Ethics of rationing the flu vaccine.

IT IS GOOD TO SEE THAT THE CENTERS FOR Disease Control are seeking ethical guidance about the rationing of flu shots this year (“Ethicists to guide rationing of flu vaccine,” J. Couzin, News of the Week, 5 Nov., p. 960). They should also be seeking ways to reduce the scientific uncertainties that make this ethical question difficult. For example, how effective is the influenza vaccine in different age groups, and in preventing disease, mortality, and risk of transmitting to others? How much benefit do hospital patients or nursing home residents receive through reduced risk of transmission if the staff of these institutions are vaccinated, compared with the benefits of being vaccinated themselves? Surely the answers to these questions are important inputs to the ethical calculus, and existing data are not adequate to answer them. Attempts to solve this short-term ethical problem should not obscure the larger failures that led to it. It has been common knowledge for years that the influenza vaccine supply was fragile at best, and no serious effort has been made to ensure a safe and plentiful supply. This failure also increases the risk of delays and and limited supplies of the new vaccine that will be required for a pandemic. Other pandemic preparedness activities, including surveillance for new strains in Asia, are seriously underfunded. Big failures of policy and politics have led to ethical dilemmas that would not otherwise have existed. While offering their guidance for the short term, perhaps the ethical advisory board can also highlight the ethical and other benefits of taking actions to minimize the likelihood of rationing in the future. MARC LIPSITCH Department of Epidemiology, Harvard School of Public Health, 677 Huntingdon Avenue, Cambridge, MA 02115, USA. Jellyfish Blooms in the Yangtze Estuary