Monday, January 30, 2006

Problems with Current Distribution Schedules for Pandemic Vaccines

I wrote this last semester for my Microbiology class. I hope you enjoy reading it just as much as I enjoyed writing it! (My reference list is available.)

In class I have been intrigued by our studies of diseases: the prevention, the outcomes, and the impacts on society. I have been terrified some days, but I have come to a different understanding of our intimate relationship with diseases; we need them in order to thrive. Diseases, epidemics, and pandemics are a way of life, evolutionary eliminators, and should not be considered the imminent threats they disguise themselves as. I am going to try to show the balance Earth is trying to maintain in allowing for diseases, particularly the looming influenza pandemic.

The history of influenza pandemics dates back to at least the sixteenth century. The more widely known 1918 pandemic of the “Spanish flu” is believed to have originated in U.S. military bases. It spread to approximately 20 – 40 % of the world’s population killing an estimated 40 million people from complications arising from the initial influenza infection. Contrary to modern thought, the age group to suffer the most complications (and eventually deaths) was the 20-40 year olds. In other commonly known influenza pandemics, the virus mostly infected children, adolescents, and young adults; which suggests that some of the elderly had acquired immunity against it. (Sarubbi)

Today, if a pandemic were to strike, some of the groups characterized at “high risk” are: “all children aged 6 to 23 months, adults aged 65 years and older, all women who will be pregnant during the influenza season, health-care workers involved in direct patient care, and persons 2 to 64 with chronic medical conditions (Campos-Outcalt, D).” I understand both the ethical and political reasons behind this, and I don’t agree with them. According to Szucs, 37% of children below the age of 20 are infected with influenza every year. It also has been shown in several studies that vaccines given to children are highly effective in preventing the spread of the flu (Clinician Reviews & Szucs). Compared to children, only 10 % of the elderly over the age of 60 get infected. Data has also been found that “despite a 15% to 25% increase in the rate of flu vaccine coverage in the elderly during the past 25 years, mortality from influenza has remained flat over the past 20 years (Russell, J.).” Given these numbers one can conclude that the children need to be placed in the highest priority group to receive vaccines whereas vaccines for the elderly need to be limited.

It is estimated by the Center for Disease Control that the total cost of a pandemic would be around $166.6 billion. “Indirect costs of influenza can account for 80-90% of the total costs and stem largely from absenteeism and loss of work productivity (Szucs).” Being as the effectiveness of the influenza vaccine is proven to be greater among children and healthy adults, it would be more cost efficient to vaccinate those age groups more than the elderly. If you consider an extreme vaccination plan where the entire elderly population were to be vaccinated, very few young people were, and even fewer “healthy adults,” most of the deaths would occur in the working “healthy adult” range, and thus less income would be generated as a whole. Not to mention, one must also consider lost income of working families dealing with sick children. If the elderly is already not contributing to the national gross product, they are going to suffer even more if they lose their support (adults who pay taxes and provide care for the elderly). Essentially, it doesn’t make much sense to vaccinate an already dieing population, when saving the healthy is completely overlooked. The World Health Organization wants countries to stockpile enough vaccine for at least 25% of their populations. If there is such a shortfall of vaccines, one can assume that vaccine shortage distribution rules (as in the 2004-2005 season) would be put into effect.

The total U.S. population estimated to die from the pandemic is between 89,000 and 207, 000. If we look at this from a larger scale, this is just evolution in progress. The population of the entire United States of America is 297,758,039 (U.S. Census Bureau). If the maximum number of people were to die, it would only be 0.07% of the population; meaning only 7 in 10,000 people would die. In Bozeman alone, the absolute maximum number of people that would die would only be about 30. On an ethical scale, that is horrible. One person could be someone’s loved one, parent, child, etc., but, it does not justify the apparent media need to scare the public into thinking everyone is going to die. Plus, the people that will survive the pandemic will be that much stronger against any other similar virus that decides to make additional rounds.

According to Wikipedia, Online Encyclopedia, “evolution is the process by which populations of organisms acquire and pass on novel traits from generation to generation, affecting the overall makeup of the population.” If a pandemic were to hit, those who are infected and survive will essentially create a hybrid of people who will carry some immunity against any future influenza outbreak. In the influenza pandemic of 1967, it is believed that since a previous pandemic in 1957 was caused by similar viruses, “a degree of immunity may have moderated the disease (Sarubbi).” The potential H5N1 virus is evolving to better suit its needs, I think it is time humans follow the same path; therefore a pandemic would be the appropriate means for that movement.

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