Re: vaccine prioritization during a pandemic

Just an observation: apropos to our recent discussion of different
approaches to ethics, this proposal seems entirely utilitarian. Taking a
deontological approach, how this proposal fare in light of scriptural
injunctions to care for the poor and oppressed? Or taking a virtue
approach, is this the sort of proposal that supports the development of a
virtuous community? The idea that *"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"* seems troubling under either a Christian-influenced
deontological or virtue approach.

On 5/17/06, drsyme@cablespeed.com <drsyme@cablespeed.com> wrote:
> 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 10:53:51 2006