Experts Argue Over Allocation of Bird Flu Vaccine

If and when a bird flu (H5N1) pandemic occurs, experts estimate there will be only enough vaccine to protect one in every 10 Americans.

Now, an essay in the May 12 issue of Science is heating up the debate on who that lucky 10 percent should be.

Countering the federal government's policy of placing the elderly near the top of the list, two medical ethicists from the National Institutes of Health (NIH) say that after doling out the vaccine to essential health workers, people between 13 and 40 years of age should be next in line to receive the shot.

"What we are arguing is that younger people have more of their life to lead, and they ought to get higher priority," explained Dr. Ezekiel Emanuel, chairman of the department of bioethics at The Clinical Center, which is part of the NIH.

He and co-author Dr. Alan Wertheimer stress that their opinion piece does not represent any official stance on the issue by the NIH, but they do hope it widens the debate on what could one day prove to be a very divisive issue.

Two U.S. bodies -- the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Policy (ACIP) -- have helped craft the nation's flu vaccine allocation strategy in the event of a pandemic.

Everyone on the panels agreed that vaccine production staff and health-care workers should get top priority for any vaccine. Then were people at high risk for death or hospitalization due to preexisting health conditions, as well as pregnant women, and a few key government leaders.

"You have to decide what the number one priority is, and we felt that that priority was saving lives and decreasing hospitalizations," said ACIP chairman Dr. Jon Abramson, who is also chairman of the department of pediatrics at Wake Forest University Baptist Medical Center, in Winston-Salem, N.C.

According to Abramson, that means doling out vaccine to those people deemed at highest risk of dying should they become infected. With the lone exception of the 1918 pandemic -- in which young adults were most at risk -- "it is mainly the elderly and those with underlying cardiopulmonary and other chronic conditions that are most at risk" in flu pandemics, he said.

"People in their late teens/early 20s should get priority because [society] has already invested a lot in them, and they are just on the cusp of leading their lives," Emanuel said. It's precisely for these reasons that the death of a young person always seems more tragic to us vs. the death of someone much older."

"Part of the dilemma in developing vaccine-rationing policy is that we just don't know who's likely to be the most vulnerable -- the young, the old or the in-between," said Dr. G. Caleb Alexander, an assistant professor of medicine at the University of Chicago's MacLean Center for Medical Ethics.

But he said the policy as it stands now is based on a sense of "equity": Outside of health-care workers, no one group should get priority because of age or any other factor, other than their vulnerability to the virus. He said ethicists were included on the NVAC/ACIP panels and were familiar with Emanuel and Wertheimer's position, but "none of them bought that argument."

Source: HealthDay: Experts Argue Over Allocation of Bird Flu Vaccine

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