Shadow of people waiting in a queue

Who gets the medicine?

If there is not enough medicine to go round, who should be first in line – and who should decide?

Thanks to global disease surveillance, we are likely to have advance warning of an influenza pandemic. And we have some tools to head it off.

But the UK alone has 64 million people to protect – almost certainly there is not going to be enough oseltamivir or flu vaccine to go round, at least initially. Antiviral drugs would be most effective if used prophylactically – to prevent people becoming infected. But who would get them?

Some suitable causes are hard to disagree with – people involved in drug/vaccine manufacture for starters, as well ‘frontline’ healthcare workers. But who else? Are our politicians deserving causes? Civil servants? Teachers? The Royal Family?

This is a difficult ethical issue. The ‘utility principle’ is often put forward, and argues for the distribution that saves the most lives in the long run. The ‘equity principle’ puts greater emphasis on ‘fairness’ of distribution.

A 2006 academic paper suggested that, with limited vaccine supplies, a simple ‘save the most lives’ equation is not necessarily the best strategy. A better approach would be to maximise the number of years of life saved, and to take account of the ‘investment’ in life to date. Crudely put, that means prioritising people from late childhood to middle age.

This may seem distasteful, and the authors acknowledge they are proposing “the least bad solution to a tragic situation”, but some decisions of this kind may have to be made. So who would make these decisions? Nancy Kass, an ethicist at Johns Hopkins University, has argued that lay heroes – the unsung individuals on whom society depends, such as truck drivers and refuse collectors – should be included; without them, society may not function.

And, she argues, ‘ordinary people’ should also be involved in discussions about priorities. Partly this is to ensure fairness, but also to create a sense of transparency and buy in – why should people agree to plans that they have had no chance to influence?

Lead image:

Michael/Flickr CC BY NC


About this resource

This resource was first published in ‘Epidemics’ in September 2007 and reviewed and updated in January 2015.

Health, infection and disease
Epidemics, Influenza special issue
Education levels:
16–19, Continuing professional development