In 2009, the Public Health Agency of Canada (PHAC) provided guidelines about which groups should be given first access to the H1N1 influenza vaccine. These guidelines recommended that people under 65 with chronic health conditions should be among the first groups to receive the H1N1 influenza vaccine. Severe obesity was among the relevant chronic health conditions identified by PHAC. Since health care is under the jurisdiction of the ten Canadian provinces, the provinces were not required to follow these recommendations in their respective mass vaccination campaigns. Only one province (Manitoba) followed the PHAC recommendations with respect to severe obesity. Four provinces did not offer early vaccination to this group. Other provinces listed severe obesity as a sequencing category late in the vaccination campaign or placed narrow age restrictions on those who were given early access. This commentary argues that the Canadian provinces demonstrated an ambiguous commitment to the early vaccination of people who were severely obese, and that there is evidence that the stigma of obesity influenced H1N1 influenza vaccine sequencing decisions in many Canadian provinces.
In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.