Re: vaccine prioritization during a pandemic

Ok no takers yet, so I will start.

I think that the current proposal for vaccine distribution from NVAC,
assumes that the death rate among the young and healthy would be low. So
vaccinate the very old, and very young, and those that would be less likely
to survive if they got the flu, the young and healthy would be likely to
pull through. They might get sick, but they would live.

But what if the fatality rate from H5N1 was higher? So far the cases of
bird flu that have occurred in Asia, (hat was transmitted from birds) the
fatality rate is 33%. Which of course is very high, way higher than typical
flu epidemics, which is less than 1%.

But lets look at the 1918 pandemic for one minute. Here the death rate was
higher than normal, about 2.5% overall. But the 1918 pandemic was unique
for one very important aspect, and that is it killed a lot of people between
the ages of 15 to 50 way more than any other pandemic. All other flu
pandemics have what is called a U shaped death rate, that is most of the
deaths were the youngest, and the oldest. However the 1918 pandemic has
what is called a W shaped death rate, that is, there were a lot of deaths in
the 15 to 50 age range. In fact the fatality rate in that population
approached 4% which is higher than the average fatality rate for that
pandemic.

No one knows why that pandemic killed so many people, that were otherwise
healthy from the ages of 15 to 50, ages that are usually protected from
fatality.

If the shape of the fatality rate for the bird flu pandemic, if it occurs,
is going to be W shaped, does this change the decision making? Obviously
that would only be speculation, but is it wise to protect that age group in
case that is what is going to ocurr?

Here is a good reference for the 1918 pandemic and death rates.

http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm

----- Original Message -----
From: <drsyme@cablespeed.com>
To: <asa@calvin.edu>
Sent: Wednesday, May 17, 2006 2:21 PM
Subject: 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 22:35:31 2006