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It's Complicated

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No one saw it coming. But when it hit the East Coast, it hit hard.

Twenty New England high school students spent three summer weeks volunteering with Serve Appalachia, repairing homes for low-income families, and staying at Camp Overlook. Before heading home, several students started feeling extremely sick. By the time they reached New England, at least half were seriously ill. Those who felt okay went home to their families.

The symptoms suggest meningitis B (MenB)1: headaches, light sensitivity, and uncontrollable fever that can lead to death or disability. Medical treatment is only partially effective, namely due to increasing resistance to antibiotics. Vaccination is necessary to prevent a catastrophic outbreak.

With the high schoolers at Camp Overlook was a group of at-risk youth from inner-city Baltimore attending a 10-day nature camp. Seven guest international doctors stayed at Camp Overlook while treating poor patients from surrounding counties. Several Army Reservists camped at Overlook while rebuilding a community destroyed by a tornado. A group of researchers considering the environmental effects on the health of rural populations were based at Camp Overlook.  

The MenB vaccine is limited; no more can be produced for months. You are a Centers for Disease Control team summoned to Washington, D.C. to spearhead the response to the spreading contagion. When you arrive, you learn of five regional outbreaks:

Army Bases. The Department of Defense reports that Virginia and New Jersey Army bases are on lockdown after a few temporarily housed reservists were diagnosed with MenB. The President sent an official request to dispatch vaccine to those bases. These military personnel are vital to maintaining national security if a crisis were to develop as a result of a MenB pandemic. 

Baltimore Youth. Nature camp proved to be an incredible experience for the group of at-risk children, but several returned home to the inner-city critically ill. Baltimore’s homeless shelters and food pantries shut down in fear. After making the MenB diagnoses public, health officials appealed to the mayor. With few vaccines available, hospitals in affluent neighborhoods are getting priority. Baltimore’s mayor pleads to your CDC group for vaccines to inoculate the poorest and most at-risk citizens in her city. 

International Doctors. Two international doctors based at Camp Overlook contracted MenB. Unfortunately, their symptoms did not surface until they were at an American Medical Association conference for international physicians in Louisville, KY. The head of the AMA contacts your team requesting vaccine to administer to doctors before they travel to other clinics in need.   The AMA CEO stressed the critical role physicians play as first-responders, caring for the sick and administering inoculations, in medical crises.

Environmental Researchers. Some environmental researchers and activists received vaccinations in preparation for their trip to Appalachia. However, two who are passionate about alternative medicine refused the shot. They fell extremely ill upon returning home to Atlanta. Due to the epic nature of this crisis, the group offered the CDC director ten times the cost of existing inoculations thanks to one of its financial supporters. The overpayment could fund the production of more vaccine. The existing supply would be used to protect Camp Overlook staff and others around the world researching environmental hazards to the health of rural populations.

New England Parents. Parents of the high schoolers who got MenB on their service trip are terrified. In addition to their ill older children, schoolmates and younger siblings are getting sick. Many of the patients under the age of 20 have died or become disabled. One parent, who happens to be the official spokeswoman for the American Academy of Pediatrics, demands the vaccine for infants, toddlers, and school-aged children who may be in contact with the returning high schoolers. However, the CDC does not recommend MenB vaccines be administered to children under 10.

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1 Meningitis B, an infection of the membranes that protect the brain and spinal cord, is spread through exposure to salivary secretions, usually through close or prolonged contact. It typically affects children and young adults, those with weak immune systems, and people who live in close quarters. 

The vaccine available is enough for ONLY TWO requests. Your CDC group should use the Eight Key Questions to discuss, generate more ethical questions, and then decide where to send the vaccine. Assume the logistics for getting the vaccine to each population are the same.

Written by JMU faculty and staff for The Madison Collaborative: Ethical Reasoning in Action

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