Community perspectives on distributing an initially limited supply of vaccines in the event of an influenza pandemic
The citizens’ jury process is an effective way to involve citizens in developing a thoughtful, well-informed solution to a public problem or issue.
Citizens’ juries are a lot like juries in a court room. They are made up of about a dozen people, who meet over two days. They hear expert testimony and then deliberate to make a decision about what they think is the right thing to do. On the final day of their moderated hearings, the members of the Citizens’ Jury vote on the issues and give their recommendations.
The Australian Government Department of Health recently commissioned APPRISE to trial the citizens’ juries process, an innovative method for involving the community in public policy development.
How should we distribute initially limited supplies of vaccines in the event of an influenza pandemic?
Every year there is a seasonal influenza outbreak. However, every few decades there is a much more devastating influenza pandemic. It is possible to develop a vaccine to protect against pandemic influenza, but the nature of vaccine production means that not enough will be available immediately to protect all of the Australian population. Australian Government policy is to vaccinate all Australians against pandemic influenza. Pandemic vaccine will be released in batches over a period of several months until everyone who wants to be, is vaccinated. However, as a consequence, prioritising certain groups for vaccine access must be part of Australian vaccination policy.
Complex decisions will need to be made about how to balance potential risks and likely benefits of different vaccine distribution strategies. Decision making is complicated in this area because pandemic influenza viruses can have different levels of transmissibility and severity, which determines how quickly a pandemic spreads and how many people are likely to become hospitalised or die. In addition, because the vaccine is new, there is likely to be uncertainty about how effective and safe it may be.
What we hoped to achieve
Our aim is to understand and describe what informed members of the public think is the best way to distribute limited vaccination resources during an influenza pandemic. We will use this research to inform decision makers of public preferences and to enhance the development of a framework to assist stakeholders to act in ways that make community values explicit.
We held citizens’ juries in Wollongong (NSW), Melbourne (VIC) and Kalgoorlie-Boulder (WA) between April and May 2019. Thirty-four people aged 18–74 and of diverse cultural backgrounds were recruited across the locations by a professional research service to participate as jurors. The recruitment company contacted potential participants using:
- randomly generated list-based samples of mobile and fixed-line telephone numbers located in specific geographic areas
- a social media advertising strategy targeted but not specific to a topic.
The question for these citizens’ juries
Current government policy is to provide direct protection to groups at higher risk of severe illness through prioritising their vaccination during a pandemic.
In Part A we asked jurors if the government strategy for distributing vaccine during the early phases of an influenza pandemic needs to be changed:
PART A: In the event of a Low Transmission / High Severity pandemic should the government (Please provide reasons for your decision):
- A. continue to prioritise a strategy of direct protection by aiming to vaccinate those most at risk from the disease
- B. adopt a strategy of indirect protection by prioritising the vaccination of those most likely to spread the disease.
In Part B we asked jurors to consider the strength of their commitment to the strategy chosen in Part A, and to consider how the strategy should be implemented
PART B: During this jury you have heard a lot of information about how different properties of the virus and the vaccine can make a pandemic vaccination strategy more or less effective. Please consider the following questions, and provide reasons for your answers:
- Would you support the adoption of the same strategy as Part A in the event of a High Transmission / High Severity pandemic?
- All things being equal, is it better to partially protect lots of people with a single dose of vaccine, OR is it acceptable for authorities to withhold vaccines from people at low risk so that a two-dose strategy can be implemented to give high risk groups better protection?
- Of the information you have heard, which is most essential to communicate to citizens about why different groups will get earlier access to vaccines during a pandemic?
The evidence presented to the juries
Talk 1. Influenza: the virus, the pandemics, the vaccines – presented by Professors Peter Massey and Lyn Gilbert
Associate Professor Peter Massey
Associate Professor Peter Massey is a Clinical Nurse Consultant and Program Manager for Health Protection with Hunter New England Health. He has worked in public health in rural and regional New South Wales for more than 30 years and has expertise in immunisation, communicable disease control, public health emergencies and Aboriginal health. Peter brings a strong rural and equity focus to all aspects of public health, along with experience in research capacity building and community-based research. Peter has strengths in mixed methods research, operational research, and has research and practice experience in zoonoses and One Health.
Professor Lyn Gilbert
Professor Lyn Gilbert is an infectious diseases physician and clinical microbiologist who was director of laboratory services at the Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, from 1991 to 2010. Lyn is a clinical professor at the University of Sydney, senior researcher in the Marie Bashir Institute and research associate at Sydney Health Ethics in the School of Public Health at the University of Sydney. Her research has previously focused on microbial epidemiology, prevention and control of many types of communicable diseases including healthcare-associated infections.
Talk 2. The role of vaccines in pandemic response – presented by Professor Jodie McVernon
Professor Jodie McVernon
Professor Jodie McVernon is a public health physician and epidemiologist. She is currently Director of Epidemiology at the Peter Doherty Institute for Infection and Immunity, at the University of Melbourne and Royal Melbourne Hospital. Jodie’s research focuses on understanding how infectious diseases spread in populations. Her motivation is understanding how best to use vaccines and other public health measures to limit the burden of disease they cause. Over more than ten years, she has provided advice to the Australian Government’s Office of Health Protection on pandemic influenza preparedness and response.
Talk 3. Modelling the impacts of different vaccine distribution strategies – presented by Dr Rob Moss
Dr Rob Moss
Dr Rob Moss is a mathematical biologist in the Melbourne School of Population and Global Health at the University of Melbourne. His research focuses on developing methods to predict, and identifying how to mitigate, the impact of infection diseases, with a particular emphasis on seasonal and pandemic influenza. This includes the use of scenario modelling to inform recommendations for the tailoring of public health interventions – such as targeted antiviral distribution and vaccination – and the synthesis of real-time surveillance data with mathematical models to provide real-time forecasts of disease activity.
Talk 4. Ethical Perspectives on prioritising pandemic vaccine – presented by Dr Jane Williams
Dr Jane Williams
Dr Jane Williams is a public health ethics researcher and teacher. She is a research fellow with Sydney Health Ethics and the Charles Perkins Centre at the University of Sydney and works in Australia and Singapore. Her research explores the ethics of infectious disease prevention, public health research, cancer screening, and reproductive health.
The Australian Centre for Health Engagement, Evidence and Values is an independent research centre of the University Wollongong associated within the School for Health and Society at the Faculty of Social Science. The Centre was established in 2018 with the aim of employing innovative approaches to research, education, consultation and community outreach activities. In each of these areas the Centre stimulates creative thought, dialogue and action by engaging different disciplinary perspectives including medicine and science, public health, philosophy, ethics and bioethics, sociology, history and law.
For more information please follow this LINK: https://www.uow.edu.au/social-sciences/research/centres-groups/acheev/