The Athena Institute S.P. Docter MSc Professor G.J. Van der Wildt
Discipline of Public Health A/Professor A. Braunack-Mayer, Dr J. Street
Public perceptions of resource allocation in a Pandemic: A Citizens’ Jury using Grid/ Group Analysis
Research & Method
Objective To investigate the South Australian community view on the allocation of antivirals and vaccines in order to determine to what extent the allocation suggested in the Australian Health Management Plan for Pandemic Influenza corresponds with community views in South Australia. Method Citizens’ jury on antiviral and vaccine allocation ( 9 members) Interviews with experts on antiviral and vaccine allocation ( 5 interviews)
Grid/Group Theory
‘Cultural bias’ is the way people’s choices are influenced by social norms and values (GROUP) and the way people ascribe legitimacy to institutions and rules of procedures (GRID).
Fatalism Hierarchy
Grid: who should make the decisions, How are the roles set in society.
‘I don’t care, it’s a lottery’
‘Somebody has to
tell me what to do’
‘I’ll figure it out myself’ Individualism Mary Douglas
‘I love to discuss’
Egalitarianism
Group; act in the interest of individuals or interest of population, focusing on individuals or on group cohesion
Fatalism
Hierarchy
GRID: WHO SHOULD DECIDE?
Individualism
Egalitarianism
GROUP: WHO SHOULD HAVE PRIORITY?
Results:who should decide?
Jury Grid
Small role for community involvement
Colin: “this should not be left to the politicians! I think that they have too much vested interest.”
Decisions should be made by expert committee rather than left to politicians Faith in a committee that consists of intelligent, ethical and well rounded people with knowledge about the pandemic influenza.
Expert Grid
Decisions made by Commonwealth government advised by experts. No community involvement Experts think that the government ought not to provide sensitive information to the community, because they might not be able to handle sensitive information.
Results:who should decide?
Fatalism Hierarchy
GRID
Individualism
Egalitarianism
Results:who should have priority? Jury Group
Health care workers
Illness or infection of health care workers will affect the amount of workforce (community). Essential services: Maintain community functioning because community will need access to essential services. (individualistic) Desire to preserve structure and social order by keeping it running. (communitarian) Military No expectation of violence, panic or disruption of society. Military will play a jurisdictional and humanitarian role to maintain a structured and orderly community. (hierarchical and communitarian)
Results:who should have priority? Experts Group
The duty to provide health care Reciprocity
Expert 2: “ It’s one thing in return for another, the health care worker would be given the maximum protection, but only if they turned up for work.”
Protecting the public from harm Allocation of antiviral drugs and vaccine to people vulnerable to severe illness from infection.
Results:who should have priority?
Fatalism Hierarchy
Individualism
Egalitarianism
GROUP
Conclusion
High grid
Fatalism
▪ ▪ ▪
+
Hierarchy
▪ ¤
▪ : Experts’ perspectives +: AHMPPI perspective ¤: Jury perspective
▪
Individualism
Low grid/group
Egalitarianism
high group
Recommendation
There was a good fit between community and expert views. However: The Jurors considered that other people can make decisions on our behalf but the community wants to be informed and wants some involvement.
This suggests that the public needs more information. It also implies that a form of community involvement in the decision making process could support compliance during a pandemic.