If a bird flu pandemic occurs, only 1 in 10 Americans is likely to be vaccinated within the first year given the current level of vaccine production.
So who should get the goods?
The existing U.S. Department of Health and Human Services Pandemic Influenza Plan prioritizes those at highest risk of hospitalization and dying—such as the elderly, very young, and chronically ill.
But a new paper flips the existing distribution model on its head and makes an ethical case for prioritizing those between early adolescence and middle age.
The study, appearing in tomorrow's issue of the journal Science, is sure to raise eyebrows. That's why experts stress that the time to tackle such a potentially explosive issue is now, before a pandemic occurs.
"One of the things that I keep saying is that we haven't had enough public debate and discussion about what the rules should be," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics.
Caplan, who is not involved in the study, recalled that distribution rules during recent seasonal vaccine shortages were often disregarded.
"The only way that you can have buy-in is if people both understand what the rule is and what the rationale is," he said. "That's absolutely critical if we're going to have any kind of orderly distribution of scarce resources."
Medical Ethics
There are many different ethical principles that can be used to ration scarce and vital commodities.
"Women and children first" was a system most famously used (though not universally practiced) to allocate lifeboat space on ocean liners.
The "first come, first served" ethic is commonly employed in hospitals—admitted patients aren't kicked out to make room for those in worse condition.
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