For many years, balancing individual human rights against social benefits has been the standard theme for public health ethics. Here I would like to update you on a recent discussion in Japan.
Last month a new law was introduced in Japan. Originally the enactment was planned later, but it was speeded up because of the recent series of death cases from emerging bird flu in neighboring Asian countries. This new law is entitled,
- Act in response to new flu strains and other diseases
Unlike existing laws, such as the Immunization Act and the Act on Infectious Diseases, this new law is clearly intended to empower national and areal authorities to take substantial action. For example, in order to,
- “prevent the spread of a disease,”
- “protect a citizen’s rights or health,” or
- “avoid social and economic confusion,”
these authorities can close public spaces or meetings, take special actions to sustain infrastructures, and direct medical staff to treat patients. This law was mainly drafted by bureaucrats and passed lacking sufficient explanation and public debate on the draft.
Based on the act, a national plan for prioritizing vaccine has become a matter of discussion. There are more than one hundred million people living in Japan, and securing vaccine for them quickly has been regarded as difficult. Therefore, this topic can be understood as a matter of distributive justice, and various methods for achieving justice have been discussed.
According to the recent draft plan, medical and caring staff, public officers, and manpower to sustain infrastructure are included in the prioritized class. It is not surprising that the longer the discussion goes on, the more people insist that they should be included in this class. For example, food industry workers are also suggested to be added to the class. Until now the targeted population has already reached more than 20 million! There was a similar discussion during the A/H1N1 swine flu “pandemic” in 2009, and many groups argued that they should have priority getting immunized.
Discussion on vaccine allocation is not unique to Japan. Until now, various ways of rationing, such as utility-based or justice-based allocation, have been suggested, as recently summarized by Buccieri and Gaetz in Public Health Ethics.
The nature of virus complicates the problem. It is difficult to know the nature of each flu virus just after outbreak of the pandemic. At least we can say that the scientific validity of a vaccine rationing plan should be continually tested, and flexible and practical interpretation will be needed. Furthermore, whichever principle for rationing we chose, the principle has to be shared and understood by the society in order to be effective in a real situation. On this point, today’s planning concerning the “prioritized class” in Japan needs further transparency about the evidence of setting the class – for rational policy making.
I also consider that cooperation between northern and southern countries should be more in focus. We remember concerns shown by some southern countries that pandemic vaccine was mainly occupied by the developed countries, and it was difficult for them to secure vaccine for their own citizens. Some emerging flu viruses lead to fatal conditions in developing countries, but do not have so serious consequences in developed countries. Nevertheless, vaccine allocation has been independently coped with by many countries.
Considering the global context of pandemic flu, I think that rationing vaccine as a domestic matter cannot be morally justified from the “justice” or “utility” point of view.
We are not sure that a pandemic will come or what will it be like. Fickle viruses haunt our thinking and test core value of our civilized society and the way of justice.
Yusuke Inoue
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