How to Ration Flu Vaccines

Today's Wall Street Journal asks a fascinating question about the allocation of scarce resources: If you have a limited number of flu vaccines, who should get them?

In May, scientists at the National Institutes of Health stirred things up with a paper calling into question the policy that aims to save the most lives by first vaccinating the old, the very young and the sick, putting last those who are two to 64 years of age. The value of a life, they argued, depends on age. A 60-year-old has invested a lot (measured by education and experience) in his life, but has also reaped most of the returns. A child has minimal investment. A 20-year-old has great investment but has reaped almost none of the returns. Conclusion: To maximize investment in a life plus years of life left, 13- to 40-year-olds should have first claim on rationed vaccine, explains NIH's Ezekiel Emanuel....

Evidence keeps accumulating that vaccinating the elderly might not even be the best strategy for minimizing deaths. The reason is that during some flu pandemics, the mortality rate among the elderly is hardly higher than during nonpandemic years. The flu certainly kills some old people, says Dr. Emanuel, but many would have died anyway. In addition, they may not benefit from flu vaccines as much as is assumed: A 2006 study found that the antibody response by people over 65 is less than half that in young adults....

The common-sense notion that vaccinating the elderly is the best way to save the elderly also deserves scrutiny, according to a study this week in the journal PLoS Medicine. Infants and the elderly don't spread the flu as much as, say, a schoolchild or business traveler. Might you decrease both illness and death, including among the old, by vaccinating other age groups first?