[SERI]In a pandemic, who gets the vaccines?

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[SERI]In a pandemic, who gets the vaccines?

History is often shaped by seemingly trivial events, such as the ones triggered by microbes. The most well-known case is the depopulation of the New World since the late 15th century, when Christopher Columbus “discovered” the Americas, as documented in “Guns, Germs, and Steel” by anthropologist Jared Diamond.
According to this account, the estimated population of North American Indians just before Columbus’ landing was 20 million. Within a century or two, the number declined to as low as 1 million, or 5% of native inhabitants. The main culprits were garden-variety germs carried by soldiers and sailors from the Old World such as smallpox, measles, typhus, and influenza, to which native Indians had never been exposed.
It is mind-boggling to imagine what course modern-day America might have taken if not for those then-lethal germs.
In this hygiene-conscious era, people are oblivious to the fact that they are still at the mercy of infectious diseases, and history is once again on the edge of being overtaken by a contagion, a flu virus. Since 1997, a strain of bird-flu virus called H5N1 has swept through parts of Asia and Europe, killing 100% of the domesticated birds in its wake, signaling that something bigger was yet to come.
Once this deadly germ crosses the species barrier by mutating into a mammalian version, and spreads to humans through person-to-person contact, public-health officials around the world fret there is no stopping it unless yet-to-be-developed miracle medicines to prevent and cure the disease are created. The World Health Organization estimates the human mortality rate from a bird-flu pandemic would be 2 million to 7.4 million in a mild-case scenario. In Korea, casualties would reach 55,000, and another 9 million would be sick.
Are we totally helpless against the unfolding of this gruesome event? The answer is no; there is already a drug on the market to relieve the symptoms associated with human bird flu. It is called oseltamivir, a drug marketed under the brand name Tamiflu in the United States. But the problem is the drug maker Roche can’t make the vials fast enough to help the world’s health authorities stockpile adequate amounts of doses in time for an impending outbreak. Typically, it would take six months to produce the drug custom-tailored to the viral strain currently in circulation.
The U.S. government, for example, has stocked up on less than 3 million doses of Tamiflu, just enough to treat 1% of its population. According to Korea’s health authorities, meanwhile, the nation’s Tamiflu inventory is for 1 million people only (just over 2% of the population). From these figures, it is obvious that governments, even those of the First World, are awfully unprepared in the event of an apocalypse.
Nevertheless, there are so many things governments can do, other than focusing blindly on Tamiflu stockpiling, or airing lame public service messages urging people to cover their mouths when they cough. For example, they could minimize death tolls and social disruptions by coming up with well-designed contingency plans, one of which would be setting firm rules on what groups of the population should get medical attention first, including Tamiflu shots.
This question of prioritization in a situation where medical services and supplies are in short supply and thus should be rationed is very important because the priority groups may change depending on the prevailing principles of society.
Conventional wisdom dictates that in an emergency situation like this you should save the old, the very young, and the sick first. But a recent Wall Street Journal article (“If We Must Ration Vaccines for a Flu, Who Calls the Shots?” Oct. 6) called this guiding principle into question, and instead suggested alternative priorities.
Based on the argument put forward by Ezekiel Emanuel of the National Institutes of Health, the article’s writer said 13- to 40-year-olds, erstwhile the last group on the waiting line, should have first claim on rationed vaccine. The logic is simple: Saving the most “life years” is more important than saving the most lives.
For example, a 60-year old has invested a lot, in terms of education and experience, but has also reaped most of the returns in life. An infant has minimal investment, albeit so many years ahead to live. A 20-year-old has great investment but has reaped almost none of the returns.
In addition, vaccinating the socially active first and then those rarely leaving home last, thereby cutting the chain of disease transmission, would be a better strategy to minimize deaths. Besides, in some flu pandemics, such as the 1917-18 Spanish Flu, it was the 20- to 40-year old age group that suffered the most casualties.
The question of rationing an important resource like life-saving drugs may be highly controversial. But it is something we have to think through well before an actual crisis materializes. Government officials, not just those in health- and farming-related agencies but in all the critical ministries within the government, should realize that they have a truly tough job ahead with millions of human lives at stake.

* The writer is managing editor of SERIWorld, Samsung Economic Research Institute’s English-language Web site. The views expressed in this column are the author’s and do not represent those of the publication that carries it.


by Chung Sangho

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