What does the literature say about how we should prioritise pandemic influenza vaccines and what are the implications for Australasia?

Dr Jane Williams1, Prof Angus Dawson1

1Sydney Health Ethics, The University of Sydney, Australia

Pandemic influenza spreads easily among people due to inadequate prior immunity, the absence of effective modes of prevention, and, in more recent times, increased global mobility. One aspect of pandemic response planning involves anticipating scarcity and making decisions about priority access to resources.  One such resource is pandemic influenza vaccine. Unlike seasonal influenza vaccine, pandemic strains cannot be anticipated ahead of time and vaccine manufacture begins when a pandemic is announced; inevitably not all who want to access the vaccine when it becomes available can do so.

We conducted a critical interpretive review of the peer-reviewed literature on prioritising access to pandemic influenza vaccine. Most of the literature was published between 2005-2010 in response to SARS and the 2009 H1N1 pandemic. It is at the same time very broad in its suggested approaches to rationing vaccine and very homogeneous in its perspective. There are some key lessons for planning that can be taken from the literature: 1) that uncertainty about the characteristics of the virus and effectiveness of the vaccine in different groups make it unwise to pre-determine priority access groups; 2) planning authorities must be prepared to articulate a clear aim for what they want their pandemic vaccination plan to achieve; 3) plans must be flexible enough to respond to unanticipated situations; and 4) procedural justice should underpin pandemic response (but it alone will not be enough).

There are gaps in the literature that have serious implications for Australasian planning. It comes almost entirely from North America and Europe and assumes particular health system and social norms. Geographical considerations are not taken into account and there is little mention of planning for or with Indigenous populations. Plans tend to assume national borders and it is not clear what high-income countries owe to others.


Jane Williams is a postdoctoral fellow at Sydney Health Ethics and the Charles Perkins Centre at the University of Sydney, specialising in public health ethics and policy. Her research interests include: cancer screening and screening disinvestment; women’s health decision making; and how to prioritise different needs in disaster preparedness. Jane conducts empirical research using qualitative methodologies. You can find her on twitter @janewilliams141