Classic ethics issue

The flu season is around the corner again. If you have only limited supply of flu shots, how would you ration them? The conventional wisdom is that you vaccinate the young and elderly first. But there is some challenge to this in today's WSJ:

First, ethics. 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.

Second, efficacy. Let's leave aside the fraught question of the value of a life. 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.

Critics reply that the elderly are more likely to die if they get the flu, so ethics requires you protect them, the most vulnerable, first. Indeed, in the 1957 and 1968 pandemics, the very young and very old had the highest flu-mortality rates. But in the 1918 pandemic, 20- to 40-year-olds and children under five had the highest mortality rate. The elderly were more likely to either not become infected or to survive if they did, perhaps because only someone with a sturdy immune system lived to a ripe old age back then.

In this regard I wish we were living in a communist Utopia where everybody always gets what he/she desires. We are not. Resources are scarce and we have to make choices every day, one way or the other. A lot of times the frontier we face is just unpleasant that we have to make tough choices. Some people rely more on morals and ethics to balance the tradeoff, while others tend to adopt a more utilitarian approach. One is not necessarily superior to the other and I admit that the moralist and utilitarian in me are fighting all the time. However, the dominant libertarian in me is satisfied as long as people are making those choices by their own.