Young or Old-Who should be first?

With limited stocks of the bird flu vaccine a "fundamental ethical dilemma’ was being faced by society as to who should get the injections first.

While health staff and the elderly are often considered as the priority group a research published in Science calls for the right of the youth to live through all life's stages and should therefore be considered a priority.

The research stated that the primary issues were to ‘decrease health impacts’ including illness and death and the second goal was to limit impacts on society.

However the researchers, led by Ezekiel Emanuel of the National Institutes of Health, propose the consideration of an alternative ethical framework.

According to the researchers vaccines protecting against any new form of the H5N1 strain of bird that is easily transmitted among humans will be always be limited in supply. In addition in all likelihood no more than 10% of the US population would be inoculated against the disease in the first year.

The three major flu pandemics have only sent out confusing pictures of who was most likely to be at risk.

The report says: "With limited vaccine supply, uncertainty over who will be at highest risk of infection and complications, and questions about which historic pandemic experience is most applicable, society faces a fundamental ethical dilemma. Who should get the vaccine first?’

In the past also a range of principles have guided the rationing of medicines or vaccines such as ‘saving the ones most likely to recover’ and ‘saving the most lives.’

This research team however underlines the policy of giving vaccines to those who have an opportunity to live through all stages of life, adding that death seemed more tragic when a child or young adult dies than an elderly person - not because the lives of older people are less valuable but because the younger person had not had the opportunity to live and develop through all stages of life.

They conclude that a global pandemic would make all the issues about prioritizing vaccines and working with other countries even more pertinent.

Department of Health has mentioned that it would be guided by World Health Organization principles which aimed at protecting healthcare workers at risk, and especially those needed to keep essential services running. In addition vulnerable groups would be given priorities in reducing the spread of infection by immunizing those in closed communities and children.

A spokeswoman added: ‘The UK National Influenza Pandemic Committee (UKNIPC) will make final decisions regarding priority groups and priority order.’