When there is not enough medicine for all, how should government prioritize who gets the scarce doses first?
One seemingly obvious answer, and one endorsed by two federal committees, would be to ration the medicine in such a way as to save the most lives possible. But in a paper appearing in the May 12 issue of the journal Science, University of Vermont ethicist Alan Wertheimer, professor emeritus of political science and current visiting scholar at the National Institutes of Health, and Ezekiel Emanuel, head of the NIH's clinical bioethics department, argue for an alternative approach.
Attempting to save the most lives gives the oldest, youngest and sickest priority for vaccination. Guidelines from the National Vaccine Advisory Committee and the Advisory Committee on Immunization Policy, in fact, place healthy people aged 2 to 64 as the very lowest priority, below even funeral directors.
Emanuel and Wertheimer's distribution recommendations are different: they put healthy people from early adolescence to middle age toward the front of the line for vaccination. (Both sets of recommendations give first priority to frontline health-care workers and people involved in producing and distributing vaccine.) They argue for allocating scarce medicine by accounting for an individual's degree of investment in his or life, balancing that consideration with attention to life expectancy.
"The idea is that it's important to ask whose lives are they and at what point in life are they," says Wertheimer, who co-developed the UVM Honors College's first-year ethics curriculum before retiring last year. "There is a big difference between saving the most lives and the most life years."'"/>