I know it sounds cold-blooded. But frankly it makes sense to me for society to give priority in such an emergency to protecting its more productive citizens and those persons who can best help to maintain civic order. And that basically means teenagers and adults. It might well be best for many of the elderly to go without protection so that the community as a whole can maintain at least some basic degree of order and preserve itself for future generations. It’s a question of allocating critical resources in an emergency.
Of course, a great deal depends on exactly how badly a pandemic threatens to disrupt society. If it reaches the point where there are critical shortages of personnel necessary to keep the financial system going, generate electricity, keep hospitals running, control crime, and so forth, then someone’s going to have make some very hard decisions about who gets protection from the flu and who doesn’t.
If we can make enough vaccine for everybody in time, great. But if not, somebody has to go to the bottom of the waiting list.
There are other, better, reasons to not focus on immunizing the elderly (and some other high risk individuals) in the face of limited supplies as well. The elderly are least likely to respond vigously to the vaccine. The elderly are not the population that spreads the disease the most. The best way to protect the high risk population may be to not let them get exposed in the first place.
Immunizing school kids may be the most effective tactic in the face of limitted supply. They are responsible for most local spread of disease and they respond well to the vaccine. Immunize them and others are protected by virtue of not being exposed in the first place.
“Sorry, Mom, but you’re old and really not very productive. And frankly, I was alway annoyed at your making us eat liver every Thursday when we were kids. So, no vaccine for you!”
Seriously, though, how about prisoners? The mentally retarded? We withhold vaccines from them too, right?
My main criticism is that the article seems to ignore the possibility that death rates may be considerably different for persons of different ages and, er, degree of robustness. I seem to recall hearing the figure of 50% mortality for some strisn of flu, but I don’t know whether the rate is the same for all ages or not. Maybe triage for susceptibility to mortality is a better way to go.
Or, how about instead, since avian flu hasn’t actually jumped to humans yet, we allocate some money to ensure that there’s enough anti-influenza agent to go around? You know, plan ahead? It’s just crazy enough that it might work!
I saw an article in Science a few months ago analyzing strategies for preventing the spread of influenza virus. It turned out the most effective strategy was to vaccinate all school age children. This was least costly and prevented the most cases of flu in **all ** age groups.
School age children are the “vector” for the flu. So, vaccinating a single child could prevent many cases in the elderly. Also, as mentioned above, the vaccine is more effective in giving immunity in the young.
ISTM that a serious flaw in the OP’s source’s argument is the failure to take into account different risk levels from disease in different populations, as El Kabong commented.
I thought that was already the rationale for encouraging elderly and sickly people to get ordinary flu vaccines annually, while telling the young and healthy not to bother. Because young healthy people who get flu aren’t likely to die of it, whereas less hardy people might.
If we’re talking about some hypothetical pandemic that kills the same percentage of people at all age levels, then I can see where we open up some space for “survival of the fittest” arguments. But if a particular disease is significantly less life-threatening for the young and healthy than for the old and sick, then I don’t see the sense in putting the young and healthy first in line for the vaccine.
Vaccinating a single child will probably only save one child. For herd immunity you would need to vaccinate a significant proportion of all children (probably more than 80%). It doesn’t take a big drop in vaccination rates for herd immunity to fall apart. MMR uptake in the UK came very close to dropping to a critical level post Wakefield debacle. Had that happened we would have seen significant outbreaks of disease amongst previously protected non-immunised persons.
My strategy for immunisation would be, in order of importance:
Primary and seconday healthcare workers (someone has to look after the sick)
Children of school age, law enforcement, people in care-homes and prisoners (critical personnel and those who are in cramped conditions, prisons especially are breeding grounds for disease. TB is endemic in the Russian prison system, you go to jail in russia, you get TB)
Persons under-65 (essentially, the workforce. The economy will be needed after the disease is gone)
Everyone else
Pubic policy isn’t always nice, limited resources will always mean someone loses out. It might be better for the nation as a whole if we let grandma die if it means that law and order doesn’t breakdown.
(shrug) I don’t see it as a “survival of the fittest” measure to allocate scarce resources so as to forestall massive disruption or complete breakdown of critical social services (e.g. health care and preservation of public order).
Many young, healthy people died of flu during the last global pandemic during WWI. We’re not talking about a week or two in bed with a bad cough, a fever, and some aches and pains; we’re talking about something that will kill many people in their prime. Read some accounts of the Spanish influenza outbreak that took place early in the 20th century.
What is more, you can’t just make millions of doses of vaccine appear overnight. The lead time between the beginning of vaccine production and the time that the first major impact of the pandemic will be felt probably won’t allow us to produce more than a few million doses.
There just won’t be enough for everybody, and it simply makes sense to provide the vaccine to those whose services are critical to the functioning of society.
Bear in mind that I myself probably wouldn’t get the vaccine under this restiriction.
Define old.40 50 60 What about Cheney and Bush, Senators congressman?You think the people in power will accept that.Heads of Industry the rich, get rteal
If that’s what we’re talking about—i.e., a disease where mortality rates aren’t significantly lower for the young and healthy than for other groups—then I see your point.
But is that necessarily what we’re talking about? If not—that is, if a young and healthy person has a significantly higher chance of surviving a particular pandemic disease than an older or sicker person—then I don’t see the logic of automatically putting the young and healthy first in line for the vaccine.
I do agree that it makes sense to prioritize the vaccination of healthcare and law-enforcement workers, groups with high risk of transmission such as schoolchildren, etc. But once those top priorities are taken care of, I think differences in mortality risk should be taken into account. If I have a 1-in-10 chance of dying if I catch the Next Big Flu and my 80-year-old mother has a 9-in-10 chance of dying if she catches it, I’d rather have her get the vaccine.
The problem is that there really is no place in public policy, and this is really what this discussion is about, for decisions based on emotions.
Public policy is about doing what is best, or what we think is best, for the nation as a whole.
I think that losing, to use your figures, 10% of the workforce would be a bigger disaster for a nation than losing 90% of it’s retirees.
The loss of a loved one is a tragedy on a personal scale, but when you are talking about issues that affect millions (in this case tens and hundreds of millions) of people then it’s probably best that the people who will make the hard decisions put their feelings to one side.
Unfortunately, public-policy issues of this nature are deeply entangled with emotions. If a government policy is going to provoke strong negative emotions among the public by appearing to be cruel, selfish or heartless, it had better have impeccable pragmatic logic to back up its decisions.
And what I’m pointing out is that a decision to prioritize the young and healthy over the old and sick for vaccination may not be impeccably logical, if the young and healthy have a much better chance of surviving the disease.
Well, you’re assuming here that every unvaccinated person in the country is going to catch the disease. AFAIK, most pandemics don’t work like that. IMO, we should base our disease-control strategies on the best information we have about the specific characteristics of the particular disease we’re trying to control.
You’re right that we shouldn’t make difficult public-health decisions based on sentimentality, but we also shouldn’t make them based on bad reasoning. Setting up a pseudo-pragmatic principle like “the elderly and sick are more expendable” as our main yardstick for decision-making, irrespective of other important issues like differences in mortality rate or transmission risk, is bad reasoning.
And bad reasoning that produces a strong negative reaction in public opinion is especially ill-advised. If you’re going to impose a draconic government policy that many people will find shocking or immoral, you need to be able to provide very solid rational justification for it.
I don’t disagree. I was working on the assumption of 100% morbidity. Obviously public policy decisions of any kind are best made when you have as many of the facts as possible. However, I still stand by my assertion that the workforce should be protected, even if that means sacrificing a large number of retirees.
I have no real understanding of spin or the way in which the public reacts to difficult moral and ethical issues, especially if we are talking about the US public. I would have to leave that to others to argue. A decision on this sort of scale would likely have huge ramifications for elected officials, although I would hope that they would not make pandering to their electorate the priority.
The thing is, if it’s a “1918-style” pandemic, it’s not just that the young and healthy also get sick - it’s that they get sick and die at a higher rate than the elderly. That strain was unusual in that is disproportionaly struck young and healthy victims, and they often died within a day.
If is the case in an actual pandemic, I would most definitely support immunizing the younger workforce first - even if I didn’t fall into that demographic at the time.
Didn’t the fact that the younger population was involved in fighting WWI have a lot to do with why they were so hard hit by the 1918 flu? They were living in cramped conditions and traveling more than would normally be the case.