Re: vaccine prioritization during a pandemic

Whatever light gets shed by scientific analysis, perhaps the spread of
that influenza came courtesies of the sword -- yet another one of the
"blessings" of war is to make a virus paradise on our ever shrinking
globe. One rumor (it might be well-documented but I haven't looked
into it) has it that the first case of spanish influenza was treated
right here in Ft. Riley, KS.

--merv

jack syme wrote:

> 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?
>
>
>
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Received on Thu May 18 08:35:59 2006