The National Vaccine Advisory Committee and the Advisory Committee on Immunization Policy has issues guidelines based on providing vaccines to those who are at highest risk of death from influenza and related conditions. Based on the guidelines the elderly, infants and those with chronic illness would have the highest priority among the general public after health workers and those who produce the vaccines. This policy has meant that people between the ages of two to 65 are generally left without immunization each flu season. While most recent flu outbreaks have not affected people in that age group, the 1918 flu epidemic did. The 1918 flu killed from 20 to 40 million people worldwide with about 500 thousand in the United States alone dying. That flu hit adults between the ages of 20 and 45 years of age particularly hard.
Experts fear that another influenza epidemic similar to the 1918 flu could sicken 90 million people and vaccine production and distribution could be seriously limited.
A paper in the May 12, 2006 issue of the journal Science argues that vaccines should be distributed in a different manner than the guidelines suggest. University of Vermont ethicist Alan Wertheimer, professor emeritus of political science and current visiting scholar at the National Institutes of Health, and Ezekiel Emanuel, head of the NIH's clinical bioethics department, suggest that healthy people from early adolescence to middle age be moved toward the front of the line for vaccination after health care workers and those who are producing and distributing the vaccine. They argue that scarce medicine be allocated byy accounting for an individual's degree of investment in his or life, balancing that consideration with attention to life expectancy. The paper states that vaccine allocation should be based on "life-cycle principle" The principle asserts that people should be permitted an opportunity to live through all stages of life, experiencing childhood, adolescence, a maturing career and family. Looking at the problem this way they argue that younger people should be treated ahead of the elderly as they have not had an opportunity to live their lives and fulfill their potential.
When asked if there any basis in their recommendations based on the economic impact of loosing a great number of working adults, Ezekiel Emanuel replied that some had considered that but that was not part of their argument. He also said that they hoped that bringing up the issue of possible rationing might spur preparations for a flu pandemic.
This is a sensitive issue, one that most hope never has to be addressed but it cannot be ignored. It may come down to having to decide who lives and who dies.
Sources: Science May 12,2006
