Friday, October 06, 2006

How to Allocate Flu Vaccines?

In the Wall Street Journal today, there is an article that discusses the important, but tricky question of how limited vaccines should be allocated in the event of a national emergency. The question is relevant due to concerns that have arisen over the past few years over the avian flu.

The author of the article, Sharon Begley, reports on a paper that questions the conventional wisdom on the issue:

In May, scientists at the National Institutes of Health stirred things up with a paper calling into question the policy that aims to save the most lives by first vaccinating the old, the very young and the sick, putting last those who are two to 64 years of age.

The value of a life, they argued, depends on age. A 60-year-old has invested a lot (measured by education and experience) in his life, but has also reaped most of the returns. A child has minimal investment. A 20-year-old has great investment but has reaped almost none of the returns. Conclusion: To maximize investment in a life plus years of life left, 13- to 40-year-olds should have first claim on rationed vaccine, explains NIH's Ezekiel Emanuel.

What do you guys think? If you only have a certain number of vaccines, who should get first priority?

This is a pretty controversial question, so I urge you to read the whole article before commenting and to keep the comments civil and well thought-out.

(Source: Greg Mankiw's Blog)

11 comments:

Anonymous said...

to start with, i couldn't get to the original article, because the website told me i needed to be a member before i could see the whole article. So from the excerpt of the article that i could see, i saw one fairly important point that the author failed to consider. The people once likely to die from a flu are the very old and the very young. Their immune systems are weaker and have a far more difficult time fighting off the flu than the rest of the population. The flu vaccine may be "wasted" on say 20 year olds, becuase their bodies could fight off the flu without the vaccine. Where as the elderly might not be able to do so.

Anonymous said...

that last one posted at 11:16 was by jacob hormes

Anonymous said...

It is an interesting point whether those with the most potential or those who need the most help should be protected. When a shortage of vaccinations does occur, I am not in the age bracket currently used to get the vaccine, however, simply those confines are not the only people that receive the vaccine in those times of lack. As a very allergic and asthmatic person, I, along with many others under any kind of similar circumstances, am always provided with the vaccine. I do not consider myself sickly or needing of it to survive, but the doctors provide it anyway. I think that although the age group of 13-40 does have the most potential, they have stronger immune systems and perhaps .000001% of that age bracket will die of the flu, but if they were vaccinated, perhaps more people would die overall by aid of the very young and the elderly group, and maybe even just the sickly kids like me. I think that the people in need are currently being helped, and that is what matters.

Kate Vanderlip

Anonymous said...

I agree with jacob's point. The elderly and the young are the two that are more suseptable to disease. They are the ones more likely to get the flu and possibly die from it. Those with stronger immune system or who don't get the flu every year should not be the first in line. I know they like to have the security of knowing they won't come down with the flu, but they also take away from those that need more than just the security but the assurance.
-Danielle

Anonymous said...

I had always thought that the current method of rationing the vaccines had been instituted to save as many lives as possible in the case of a flu outbreak and a vaccine shortage. It made sense, then, like Jacob, Kate, and Danielle have said, that the vaccines would be given first to healthcare workers (most susceptible to contracting the flu because they would be in direct contact with those who have it) and then to the very old and very young, both of whose immune systems are less able to resist the flu than healthy, middle-aged people. That way, in theory, few of both the healthy people and the sicker people would die from the flu--rather than no healthy people and almost all of the elderly and very young. To me, it is much less a question of who is most worthy to save but rather how to save as many as possible, and it seems that investing vaccinations in that demographic which would ordinarily have the highest probability of survival without them is counter-intuitive. The proposal of the National Institute of Health seems to resemble triage on a battlefield: army doctors know that they cannot save every fallen soldier, so they invest their time and resources in the soldiers most likely to survive with as little treatment as possible, sacrificing those soldiers who need more effort to live (in this case, that would be the elderly and young). What battlefield doctors do and what the National Institute of Health proposes is a system which maximizes use of resources and societal benefit to beget a certain group of people who are practically guaranteed to survive and in turn provide the most personal benefit to society, with an opportunity cost that they consider low because were those in other demographics to die, society would lose fewer of their potential benefits. I, however, believe that cost to be high, because with a different allocation of vaccines, fewer people overall would die from the flu every year. It all seems to be a matter of how you approach the situation.

-Nicole

Anonymous said...

I agree with Jacob and Danielle's point that the very young and very old would have weaker immune systems than the people between the ages of 13 to 40 year olds, thus making young and old people more suseptable the the flu. True, the 13 to 40 age group would have made plenty of investments in their lives without recieving much of the benefits yet, but they would also have better immune systems to help fight the virus. The flu vaccines should be allocated to the people whom would most benefit from the shots, which would be the very young and the very old in this case.
-Gautam

Brit said...

According to http://www.wrongdiagnosis.com/f/flu/deaths.htm, the flu virus causes 2.5% of deaths for children 1-4, and 3.2% of deaths for people 65 and over, but only 0.5% of deaths for teens ages 15-19. This goes with Jacob's point, that we have stronger immune systems and thus are less susceptible to the flu than the very old and the very young. However, I have to disagree with Nicole's comparison between how we apportion flue vaccines and battlefield medics. First, army doctors during WW1 and 2 (today there are enough medics that they can usually try to save everyone) would divide casualties into those that were beyond saving, those that needed immediate treatment, and those that could wait for treatment. The middle group was treated first. This fits with the current policy: the very young and very old face the most pressing danger, and need the most immediate treatment. However, in the army a patient's rank determined the order of their treatment; a colonel with a bullet in his arm trumped a private who was bleeding to death. Why? Because colonels and other officers would have received years of invaluable training and experience, whereas privates were a dime a dozen, and far less important. If we are going by this analogy, shouldn't we aim to save the members of society who are more important because they have the most to offer, that is, the 15 to 60-year-olds, instead of the very young, very old, and infirm, who have almost nothing to offer?
/inhumanity off

Anonymous said...

I couldn't get the real article either, so I'm not completely in the loop here, but I wouldn't say that people over 60, children under two, and some sicker people have nothing to offer: someone who is over 60 has probably gained a lot of wisdom from experience and other somewhat corny things like that. But as most of you guys have already said, it's not really about who should get priority, but saving the most total people, since people 3-64 are the most capable of fighting off the virus on their own. And it does make sense that health care workers are in the priority group, too, since some of them are exposed to these types of viruses day after day in their jobs. I think Kate (and others) is right: the system right now is helping the people who need it most, and that's the way it should stay. -Carrie

Anonymous said...

I disagree with Jacob and Danielle. I don't think that we should give the vaccines to old people. I don't mean to sound terribley insensitive but they are going to die soon anyway...Proirity should go to children and people in their 20s since they are America's future. If there was ever a shortage of vaccines, they should be distiributed to those who would benefit the country in the long run as opposed to those who aren't particulary useful. Again, sorry for being so insensitive; however, medically and economically, it would make more sense to give the vaccines to children and younger people.
-Veronica

Anonymous said...

I could not access the original article because I was not a subscriber. I feel that I agree with many people before me in the the vaccine should be given to healthcare workers and the young, but I believe the VERY old should not be given such immediate attention. By very old I mean, 80 or older. I think those people have a worse chance of living even with the vaccine because they are natrually weaker by that point in their lives. The vaccine could possibly be wasted on giving it to the very old. I believe most teens and young adults have a better chance of fighting off the virus so they should not be high in priority for getting the vaccine either. But how many health care workers can be offered the vaccine before infants? What is the number that divides the vacinnes amongst the different ages or catagories? Some may not be full time health workers, but still reap the benefits of getting the vacinne, when there is a young adult needing that vaccine that does not get it due to shortage. Some allocation must be done to evenly divide amongst the groups recieving the vaccine at all.

-Sara Diehl

Anonymous said...

I agree with what Jacob said. Even though people who are in their 60s or older have given a lot to society, I do not think they are the most valuable. Young children should be given the first priority because they still have the most potential. I think that next the elderly should be vaccinated. The people in the prime of life might lose some productivity for a few weeks but they will survive. If there is a shortage, than they should be the last ones to get it.

-Brian Meier