemic Influenza: Prioritizing Homeless and Hard-to-Reach Populations
Ethical Vaccine Distribution Planning for Pandemic Influenza: Prioritizing Homeless and Hard-to-Reach Populations
复制标题
DOI：
10.1093/phe/pht005
复制
发表时间：
2013-07-01
影响因子：
2.1
通讯作者：
Gaetz, Stephen
中科院分区：
文献类型：
--
作者：
Buccieri, Kristy;Gaetz, Stephen
在大流行期间有限疫苗的分配方式是一个伦理问题。效用原则被用来论证根据疾病传播的流行病学和维持社会运作等因素应优先考虑某些个人。公平原则被用来鼓励考虑到所有决定的经济和社会成本的公平做法。我们认为，这两个原则是通过无家可归者的优先接种疫苗，因为这一战略保护了医疗脆弱的人口，同时减少了传播给他人的机会，因为他们通过人口稠密的城市空间。我们开始通过审查围绕道德疫苗分配的辩论。然后，我们认为无家可归者是一个医学上的高风险人群，他们可能会通过他们的流动性导致疾病的传播。由于无家可归者的免疫接种率普遍较低，许多人无法获得主流医疗保健，我们认为必须利用社区疫苗诊所来接触这些人。我们提供支持，通过分析多伦多公共卫生的运作，在庇护所和下降中心在pH1N1的疫苗诊所，并得出结论，这种策略是有效的免疫无家可归的人，汇集了公平和效用的原则。
The manner in which limited vaccines are distributed during a pandemic is an ethical issue. The utility principle has been used to argue priority be given to certain individuals based on factors such as the epidemiology of the spread of disease and maintaining the functioning of society. The equity principle has been used to encourage fair practices that account for the economic and social costs of all decisions made. We argue that both principles are met through priority vaccination of homeless individuals, as this strategy protects a medically vulnerable population while reducing the chances of transmission to others as they move through populated urban spaces. We begin by reviewing debates around ethical vaccine distribution. We then argue the homeless are a medically high-risk population who may contribute to the spread of disease through their mobility. As immunization rates are generally lower among the homeless and many do not access mainstream health care, we argue that community vaccine clinics must be used to reach these individuals. We provide support by analyzing Toronto Public Health's operation of vaccine clinics in shelters and drop-in centres during pH1N1 and conclude that this strategy is effective for immunizing homeless individuals, bringing together the equity and utility principles.