Swine Flu, Civic Responsibility and Healthcare Reform

There is an interesting recent development which I expect will figure prominently in the health care reform debates in the US Congress scheduled for September 2009.

Recent estimates from the Centers for Disease Control (CDC) indicate that about half of the US population will be inflicted with swine flu in the 2009/2010 flu season and that there will be about 45,000 additional influenza related deaths in the US due to the swine flu in this flu season. Historically, with never enough vaccine for everyone, vaccination priority has been given to those most likely to die from the disease which is to say infants whose immune systems are not fully developed and seniors who frequently have other health issues and less robust immune systems. This approach can be referred to as the vaccinate "those at risk" vaccination strategy. Unusually, the experience with the swine flu so far is that the disease impacts seniors less severely than other segments of the population perhaps because many seniors have a limited immunity from past contact with a flu strain similar to the current swine flu.

A new study argues that vaccinating those most likely to spread a disease such as school age children and 30 to 40 year olds who are most likely to be working and in contact with a large number of customers and co-workers will result in fewer people becoming ill and fewer people dying from a communicable disease. In fact, this "vaccinate the spreaders" method of prioritization has been recommended by the CDC's advisory committee on immunization practices but the official recommendation from the CDC is still to "vaccinate those at risk".

In summary, prioritizing vaccinations for those most likely to spread the disease will result in fewer deaths, fewer people sick and less economic impact (fewer lost work days) to the US in total compared to prioritizing vaccinations for those at risk. However, this strategy will increase the chances of any individual senior or infant contracting the swine flu and dying. However, it should be noted that the experience with the swine flu thus far is that seniors unusually have less severe symptoms with the swine flu than younger flu victims perhaps because the seniors have previously been inflicted with a flu strain similar to the swine flu which has given them partial immunity.

Because of political issues rather than medical issues, I think that vaccine distribution will be prioritized based on the current 'at risk' method. However, the CDC has recently expanded the at risk definition to include young adults. For the greater good, seniors should be low on the priority list but for political reasons rather than medical reasons I expect that they will stay on the top of the list.

Where it gets interesting is that if the vaccine supplies are in sufficiently short supply so as to make it difficult for seniors to get vaccinated, which is likely, this will become a very vocal headline in the health care reform debate. There will be outcries that the government is rationing medical care and that the government is limiting care for seniors who are in some way less valuable than younger people. The issue will reinforce the "pull the plug on grandma" soundbite.

I would hope that the seniors keep everything in perspective and support a policy which provides for the greater good rather than the individual benefit. In other words, I would hope that we are good citizens but I am not hopeful.