Re: vaccine prioritization during a pandemic

Crowding of men in wartime situations, especially things like the trenches
of WWI, is conducive to spread of quickly acting & lethal pathogens. When
hosts are more widely spead, a virus has to let its host live long enough to
come in contact with another potential host. When potential hosts are very
crowded, viruses that kill their hosts off quickly can still spread.

Shalom
George
http://web.raex.com/~gmurphy/
----- Original Message -----
From: "Mervin Bitikofer" <mrb22667@kansas.net>
To: <asa@calvin.edu>
Sent: Thursday, May 18, 2006 8:28 AM
Subject: 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?
>>
>>
>>
>>
>
>
>
Received on Thu May 18 08:51:07 2006