On November 9, 2020, presumed President Joe Biden asked Ezekiel Emanuel, M.D., Ph.D., to serve on his coronavirus task force.  Emanuel is currently the Vice Provost for Global Initiatives at the University of Pennsylvania, among other titles.  While his official biography states he is the most widely published and cited bioethicist in the world, in the U.S. he is probably best remembered as being one of the chief architects of the Patient Protection and Affordable Care Act (ACA), or Obamacare, and penning an article in the October 14, 2014 The Atlantic, “Why I Hope to Die at 75.”

In his column Dr. Emanuel discusses how his belief drives his family and friends crazy, that he cannot mean it, especially as he gets closer to that age, and he will certainly push that age back.  But he says, “I am sure of my position.”  He argued that once he reaches 75, he will not actively end his life, nor will he prolong it either.  His last colonoscopy will occur at age 65, there would be no screenings for prostate cancer at any age and no flu shots.  He said, “if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs.”

In the September 11, 2020 edition of Science, Dr. Emanuel and 17 others published “An Ethical Framework for Global Vaccine Allocation.”  It raised a lot of eyebrows.

They wrote, “Once effective coronavirus disease 2019 (COVID-19) vaccines are developed, they will be scarce.  This presents the question of how to distribute them fairly across countries. Vaccine allocation among countries raises complex and controversial issues involving public opinion, diplomacy, economics, public health, and other considerations.”  They offer what they believe is an “ethically defensible and practical proposal for the fair distribution of COVID-19 vaccine:  the Fair Priority Model.”  They acknowledged that, “Thankfully, many producers have publicly committed to a ‘broad and equitable’ international distribution of vaccine.” They also state that some national governments have “publicly committed to a fair distribution.” 

The authors claimed that fairly distributing a COVID-19 is a matter of “distributive justice” and although nations will undoubtably be the initial recipients, it is important that “fair distribution across countries must reflect a moral concern for the ultimate recipients: individuals.”  They focus on mitigating the three harms caused by the virus:  the deaths and permanent organ damage it causes; the indirect harm and death the virus causes to others who are not infected because of stressed healthcare systems; and the devastation the virus has caused to economies leading to high unemployment, increased poverty and starvation.

Few, if anyone, would disagree with those motivations.

Their Fair Priority Model proceeds in three phases, beginning first with aiming “at reducing premature deaths and other irreversible direct and indirect health impacts” to determine who gets the vaccine first.

That first step is what is raising concerns.  They call for using the, “Standard Expected Years of Life Lost (SEYLL) averted per dose of vaccine as the metric for premature death.  SEYLL calculates life years lost compared to a standardized reference life table – that is, a person's life expectancy at each age as estimated on the basis of the lowest observed age-specific mortality rates anywhere in the world.”  The authors mention “premature deaths” 10 times and state up front that surveys suggest there is “popular agreement that a premature death that prevents someone's exercising their skills or realizing their goals later in life is worse than a death later in life.”  In other words, reducing premature deaths does not include the elderly; they are on their own.

One of many people that were critical of the Emanuel ethical framework was sociologist Lyndsay Green who has focused her research on aging well ever since she turned 60 years old.  Disturbed by the Fair Priority Model, she wrote in the November 12 Market Watch that the model “assumes that lives of young people are worth more than those of older people because a young person has more years to live and those years are going to be productive.”  She noted that many older adults are leading active lives, and often provide critical support in the medical community, to their families, and friends.  She said, “Where I live, in Canada, COVID-19 deaths have occurred mainly in long-term care homes.  If you lived in one or a retirement home, you had a 74 times greater chance of dying from COVID-19 than if you were the same age and living in your own home.  What these COVID-19 victims died from was not their advanced age; they died of failed public policies.”  She said their deaths were not timely but premature and they had “unknown years ahead of them and were making contributions to society and to their families.”

She urges governments to resist the use of “chronological age as a baseline for determining policy and avoid assumptions about someone’s quality of life based on their age.”

U.S. government officials heading up Operation Warp Speed (OWS) and pharmaceutical companies have been working together since May 2020 to deliver a safe and effective vaccine to Americans as quickly as possible.  President Trump said in a November 12 briefing that the “vaccine will be distributed to frontline workers, the elderly, and high-risk Americans immediately” and that by “vaccinating the elderly and the high-risk, we will effectively end this phase of the pandemic and allow seniors to reclaim their golden years.”

The pharmaceutical companies that are part of OWS have announced they are ramping up supply and seeking government approvals across the globe so their vaccines will reach their citizens.  This good news is occurring at an amazing speed without sacrificing safety.

Dr. Vivek Murthy, a former U.S. Surgeon General, was appointed a co-chair of Biden’s coronavirus task and said that enough people will have to be vaccinated to create herd immunity, probably about three quarters of the population.  Beyond that, we do not yet know if they will divert from plans put in place by the Trump administration and create a new distribution system that would delay delivery of the vaccine.  No doubt, there are many, especially the elderly, who hope Dr. Emanuel and others of his ilk will not be in charge of this process.