May 16, 2006

Rationing the flu vaccine

Ezekiel J. Emanuel and Alan Wertheimer, who work here, write in Science:
Because of current uncertainty of its value, only "a limited amount of avian influenza A (H5N1) vaccine is being stockpiled". Furthermore, it will take at least 4 months from identification of a candidate vaccine strain until production of the very first vaccine. At present, there are few production facilities worldwide that make influenza vaccine, and only one completely in the USA. Global capacity for influenza vaccine production is just 425 million doses per annum, if all available factories would run at full capacity after a vaccine was developed. Under currently existing capabilities for manufacturing vaccine, it is likely that more than 90% of the U.S. population will not be vaccinated in the first year. Distributing the limited supply will require determining priority groups.
What follows is a chilling discussion of rationing schemes.
The save-the-most-lives principle [...] justifies giving top priority to workers engaged in vaccine production and distribution and health-care workers. They get higher priority not because they are intrinsically more valuable people or of greater "social worth," but because giving them first priority ensures that maximal life-saving vaccine is produced and so that health care is provided to the sick. [...]

We believe that a life-cycle allocation principle [giving priority to younger people] based on the idea that each person should have an opportunity to live through all the stages of life is more appropriate for a pandemic. There is great value in being able to pass through each life stage--to be a child, a young adult, and to then develop a career and family, and to grow old--and to enjoy a wide range of the opportunities during each stage. [...] People strongly prefer maximizing the chance of living until a ripe old age, rather than being struck down as a young person. [...]
So, the problem is flu vaccine scarcity and part of the solution is "ethical" rationing. Notice, however, that almost all goods are scarce (and bads too abundant). One big advantage of allocation of scarce goods through free markets is that the process of allocation creates an incentive to produce more of those goods. In the case of a flu pandemic people would be willing to pay a lot for the vaccine and for medical care. In a free market, individuals and firms able to provide those goods would find it in their own interest to do so in large amounts. Rationing does nothing of the sort. Rationing creates little incentive to production and much incentive to corruption. A free market would save many more lives.

1 comment:

  1. I'm completely in agreement. It always surprise me that most of people associates the corruption (and the consumers exploit) with the free market. It's all the opposite.