In the case study involving the flu strain spreading in urban Minnesota, there certainly is a moral dilemma, as there would be in any situation where one has a vaccine for a potentially deadly disease but not enough of that vaccine to protect all of the members of a given population. In the case of the influenza, it is a frightening disease. Between September of 1918 and June of 1919, 675,000 Americans died of either pneumonia or influenza, easily more than the number of Americans killed in both World Wars, Korea and Vietnam (Redican). Intriguingly, though, it was the young adults, normally among the healthiest part of a society, who tended to die the most quickly from the flu during that epidemic (Garrett, Vawter, Prehn, DeBruin & Gervais). As a result, it is still a disease that can cause panic. However, to make the best decision here, there are several questions that I would ask:
- Is the flu strain bacterial or viral?
- Are any other people catching the disease besides middle-aged Caucasians? In other words, is the infection primarily or solely among middle-aged Caucasians? If they are the only people getting it, that would certainly be a change in the pathology of the flu.
- How does the disease seem to be spreading – through the air, bodily fluids, or other medium?
At first blush, the method that the doctors are using makes a lot of sense. First responders need protection from the disease, because they are willingly making themselves vulnerable to contagion by rendering aid. Next, targeting the demographic that is most susceptible to the disease makes sense as welldepending on the method of transmission and the degree of exclusivity that marks this disease. For example, in a flu outbreak in Tecumseh, Michigan, in 1968, a flu outbreak threatened an entire community, but there was not nearly enough vaccine. Doctors decided to use the vaccines for kids of school age; their lower level of natural immunity, their large number of contacts with others, and their forgetfulness in the areas of personal hygiene all make them prime candidates to spread disease (Begley). Even though the elderly also have reduced immunity levels, the harsh calculus of an epidemic dictates that widespread death among the elderly is less costly to society than widespread among the young; after all, the older die at a much higher rate anyway, and the young have more to contribute to society through the rest of their lives than the elderly too, simply through the number of years that they have left. One thing to consider, though, as we ponder this hypothetical, is that by giving companies the incentive to manufacture vaccines, by allowing them to maintain the profitability of sales, would ensure that no shortage would ever come about (Roberts).
One area that has not yet come up for discussion is the racial element of the decision. It is true that reported incidence of this strain of the flu affects middle-aged Caucasians. However, it is also possible that the media have been influenced to report it this way, or the lack of available health care to minorities and other disadvantaged groups has led to underreporting of incidence among those groups (Zimmerman). Either way, the possibility for racial and socioeconomic discrimination harming the health of others is very real. Because of the lack of information, I would have given the second round to school-age children to minimize the transmission as much as possible.
Works Cited
Begley, Sharon. “If We Must Ration Vaccines for the Flu, Who Calls the Shots?” Wall Street Journal 6 October 2006. . Web.
Garrett, J., Vawter, D., Prehn, A., DeBruin, D., and Gervais, K. “Ethical Considerations in Pandemic Influenza Planning.” Clinical and Health Affairs April 2008. . Web.
Gathany, Jim. “Ethical Lessons from the 2009 H1N1 Pandemic.” . Web.
Ludwig, Sarah. “Influenza Vaccine Shortage: The Ethics of Rationing.” . Web.
Redican, Lindsay. “The Forgotten Killer.” . Web.
Roberts, Russ. “The Ethics of Rationing.” . Web.
Wynia, Matthew. “Ethics and Public Health Emergencies: Rationing Vaccines.” The American Journal of Bioethics 6(6): 4-7. Print.
Zimmerman, Richard. “Rationing of Influenza Vaccine During a Pandemic: Ethical Analyses.” Vaccine 25(11): 2019-2026. Print.
