In an earlier post, I cited a push for treatment of a set of thirteen neglected diseases in addition to the big three. Part of this push was the note that it's not just deaths, but years lost to disability, that matter.
In the 12 May, 2006 issue of Science, Emanuel and Wertheimer advance a similar argument for vaccinations in case of a flu pandemic.
The traditional vaccination model is "save the most lives." By this model, medical personnel are vaccinated first, then those who are expected to be most vulnerable -- the sick, elderly and very young. They argue that instead of this approach, the most ethically sound approach is what they call "the life-cycle principle." I'll present it in their words:
We believe that a life-cycle allocation principle based on the idea that each person should have an opportunity to live through all the stages of life is more appropriate for a pandemic. 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 family, and to grow old--and to enjoy a wide range of the opportunities during each stage.
...and...
Death seems more tragic when a child or young adult dies than an elderly person--not because the lives of older people are less valuable, but because the younger person has not had the opportunity to live and develop through all stages of life. Although the life-cycle principle favors some ages, it is also intrinsically egalitarian. Unlike being productive or contributing to others' well-being, every person will live to be older unless their life is cut short.
They then modify this with an "investment refinement" that says that having invested in life -- developing hopes, dreams and interests -- also adds priority. This yields a final model in which people in the midrange of age, say 20-40, have the highest priority for vaccinations. As a final adjustment, they do agree that medical personnel should be vaccinated first, to maximize the total return on the vaccines.
As Tim correctly pointed out, the concept of seemingly putting babies and old people last won't fly with a lot of people, but as the authors point out, at least part of this model is intuitive. When a twenty-year old dies, it's a tragedy. When a ninety-year old dies, you think they lived a good, long life. Why shouldn't vaccination follow our intuitive, human model?
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