Pan-canadian public health network council report and policy recommendations on the use of antivirals for prophylaxis during an influenza pandemic

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Key Considerations and Expert Reviews

4. Ethical/Societal Considerations

A fair and just society expects its governing bodies to develop policies that are in accordance with societal values and ethically sound principles (see Annex 3.4). TGAP presents its specific thoughts and conclusions in this section, but has taken ethical considerations into account across all areas of its deliberations. It is important that ethical considerations form a part of public communication regarding the decision reached as a result of TGAP’s recommendations.

Key Findings

Public health medicine is goal-oriented, therefore, an underlying ethic of public health initiatives invokes the duty to respect the goals of the program. On the issue of providing prophylactic antivirals for influenza during a pandemic, the goals are clearly stated in the CPIP, namely minimizing serious illness and overall deaths, and minimizing societal disruption among Canadians as a result of an influenza pandemic. These are supplemented by the goals of the Antiviral Strategy, presented earlier in this paper, which seek to contribute to the CPIP goals in specific ways.

Because the overall aim of any public health program is to provide the greatest medical good for the greatest possible number of people, it is important to weigh advantages and disadvantages in establishing any distribution priorities, and to ensure that the process is fair and transparent. Objective criteria are proposed as a means of achieving this. In order for the process to appeal to stakeholders and the general public, the criteria themselves must be chosen carefully to reflect values that Canadian society cherishes, such as protection of the most vulnerable, fairness and equity, and reciprocity, a sense that those who might be prioritized for prophylactic antivirals would remain committed to their role and duty to protect others during a pandemic. Further, when any medical intervention is proposed, there is a duty to keep in mind that there are risks related to the use, as well as the non-use, of antivirals. Planners must also consider logistical or implementation issues, since the inability to confront these practical impediments may render the arguments in favour of stockpiling antivirals for prophylaxis futile.

Conclusions

Based on the above, the following criteria are proposed to assist in deciding which groups should be considered for the prophylactic use of antivirals during an influenza pandemic:

• contribution towards the goals of reducing serious illness, overall deaths, and societal disruption;
• medical need;
• scientific merit; and
• logistics.

TGAP recognizes that those responsible for making decisions on the issue of deciding whether F/P/T governments should stockpile antivirals for prophylaxis must deal with the important and difficult task of properly portraying the level of risk, perceived or real, faced by the public and stakeholders. These decision-makers have a duty of accountability to their constituents, and should provide carefully designed education and/or public awareness campaigns to inform and educate stakeholders, such as health care providers and the general public, on the intricacies of the issue and the reasons for the decision.

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