Rationing the flu vaccine.

In October 2004, the CDC announced that Chiron Corporation, chief supplier of inactivated influenza vaccine for the United States for the 2004–2005 flu season, would not be providing the 50 million vaccinations it had promised—half of the anticipated 90–100 million doses from all sources projected for the flu season. The resultant shortage set off a firestorm of concern. Well known to health care providers, but less so to the general public, flu is a major killer. Last year, flu-related illnesses caused more than 36,000 deaths and approximately 200,000 hospitalizations in the United States alone. The ethical challenge was how to decide who should receive this scarce life-saving preventive treatment. This column sketches one approach to addressing this dilemma that explains and justifies core features of the rationing scheme followed by the Centers for Disease Control and Prevention (CDC) and local public health officials. I also identify a number of related issues that emerged in the face of the vaccine shortage.