In the next influenza pandemic, should a 60-year-old woman with heart disease and asthma receive a flu vaccine before a healthy 4-year-old? Proposed government guidelines would put the older woman ahead of the child. But two bioethicists at the National Institutes of Health argue that younger, healthier people should get preference.

The proposed government vaccine rationing plan is based on a desire to save the most lives. But writing in the journal Science, the two bioethicists advocate the "life-cycle principle," which is based on the notion that each person should have the chance to live through all stages of life.

Given the current state of vaccine manufacturing and distribution, rationing would be inevitable if a flu pandemic were to develop in the next few years. Everyone seems to agree that top priority for available vaccine should go to workers in vaccine factories and health care workers. But who's next?

Under the government's plan, priority goes to people over age 65 who have at least one high-risk health condition (such as asthma, heart disease, or emphysema). At the bottom of the pecking order? Healthy people ages 2 to 64.

The life-cycle principle turns this order on its head, giving preference to healthy people, with the youngest getting highest priority. The article authors propose modifying this approach with the public-order principle, which would also give priority to workers responsible for maintaining public safety and order, such as fire personnel, police, utility workers, and the military.

For more on government planning, go to http://www.pandemicflu.gov.

Source: Public Health: Who should get influenza vaccine when not all can?, Science, EJ Emanuel, A Wertheimer, May 12, 2006.