Employees of Canada's sole manufacturer of H1N1 influenza vaccine received immunization shots Thursday along with their spouses and offspring. Was it shocking queue-jumping or gold-standard health ethics?
The answer is gold standard. The children and their mummies and daddies walking through the doors of the Quebec's GlaxoSmithKline Inc. did so with the nod, if not the blessing, of medical ethicists.
Most plans for pandemic influenza preparedness place front-line health care workers and vaccine production and distribution workers at the top of the list for being inoculated. The principle is that people who care for the sick and make provisions for keeping others healthy need to be healthy themselves.
Immunizing children and spouses at the same time is a little dodgy, but probably defensible.
As the flu virus flies across the country and the vaccine roll-out still hits bumps, Canadians are getting edgier about who among their fellow citizens succeed in getting needled.
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Ethicists such as Ross Upshur, director of the University of Toronto's Joint Centre for Bioethics, say that, if governments want the public to co-operate and accept difficult decisions, they must be transparent and open in explaining what ethical choices have been built into pandemic plans.
Dr. Upshur also said that, in a society where citizens generally trust each other's moral behaviour, have a collective sense of caring for one another and have confidence in their governments to deliver on their commitments, there's a low likelihood of people sneaking treatment ahead of sequencing - queue-jumping, in a word.
Thus, on the one hand, there's the experience of Winnipeg school teacher Kelly Fuerst.
At least 10 people she knows, she said, went with their children to a public clinic at the University of Manitoba and got vaccinated even though they weren't in a priority group. But when Ms. Fuerst's husband went to the clinic with their severely disabled son, he was told that, because of a vaccine shortage, caregivers of high-risk people - like their son - no longer qualified.
Ms. Fuerst doesn't blame her acquaintances who, as she puts it, "slid into line. That's human nature." They were looking after their children. She blames the bad organization of health authorities.
On the other hand, hockey players for the Toronto Maple Leafs, the Calgary Flames and the minor league Abbotsford, B.C. Heat - all of them successfully jabbed but almost all outside the priority groups for immunization - cannot be said to have contributed to Canadian social cohesion.
Yet one ethical model designed by U.S. health economists for setting priorities for who gets vaccinated says otherwise. It's called the principle of "save those who are instrumental in making society flourish through economic productivity or by contributing to the well-being of others."
The Calgary Herald newspaper applied the principle in an editorial on the Calgary Flames, noting first that team members play in venues where thousands of people gather, and . . . "are in close sweaty contact with the players of other teams."
But getting the team and their families vaccinated, it said, also "makes good business sense" - likely the same maxim of U.S. financial giants Citigroup and Goldman Sachs, which got short-supply vaccine from New York City health authorities against a backdrop of outraged media reports.
With reports from Rhéal Séguin, Justine Hunter, Dawn Walton, and Caroline Alphonso
The Globe on H1N1
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