Over 50 You Are On Your Own

Over 50 You Are On Your Own

By Abigail Trafford

VINALHAVEN, Maine -- Idyllic here, with long lazy days by the sea. Sophia, 6, and Lila, 4, splash in the plastic pool in front of the house. Their parents are going for a row. I am the presiding grandmother in this faraway place of peace and beauty, so protected from the gathering storm of world events.

But suppose there's a knock on the door and standing there is the official Grim Reaper from the Centers for Disease Control and Prevention who says: "One of you in this household has to die!" Of course, I would throw myself at the Reaper's feet and cry: Take me! Spare the young! I've had my turn!

But is this good social policy?

The question is raised in a provocative report by two government scientists about who should get scarce medical resources. They argue that the standard policy for flu vaccinations that favors older men and women over younger adults should be changed in preparation for a possible pandemic of avian flu.

Ordinarily, people over 65 and those who have chronic illnesses are given priority. As a group, they are the most vulnerable. Protecting the most vulnerable saves the most lives.

But avian flu is not an ordinary flu. Chances are, it will never turn into a global catastrophe, but if it did, some researchers speculate that it could lead to 90 million cases and 1.9 million deaths. There is no way to manufacture enough vaccine in time to protect everyone in the United States. So who should get the potentially lifesaving vaccine?

"This is a tragic choice," says bioethicist Ezekiel J. Emanuel at the National Institutes of Health, who with his colleague Alan Wertheimer suggested an alternative policy in a report in the May 12 edition of Science magazine.

Both the rebel authors and the traditionalists (that is, the government's National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices) would give top priority to those working to manufacture and distribute the vaccine and to front-line health care professionals. And both would give preference to key government leaders. The fight is over what's left for the general public.

The rebels challenge the principle of saving the most lives. What about saving people with the most years yet to live? Their formula is based on the principle that all people deserve the chance to live out their lives and grow old -- especially teenagers and young adults who have survived childhood and face many decades ahead. Twenty-year-olds, for example, are more "valued than 1-year-olds because the older individuals have more developed interests, hopes and plans but have not had an opportunity to realize them," write the authors.

Presumably, really older individuals -- those over 65 -- have had all the opportunities they need to realize their hopes and plans and interests -- so they are less valued than 20-year-olds. In the new formula, the winning age cohort in the vaccine rationing sweepstakes would be healthy people 13 to 40. Next in line would be those 7 to 12 and people 41 to 50. After 50, forget it!

Sophia and Lila are out of the pool. The cousins are coming for dinner, and I am setting the table. The numbers gnaw at me. Public health policy is beginning to sound like television programming, which is aimed at people between 18 and 49. The networks don't want older viewers, because advertisers don't seek older customers. Even though, with the aging of the boomers, the fastest-growing segment of the population is over 50.

Now ageism seems to be getting a theoretical justification in rationing medical services. The principle of "years yet to live" wins over "lives saved." It's as though television producers were to justify their prejudice against older people by saying that they value the years a viewer may stay glued to the tube over the total number of viewers in a season. Never mind that healthy people over 50 can look forward to many more decades of watching television and shopping.

My daughter comes in from rowing. (She and her husband fall into the privileged demographic.) I simmer down. There are good scientific reasons to favor the young in the case of avian flu. In the flu pandemic of 1918, young adults were at greatest risk of illness and death; they might again be the ones most in need of protection.

The main problem, as the rebels point out, is that the country doesn't have the capacity to produce enough vaccine to stem a future epidemic. Only about 10 percent of the population could be immunized in the first year.

Sophia and Lila sit down for supper. There is no knock on the door -- not yet, anyway. But the world has changed since I was a little girl visiting my grandmother at this same place. Unlike previous generations, I have a new stage of life ahead of me, thanks to health gains and longer life spans. There is more to do, many to love, much to contribute.

Fate is uncertain, but my granddaughters have a good statistical chance to reach the age of 80, or even 100. I want them to grow up in a culture that values old people.