Ethics experts on the wrong track – VG

JON HENRIK LAAKE, leader of the Norwegian Association of Anesthesiology
MAGNA HANSEN, Vice President of the Norwegian Association of Anesthesiology
SKULE MO, member of the board of the Norwegian Association of Anesthesiology
CAMILLA CHRISTIN BRÅTHEN, member of the board of the Norwegian Association of Anesthesiology
EIRIK ADOLFSEN, member of the board of the Norwegian Association of Anesthesiology
GUNHILD ØVERLAND, member of the board of the Norwegian Association of Anesthesiology

On Tuesday 17 November, a group of “experts in ethics and prioritization” appointed by the National Institute of Public Health presented the report Advice on priority groups for coronary vaccination in Norway. Here it is recommended that healthcare personnel take second place when vaccinating the population, behind patients in the so-called risk groups. Only in the case of a generalized infection in the population, the group of experts will put the health personnel first in the queue.

The expert group’s proposal is contrary to common practice in epidemics. It is common for health professionals in advanced positions (with a high risk of becoming infected and infecting others) have the first priority when the population is to be vaccinated.

There are three main reasons for this: First, healthcare professionals, like all other employees, have a general requirement of protection when they are asked to perform work that could endanger their own life and health. Second, infection and illness among health professionals may mean that important health services cannot be performed. Third, healthcare professionals who are not protected by the vaccine themselves can infect their patients and therefore pose a risk to the health of vulnerable patient groups.

Li Wenliang (b. 1986) was the ophthalmologist who became known around the world when on December 30, 2019, he had the courage to tell what seemed to be a new infection situation in Wuhan. He himself became infected with the coronavirus and died on February 7 of this year. In northern Italy, more than 100 doctors have died after close contact with patients with covid-19 in the first phase of the pandemic. The risk of infection and illness for healthcare professionals has been gradually documented and, in a Scottish study, the risk of being admitted to hospital for COVID-19 was found to be 2 to 5 times higher for healthcare professionals. health with close contact with the patient than in the rest of the population.

It is morally problematic to ask a group of citizens to do work that involves a well-documented health risk and, at the same time, deny them the best possible protection against disease. For employees doing this type of work, it does not matter much what the general spread of the infection is in the surrounding community – in a hospital ward treating coronary patients, the risk of infection is high in any case.

In the event of epidemics, the health service is completely dependent on qualified health personnel staying healthy. For the individual, the proven infection will lead, at best, to home isolation and, at worst, to serious illness. Also, all close contacts must be quarantined. This was what happened in the Ullevål eye department in March this year and it meant that patients had to be transferred to Stavanger, Bergen and Trondheim. We already know that the pandemic can lead to a critical shortage of key personnel in our intensive care units, and for intensive care and reception rooms, an outbreak of infection could bring the entire business to a standstill. We have no reserve crews to take off.

The expert committee assumes that health personnel working with vulnerable patient groups should have priority for vaccination because patients run the risk of being infected by health personnel. However, healthcare professionals who treat patients with coronary heart disease and who are themselves at risk of being infected by their patients are not covered by this point. This is because the transmission route is the opposite of what is expressed in the commission’s proposal.

It is generally recognized that safeguarding the physical and mental health of employees is of vital importance in the event of serious epidemics. This spring, the country’s hospital employees have had to feel the consequences of inadequate access to infection control equipment. We have been informed that it can be important to use poor emergency technical solutions in the treatment of patients, and now a committee of experts informs us that we must be carefully at the end of the line when vaccines are to be administered. This reveals an instrumental attitude towards health service employees and can rightly be perceived as offensive.

In the group of experts, we did not find doctors, and the affected parties, that is, representatives and relatives of patients, other employees of the health sector and representatives of other parts of society, stand out in their absence. The recommendation that the expert group has presented to the Norwegian Institute of Public Health deviates from previous practice and also from the recommendations given by large international organizations (WHO and National Academies of Sciences, Engineering and Medicine).

It should not be taken for granted.
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This text was published for the first time in Den norske legeforening magazine and reproduced here with permission.