vaccine prioritization during a pandemic

In the May 12 2006 isue of Science, Ezekiel Emanuel,
from the department of Clinical Bioethics at NIH, and Alan
Wertheimer propsed a scheme for rationing flu vaccine if
there is a H5N1 pandemic. They propose that healthy
people 13 to 40 years of age have the second highest
priority of being vaccinated. Those that produce the
vaccine and frontline health care workers are top
priority. This contrasts with the current recommendations
from the National Vaccine Advisory Council (NVAC), and
the Advisory Committee on Immunization Policy (ACIP),
recommendations that vaccine first go to vaccine makers,
and health care workers, followed by people 6 months to 64
years of age that are at high risk of complications from
the flu, and those that are otherwise at high risk to
contract the illness.

The article gives examples of possible ethical principles
that can be used for rationing. “save the most lives”,
 “women and children first”, “first come first served”,
“save the most quality years”, “save the worst off” (as
in organ transplantation today), “reciprocity” (you give
an organ you get an organ), “save those most likely to
fully recover”, “save those most instrumental in making
society flourish”

He claims that the NVAC and the AICP recommendations are
based on the principle of “save the most lives”. They
disagree with this prioritization, because there is time
to deliberate about priority rankings. They propose
prioritization based on what they call a “life cycle
allocation principle”. This prioritization starts with
the idea that each person “should have an opportunity to
live through all of life’s stages”. Basically the idea is
that younger people have priority over older people.
 However they refine this idea into an alternative
prioritization called the “investment refinement of the
life cycle principle including public order.” In this
prioritization gradations are given within a life span
such that adolescence to middle age has the highest
priority. They state “within this framework 20 year olds
are valued more than 1 year olds, because the older
individuals have more developed interests, hopes, and
plans but have not had an opportunity to realize them.”
 They also invoke the principle of public order, which
emphasizes “the value of ensuring safety and provision of
necessities, such as food and fuel.”

To summarize the NVAC and ACIP vs Investment refinement
of LCP (IRLCP):

Vaccine production workers and health care workers are
vaccinated first in both proposals.

Then NVAC/ACIP recommend high risk individuals 6 to 64,
pregnant women, others at high risk of exposure,
emergency response workers, high ranking government
officials. Followed by healthy individuals over 65,
people 6 to 64 of moderate risk, healthy children 6 to 23
months, other, public health and emergency response
workers. Followed by other government workers, funeral
directors, and last healthy people 2 to 64 years.

In contrast IRLCP recommends (after vaccine producers and
health care workers) people 13 to 40 years of age that are
of low risk, public health, military, police and fire,
utility and transportation workers, telecommunications and
IT workers, funeral directors. Then people 7 to 12 years,
and those 41 to 50 years old that are low risk. Then
people 6 months to 6 years and 51 to 64 years that are low
risk. Followed by people over 65 that are low risk.
 Finally those 6 months to 64 years that are high risk,
followed by people over 65 that are high risk.

This is an interesting proposal and I think could spark
some interesting debate. Comments?
Received on Wed May 17 14:23:19 2006