Philadelphia Inquirer on avian flu vaccine allocation strategies
In an editorial today titled "Who gets the shots?", The Philadelphia Inquirer reflects on the paper in Science this month by Emanuel and Wertheimer (which we wrote about on May 12) challenging the current paradigm for avian flu vaccine distribution when supplies are limited.
The Inquirer's four-sentence summary of the Science paper does not quite do justice to the authors' argument in favor of vaccinating those in the middle of life (roughly, 13-40 years old) ahead of the very old or very young. The original paper is very much worth reading, but a subscription is required to access it here.
The editorial's position? "Ultimately, the country will need one set of priorities, designed federally, implemented locally. The discussion needs to happen now, long before a crisis arrives."
Agreed. The key question, however, is how to determine the aforementioned set of priorities, particularly when analyses based on public health and ethics don't necessarily lead to the same conclusions. Should the first goal be to minimize loss of life in absolute terms, thereby valuing the life of an 85-year-old with a host of other medical problems as equal to (or perhaps greater than) that of a healthy teenager? Or should the first goal be to minimize the virus' spread, thus prioritizing those groups known to be better vectors for transmission (e.g., young schoolchildren). These and other questions are difficult enough when thinking in general terms, but become all the more wrenching when the generic '85-year-old' or 'schoolchild' are more accurately thought of as someone's grandmother or grandson.
Discussion is vital, but reaching any degree of consensus on these topics seems to be, at best, an uphill battle. More difficult still will be ensuring widespread public buy-in once it becomes clear who is at the bottom of the list to receive the vaccine. As if this weren't tall enough a task, the agreed-upon system must then somehow be faithfully adhered to even in the worst days of a potential crisis, when the best, non-controversial disaster plans typically fail amid the chaos.
Much to be done, and The Inquirer is right to shine a light on the urgency and importance of the work.
The Inquirer's four-sentence summary of the Science paper does not quite do justice to the authors' argument in favor of vaccinating those in the middle of life (roughly, 13-40 years old) ahead of the very old or very young. The original paper is very much worth reading, but a subscription is required to access it here.
The editorial's position? "Ultimately, the country will need one set of priorities, designed federally, implemented locally. The discussion needs to happen now, long before a crisis arrives."
Agreed. The key question, however, is how to determine the aforementioned set of priorities, particularly when analyses based on public health and ethics don't necessarily lead to the same conclusions. Should the first goal be to minimize loss of life in absolute terms, thereby valuing the life of an 85-year-old with a host of other medical problems as equal to (or perhaps greater than) that of a healthy teenager? Or should the first goal be to minimize the virus' spread, thus prioritizing those groups known to be better vectors for transmission (e.g., young schoolchildren). These and other questions are difficult enough when thinking in general terms, but become all the more wrenching when the generic '85-year-old' or 'schoolchild' are more accurately thought of as someone's grandmother or grandson.
Discussion is vital, but reaching any degree of consensus on these topics seems to be, at best, an uphill battle. More difficult still will be ensuring widespread public buy-in once it becomes clear who is at the bottom of the list to receive the vaccine. As if this weren't tall enough a task, the agreed-upon system must then somehow be faithfully adhered to even in the worst days of a potential crisis, when the best, non-controversial disaster plans typically fail amid the chaos.
Much to be done, and The Inquirer is right to shine a light on the urgency and importance of the work.
Labels: Allocation, Pandemic flu, Planning
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