Who Should Get Influenza

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Who Should Get Influenza Vaccine When Not All
Can? Ezekiel J. Emanuel and Alan Wertheimer
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The Influenza Pandemic of 1918 http//virus.stanf
ord.edu/uda/
Juan Gris, b. Mar. 13, 1887, d. May 11, 1927
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Juan Gris The Sunblind
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BASIC POINTS

• According to the U. S. Department of Health and
  Human Services, a pandemic influenza in the U. S.
  could result in nearly two million deaths, 90
  million ill, with 10 million hospitalized, and
  1.5 million requiring ICUs (Intensive Care
  Units).
• Emanuel and Wertheimer Under currently existing
  capabilities for manufacturing vaccine, it is
  likely that more than 90 of the U. S. population
  will not be vaccinated in the first year.
• Thus distribution of available vaccine will have
  to be prioritized.

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ETHICS AND VACCINATION

• E W Clear ethical justification for vaccine
  priorities is essential to the acceptability of
  the priority ranking and any modifications during
  the pandemic.
• Priority is given to health-care providers,
  vaccine workers, and elderly people who are ill
  by both the National Vaccine Advisory Committee
  (NVAC) and the Advisory Committee on Immunization
  Policy (ACIP). According to their
  prioritization, people between the ages of 2 and
  64 who are healthy are at the bottom.
• E W believe that an alternative ethical
  framework should be considered.

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SAVE THE MOST LIVES

• Both the NVAC and the ACIP scheme for
  prioritizing the distribution of vaccine was
  based on the save-the-most-lives principle.
• The reason that health-care workers and vaccine
  producers are placed at the top is not because
  their lives are considered to be intrinsically
  more valuable than the lives of others, but
  because giving them first priority ensures that
  maximal life-saving vaccine is produced and so
  that health care is provided to the sick.

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THE LIFE-CYLCE PRINCIPLE I

• Although Emanuel and Wertheimer think that the
  save-the-most-lives principle may be justified
  in some emergencies when decision urgency makes
  it infeasible to deliberate about priority
  rankings and impractical to categorize
  individuals into priority groups, they disagree
  with the NVAC and the ACIP that it is justified
  for a pandemic.
• Rather, they advocate a life-cycle allocation
  principle based on the idea that each person
  should have an opportunity to live through all
  the stages of life.

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THE LIFE-CYLCE PRINCIPLE II

• According to the life-cycle principle There is a
  great value in being able to pass through each
  life stage to be a child, a young adult, and to
  then develop a career and family, and to grow old
  and to enjoy a wide range of the opportunities
  during each stage.
• The authors think that most people endorse this
  principle for themselves since most of us want
  the opportunity to go through the various phases
  of life and experience things that these phases
  of life have to offer.

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THE LIFE-CYLCE PRINCIPLE III

• For the authors, death at an early age is more
  tragic than death at an advanced age, not because
  the lives of the elderly do not have value, but
  because people who die young have not had the
  chance to experience and develop through
  different stages of life.
• Although the life-cycle view of prioritizing
  lives favors saving young lives over old lives,
  it is also intrinsically egalitarian.
• Unlike being productive or contributing to
  others well-being as in NVAC and ACIP, every
  person will live to be older unless their life is
  cut short.

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THE INVESTMENT REFINEMENT I

• EW A pure version of the life-cycle principle
  would grant priority to 6-month-olds over
  1-year-olds who have priority over 2-year-olds,
  and so on.
• An alternative, the investment refinement,
  emphasizes gradations with a life span. It gives
  priority to people between early adolescence and
  middle age 13 to 40 years old on the basis of
  the amount the person invested in his or her life
  the nature of their occupation key government
  workers, public health, police, fire fighters,
  etc. balanced by the amount left to live. less
  than 2 high-risk conditions

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THE INVESTMENT REFINEMENT II

• Within the framework of the investment
  refinement, 20-year-olds are valued more than
  1-year-olds where the reverse is true for the
  life-cycle principle because the older
  individuals have more developed interests, hopes,
  and plans but have not had an opportunity to
  realize them.
• Although EW recognize that the groupings of
  people in their table could be modified, they
  think that they indicate ethically defensible
  distinctions among groups that can inform
  rationing priorities.

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PUBLIC ORDER

• Public order focuses on the value of ensuring
  safety and the provision of necessities, such as
  food and fuel.
• The need for public order would mean that
  priority would be given to people, such as
  police, fire fighters, ambulance workers, etc.,
  who are required for safety.
• And it would mean that priority be given to
  people who are required for basic necessities to
  be met, such as people in the food industry,
  utility workers, transportation workers,
  communications workers, etc.

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IRPOP

• For Emanuel and Wertheimer, the investment
  refinement principle IRP combined with the
  public-order principle OP should be the
  ultimate objective of all pandemic response
  measures. IRPOP
• This includes priority ranking for vaccines and
  interventions to limit the course of the
  pandemic, such as closing schools and confining
  people to homes.
• These two principles should inform decisions at
  the start of an epidemic when the shape of the
  risk curves for morbidity the relative incidence
  of disease and mortality are largely uncertain.
• Depending on patterns of flu spread, some
  mathematical models suggest that following IRPOP
  priority ranking could save the most lives
  overall.