If Bird Flu Hits, Protect Young Adults First, Ethicists Say

If the United States experienced a bird flu pandemic, and there were only a few million vaccinations on hand, who should get immunized first?

The current plan is to immunize hospital workers and paramedics, and then those who would have the hardest time fighting off the infection, such as older adults and kids.

But two biomedical ethicists argue that's the wrong approach.

In a column in today's issue of Science, they say vaccine rationing should not be based on medical questions -- such as who has the weakest immune system.

Rather, the ethicists argue, experts should consider the philosophical question of who would benefit most in the long term.

Their provocative proposal is simply a suggestion, without any binding force. The avian flu has so far not mutated into a form easily transmittable among people, and there is no pandemic anywhere in the world. But if one were to occur, health officials would have to decide how to use the available resources.

A vaccine is currently in development but its effectiveness hasn't been proved. Even after a vaccine is perfected, it could take months or even years to produce it on a mass scale. More than likely, the United States could face a situation in which the vaccine must be rationed.

So who should get those limited supplies? It's a difficult but important question, say Ezekiel Emanuel and Alan Wertheimer, both in the department of clinical bioethics at the National Institutes of Health.

In their column, they argue every person, ideally, should have the opportunity to experience all the stages of life. But in a pandemic, kids should not be a big a priority, since they have not invested enough into their lives yet; on the other end, older people have experienced more of life's stages, so they don't deserve priority either.

They suggest a "cycle of life" priority that gives preference to people 13 to 40 years old -- as long as they are reasonably healthy. If they have high-risk conditions that make them a lower bet for a long life, they drop down on the priority list.

"There is 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 a family, and to grow old -- and to enjoy a wide range of opportunities during each stage," the authors state.

This suggestion also has some practical value, although the ethicists stick solely to the philosophical argument. It would surely be extremely controversial, and no doubt many experts would support alternative plans for vaccinating the public.

Most parents of small children are in Emanuel and Wertheimer's target age group. If they were vaccinated, they would be less likely to transmit the virus to their kids.

And while the two ethicists' plan would no doubt alarm older Americans, in the limited cases in which the bird flu in its current form has proved fatal, it has killed mostly young, healthy humans -- not kids and older adults.

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