Who Should Get Influenza Vaccine When Not All Can?

Published in Science, this 2-page paper examines the prospect of vaccine rationing in the
event of an avian influenza (bird flu) outbreak and implies some communication challenges that may arise. Namely, focusing on the United States context, the authors note that, under currently existing capabilities for manufacturing the H5N1 vaccine, "it is likely that more than 90% of the U.S. population will not be vaccinated in the first year." In an effort to set out a plan for determining priority groups in the event of a pandemic influenza outbreak, the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Policy (ACIP) have recommended a prioritisation scheme that places vaccine workers, health-care providers, and the ill elderly at the top, and healthy people aged 2 to 64 at the bottom. The authors note that, "As the NVAC and ACIP acknowledge, such important policy decisions require broad national discussion. In this spirit, we believe an alternative ethical framework should be considered."

To that end, the authors propose an alternative priority ranking of influenza vaccine, one that draws on a combination of two principles:

1. A refined life-cycle allocation principle, which is based on the idea that each person should have an opportunity to live through all the stages of life (to be a child, a young adult, and then to grow old). This principle is informed by the observation that death seems more tragic when a child or young adult dies than an elderly person. It is meant to be egalitarian in that a person's productivity to society and/or contribution to others' well-being does not factor in to the determination. The authors propose an investment refinement for this principle, which gives priority to people between early adolescence and middle age on the basis of the amount the person invested in his or her life balanced by the amount left to live.
2. A public order principle, which focuses on the value of ensuring safety and the provision of necessities, such as food and fuel.

Together, these two principles lead the authors to the "investment refinement combined with the public-order principle" (IRPOP), which they say emphasises people between 13 and 40 years of age - while also giving high priority to vaccine production and distribution workers, as well as health-care and public health workers with direct patient contact (like the NVAC and ACIP ranking). IRPOP is meant to serve as a vaccine dissemination strategy, providing guidance in the event of a pandemic experience like avian flu.