I had heard that the biggest reason the 1918 influenza struck the young so badly was that it bore a resemblence to another epidemic flu that has struck at around the turn of the century. People exposed to the previous flu had some immunity to the 1918 strain.
This made me think. 90% is a big number. But you also have to consider that the workforce is also the parenting force. If 10% of the parents of young children died, this would cause some serious problems.
It also seems like it would be easier to isolate the elderly. Presumably you would want the infastructure to work as well as possible, even (or especially) durring such a time, and to keep it running the workforce has to continue to interact with people. The elderly can be relatively isolated without shutting everything down.
This would never go over. People have no sympathy for people in jail. They would much rather you give the vaccine to their cancer-riddled 103 year old grandmother than to the 20 year old gang member doing 5-10. High risk or not, there would be rioting over that.
During the last flu vaccine shortage, the prison in which my husband works was roundly denounced by the local media. They were outraged that all of the inmates had been given the flu vaccine, but law-abiding citizens couldn’t get it.
Over and over, the prison tried to explain why this was a reasonable measure to protect public health. In a prison, or other high-density populations, viruses get passed back and forth, mutating in the process. The employees can carry the “new” virus out into the public.
However, the media never lets reason get in the way of a good outrage story, so the prison was fielding angry calls for weeks until the next outrage-of-the-month came along.
So we seem to have three considerations here:
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** Humanitarian: ** Protecting or saving the life of an individual simply for the sake of protecting or saving that life.
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** Disease Prevention: ** Preventing specific populations, e.g. schoolchildren and prisoners, from becoming reservoirs of infection.
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** Protecting critical personnel: ** Protecting those persons critical to the basic functions of society, e.g. medical personnel, police and firemen, utility workers, food production and distribution, financial industry, etc.
From my point of view, priority ought to be 3, then 2, then 1.
Does anybody have other considerations? Would anybody chose a different order of priority?
I think that’s rather reasonable. While no one wants to see a beloved grandparent get sick (and, of course, feel insulted that their family members are considered a low priority) sometimes it comes down to a simple case of numbers. In a true disaster situation, we would want to save as many people as we could, and that means vaccinating first those who have the greatest potential for spreading the disease-- healthcare workers, and others who come into contact with large numbers of people, and people living in close quarters.
I’ve often thought that if there ever was a plague, we’d be doomed because people, unless forcibly restrained, would refuse to obey quarantine orders. Everyone would consider themselves, or their circumstances, to be an exception. “But I’ve got to go check on my relatives!” “But we needed an item from the store!” “I may have been exposed, but I’m not sick. Why should I have to stay at home?” “I’m not staying in the city where everyone is sick.” And lastly, quackery. “I read on the internet that if I drank honey and vinegar water, I’d be protected from the illness.”
The three criteria aren’t really separate; since everybody who gets the disease presumably is able to transmit it to others, protecting critical personnel and “humanitarian” vaccinations both count as disease prevention measures. But I get your basic point about theoretically separating them in order to provide a metric for targeting a particular vaccination effort.
I might suggest putting 2 and 3 on the same level, or even prioritizing 2 over 3 in certain cases. For example, if the disease starts in a certain geographical area and it looks as though we have a good chance at preventing it from spreading to other areas, then we should prioritize vaccinating people in the affected region rather than, say, firefighters located on the other side of the country.
Absent such considerations, though—if a pandemic really is everywhere and everybody is about equally vulnerable to it—then yes, we need to make sure we have society’s foot soldiers such as doctors and police protected, even before we vaccinate the populations where we get the biggest epidemiological bang for the buck.
Do junior high and high school health classes cover the basic concepts of epidemiology and related public health procedures (such as vaccination, quarantine, vaccine rationing, mandatory notification, etc.) nowadays? ISTM they really ought to. These are things that every citizen ought to have some knowledge about. (Actually, do they even have junior high and high school health classes anymore?)
I don’t see any way of convincing the Teeming Millions that this calls for anything beyond 1)vaccinating the prison employees and 2)keeping the prisoners in prison (under the label “quarantine” if their terms run out while the crisis is in effect).
Won’t work, though. Two reasons:
A vaccine is only good against one specific strain of the virus (generally speaking.) If you immunize the prison personell against H5N1-Human Variant 1A, it will still pass around the population. It will then mutate and become H5N1-Human Variant 1B, H5N1-Human Variant 1C, H5N1-Human Variant 2A, and H5N2- Bovine Variant Carried By Humans. At least one of the variations won’t be covered by the vaccine, and the guards may start dropping dead of that.
Secondly, many viruses can still be carried by vaccinated individuals. They may not get sick, but if exposed, they can still spread it to the outside population.
WhyNot, maybe a way of putting that for the Teeming Millions would be:
“Closely confined groups of people are like petri dishes for mutant viruses. We’re vaccinating the prisoners because if we let this flu spread among them unchecked, it has a much higher chance of developing into a new flu strain, resistant to the vaccine, that will spread to people outside the prison.”
This just in; the Bird Flue virus seems to be dying out in asia. Does this mean:
(A) a newer, more dealy starin is being mutated?
or
(B) The bord flue is an evolutionary dead end-it cannot jump to humans, and kills its avian hosts too quickly to allow it to spread?
I have heard the story about the 1918 virus: young healthy men and women dropped like flies, while the elderly were not greatly affected. Might that have been due to exposure to an earlier virus? or was it because the younger people had a much stronger immune response?
As Szlater mentioned earlier, that is an established theory. I hate to recommend the book because it’s poorly written (even non-fiction should have some standards for organization and mechanics), but it’s one of the things discussed in depth in **Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It ** by Gina Kolata.
As for the OP, if there was a shortage, I’d be more inclined to want it to be given to the young than the elderly. I don’t have anything against the elderly (except on a case by case basis) but kids are walking germ incubators, and vaccinating them will do us all more good than vaccinating the typical elderly person who isn’t socially active and out there spreading disease.
I wouldn’t recommend beginning with school-age kids, however, but much younger. If you’ve ever worked with very small kids in daycares or preschools, they’re sick all the time. Then they make their parents sick, who go to work and make their coworkers sick, who go home and… the last time I looked it up, you can vaccinate anyone older than six months old for the flu, and if they’re going to be with lots of other kids rather than spending their days at home, I’d start there.