9 - Pandemic intervention & rationing

Question 1

what is LIVES?

Answer 1

Other things being equal, it is right to maximize the number of lives saved under given constraints (minimize lives lost)

Question 2

What is YEARS?

Answer 2

Other things being equal, it is right to maximize the number of life years saved under given constraints (maximize QALYs saved)

Question 3

What is FAIR?

Answer 3

Other things being equal, it is right to maximize the number of lives saved below R or, given all lives below R being saved, it is right to maximize the number of lives saved above R (give priority to ages under a given threshold)

Question 4

on which point do FAIR and LIVES converge?

Answer 4

Likelihood: Save the individual with the higher probability to survival

Ex: Vaccine distribution→ Give to the individual who has a higher survival likelihood of surviving if infected

Question 5

which goal was used during the COVID-19 pandemic>

Answer 5

LIVES , satisfies teh common-ground restriction

Question 6

What are three representative goals of pandemic responses?

Answer 6

LIVES, FAIR, YEARS

Question 7

what is the difference between confirmed cases and excess mortality?

Answer 7

Confirmed cases: Rough estimate, conduct diagnostic test before or after death to determine if had COVID-19 → May have died from something unrelated though
Excess Mortality: Captures the number of deaths from all causes (changes each year, then take average every few years) → Considers direct (COVID-19- related) and indirect deaths (reduced car accidents from COVID, but increased domestic abuse, suicide, etc)

Question 8

why can there be a difference between observed and expected deaths?

Answer 8

The difference between observed (confirmed) and expected deaths can be caused by indirect factors which may inflate (other factors contributing to death toll) or underscore (individuals didn’t get tested for COVID-19) the number of deaths.

Question 9

what are three ways to prioritise during a pandemic?

Answer 9

1. Order priority
2. Zero-sum priority
3. Proportional priority

Question 10

describe denmark’s vaccine rollout:

Answer 10

Health care professionals and people with chronic disease People aged 80 or older;
People aged 75-79;
….
People aged 50-54;
People aged 16–19 and 45–49; People aged 20–24 and 40–44; People aged 25–29 and 35–39; People aged 30–34;
People aged 12–15.

→took superspreaders very differently, epidemiological evidence that it makes a lot of sense to do it this way, prevents mortality in older ppl

Question 11

Which principle does Hirose argue is the best to follow during a pandemic?

Answer 11

It ultimately concludes that the principle of saving as many lives as possible (LIVES) is the most suitable guiding principle for pandemic response and preparedness, mainly because it meets the “common ground restriction” and is less objectionable than the other principles.

Question 12

which factors should one consider when priority-setting in resource allocation during a pandemic?

Answer 12

fairness of age-based priority, the consideration of super-spreaders in vaccine allocation, and the potential impact of vaccine hesitancy and socioeconomic factors.
all of these must be discussed openly and transparently

Question 13

what is the desert-based view for unvaccinated individuals?

Answer 13

Unvaccinated people could have received vaccination but chose not to although they knew, or were reasonably expected to believe, that vaccination reduces the risk of infection, hospitalization, and death. Unvaccinated people chose to take the risk and are not entitled to claim an ICU bed when their health condition deteriorates due to the pandemic disease

Question 14

what is the luck egalitarian view for unvaccinated individuals?

Answer 14

Luck egalitarianism in health holds that inequality in health outcomes is bad or unjust when and because it refects the diferential efects of circumstances beyond people’s control and that inequality in health out-comes is not bad or unjust when and because it refects the diferential efects of people’s deliberate choice

Question 15

what is the financial penalty view for unvaccinated individuals?

Answer 15

all patients who require critical care will be treated in the same way upon entrance of the ICU, regardless of their vaccination status. But the patients unvaccinated by choice are required to pay the price for the bad efects of their choice. There might be diferent ways to pay the price (Daniels 2007).
- Unvaccinated patients (except people medi-cally ineligible for COVID-19 vaccination) pay the full cost for pandemic-related health care with no health insurance reimbursement so that they do not put the unfair fnancial burden on the shoulder of vaccinated people.
- tax the unvaccinated to offset disproportionate demand for healthcare

Question 16

what is order priority setting?

Answer 16

It is concerned with who gets frst, who gets next, and who gets last. This type of priority setting is demanded when resources are sufcient to meet everyone’s needs in the long run but scarce in the short run

Question 17

what is zero-sum priority setting?

Answer 17

It is concerned with who gets and who does not get at all. This form of priority setting occurs when the resource is indivisible, that is, impossible to divide it up.

Question 18

what is proportional priority-setting?

Answer 18

It is concerned with who gets more and who gets less. This type of priority setting is needed, for example, when the good is divisible.

Question 19

how does scarcity affect priority-setting?

Answer 19

there must be multiple rationing principles to meet the challenges from diferent degrees of scarcity. That is, the rationing criteria should usually be multi-tiered

Question 20

which principle gives the highest priority to frontline healthcare workers for ICU beds?

Answer 20

LIVES

Question 21

what is the restrictive approach?

definition priority group

Answer 21

restrictive approach to the defnition of a priority group. According to the restrictive approach, the closer and more relevant the health care resource under consideration is to the event of death, the tighter and more restrictive the defnition of a priority group must be as well as the number of them

Question 22

what are three implications of giving priority to patients with the greatest rate of survival using LIVES?

Answer 22

1 - patients w frailty are eliminated from the pool, would imply low priority to old people
2 - younger people w compromised immune systems are also not prioritised, which seems unfair
3 - redistribution of ventilators - can save more people, but withdrawing leads to patient’s death

Question 23

which points should be considered for prioritu setting for vaccine roullout

Answer 23

-superspreaders, ie toung people
- urban vs rural areas
- SE groups to prioritise

Question 24

Summarise the Gonzalez-Savulescu reading

Answer 24

The paper discusses the challenges of implementing regional allocation strategies, including the tension between local and regional interests, the potential for political interference, and the need for coordination and collaboration among healthcare institutions and government agencies. The authors argue that a fair and effective allocation system should involve a combination of centralized and decentralized decision-making to address these challenges.