Women and Children First?

The U.S. Department of Health and Human Services recently posted its Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine.

Given that influenza vaccine supply will increase incrementally as vaccine is produced during a pandemic, allocation decisions will have to be made. Such decisions should be based on publicly articulated and discussed program objectives and principles. The overarching objectives guiding vaccine allocation and use during a pandemic are to reduce the impact of the pandemic on health and minimize disruption to society and the economy.

DHHS notes that public and stakeholder meetings did not yield a single, overriding objective for pandemic vaccination, where one target group was granted preference over all others. However, an important and consistent emphasis from these meetings was the desire to designate healthy children (as opposed to those at increased risk) as being of inherently higher priority than the general population of adults aged 19-64.

Obviously, first priority must be given to protecting those who 1) are essential to the pandemic response, 2) are involved in critical infrastructure, 3) provide health care and community support services, or 4) are involved in national security. Less clear is the rationale of giving preference to otherwise healthy children to the exclusion of productive adults, especially in light of the stated goal to “minimize disruption to society and the economy.”

The response to protect our children is visceral – an inborn emotional reaction that is nearly universally shared. At the level of the family, the person, or the selfish gene this seems eminently sensible. But, does it really make for rational public health policy? Infants and small children have great potential, but little actual, societal value. Why, then, are we so willing to hold youth so dear and experience, ability and wisdom in such comparatively low regard?

Taken to absurd extremes, such an outlook leads to the placement of the “unborn” on a par with autonomous adults insofar as moral regard is concerned. Potential value is given greater purchase than actual value. Yet if we set aside emotion for a moment, it should be clear that this is exactly the opposite of the outcome we should desire. If a crude phrase will be forgiven, the replacement cost of infants and small children is considerably lower than that of an adult of working age, in whom our society has invested in education and training.

The allocation of scarce vaccine resources during a pandemic poses an important conundrum, and DHHS is to be commended for grappling with the issue before the a pandemic is upon us. But, we need to be more coldly rational in deciding who will share this lifeboat. Sound public health policy demands it.

Leave a Reply